I’ve spent a few posts discussing possible causes of my ulcerative colitis, and here I want to pause and examine those causes so far. Together, in the fall of 2014, these pieces were starting to form a picture in my mind and to fit together, helping me understand my disease.
The possible causes varied widely. It seemed likely that more than one, and possibly all, had played a role. Some, like diet and lack of exercise, involved my own actions–things I could have done differently and would now give almost anything to go back in time and change. Other causes, like stress, would have been harder to influence, though I wished I had somehow done more to manage my stress levels pre-disease, too. And still other possible causes were things I could not have done much about at all. Especially genetic predisposition, but also environmental toxins, since many of my biggest exposures had occurred at times when I didn’t know much about the dangers.
Along with the possible causes I’ve discussed, by fall 2014 I had come across a few others as well. I will briefly address each of them here, to complete the list I was working with then.
First, some scientists believe that colitis can be triggered by viruses or other pathogens. According to the Mayo Clinic: “When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.”
I had read this in many similar websites about the causes of UC. But I had decided to shrug this one off, because if I did have a virus or infection in 2012 or 2013, I was not aware of it. Prior to my disease onset, my health was as normal as it had been for a few years–generally weak and inflamed, but without any strange new pathogens, as far as I could tell.
Second, there was the theory that, as Donna Jackson Nakazawa mentions in The Autoimmune Epidemic, vaccinations can lead to autoimmune disease:
As a public health tool, vaccines are an astonishingly beneficial and cost-effective life-saving intervention against infectious disease. But they have their downsides, and autoimmune disease is emerging as a potentially dark one. In 1994, the Journal of the American Medical Association reported a dangerous relationship between diphtheria, tetanus, and oral polio vaccines and a number of autoimmune disorders, including Guillian-Barré syndrome. Similarly, a correlation has been reported and debated in scientific journals for years between the hepatitis B vaccine and multiple sclerosis as well as rheumatoid arthritis.
When I first read these passages, my stomach did a flip flop. I had gotten my first flu shot ever in winter 2013-14. I thought I remembered getting it in November or December, close to the time when my symptoms had started! Was it possible that I had unwittingly given myself colitis?
But I looked on my calendar, where I’d marked my flu shot appointment, and found I’d been wrong: the shot was in January. I was certain I’d had symptoms before then–I remembered noticing my then-mysterious symptoms ease when I went home to Portland for Christmas. So along with the virus cause, I could scratch the vaccination cause off my list.
(And let me digress briefly to add an important note about vaccinations, because few things make me angrier than science denial that puts people’s lives at risk. Vaccinations are critically important to all of our health, and the recent antivaxxer movement is dangerously irresponsible in its sweeping, unscientific claims about vaccines. Nakazawa’s book came out in 2009, before Andrew Wakefield’s “research” on the alleged link between autism and vaccinations was exposed as fraudulent. There is NO LINK between vaccinations and autism. Glancing at a few scientific articles, it does look like Nakazawa’s mention of vaccines’ occasional, potential link to autoimmune disease is at least being considered by scientists–for instance here. And proven links have occurred, in rare and specific cases, for instance in a 1976 outbreak of Guillan-Barré syndrome associated with the swine flu vaccine. Nevertheless, the benefits of vaccines far outweigh the risks, which are miniscule. In a 2010 interview, Nakazawa assured the interview host that she has vaccinated her own children (minute 9:30), despite their being at obvious risk for genetic predisposition to autoimmunity. In that same interview, though, she does have some of her facts and sentiments wrong, at least according to prevailing medical expertise. She describes childhood vaccinations as overburdening the immune system (minute 9:45), while doctors and researchers agree that the burden is negligible. I would hope that, were Nakazawa writing or speaking on the topic of vaccines today, she would revise some of her outdated statements. This is the only area in which her research seems suspect, and unfortunately, it casts a shadow over the rest of her expertise.)
Finally, Nakazawa mentions vitamin D deficiency as potentially linked to autoimmune disease:
[V]itamin D can be protective against not only multiple sclerosis but inflammatory bowel disease. According to [Gerry] Mullin, 75 percent of Crohn’s patients are deficient in vitamin D. There is growing evidence that vitamin D plays a central role in rebalancing T-cell activity.
Now, here was a potential cause I could take seriously. Vitamin D inhibits inflammation, which helps explain why autoimmune diseases could be triggered by low levels. And two years earlier, I had tested positive for vitamin D deficiency during my quest to diagnose what turned out to be a walnut allergy. I took vitamin D supplements for months afterwards, but because I soon figured out my allergy and my symptoms cleared up, I was never tested again to determine whether my D level had risen back to the normal range. Since then, I had largely confined myself to the indoors, often not leaving the apartment till the sun was down–I liked to walk in the evening to avoid putting on sunscreen. It seemed quite likely that my vitamin D levels had continued to be low over the course of the last couple years, especially since I hadn’t consistently taken that vitamin.
Vitamin D, then, rounded out my list in fall 2014. Here is the list I was working with:
Possible Causes of My Colitis
- Genetic predisposition to autoimmune disease.
- Increased inflammation, from:
- Prolonged stress.
- Lack of exercise. (Exercise is anti-inflammatory.)
- Vitamin D deficiency.
- Immune imbalance–a confused immune system–from:
- Prolonged stress.
- Chemical toxins in the environment.
- Gut bacteria imbalance, from:
- Poor diet.
My genetics, chronic inflammation, and confused immune system might have set the stage. And then, when my gut bacteria eventually became imbalanced, that tipped things over the edge and led my body to start attacking my colon.
It felt good to arrive at this narrative. A relief: the puzzle was coming together. If I could understand my disease, then I could master it, subdue it. Knowledge was the first step…I hoped.