Crohn’s Disease

the words "out of order" written across a stomach

Inflammatory bowel disease (IBD) is a general term for group of diseases involving gut-wall inflammation. Chronic IBD is generally divided into two major groups: Crohn’s disease and ulcerative colitis. Crohn’s disease is a subcategory of IBS that contributes to morbidity, particularly in industrialized nations. It can affect people of any age, but is more commonly diagnosed in young adults and adolescents.

Crohn’s disease is a poorly understood auto-immune disease that induces inflammation in the final part of the small intestine and the beginning section of the colon. It often causes bloody stools and malabsorption problems. Crohn’s disease is characterized by periods of exacerbation and remission. While it may be acute, it is mainly a chronic and often disabling disorder. It often affects young people, causing fever, diarrhea, and pain after eating, sometimes leading to serious complications. Besides the general belief that it is caused by an auto-immune deficiency, another possible cause may be a systemic virus or bacterium. A combination of genetic, environmental allergens, and immune system factors could interact to trigger the disorder. However, stress has not been shown to correlate with Crohn’s exacerbation.

Ulcerative colitis causes the patient to have tenderness along the colon. Although some significant differences exist in their location and the way they affect the bowel wall, they both can cause abdominal pain and cramping with frequent, urgent bowel movements marked by blood, mucous and pus. In addition to genetic factors and bacterial infections, both diseases are affected by diet.

Complications of both can include infections and abscesses, hemorrhoids, fistulas, malabsorption of nutrients and weight loss. IBD can increase the risk of gastrointestinal cancer. Although the etiology of other auto-immune diseases (like lupus, rheumatoid arthritis, thyroiditis, and hepatitis) are poorly understood one commonality in these disease states seems to be allergies–both environmental and food. IBD should be distinguished from irritable bowel syndrome (IBS or Leaky gut), a much less serious condition. IBD involves actual physical changes associated with intestinal wall inflammation. IBD is a perplexing, long-term condition that affects one’s lifestyle, mental and social activities and can be associated with multiple hospitalizations and surgery.

RISKS AND MAJOR FACTORS INVOLVED IN INTESTINAL PERMEABILITY: 

  1. Alcohol use and cigarette smoking 
  2. Cancer radiation therapy 
  3. Corticosteroid use 
  4. Excessive sugar consumption 
  5. Excessive stress 
  6. Food allergies 
  7. Gastrointestinal infections 
  8. Overuse of Non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotic drugs 
  9. Nutrient deficiencies 
  10. Premature birth 

Food allergies and intolerances of specific foods and food groups can be linked to the initiation or aggravation of IBD. In one study, where possible allergic foods were eliminated, 85% of IBD patients showed remission. The culprits include cow’s milk, eggs, wheat gluten, citrus fruits, beans, peanuts, and salicylate-rich foods. Dairy foods may account for the highest percentage. 

Higher than normal levels of homocysteine are also a risk factor in patients with Crohn’s. Supplementation of vitamins B6, B12 and folate are recommended to lower homocysteine levels. Increased platelet count is another feature of Crohn’s disease and may compromise the patient’s blood-clotting ability. Crohn’s disease may also cause mitochondrial dysfunction, which has a negative affect on the energy producing ability of the cell. This problem can lead to numerous health problems including poor energy and chronic fatigue. An increased risk of osteoporosis is a significant long-term problem with Crohn’s patients. All precautions to decrease bone loss should be investigated.

SYMPTOMS

The symptoms associated with Crohn’s disease are many and varied, according to each patient. The main symptoms include:

  1. Diarrhea. Typically more than 3 or 4 bowel episodes a day. 
  2. Blood in the stool. Usually present, but the amount of blood varies. 
  3. Abdominal pain and cramping. There can be tenderness in the lower right quadrant. 
  4. Fatigue. Can be caused by poor nutrient absorption, anemia, blood loss, and/or stress on the adrenal glands. 
  5. Weight loss or anorexia. These symptoms are commonly due to poor digestion and absorption of nutrients. 
  6. Appetite. Often decreased during periods of disease exacerbation. 
  7. Cancer of the colon is increased. 

DIET

Dietary changes can be very helpful. People with IBD disease eat more sugar and it is suggested that all excess refined sugar (including soft drinks and processed foods with added sugar) be eliminated from the diet. A high animal protein and high fat diet (other than cold water fish) has also been linked to IBD disease. As with other auto-immune diseases, it may be beneficial to eat less meat and dairy fat, and more vegetarian foods. Boosting plant foods, including whole grains and brown rice, while avoiding all the “white foods” (white sugar, white milk, white rice, and white flour) research has shown that hospitalizations have been reduced. The use of the sugar substitute aspartame should be severely restricted. Use of prebiotics (foods that are sources of friendly bacteria–i.e. fiber, kefir, and yogurt and fructooligosaccharides [FOS]–are encouraged. Implementation of the Elimination Diet can be useful.

In many cases a low fiber diet is recommended in patients with symptoms of obstructive bowel disease. Fiber may increase the symptoms of intestinal obstruction. In severe cases, a liquid diet or total parental nutrition may be necessary to rest the intestines. However, fiber is good for patients who are asymptomatic. Supplementation with folate, vitamin B12 and calcium should be given when the patient when malabsorption is present.

Recently the Physicians Committee for Responsible Medicine reported that the United States Dairy Association is once again battling Johne’s (pronounced yonees) disease, caused by a bacterium that interferes with digestion, lowering milk production, and eventually killing infected cows. Research has linked the disease to the human intestinal disorder Crohn’s disease. In 2000, Oregon State University and the USDA implemented a plan to carefully screen cow’s blood and fecal samples for the bacteria, but this won’t provide protection for the average consumers.

