Vitamin D Put to the Test for Crohn’s Disease

Inflammatory bowel disease (IBD), “a chronic inflammatory condition of the intestine that causes abdominal pain, diarrhea, and weight loss,” includes Crohn’s disease and ulcerative colitis. When we compare identical twins, even though they have the same genes, most of the time, if one twin has IBD, the other does not. In that case, there must be some important, non-genetic trigger factors. What might they be?

Studies like the ones I discuss in my video Vitamin D for Inflammatory Bowel Disease offer a clue. Why do those living in the southern United States have lower IBD rates than those living in the north? Maybe it’s because Southerners get more sun, which means more vitamin D and which may also mean less inflammation.

So, do people with Crohn’s and ulcerative colitis who have low vitamin D levels have worse disease? Apparently so. Not only is there an increased risk of surgery and hospitalization, but those who normalize their vitamin D levels appear to reduce their risk of relapse. However, instead of better vitamin D levels leading to better Crohn’s, maybe better control of Crohn’s led to better vitamin D. Indeed, perhaps they felt so good, they went outside more, “increasing physical activity and outdoor sun exposure.” We can’t tell if it’s cause and effect unless we put it to the test.

The first pilot study tried 1,000 units of vitamin D a day and saw no change in the Crohn’s disease activity index. At six weeks, however, there may have been a slight increase in IBD quality of life scores, but even that disappeared by year’s end, so the results were pretty disappointing overall. Perhaps the researchers didn’t use enough vitamin D? How about 1,200 IU a day? At that level, the relapse rate appeared to be cut in half, as you can see at 1:45 in my video, though there were too few people in the study to reach statistical significance. What happens with 2,000 IU of vitamin D a day? Gut leakiness (so-called intestinal permeability) continued to worsen in the placebo group, but appeared to stabilize in the vitamin D group, though only those who reached blood levels over 75 nanomoles per liter appeared to have a significant drop in inflammation. And, indeed, if Crohn’s patients are started on 1,000 IU of vitamin D per day and then the dose is ramped up until a target blood level is reached, it’s possible to get a significant boost in quality of life accompanying a significant drop in disease activity, as you can see at 2:19 in my video. Disease scores under 150 are considered remission, so “the majority of patients achieved remission” with improvements in disease activity in all but one person in the study. This suggests that Crohn’s patients may want to take 5,000 IU of vitamin D a day, but that’s nearly ten times the Recommended Daily Allowance. Why so much? Because that’s what it may take to get vitamin D levels that are normal for our species—that is, the kind of levels one might get running around half naked in Africa, as we did for millions of years.

For more on the role diet can play in preventing and treating inflammatory bowel diseases, see:

Interested in learning what else healthy vitamin D levels can do for you and your family? Check out:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

The Benefits of Ginger for Osteoarthritis

If ginger is so effective against migraines and also helps with the pain of menstrual cramps, what about osteoarthritis? I explore this in my video Ginger for Osteoarthritis.

An all too common disorder, osteoarthritis produces chronic pain and disability. The first major study, published in 2000, showed no benefit of ginger extract over placebo, but that study only lasted three weeks. The next study, in 2001, lasted six weeks and, by the end, was able to show significantly better results compared to placebo. However, because the placebo did so well, reducing pain from the 60s down to the 40s on a scale of 1 to 100, ginger reducing pain further down into the 30s was not especially clinically significant, so an editorial in the official journal of the American College of Rheumatology concluded that “ginger should not be recommended at present for treatment of arthritis because of the limited efficacy.”

Since that time, there have been a few other trials that showed more impressive results, such that ginger is now considered “able to reduce pain and disability” in osteoarthritis. How does it compare to other treatments? Since osteoarthritis is a chronic disease, it’s especially important to weigh the risks versus the benefits of treatment. The commonly used anti-inflammatory drugs can carry serious cardiovascular and gastrointestinal risks. For example, nearly half of the osteoarthritis patients on drugs like ibuprofen were found to have major injuries to the lining of their small intestines. That risk can be reduced by taking additional medication to counteract the side effects of the first drug.

Ibuprofen-type drugs reduce our stomach lining’s ability to protect itself from stomach acid, so blocking acid production with a second drug can lower the risk. However, ginger can actually improve stomach lining protection. Indeed, at the kinds of doses used to treat osteoarthritis—about a quarter- to a half-teaspoon a day—ginger can be considered not just neutral on the stomach, but beneficial. So, ginger can be as pain-relieving as ibuprofen but without the risk of stomach ulcers.

