Crohn's Disease

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Myths:

Chrohn's Disease can only be helped with medication.

Facts:

There are a number of proactive steps one can take that may significantly help reduce the symptoms of Chrohn's Disease.

Overview:

An estimated more than 1 million Americans have ulcerative colitis or Crohn's disease, the two most common forms of inflammatory bowel disease (IBD). These conditions, which can be painful and debilitating, cause chronic inflammation of the digestive tract.

Ulcerative colitis and Crohn's disease are very similar - so similar, in fact, that they're often mistaken for one another. Both inflame the lining of your digestive tract, and both can cause severe bouts of watery diarrhea and abdominal pain. But Crohn's disease can occur anywhere in your digestive tract, often spreading deep into the layers of affected tissues. Ulcerative colitis, on the other hand, usually affects only the innermost lining (mucosa) of your large intestine (colon) and rectum.

Symptoms:

Chronic diarrhea with abdominal pain, fever, loss of appetite, weight loss, and a sense of fullness in the abdomen are the most common symptoms. About one-third of Crohn's patients have a history of anal fissures or fistulas.

Causes:

No one is quite sure what causes IBD, although there's a consensus as to what doesn't cause it. Researchers no longer believe that stress is the main culprit, although stress can often aggravate symptoms. Instead, current thinking focuses on the following possibilities:

Immune system Some scientists think an unknown virus or bacterium may cause IBD. The digestive tract becomes inflamed when the body's immune system tries to fight off the invading microorganism. It's also possible that inflammation may stem from the virus or bacterium itself.
Heredity About 20 percent of people with ulcerative colitis or Crohn's have a parent, sibling or child who also has the disease. Scientists are searching for a gene or genes that might make you susceptible to IBD.
Environment Because IBD occurs more often among people living in cities and industrial nations, it's possible that environmental factors, including a diet high in fat or refined foods, may play a role.

Conventional Treatment:

Diarrhea and cramps may be treated with anticholinergic drugs, loperamide (Imodium®), diphenoxylate (Lomotil®), or codeine. Anal irritation and loose stools can sometimes be improved by giving methylcellulose (e.g., Citrucel®) or psyllium preparations (e.g., Fiberall®, Konsyl®, Metamucil®, Perdiem®). Sulfasalazine (Azulfidine®) is used in patients with mild to moderate colitis. Corticosteroids may be used during acute exacerbations, although long-term corticosteroid therapy does more harm than good. Certain immunosuppressive drugs may also be effective, including azathioprine (Imuran®) and 6-mercaptopurine (6-MP, Purinethol®). Secondary infections are managed with antibiotics.

Complementary Treatment:
Shopping Tips

Helpful: Cod Liver Oil 250 ml - lemon flavor (CODL4) - Cod Liver Oil

Diet & Nutrition

Nutritional Supplements

Fish oil: A special enteric-coated, "free fatty acid" form of EPA/DHA (providing 2.7 grams per day of the omega-3 fatty acids EPA and DHA) taken from fish oil may decrease inflammation associated with Crohn's disease.
Vitamin D: Malabsorption of vitamin D is common in Crohn's disease and can lead to a deficiency. Vitamin D has been shown to prevent bone loss in Crohn's patients.
Multiple vitamin/mineral: Crohn's disease often leads to malabsorption. As a result, inadequate levels of many nutrients are common. For this reason, it makes sense for people with Crohn's disease to take a high-potency multivitamin/mineral supplement. In particular, deficiencies in zinc, folic acid, vitamin B12, vitamin D, and iron have been reported.
Saccharomyces boulardii: Diarrhea caused by Crohn's disease and other conditions has responded to Saccharomyces boulardii supplementation (250-500 mg two to three times per day) in double-blind research.
Zinc: 25-50 mg per day, balanced with 2-4 mg per day of copper.

Helpful Herbs

Agrimony
Aloe (Aloe vera, Aloe barbadensis)
Chamomile (Matricaria recutita)
Cranesbill (Geranium maculatum)
Green tea (Camellia sinensis)
Licorice (Glycyrrhiza glabra)
Herb combination: Marshmallow (Althea officinalis), Slippery elm (Ulmus fulva), and Cranesbill (Geranium maculatum) combination
Oak (Quercus spp.)
Witch hazel (Hamamelis virginiana)
Yarrow (Achillea millefolium)

Helpful Lifestyle Changes

Quit smoking There is evidence that smoking worsens Crohn's.

