Imagine Dragons is an American pop-rock band from Las Vegas, known for their hit songs "Radioactive," "Thunder," and "Believer." Their lead vocalist, Dan Reynolds, surprised fans in 2015 by announcing that he has been diagnosed with two medical conditions. He was diagnosed with ulcerative colitis (UC) at the age of 21, and ankylosing spondylitis at 24. He also has suffered from depression and anxiety.
With the help of rheumatologist Susan Baker, MD, he started treatment and closely examined his diet and exercise routines. One of the first things that had to go was his "cereal addiction" and a diet high in processed foods.
"I went on an anti-inflammatory diet. Everyone is different," he . "What works for me is a lot of fish, chicken, rice, vegetables. I'll avoid bread, dairy, and sugar. I eat fruit and get natural sugar, but I avoid anything that's processed."
He also amped up his exercise routine, making it a daily priority and exercising from 1-3 hours/day. Besides weight training, he also does yoga to prevent stiffness and pain. In January 2019, he was even featured in . During disease flare-ups, he takes a biologic medication to ease pain and get him back into remission.
In the EH interview, Reynolds that anyone struggling with medical or mental health issues try and be kind to yourself and remove stressors in your life:
"Do things every day that will de-stress your life. Treat yourself to whatever shuts your mind off. If I need to listen to my true-crime podcasts, or go to the gym, or read my book, that's what I'm going to do. My priority in life is my health. If my health isn't there, I can't do anything -- I can't be a good dad, a good musician, a good husband. I can't stress the need to de-stress enough."
Ulcerative Colitis
Ulcerative colitis is a chronic disorder that affects the digestive system. This condition is characterized by abnormal inflammation of the mucosal layer of the rectum and colon. The inflammation usually causes ulcers to develop in the large intestine. UC usually appears from ages 15 to 30, although it can develop at any age. The inflammation tends to flare up multiple times throughout life, which causes recurring signs and symptoms.
UC is most common in North America and Western Europe; however, the prevalence is increasing in other regions. In North America, ulcerative colitis affects approximately 40 to 240 in 100,000 people. It is estimated that more than 750,000 North Americans are affected by this disorder. Ulcerative colitis is more common in whites and people of eastern and central European (Ashkenazi) Jewish descent than among people of other ethnic backgrounds.
What causes UC?
A variety of genetic and environmental factors are likely involved in the development of UC. Recent studies have identified variations in dozens of genes that may be linked to UC; however, the role of these variations is not completely understood. Researchers speculate that this condition may result from changes in the intestinal lining's protective function or an abnormal immune response to the normal bacteria in the digestive tract, both of which may be influenced by genetic variations.
Several of the genes that may be associated with UC are involved in the protective function of the intestines. The intestinal mucosa provides a barrier that protects the body's tissues from the bacteria that live in the intestines and from toxins that pass through the digestive tract. Researchers speculate that a breakdown of this barrier allows contact between the intestinal tissue and the bacteria and toxins, which can trigger an immune reaction. This immune response may lead to chronic inflammation and the digestive problems characteristic of UC.
Other possible disease-associated genes are involved in the immune system, particularly in the maturation and function of T cells. Certain genetic variations may make some individuals more prone to an overactive immune response to the bacteria and other microbes in the intestines, which may cause the chronic inflammation that occurs in UC. Another possible explanation is that UC occurs when the immune system malfunctions and attacks the cells of the intestines, causing inflammation.
Symptoms of UC
The most common symptoms of UC are abdominal pain and cramping and frequent diarrhea, often with blood, pus, or mucus in the stool. Other signs and symptoms include nausea, loss of appetite, fatigue, and fevers. Chronic bleeding from the inflamed and ulcerated intestinal tissue can cause anemia in some affected individuals. People with this disorder have difficulty absorbing enough fluids and nutrients from their diet and often experience weight loss. Affected children usually grow more slowly than normal. Less commonly, UC causes problems with the skin, joints, eyes, kidneys, or liver, which are most likely due to abnormal inflammation.
