Still following MAP...

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EMom
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Date Joined Aug 2007
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   Posted 10/4/2008 3:23 PM (GMT -7)   
Just ran across this. Hope it hasn't already been posted.

http://www.ncbi.nlm.nih.gov/pubmed/18789596?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

"The plausibility of a causal role of Mycobacterium avium subspecies paratuberculosis (MAP) in Crohn's disease has gone from controversial to compelling."
Mom to 16 year old boy diagnosed in June, 2007.
Omega 3s, digestive enzymes, probiotics, vit. C, calcium w/D3, a good multivitamin and SCD legal yogurt
Started The Maker's Diet in Sept. '07. Gradually learning/using more SCD recipes, too! (cooking challenged)


Ides
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Date Joined Nov 2003
Total Posts : 7077
   Posted 10/4/2008 4:31 PM (GMT -7)   
It will be interesting to read the entire article when it is published. I'm curious how this theory was reached.
Moderator Crohn's Disease Forum
CD, Ankylosing Spondylitis, lupus, small fiber peripheral neuropathy, avascular necrosis, peripheral artery disease, degenerative disc disease, and a host of other medical problems.
 


Keeper
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Date Joined Jun 2008
Total Posts : 1058
   Posted 10/4/2008 4:50 PM (GMT -7)   
The full article is published, but you would have to pay for a subscription to look at it. There is an interesting linked abstract on the right side of the page titled "Molecular evidence for Mycobacterium avium subspecies paratuberculosis (MAP) in Crohn's disease correlates with enhanced TNF-alpha secretion." In that article, the author reports that TNF levels for Crohn's patients that were MAP positive were higher than in ulcerative colitis patients that were also MAP positve. The implication is that in Crohn's there is an abnormal macrophage response to MAP. I would expect that there are several bacteria capable of causing this abnormal reaction - based on the number of different candidates in the literature.

Rider Fan
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Date Joined May 2008
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   Posted 10/4/2008 6:54 PM (GMT -7)   
But at the same time there have been studies disproving MAP and Crohn's, or at least finding no obvious co relation. Further, once patients with MAP were given treatment, they did not lower their crohn's symptoms. Sigh, sometimes I wonder if they will ever figure this out.....
Dx'ed in 1999. No surgeries.

Current meds: 100 mg 6MP. Just finished prednisone taper. Udo's Choice Probiotics (30 billion).
 
Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.


Roni
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Date Joined May 2003
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   Posted 10/4/2008 8:43 PM (GMT -7)   
Rider Fan,

do you know what kind of treatment and how long the treatment lasted? I heard from an Australian doctors report that MAP reproduces very very slowly (something like that) and it takes 2-3 years of antiobiotic treatment to effectively kill it.
This aussie doctor treats pple with severe CD with powerful antiobiotics and probiotics resulting in high remission rates (and based on MAP theory).

http://www.crohns.org/treatment/borody.htm

Keeper
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Date Joined Jun 2008
Total Posts : 1058
   Posted 10/4/2008 10:31 PM (GMT -7)   
There have been any number of studies using PCR and genetic identification that showed some Crohn's patients with no MAP in their systems, as well as some that did have it. One study that I saw showed only about 20% of their study population had MAP in their poop. It may be one of several culprits, but it probably not the sole cause.

reynoldi
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Date Joined Aug 2005
Total Posts : 244
   Posted 10/4/2008 10:44 PM (GMT -7)   
these studies looked at different depths of the intestinal wall. they should show different numbers based on how deep each study went.
"If thou wilt be observant and vigilant, thou wilt see at every moment the response to thy action. Be observant if thou wouldst have a pure heart, for something is born to thee in consequence of every action." -Rumi-
 
Diagnosed age 12 1993. on lialda, steroid dependent. tried remicade, on humira now. crohns/colitis, gerd, reoccuring duodenal ulcers. developing some lupus like symptoms. i think were all in the same sinking boat some just going down faster than others.


LMills
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Date Joined Apr 2008
Total Posts : 1753
   Posted 10/5/2008 5:43 AM (GMT -7)   
There have been as many studies proving it as those that disprove it it seems. I think it must be a trigger in some cases and a cause in others just like genetics. I really think a lot of these factors work together in creating the problem though. Plus, it would be too easy if MAP were the cause wouldn't it? And I can't recall the last time anything was terribly easy for the autoimmune diseases...seems to be the nature of how things work in this world.
20 years old, Diagnosed with moderate to severe Crohn's and Colitis in May of 2008.
Currently taking:
Prednisone(down to 10 mg), pentasa, bentyl as needed, prilosec, tandem plus, humira, and good probiotics
Surgery for ectopic pregnancy most likely the result of severe Crohn's inflammation in July of 2008.
http://weblog.xanga.com/harlequin_garret


Osprey101
Regular Member


Date Joined Apr 2008
Total Posts : 227
   Posted 10/5/2008 12:10 PM (GMT -7)   
The studies that show a poor or zero correlation with MAP may be flawed in that mycobacteria have traditionally been a very difficult bacterial genus with which to work. Koch's postulates have never been fulfilled with leprosy, for example, which is a mycobacterium. They are slow to grow, slow to die, and very tricky to culture; it seems likely that even sensitive PCR tests may not be effective in finding their DNA in many cases; cattle shed much larger quantities of MAP than do humans, and the veterinary tests are substantially more effective than similar tests on human biopsy and fecal samples.

