3D model of the Isotretinoin structure
Do you suffer from frequent bouts of nausea, heartburn, indigestion, stomach bloating, or diarrhea? How often do you change your schedule due to an upset stomach? Do you find yourself planning your daily itinerary around the availability of restrooms? Many people believe that rather than addressing a nutritional issue, temporary relief is available in the form of an anti-acid. Pop, pop, fizz fizz oh what a relief it is (catchy tune but really not addressing the issue)! Stomach discomfort and diarrhea can be a sign of a more serious problem called Inflammatory Bowel Disease. Inflammatory Bowel Disease (IBD) refers to two chronic diseases: Ulcerative Colitis and Crohn’s Disease. According to the Centers for Disease Control, these diseases may affect as many as 1.4 million people in the United States. Symptoms include diarrhea, abdominal pain, fever, rectal bleeding, loss of appetite, weight loss, chronic fatigue, and inflammation of the skin, eyes, and joints. Serious complications can also occur, including intestinal blockage and ulcers, malnutrition from poor intestinal absorption of nutrients, and increased risk for colon cancer.
The exact cause of Inflammatory Bowel Disease remains unknown. According to the Mayo Clinic, there are a number of possible contributing factors in the development of IBD. Genetic predisposition, a compromised immune system from a virus or bacterial infection, cigarette smoking, being of Caucasian and particularly Ashkenazi Jewish descent, and eating a very high fat and low fiber diet can all lead to IBD. The Mayo Clinic also highlights a correlation between Isotretinoin (or Accutane), a powerful medication used to treat severe acne, and Inflammatory Bowel Disease. Isotretinoin has a chemical structure and function which is similar to vitamin A. The drug was approved by the Food and Drug Administration in 1982. It has been widely prescribed despite its well-known links with birth defects and it might also impair the immune system’s response to intestinal bacteria. Hypothetically, this can result in inflammation and the development of IBD.
Research studies indicate a strong association between Isotretinoin and Inflammatory Bowel Disease. A study published in the American Journal of Gastroenterology by Crockett et. al (March 2010), reviewed a number of cases of IBD which were linked with Isotretinoin exposure. Ulcerative colitis was strongly associated with Isotretinoin use, causing a 50% increased risk of developing Ulcerative Colitis in those who have used Isotretinoin previously compared to those who have not. The higher the dosage of Isotretinoin , the greater the likelihood of developing Ulcerative Colitis.
Due to strong scientifically backed evidence indicating a connection between Isotretinoin and IBD, thousands of lawsuits have been filed against Roche Pharmaceuticals, the maker of Accutane. Many plaintiffs state they developed severe gastrointestinal disorders after taking the medication and criticize Roche for not issuing sterner warnings about the dangers of the drug. The latest development in the series of Accutane lawsuits occurred on February 16, 2010, when a New Jersey court ruled that Roche Pharmaceuticals must pay $25.16 million in damages to a man who claimed he developed debilitating IBD after taking the medication. Roche Pharmaceuticals maintains they will appeal the latest results.
The bottom line is that if you have a family history of Inflammatory Bowel Disease, or have experienced stomach issues while on Accutane , please discuss proper treatment options with your doctor. IBD management is possible through both medication management and nutrition counseling from a registered dietitian. Don’t wait! Talk to your doctor today if you are experiencing ongoing stomach discomfort. Remember you are your own best advocate!
Amy Santo
Dietetic Intern, New York Presbyterian Hospital
Master’s Candidate in Clinical Nutrition, New York University
amyjsanto@gmail.com
At least twice a week I receive phone calls from potential clients with “pre-diabetes”. The conversation usually goes one of two ways. Scenario #1: ”My doctor called and told me I have borderline diabetes. He told me to call you so that I could start on a diet to lose weight and get my blood sugars under control. I”m scared! What can I do?”. Scenario #2: “My doctor and wife made me call you because my blood sugar was a little high. I don’t have diabetes yet, so I’m not sure that I need to see you. They made me call. No rush.” I’ve been a Certified Diabetes Educator for over 15 years and I still feel the deep angst when a person with pre-diabetes contacts me who is not yet willing to make appropriate diet and exercise modifications. Pre-diabetes is an easier condition to treat than Type 2 diabetes. So early detection and treatment is essential to prevent complications.