Toxic megacolon is a rare complication of UC that can be life-threatening. Toxic megacolon involves widening of the colon and an overwhelming bacterial infection (sepsis). Ulcerative colitis also increases the risk of developing colon cancer, especially in people whose entire colon is inflamed and in people who have had UC for 8 or more years.
Management of Patients with UC
In March 2019, the American College of Gastroenterology released its new for the management of UC in adults. According to these guidelines:
"Management of UC must involve a prompt and accurate diagnosis, assessment of the patient's risk of poor outcomes, and initiation of effective, safe, and tolerable medical therapies. The optimal goal of management is a sustained and durable period of steroid-free remission, accompanied by appropriate psychosocial support, normal health-related quality of life, prevention of morbidity including hospitalization and surgery, and prevention of cancer."
UC management now strives to go beyond the control of symptoms to reduce inflammation and, thereby, promote mucosal healing. Lead author David T. Rubin, MD, of the University of Chicago, told us, "We've made tremendous advances in UC, and we've moved from being reactive to being much more proactive in maintaining sustained stable remission and minimizing complications and the need for hospitalization and surgery."
Other ACG recommendations :
1. Patients should have an assessment of disease severity based on multiple factors and measurements. In addition to classic bowel symptoms, objective indicators of inflammatory burden, previous treatment failure and hospitalizations, and impact on patient functionality and quality of life should be taken into consideration.
A new classification system for disease severity is stratified as mild, moderate-severe, and fulminant.
Mild disease: fewer than four stools per day, intermittent bleeding, Mayo endoscopy subscore of 1, elevated C-reactive protein (CRP), normal hemoglobin, and fecal calprotectin (FC) of 150 to 200 µg/g.
Moderate to severe disease: more than six stools per day, frequent blood in stool, elevated CRP, erythrocyte sedimentation rate (ESR) above 30 mm/hour, hemoglobin less than 75% of normal, and Mayo scores of 2 or 3.
Fulminant disease: more than ten stools per day, FC above 150 to 200, ESR above 30, Mayo subscore of 3, and transfusions being needed.
2. Infectious causes, particularly C. difficile, should be ruled out before making the diagnosis of UC. However serologic testing antibody panels to diagnose or rule out UC are not recommended.
3. Patients with mild disease can be induced with rectal 5-aminosalicylate therapies at a dose of 1 g/d. This can be combined with oral 5-aminosalicylate at a dose of at least 2g/d. For patients resistant to this regimen, they recommend oral budesonide multi-matrix (MMX) 9 mg/d for induction of remission. In patients with mildly active left-sided or extensive UC, they recommend oral 5-ASA therapy (at least 2 g/d) for maintenance of remission.
4. For patients with moderate disease oral budesonide MMX is recommended for induction of remission. Instead of monotherapy with thiopurines or methotrexate for induction, anti-TNF therapy using adalimumab, golimumab, or infliximab is recommended.
5. Two new drugs, vedolizumab (Entyvio) and tofacitinib (Xeljanz) have also been found to be effective for the induction of remission in moderate to severe UC. Vedolizumab is an anti-integrin drug which blocks the action of integrin on the surface of circulating immune cells and endothelial cell adhesion molecules, thereby inhibiting the interactions between leukocytes and intestinal blood vessels. Tofacitinib is an orally administered small molecule that is a nonselective inhibitor of the Janus kinase enzyme which affects cytokine function.
6. Colorectal cancer prevention recommendations:
- We suggest colonoscopic screening and surveillance to identify neoplasia in patients with UC of any extent beyond the rectum.
- When using standard-definition colonoscopes in patients with UC undergoing surveillance, we recommend dye spray chromoendoscopy with methylene blue or indigo carmine to identify dysplasia.
- When using high-definition colonoscopes in patients with UC undergoing surveillance, we suggest white-light endoscopy with narrow-band imaging or dye spray chromoendoscopy with methylene blue or indigo carmine to identify dysplasia.
7. Further study is needed before additional therapies such as dietary interventions, probiotics, and fecal transplantation can be recommended.
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