What about topical ginger treatment, as in externally applying a ginger-soaked cloth or patch to the affected joint? In a controlled study, compress versus patch, both showed remarkable and lasting pain relief for osteoarthritis sufferers. What was missing from the study, though, was a control group: There was no placebo patch. I don’t care if ginger has been applied externally to painful joints for a thousand years. The placebo effect has been shown to be remarkably effective in osteoarthritis in providing pain relief. So, until there’s a controlled study on topical ginger, I’m not going to believe it.

There wasn’t such a study until… 24 men stuck ginger slices on their scrotum.

Men with inflamed testicles applied six to ten paper-thin slices of ginger “over the affected testes,” and, evidently, the ginger group healed nearly three times faster than the control group. Unfortunately, the original source is in Chinese, so I can’t get further details, as is the only other controlled study on topical ginger I could find, whose title apparently translates to “Evaluation of point plaster therapy with ginger powder in preventing nausea and vomiting occurred after platinum-based interventional chemotherapy.” We know ginger powder taken orally can be a miracle against chemo-induced vomiting, but what about stuffing it in your belly button?

The external application of ginger powder to the so-called point of Shenque, which is the navel, was compared to the control group, who got potato powder in their belly buttons instead. The ginger group evidently had significantly less nausea and vomiting. Unfortunately, only the abstract is in English, so I can’t tell how effectively the researchers blinded the patients to the treatment. Presumably, it would be easy to tell whether or not you were in the ginger or placebo group simply by the smell, but perhaps the researchers controlled for that? Until we know more, I would suggest those who want to try ginger use it in the stomach, rather than on the stomach.

What other dietary interventions can help with arthritis? See, for example:

What else can ginger do? Check out:

If the placebo effect is really that powerful, should doctors prescribe them? They already do. See my video The Lie That Heals: Should Doctors Give Placebos? for more on this.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

The Benefits of Sesame Seeds for Knee Osteoarthritis

Doctors have been injecting arthritis patients with gold since the 1920s. In fact, “[g]old-based medicines have been in use for thousands of years…and remarkably…are still in clinical use as DMARDs,” or disease-modifying anti-rheumatic drugs, meaning they can slow the progression of rheumatoid arthritis. Unfortunately, such drugs can be toxic and even fatal, causing conditions such as gold lung, a gold-induced lung disease. “Although its use can be limited by the incidence of serious toxicity,” injectable gold has been shown to be beneficial to patients with rheumatoid arthritis. But maybe, as some researchers have suspected, some of that benefit comes from the sesame oil that’s injected, which is used as the liquid carrier for the gold.

As I discuss in my video Sesame Seeds for Knee Osteoarthritis, sesame seeds contain anti-inflammatory compounds with names such as sesamin and sesamol, which researchers suggest “may serve as a potential treatment for various inflammatory diseases.” Those observations, however, came from in vitro (test tube) studies. First, we have to see if sesame seeds have an anti-inflammatory effect in people, not just in cells in a petri dish, but there haven’t been any studies on the effects of sesame seeds on inflammatory markers in people with arthritis, for example…until now.

The abstract states: “Considering the high prevalence of osteoarthritis (OA) and since until now there had not been any human studies to evaluate the effect of sesame in OA patients, this study was designed to assess the effect of administration of sesame on inflammation…” Indeed, researchers found a significant drop in inflammatory markers, but what effect did sesame seeds have on the patients’ actual disease?

Fifty patients with osteoarthritis of the knee were split into two groups. Both received standard treatment, but the sesame group also received about a quarter cup of sesame seeds a day for two months. Before they started, the patients described their pain as about nine out of ten, where zero is no pain and ten is the maximum tolerable pain. After two months, the control group felt a little better and reported their pain was down to seven, but the sesame group dropped down to three and a half, significantly lower than the control group. The researchers concluded that sesame appeared to have a “positive effect…improving clinical signs and symptoms in patients with knee OA…”

The main problem with the study, though, is that the control group hadn’t been given a placebo. It’s hard to come up with a fake sesame seed, but without a placebo, researchers basically compared doing nothing to doing something, and any time you have patients do something, you can’t discount the placebo effect. That said, what are the downsides? That’s the nice thing about using food as medicine—only good side effects. Though the results are mixed, there have been studies using placebo controls that found that adding sesame seeds to our diet may improve our cholesterol and antioxidant status, and the amount of sesamin found in as little as about one tablespoon of sesame seeds can modestly lower blood pressure a few points within a month, enough, perhaps, to lower fatal stroke and heart attack risk by about 5 percent, potentially saving thousands of lives.

What other dietary interventions can help with arthritis? Check out:

If the placebo effect is really that powerful, should doctors prescribe them? They already do! Check out The Lie That Heals: Should Doctors Give Placebos? for more on this.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: