Initial studies link added sugar and IBD

Q: I am 32 years old, and I just learned I have IBD. My doctor thinks the fact that in my family we eat a lot of sweets has something to do with it. I'm not the only one with stomach issues, but I figured because it runs in the family, it is genetic. Do you think it could really be from too much sugar?

A: Inflammatory bowel disease, or IBD, is a general term used to describe a group of disorders that arise from chronic inflammation of the digestive tract. The most common of these are Crohn's disease and ulcerative colitis. Although Crohn's disease can affect any part of the digestive tract, most people experience problems in the area between the ileum, which is the end of the small intestine, and the start of the colon, or large intestine. In ulcerative colitis, the individual develops sores along the inner lining of the colon and rectum. Both ulcerative colitis and Crohn's disease can cause abdominal pain, diarrhea, rectal bleeding, urgency to defecate, unintended weight loss and fatigue.

It's true there's evidence that IBD, which affects upward of 3 million people in the U.S., runs in families. Stress, diet and age also appear to play a role. Both ulcerative colitis and Crohn's disease often develop in a person's 20s and 30s. IBDs are also believed to arise from immune system impairment or malfunction.

This brings us to your doctor linking your IBD diagnosis to excessive sugar consumption. A study using mice, which was published last fall in the journal Science Translational Medicine, found evidence that added sugar in the diet can lead to IBD, and also make existing disease worse. Americans eat an estimated 65 to 70 pounds of added sugar per year, the highest rate in the world. Considering that the U.S. accounts for from one-third to one-half of all cases of IBD worldwide, it's easy to see how the IBD-sugar connection became a subject of inquiry.

In that study, researchers looked at three groups of mice: those with a healthy gut, a group genetically predisposed to develop colitis and a group fed a compound to induce colitis. The mice were then further divided into new groups. Some received simple sugars for seven days in concentrations equivalent to a soft drink. Others had no added sugars in their diet. At the end of the week, the mice on the sugary diets developed colitis that was far more severe than the sugar-free mice. The gut microbiomes of all the sugar-fed mice were significantly altered, with a marked increase in bacteria that degrade the layer of protective mucus that lines the gut.

Whether or not eating sugar erodes the protective mucus in the guts of humans remains to be seen, but these findings are intriguing. And considering we already know that too much added sugar has an adverse impact on heart health, blood sugar control, inflammation and even on mood, we think cutting back would be good not only for your gut, but also for your general health.

Q: What can you tell me about the new monthly HIV treatment that was recently approved? My uncle has been living with HIV for almost 25 years. He's a senior citizen now, and growing forgetful about all of the meds he's on.

A: You're referring to a monthly injectable HIV treatment that was just given the green light by the U.S. Food and Drug Administration. It's an extended-release drug — the first of its kind to win FDA approval — and it will be a game-changer for a lot of people living with HIV. The treatment, which comes in a two-shot combination, isn't for everyone, and it comes with some caveats.

Human immunodeficiency virus, or HIV, is a virus that attacks the immune system. Left untreated, it can cause the disease we know as AIDS, or acquired immunodeficiency syndrome. It's most often spread through unprotected sex or sharing syringes with an infected individual. It can also be acquired in a medical setting via infected blood products. However, since the implementation of HIV testing of blood products and donated organs, this type of transmission is rare. While mother-to-child transmission during pregnancy, labor or breastfeeding is also possible, effective interventions have lowered that transmission rate to less than 5%.

At this time, about 1.2 million people in the U.S. are living with HIV. About 14% of them — that's 1 in 7 — aren't aware of their HIV-positive status.

Until the advent of antiretroviral therapies in the early 1990s, the average life expectancy of someone with AIDS was one year. Thanks to antiretrovirals, HIV/AIDS became a manageable chronic condition. At first, to prevent the virus from replicating and to limit drug resistance, treatment consisted of multiple medications taken throughout the day. This eventually changed to fewer pills, but for certain patients, including some older adults, this was still a challenge.

The newly approved drug, known as Cabenuva, is a complete regimen that gets injected once a month. It allows patients, like your uncle, to improve their compliance. They go from having to remember to take their medication 365 times per year to receiving the treatment monthly. Cabenuva combines an existing drug with a new drug, packaged together and given as two separate shots. An every-other-month regimen, which is already available in Europe, is being tested in the U.S. The FDA also approved the new drug in tablet form, to be taken for a month prior to starting the injectable therapy. The goal is to prep the body for a smooth transition to the injectable drug.

As with all drugs, the new injectable therapy has potential side effects. These include fatigue, headache, joint and muscle pain, swelling at the injection site, rash, dizziness and trouble sleeping. Cabenuva is meant for people who are already on a successful HIV/AIDS regimen, with no previous treatment failure, and who have no history of resistance to the antiretroviral drugs in the injectable. The therapy, which is eligible for insurance coverage, cannot be administered at home and requires monthly clinic visits.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.