Results from RMAT (rifabutin and macrolide antibiotic therapy) trials for CD patients have been, on balance, good. However, if MAP is a major cause of CD, it’s reasonable question why the trials have not achieved a much greater short-term and long-term remission rate. So, is there a missing piece to this complex puzzle?

I’m proposing that MAP causes disease by attaching itself to a host's gut lining and fermenting a wide-range of sugars to produce enough organic acid(s) at low ph to burn the gut lining. Indeed, a significant number of studies have noted high sugar consumption in Crohn’s sufferers, and a number of other studies and a recent case-study have observed remission in CD patients after following low-carb (sugar-restricted) diets.

Also, several studies have noted disease improvement in CD sufferers taking probiotic supplements. And some studies have noted no symptom improvement. If MAP is a major cause of CD, why would probiotics facilitate disease improvement? A study by Donaghy JA and colleagues, found that specific probiotic strains (Lb. paracasei isolates) inhibited MAP growth in milk, and they concluded that the possibility exists for “their use as biotherapeutic agents in the gastro-intestinal tract”.

If MAP causes CD and the disease-causing is mechanism is acid production, combining RMAT with a low-carbohydrate diet may be the most effective way to treat Crohn’s disease. And, if remission is achieved on such a regimen, swapping to a maintenance program involving, again, a low-carb diet combined with a clinically-effective probiotic formula may be the most effective way to maintain remission.

Additionally, a clinically-proven probiotic formula may be an effective alternative for RMAT-intolerant CD patients.