Helpful Dietary Changes

Avoid sugar A person with Crohn's disease might consume more sugar than the average healthy person.
Reduce animal protein and fat: Reduce animal protein and fat (from foods other than fish) in the diet. Eat fish (3.5 to 7 ounces per day) instead of chicken, beef, or pork
Avoid food allergens: Some people with Crohn's disease have food allergies and have been reported to do better when they avoid foods to which they are allergic. Baker's yeast (found in bread and other bakery goods) is thought to be a possible trigger for Crohn's disease. Yeast and some cheeses are high in histamine, which is secreted during an allergic response. People with Crohn's lack the ability to break down histamine at a normal rate, so the link to yeast and dairy may not be coincidental.
Avoid nuts, raw fruit, and tomatoes, in selected cases: Some people find that these foods aggravate Crohn's symptoms; other foods may also cause problems. Elimination diets should be supervised by a qualified healthcare practitioner.

Discussion

Sugar

A person with Crohn's disease might consume more sugar than the average healthy person.

A high-fiber, low-sugar diet led to a 79% reduction in hospitalizations compared with no dietary change in one group of people with Crohn's disease.
Another trial compared the effects of high- and low-sugar diets in people with Crohn's disease.
People with a more active disease were reported to fare better on the low-sugar diet than those eating more sugar. Several people on the high-sugar diet had to stop eating sugar because their disease grew worse. While details of how sugar injures the intestine are still being uncovered, doctors often suggest eliminating all sugar (including soft drinks and processed foods with added sugar) from the diets of those with Crohn's disease.

Animal Protein

A diet high in animal protein and fat (from foods other than fish) has been linked to Crohn's disease in preliminary research. As with many other health conditions, it may be beneficial to eat less meat and dairy fat and more fruits and vegetables.

A two-year trial compared the effects of having people with Crohn's eat fish high in omega-3 fatty acids (EPA and DHA) or a diet low in fish. The fish-eating group had a 20% relapse rate compared with 58% in those not eating fish.

Allergies

Some people with Crohn's disease have food allergies and have been reported to do better when they avoid foods to which they are allergic. One study found that people with Crohn's disease are most likely to react to cereals, dairy, and yeast. Increasingly, baker's yeast (found in bread and other bakery goods) has been implicated as a possible trigger for Crohn's disease. Yeast and some cheeses are high in histamine, which is involved in an allergenic response. People with Crohn's disease lack the ability to break down histamine at a normal rate, so the link between yeast and dairy consumption and Crohn's disease occurrence may not be coincidental. However, the allergy theory cannot account for all, or even most, cases of Crohn's disease.

Elemental diets contain amino acids (rather than whole proteins, which can stimulate allergic reactions) and are therefore considered hypoallergenic. They have been used extensively as primary therapy in people with Crohn's disease, with remission rates comparable to those of steroid drugs. Nevertheless, diets containing intact proteins derived from dairy and wheat have proven equally effective at controlling the symptoms of Crohn's disease. Until more is known, it is premature to conclude that food allergy plays a significant role in the development of Crohn's disease or that a hypoallergenic diet is any more likely to help than a diet whose protein is only partially broken down.

Nuts, Raw Fruit, Tomatoes

In one trial, people with Crohn's disease were asked which foods aggravated their symptoms. Those without ileostomies found nuts, raw fruit, and tomatoes to be most problematic, though responses varied from person to person, and other reports have displayed different lists. (Ileostomies are surgical passages through the wall of the abdomen into the intestine that allow the intestinal contents to bypass the rectum and drain into a bag worn on the abdomen.) People with Crohn's disease wishing to identify and avoid potential allergens should consult a doctor.

There is preliminary evidence that people who eat fast foods at least two times per week more than triple their risk of developing Crohn's disease.

Smoking

People with Crohn's disease are more likely to smoke, and there is evidence that continuing to smoke increases the rate of disease relapse.

Vitamin D

Vitamin D malabsorption is common in Crohn's and can lead to a deficiency of the vitamin. Successful treatment with vitamin D for osteomalacia (bone brittleness caused by vitamin D deficiency) triggered by Crohn's disease has been reported. Another study found 1,000 IU per day of vitamin D prevented bone loss in people with Crohn's, while an unsupplemented group experienced significant bone loss. A doctor should evaluate vitamin D status and suggest the right level of vitamin D supplements.

