IBD | Crohn's Disease
Nutritional and Lifestyle Discussion
Crohn's disease patients seem to consume higher levels of sugar than most healthy people.1
- It has been reported that a low sugar, high fiber diet gave rise to a 79% hospitalization reduction with comparison to no change in dietary elements in Crohn's disease patients.2,3
- And those with an active disease did better on a low sugar diet.3 In fact, several patients in the control group on a high sugar diet had to decrease their sugar intake because the disease was worsening. The effect of sugar on the intestine and immune system are still being investigated, but many medical practitioners recommend eliminating all foods containing sugar, including processed foods and soft drinks.
Diets with lots of non-fish animal protein and fats has been connected to Crohn's.4 Therefore, it may be helpful to consume less fat from dairy foods and meat and add more vegetables and fruits to the diet.
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.22
Some Crohn's patients find some relief from avoiding foods to which they are allergic. One study found that such patients are most likely to react to dairy, cereals, yeast.5 Baker's yeast may be a Crohn's disease trigger.6 Some cheeses and yeast have high levels of histamine, which in turn, is connected to allergic responses. Crohn's patients have a lower rate of metabolizing histamine7 and thus, the connection between dairy products and Crohn's may be more than coincidental.
Elemental diets, often used in treatment of Crohn's,8-10 involve gastric tube or intravenous feeding of nutrients, but not amino acids rather than protiens (which can trigger allergies) and are considered to be hypoallergenic. As therapy, they have response rates comparable to steroids. However, diets with whole proteins from dairy and wheat have also been demonstrated to be effective.11-13
Nuts, Raw Fruit, Tomatoes
In one trial Crohn's patients (who did not have ileostomies,39 asked about foods that appeared to aggravate symptoms reported that nuts, raw fruit, and tomatoes cause the most problems14 although this was not uniform.15 Patients with Crohn's disease should consult their medical practitioner about avoiding allergens.
Researchers have reported that people who consumer fast foods at least twice a week more than three times the risk of developing Crohn's.16
Crohn's patients are often smokers, and evidence shows that smoking increases the rate of reoccurance of the condition.17
The large intestine, the gut, becomes inflammed when one has Crohn's disease. The omega-3 fatty acids in fish oil, EPA and DHA, are known to reduce inflammation. Note, that it has been reported that a high ratio of omega-6:omega-3 fatty acids is correlated to Crohn's.40 When EPA consumption was increased, incidence of Crohn's recurrences declined.41
One 2 year study of Crohn's patients compared consumption of 3.5 to 7 ounces of high EPA/DHA fish daily versus a low fish diet.22 The group eating fish patients had a 20% recurrance rate, while the non-fish eating patients had a 58% relapse rate. Fish such as salmon, mackerel, herring, sardines and albacore tuna are high in EPA and DHA, and further more, the smaller fish, such as herring and sardines are lower on the food chain and thus less likely to be contaminated by environmental pollutants.
Another double blind study evaluated Crohn's patients taking 2.7g EPA/DHA daily in supplements. These patients had a 26% relapse rate after a year, versus a 59% relapse rate for placebo.23 In this particular study, the participants took a "free fatty acid" form of EPA/DHA that was enteric coated and made from fish oil. Double blind trials testing non-enteric coated and non-free fatty acid form reported no results24,25 suggesting such formulations could have advantages.
Diarrhea is one of the side effects of Crohn's. Research has reported that the beneficial bacteria Saccharomyces boulardii is helpful. Dosage has been suggested at 250mg three times daily, to 500mg four times daily (in research)27 and also has been useful for diarrhea from other causes.28
Because Crohn's often results in poor absorption of nutrients deficiences are frequent and taking a good multivitamin is important. As a result, deficiencies of many nutrients are common. In particular, deficiencies in folic acid, zinc, vitamins D and B12, and iron have been reported.29-31 Zinc, B12 and folic acid are all necessary for repair of intestinal cell damaged due to Crohn's. Medical practitioners may recommend 25-50mg zinc (with 2-4 mg copper), 800mcg folic acid, and 800mcg B12. A doctor should determine whether or not iron is needed.
It is very common that vitamin D is not properly absorbed in Crohn's patients,18, 19 resulting in deficiency. Crohn's reportedly has triggered osteomalacia, successfully treated by vitamin D supplementation20 and bone loss has also been reported and has been prevented by vitamin D supplementation.21 Check with your doctor to determine whether and how much vitamin D is needed.
Vitamin A is used by the body for repair and growth of cells lining the large and small intestines.32 Vitamin A supplementation has proved helpful in two case studies33,34 but in another trial such supplementation did not stop reoccurance.35 Although some practitioners recommend 50,000IU daily for adult Crohn's patients, this should be done only with a doctor's supervision, and pregnant women should no supplement with vitamin A.
Crohn's patients might have low levels of pancreatic enzymes, such as lipase.36 However such supplementation should only be done with a doctor's supervision.
Health practitioners may use herb combinations to soothe digestive tract inflammation. One such formula includes slippery elm, marshmallow, and cranesbill.37 Slippery elm and marshmallow are mucilagens which help soothe inflamed tissues. Cranesbill is an astringent. We know of no research testing their effacacy.
Other inflammation reducing herbs have traditionally been recommended for Crohn's, including chamomile, yarrow, aloe, and licorice. But cathartic formulations of aloe should not be taken. Again, we do not know of research validating these herbs for this condition.
Diarrhea which may occur during flare ups of Crohn's have traditionally been treated by herbs that contain tannin, and in one trial were found to be more effective than no treatment at all.38 These herbs include green tea, agrimony (Agrimonia spp.), cranesbill, oak, and witch hazel. They should be discontinued before diarrhea completely stopped and should be used with the advice of a knowledgable medical professional.
39. Ileostomies are surgical openings through the outer skin into the small intestine connected to a pouch to externally collect waste when the large intestine is non-functional. This procedure has now been replaced by a "J-Pouch" or "BCIR" that allows the small intestine to act as an internal reservoir.
40. Shoda R, Matsueda K, Yamato S, Umeda N. Epidemiological analysis of Crohn disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn disease in Japan. Am J Clin Nutr 1996;63:741-745.
41. Kuroki F, Iida M, Matsumoto T, et al. Serum n3 polyunsaturated fatty acids are depleted in Crohn's disease. Dig Dis Sci 1997;42:1137- 1141.
- Arthritis, Rheumatoid Arthritis, and Osteoarthritis
- Eye inflammation: iritis and uveitis
- Skin rashes
- Osteomalacia, triggered by vitamin D deficiency