Treatment with SPC-Flakes® in short intestines/intestinal resections
After the encouraging results seen in animals and healthy subjects it was desirable to test the anti-diarrhoeal effects of the specially produced cereals (SPC-Flakes®) on patients with severe hypersecretion. Severe hypersecretion is experienced in patients with short intestines, often due to major intestinal resections. An open pilot study was designed under the guidance and expertise of Professor Ingvar Bosaeus at the Department of Clinical Nutrition at the Sahlgrenska University Hospital.
The study included eight patients with varying extents of intestinal resections due to Crohn's disease. The length of their small intestine varied between 80 and 400 cm. All patients suffered from chronic diarrhoea without concurrent bowel inflammation. Six healthy controls participated. All subjects received 54 g SPC-Flakes® daily for 2 weeks. The daily dose was divided evenly over the day during at least three occasions in connection with mealtimes. Patient and control baseline diet and medications were kept unchanged.
Plasma AF activity was determined before, during and after the treatment period. The SPC diet increased AF activity in all controls. AF activity was increased from a mean of 0,28 ± 0,37 units/ml plasma prior to treatment to 1,28 ± 0,23 AF units/ml plasma after the two week treatment period (p<0,05). Elevated levels of AF (1,28 ± 0,39) were maintained during at least four weeks after intake of the SPC diet.
In the patients baseline values were low (0,04 ± 0,07), rising during the treatment period to a mean of 0,66 ± 0,45 units. The two patients with the longest remaining small intestine, 300 and 400 cm, achieved elevated AF levels comparable to healthy subjects, i.e. over 1 unit/ml plasma. These patients also lowered the number of daily bowel movements. Analysis showed that in the patients there was a significant correlation between the length of the remaining small intestine and AF induction (r=0.94, p<0.01).
It was concluded that a small intestine length of at least 1 metre is needed to induce AF and to maintain the elevated levels after the treatment with AF-inducing diet.
Lange, Bosaeus, Jennische, Johansson, Lundgren and Lönnroth, Food-induced antisecretory factor activity is correlated with small bowel length in patients with intestinal resection, APMIS, 2003; 111:985-988, view link
AF treatment of secretory diarrhoea due to carcinoid tumours
The pathology of diarrhoea in patients with short intestines in most likely due to multiple factors and for this reason it is possible that AF only influences the secretory component of the diarrhoea. Patients with neuroendocrine tumours may suffer from severe diarrhoea, that may be both difficult to treat, treatment resistant and persistent despite an otherwise optimal treatment regime.
The aim of the study was to investigate if specially processed cereals, SPC-Flakes®, or Salovum® could induce AF-activity and if AF-therapy could reduce the number of bowel movements. The treatment with AF products was administered as an additive to the patients’ ongoing medical therapy.
Eight critically ill patients were included. Six patients with the midgut carcinoid syndrome and two with metastasizing medullary thyroid carcinoma (MTC) participated.
In an initial open part of the study all patients received Salovum® for 4 weeks. This was followed by randomisation to a double-blind crossover period with SPC-Flakes® and control cereals without AF inducing ability for 6 weeks in a dose of 1g/kg bodyweight divided into four doses daily.
Treatment with SPC-Flakes® and Salovum®resulted in a significant reduction of daily bowel movements (Table 1) and several patients reported firmer stools.