Fish Oil

Inflammation within the gut occurs in people suffering from Crohn's disease. EPA and DHA, the omega-3 fatty acids found in fish oil, have anti-inflammatory activity. A two-year trial compared the effects of having people with Crohn's disease eat 3.5 to 7 ounces of fish high in EPA and DHA per day or having them eat a diet low in fish. In that trial, the fish-eating group had a 20% relapse rate compared with 58% among those not eating fish. Salmon, herring, mackerel, albacore tuna, and sardines are all high in EPA and DHA.

In a double-blind trial, people with Crohn's disease who took supplements providing 2.7 g of EPA/DHA per day had a recurrence rate of 26% after one year, compared to a 59% recurrence rate among those taking placebo. Participants in this study used a special enteric-coated, "free-fatty-acid" form of EPA/DHA taken from fish oil. Other blinded trials using other fish oil supplements that were neither enteric-coated nor in the free-fatty-acid form have reported no clinical improvement. These disparate outcomes suggest that the enteric-coated, free-fatty-acid form may have important advantages, including the reported elimination of gastrointestinal symptoms that often result from taking regular fish oil supplements. Unfortunately, enteric-coated "free-fatty-acid" fish oil is not commercially available at this time.

Saccharomyces Boulardii

In double-blind research, diarrhea caused by Crohn's disease has partially responded to supplementation with the beneficial bacterium Saccharomyces boulardii. Although the amount used in this trial, 250 mg TID, was helpful, as much as 500 mg QID has been administered in research successfully using Saccharomyces boulardii as a supplement with people suffering from other forms of diarrhea.

Multivitamins

Crohn's disease often leads to malabsorption. As a result, deficiencies of many nutrients are common. For this reason, it makes sense for people with Crohn's disease to take a high potency multivitamin-mineral supplement. In particular, deficiencies in zinc, folic acid, vitamin B12, vitamin D, and iron have been reported. Zinc, folic acid, and vitamin B12 are all needed to repair intestinal cells damaged by Crohn's disease. Some doctors recommend 25 to 50 mg of zinc (balanced with 2 to 4 mg of copper), 800 mcg of folic acid, and 800 mcg of vitamin B12. Iron status should be evaluated by a doctor before considering supplementation.

Vitamin A

Vitamin A is needed for the growth and repair of cells that line both the small and large intestine. At least two case reports describe people with Crohn's disease who have responded to vitamin A supplementation. However, in one trial, vitamin A supplementation failed to maintain remission of the disease. Therefore, although some doctors recommend 50,000 IU per day for adults with Crohn's disease, this approach remains unproven. An amount this high should never be taken without qualified guidance, nor should it be given to a woman who is or could become pregnant.

Pancreatic Enzymes

People with Crohn's disease may be deficient in pancreatic enzymes, including lipase. In theory, supplementing with enzymes might improve the nutrient malabsorption that is often associated with Crohn's disease. However, people with Crohn's disease considering supplementation with enzymes should consult a doctor.

Herbs

Doctors sometimes use a combination of herbs to soothe inflammation throughout the digestive tract. One formula contains marshmallow, slippery elm, cranesbill, and several other herbs. Marshmallow and slippery elm are mucilaginous plants that help soothe inflamed tissues. Cranesbill is an astringent. Clinical trials using this combination have not been conducted.

A variety of anti-inflammatory herbs historically have been recommended by doctors for people with Crohn's disease. These include yarrow, chamomile, licorice, and aloe juice. Cathartic preparations of aloe should be avoided. No research has been conducted to validate the use of these herbs for Crohn's disease.

Tannin-containing herbs may be helpful to decrease diarrhea during acute flare-ups and have been used for this purpose in traditional medicine. A preliminary trial using isolated tannins in the course of usual drug therapy for Crohn's disease found them to be more effective for reducing diarrhea than was no additional treatment. Tannin-containing herbs of potential benefit include agrimony (Agrimonia spp.), green tea, oak, witch hazel, and cranesbill. Use of such herbs should be discontinued before the diarrhea is completely resolved; otherwise the disease may be aggravated.

Contraindications

Refer to the individual herb for information about any side effects or interactions.

See research index