If the correlation between MAP colonization and Crohn's were so poor, then we would not have startling results like those of Warwick Selby, whose anti-mycobacterial protocol put some 95% of patients in remission. Moreover, it would explain why so few of them (perhaps 15%) remained disease-free months or years after the antibiotics were stopped: either they were re-infected with MAP, or the organism was never really gone. Mycobacteria are very slow to grow, and very hard to kill without harming the host. If the gastric environment is not changed (which presumably entails a change in diet to prevent the entire gastric flora from simply combing back, giving an ideal environment for MAP to grow), the disease reoccurs.

Another way of looking at it: take a look at the symptoms of a cow with Johne's disease, which is known to be caused by MAP. Then look at human Crohn's and the symptoms of the disease in us. For those that wish to believe it's a coincidence- more power to you. That's fine by me. But when I lost weight, it was as muscle mass. It wasn't for a couple of years that I finally became overtly sick, and after reading about MAP infection I realized it was more than just similar to the protein-losing enteropathy (PLE) of cattle with Johne's.

Rider Fan
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Date Joined May 2008
Total Posts : 1445
   Posted 10/5/2008 2:40 PM (GMT -7)   
Osprey101 said...


If the correlation between MAP colonization and Crohn's were so poor, then we would not have startling results like those of Warwick Selby, whose anti-mycobacterial protocol put some 95% of patients in remission. Moreover, it would explain why so few of them (perhaps 15%) remained disease-free months or years after the antibiotics were stopped: either they were re-infected with MAP, or the organism was never really gone. Mycobacteria are very slow to grow, and very hard to kill without harming the host. If the gastric environment is not changed (which presumably entails a change in diet to prevent the entire gastric flora from simply combing back, giving an ideal environment for MAP to grow), the disease reoccurs.



Or perhaps there is another possibility. That MAP was never the problem. Many people here are helped by Cipro and Flagyl, which have nothing to do with MAP but may bring relief by altering the good/bad bacteria balance in the gut or by providing the anti-inflammatory effects that antibiotics all have.

This MAP debate has been going on for as long as I can remember. Seems to me if it were that simple we would have a cure, unless there is some kind of conspiracy going on here, and I'm not big on conspiracies.
Dx'ed in 1999. No surgeries.

Current meds: 100 mg 6MP. Just finished prednisone taper. Udo's Choice Probiotics (30 billion).
 
Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.


Osprey101
Regular Member


Date Joined Apr 2008
Total Posts : 227
   Posted 10/5/2008 11:30 PM (GMT -7)   
Rider Fan> I agree with you that it is unlikely that MAP is the sole contributor to this disease, which is why it can be modulated- at least in the short run- with antibiotic treatments. However, I would contend that the findings by Selby- that such a large proportion of the Crohn's patients treated in this manner go into remission- who used a regimen that is highly specific to mycobacteria indicate that he's on to something.

Moreover, that the disease returns in a high proportion of the patients- but not all- is also highly interesting in that I doubt any of the patients were coached to change their eating habits. The one person who I know firsthand who has been in remission (cured?) some 4-5 years after ending the antibiotic therapy informs me their diet is very low in carbohydrates. There are several studies that advance that theory, and at least one gastroenterologist has published on the subject that he has an 85-90% "cure" rate (his word, not mine) by using carbohydrate restriction. The literature is virtually unanimous on the subject of carbohydrate restriction and Crohn's, even while other studies involving diet and the disease are all over the place, and contradict each other.

Unfortunately, there are no recent studies on the subject, and none done in large populations. I've been trying to convince gastroenterologists that this needs to be studied, but they simply comment that it's interesting and wander off.

Ah, well. Perhaps I'm just a lunatic. :)

Rider Fan
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Date Joined May 2008
Total Posts : 1445
   Posted 10/6/2008 8:24 AM (GMT -7)   
It's so frustrating, Osprey, that I usually stay away from MAP discussions. You're probably right though that there is something to it. I tried going carb free last spring and got really sick, tons of bleeding. Now I just avoid gluten, refined sugar and dairy and stick mostly to rice and some potato for carbs. I think it's helped but I'm still not doing great.
Dx'ed in 1999. No surgeries.

Current meds: 100 mg 6MP. Just finished prednisone taper. Udo's Choice Probiotics (30 billion).
 
Betaine, digestive enzymes, Candicin (oil of oregano capsules), Beta Sitosterol.

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