Inflammatory bowel disease best managed by an expert

DEAR DR. ROACH >> I am 59 and recently received a diagnosis of mild to moderate Crohn’s disease. Having been quite healthy my entire life, I find the treatment options to be overwhelming. It seems as if drug treatment — e.g. Humira — has as many detractors as supporters, and I’ve read plenty of horror stories about folks who have used it. The same can be said of Remicade and some of the other treatments. I have family members who are pushing me to consider natural treatments, such as diet modification, essential oils and the like. What course of action would you recommend?

— T.T.

DEAR READER >> Crohn’s disease is an inflammatory bowel disease of unknown cause. Unlike ulcerative colitis — the other form of inflammatory bowel disease, which affects only the colon — Crohn’s disease can affect the gastrointestinal tract anywhere from the lips to the anus.

The variability of the disease is immense. I trained in an institution with special expertise in IBD and saw the full spectrum of the disease in the days before medications like infliximab (Remicade) and adalimumab (Humira) were introduced, and I promise you that for many people, these medications are literally lifesaving. However, they clearly are not for everyone and should be used only for carefully chosen patients after a thorough evaluation by an expert. Inflammatory bowel disease should be taken very seriously, and I can’t emphasize enough how important it is to have an expert managing this condition.

Initial treatment certainly does consist of dietary modification. Lactose is so frequently a problem in people with Crohn’s disease that a trial of a lactosefree diet usually is recommended. Many experts also recommend an elimination diet, meaning removing the likely triggers for IBD flares and then slowly adding them back in to see whether they cause a problem. Probiotics have been shown to be beneficial in some people with Crohn’s disease.

Since you asked specifically about natural or complimentary treatments, I would advise you to use these in addition to, not instead of, the standard therapies recommended by an IBD expert. They can help reduce perception of discomfort and side effects.

DEAR DR. ROACH >> I’m 89, and my systolic blood pressure is usually between 130 and 140, but my diastolic is down to 50-60. What does this wide difference mean? Is it good or bad? I’ve read recently that when one is as old as I am, one should not worry about the systolic number (which has been the same for 10 years, even while taking 50 mg of losartan daily). But nothing is ever said about the diastolic.

— L.O’B.

DEAR READER >> The difference between the first number (the systolic) and the second, smaller number (the diastolic) is called the pulse pressure, and it varies considerably among normal, healthy people. A very large pulse pressure makes physicians think about four conditions. The first is aortic insufficiency, a leakage of the valve between the left ventricle and the aorta, the major blood vessel of the body. When that happens, blood flows backward into the left ventricle and causes the pressure to drop suddenly. This can be felt by a skilled examiner of the pulse, where it is called the “water hammer pulse,” after a children’s toy. Aortic insufficiency is serious and can be diagnosed easily by listening to the heart and feeling the pulses, and it is confirmed by an echocardiogram.

As we age, though, our arteries tend to calcify and harden, and that also leads by itself to a wide pulse pressure. Thyroid disease is another cause. A very slow heart rate also widens the pulse pressure. The medication you are on, losartan, relaxes arteries and is probably a good choice for someone with a wide pulse pressure.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.