Friday, December 28, 2007

Yeast Sugar Also Found in Cow’s Milk Linked to Crohn’s Disease




A new report suggests that a sugar found in Cow’s milk, contributes to the development of Crohn’s disease. This sugar mannan is also produced by the dietary yeast, Saccharomyces cerevisiae or common Baker’s or Brewer’s yeast used to bake bread and brew beer. Mannan has been shown to make white blood cells lazy and allow overgrowth of the bacteria E. coli. Both Saccharomyces cerevisiae yeast and E. coli bacteria are linked somehow to Crohn's disease based on the presence of antibodies in the blood to them found in most people with this chronic incurable bowel disorder.

Interestingly, antibodies to the yeast abbreviated ASCA are found in many people with Celiac disease and in some people with IBS. I have several patients with ASCA antibodies who have Celiac disease, mastocytic enterocolitis, microscopic colitis, IBS and other undefined conditions that I believe are a form of a leaky gut disorder. Many of these people have evidence of multiple food intolerance and non-celiac gluten sensitivity. Most improve with a gluten free diet combined with probiotics and when necessary steroids, or other Crohn's and colitis type medications.

There has been a theory for years that Crohn’s disease results from an infection. A cousin to the TB bacteria known as mycobacterium paratuberculosis is high on the suspect list because it causes a disease in sheep called Johannes’s disease that is nearly identical to Crohn’s disease in humans. Some researchers have reported evidence of this bacterial infection in patients with Crohn's disease though I could not find evidence of DNA of this bacteria or RNA of the measles virus in biopsy tissue using PCR techniques during research I did while in my GI fellowship training. Treatment directed against M. paratuberculosis has helped some Crohn’s patients further fueling the debate about its role.

More recently the focus on the role of a dietary yeast Saccharomyces cerevisiae is heating up since up to two thirds of Crohn’s disease sufferers have antibodies to this yeast in their blood, abbreviated ASCA. In addition the presence of antibodies to the outer membrane protein (OmpC) and flagella (anti-CBir1) of the bacteria E. coli has it in the fray as well along with the yeast Candida albicans that may somehow assist in the toxicity of Saccharomyces cerevisiae.

Mycobacterium paratuberculosis apparently sheds mannan, this yeast sugar also found in Cow’s milk. M. paratuberculosis bacteria and the other suspect yeast in the digestive tract, Candida albicans, also apparently trigger the development of ASCA antibodies. These researchers theorize that the presence of ASCA antibodies found in Crohn’s disease patients indicate prior infection with M. paratuberculosis bacteria. It is interesting to wonder if such an infection is a trigger for leaky gut that can precipitate various digestive symptoms as well as diseases, depending on the location of the gut injury and a person's genetic make up and environmental influences including stress, diet and gut bacteria levels.

Mannan shed by this bacterium causes white blood cells known as phagocytes (phago-eat, cytes-cells) that normally eat foreign invaders become lazy. Granulomas, collections of dead cells and debris, and abnormal connections between tissues known as fistula typical of Crohn’s disease result.

Currently, there is no cure for Crohn’s disease and the only treatments involve suppressing the body’s immune system with powerful drugs such as the steroid prednisone, biologics Remicade and Humira, and anti-cancer/anti-inflammation drugs Immuran/azothioprine, 6-mercaptopurine or methotrexate. More recently, probiotics have been showing great promise. Probiotic bacteria in preparations such as VSL#3 and the probiotic yeast Saccharomyces boulardii, a cousin of Saccharomyces cerevisiae are effective in preventing and treating Crohn’s disease to some degree in laboratory rats and humans.

Of interest is that the carbohydrate specific diet espoused by Elaine Gottschall in her book “Breaking the Vicious Cycle” limits dairy and yeast intake. This diet advocated by many for treatment of Crohn’s disease based on numerous patient testimonials of its effectiveness. Since no controlled trials have been done proving it is effective, it is not advocated by most traditional medical practitioners. The Crohn’s and Colitis Foundation of America reviews the diet on its website pointing out the pros and cons. Many of us open to the role of diet in bowel inflammation suggest it to our patients as an option.

This new data on yeast sugar mannan, found in Cow’s milk, and gut bacteria is further support of the role of diet, bacteria and yeast in bowel damage and injury. The leaky gut and hygiene theory continue to become entwined with food, bacteria and yeast proteins and sugars in human disease. What you eat and what is living in your gut are important to your health. That is why the Food Doc motto is a “healthy gut, healthy life”.

Reference: Gastroenterology 2007;133:1487-1498

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4 comments:

Anne said...

I don't have Crohn's but I do have antibodies to Saccharomyces cerevisiae. I guess I don't understand how another yeast could help with healing and not cause further problems. Wouldn't there be cross reactivity between the two strains?

The Food Doc, Dr. Scot Lewey said...

Saccharomyces cerevisiae is Baker's (or Brewer's yeast) used in cooking and fermenting alcohol. Therefore it is in many foods we eat including gluten free baked goods eaten by those on a gluten free diet. Saccharomyces boulardii is a yeast rarely eaten as it is a yeast found in a lychee or mangosteen fruit or in a probiotic yeast preparation. It suppresses Saccharomyces cerevisiae and promotes intestinal healing. It appears to tighten loose tight junctions and impair the inflammation in Crohns as well as movement of bad bacteria into lymph tissue. Henri Boulard is credited for its discovery after he noted natives in Southeast Asia eating the skin of the mangosteen fruit to combat diarrhea in Cholera. It has been studied more extensively recently as it works to help heal Crohns, maintain remission in Crohns and clear up antibiotic associated diarrhea from C. difficile bacteria. It has rarely been reported to get in the blood stream in people who severely immunosuppressed but otherwise it is felt to be very safe. Since it is not normally found in the digestive tract it only is present in the gut when you are taking it, once you stop you lose the benefit. The most common brand name in US is Florastar. Hope that helps you understand.

The Food Doc, Dr. Scot Lewey said...

Saccharomyces cerevisiae is Baker's (or Brewer's yeast) used in cooking and fermenting alcohol. Therefore it is in many foods we eat including gluten free baked goods eaten by those on a gluten free diet. Saccharomyces boulardii is a yeast rarely eaten as it is a yeast found in a lychee or mangosteen fruit or in a probiotic yeast preparation. It suppresses Saccharomyces cerevisiae and promotes intestinal healing. It appears to tighten loose tight junctions and impair the inflammation in Crohns as well as movement of bad bacteria into lymph tissue. Henri Boulard is credited for its discovery after he noted natives in Southeast Asia eating the skin of the mangosteen fruit to combat diarrhea in Cholera. It has been studied more extensively recently as it works to help heal Crohns, maintain remission in Crohns and clear up antibiotic associated diarrhea from C. difficile bacteria. It has rarely been reported to get in the blood stream in people who severely immunosuppressed but otherwise it is felt to be very safe. Since it is not normally found in the digestive tract it only is present in the gut when you are taking it, once you stop you lose the benefit. The most common brand name in US is Florastar. Hope that helps you understand.

Anonymous said...

I have Crohn's and am very interested in this info. Do you know if Goat's milk also contains mannan or is it safe? Thanks

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