A report in the New England Journal of Medicine reported that fish oil has been shown to have a significant anti-inflammatory effect and therefore might be useful as a treatment for Crohn’s disease. An enteric-coated fish oil preparation was recommended because fish oil can become rancid at a quick rate, and it better enables the oil to be released in the small intestine rather than the stomach. In a study of seventy-eight patients with Crohn’s that were in remission (inactive) 4.5 grams per day of fish oil concentrate or placebo was given for one year, in a double-blind study. Of the patients in the fish group 28% had relapses during the study, compared to 69% in the placebo group.]

CONVENTIONAL TREATMENT

Conventional treatment for Crohn’s is not curative but rather palliative. The goals of treatment are twofold: bringing the patient into remission and minimizing adverse effects (of drugs), while maintaining long-term remission. Some common pharmaceutical drugs prescribed by physicians for Crohn’s includes: sulfasalazine, Rowasa, mesalamine, prednisone (steroids), and immunosuppressive agents such as 6-mercaptopurine, Imuran, methotrexate, cyclosporine, metronidazole (Flagyl), and antibiotics (Cipro). Many of these drugs have severe side effects and adverse reactions.

It is our belief that a disease like Crohn’s can more successfully be treated with a combination of drug, nutrition, stress-management and supplemental intervention.

SUPPLEMENT PROTOCOL

  1. OMEGA-3 ESSENTIAL FATTY ACIDS (EPA/DHA)
    Dietary supplementation with high intakes of both EPA and DHA, as fish oil, is associated with modulation of the systemic inflammatory response in Crohn’s.  Supplements actually help to repair the digestive tract. Both EPA and DHA may also decrease joint pain associated with this disease, and possibly reduce the recurrence rate of Crohn’s. Fish oil goes deeply into immune cells, and decreases arachidonic acid production, a prostaglandin that increases the inflammatory response. In one study, supplementing with olive oil was nearly as effective as fish oil. Dosage: 1,000-4,000 mg daily. 
  2. PROBIOTICS
    In clinical studies, supplementing with
    lactobacillus significantly improved exacerbations of Crohn’s one week after starting the probiotics.  Clinical disease activity at 4 weeks was 73% improved.  Probiotics also worked effectively in children.  Probiotics should be supplemented to improve gut barrier function and decrease the incidence of dysbiosis (poor function of the bowel). This overall balance profoundly influences gut ecology, improves overall health, improves digestion, and may prevent reoccurrence. Dosage: 1-2 capsules between meals 2-3 times a day for acute attacks. Maintain lesser dosages when under control, but maintain consistent use. 
  3. L-GLUTAMINE
    An amino acid that is considered a major metabolic fuel for the cells of the intestines. Glutamine will help to maintain the tiny villi (the absorption surfaces of the gut). Other FREE-FORM AMINO ACIDS are proteins that are essential in the healing of the intestines. Dosage: 500 mg twice a day on an empty stomach. Take with B complex and vitamin C for better absorption. 
  4. DIGESTIVE ENZYMES
    Enzymes are necessary to break down proteins, increase gastric emptying, and maintain healthy digestion. Adding PANCREATIN is suggested. Dosage: 1-2 tablets 5-15 min before larger meals, or as directed. 
  5. MULTIPLE VITAMIN/MINERAL FORMULA
    It is important for the Crohn’s patient to get daily nutrition, and a potent daily vitamin/mineral supplement is critical. Because of decreased intestinal permeability in Crohn’s patients, it may be advisable to take a multi-vitamin in a capsule or powder form. Adding green foods (spirulina, blue-green algae, chlorella) is beneficial for more total nutrition. 
  6. MAGNESIUM
    Patients with any form of irritable bowel disease often are deficient in this important mineral due to poor absorption. Magnesium is needed to relax the muscles of the intestinal tract.  Magnesium is often lost during periods of diarrhea. Dosage: 400-600 mg per day, but decrease if diarrhea occurs.
  7. VITAMIN D
    Supplementation with vitamin D appears to be helpful for individuals with Crohn’s.  Research has found that vitamin D, either from sunshine or from supplementation from the diet, was an important factor affecting the development of IBS.  Vitamin D deficient patients may suffer with more bouts of diarrhea and have worsening of Crohn’s symptoms.  Successful treatment with vitamin D for osteomalacia (bone brittleness caused by vitamin D deficiency) triggered by IBD disease has been reported Dosage: 400-2,000 IU daily.
  8. B-COMPLEX VITAMINS
    B complex vitamins (Including extra vitamin B-12 and Folic Acid) are important for the rejuvenation of cells, especially the repair of intestinal cells, damaged by IBD disease. Folic acid becomes deficient because of poor absorption due to inflamed intestinal tissue. Dosage: 50-100 mg per day of B-complex; 1000 mcg Vitamin B12; 400-800 mcg of folic acid. 
  9. VITAMIN C and other ANTIOXIDANTS
    Patients with Crohn’s suffer from oxidative stress and have significantly lower levels of antioxidants than do healthy patients. One study found that absorption of vitamin C was lower in Crohn’s patients and they demonstrated addition adrenal stress due to low vitamin C levels. Crohn’s patients have lower levels of vitamin E, lycopene, selenium and glutathione. Antioxidants work very effectively in combination with fish oil. Dosage: Vitamin C 500-2,000 mg daily, Vitamin E 400-800 IU daily, Selenium 100-200 mcg daily, Glutathione and lycopene as directed. 
  10. BETA CAROTENE
    Beta Carotene is needed for the growth and repair of cells that line both the small and large intestines.  Dosage:  10,000-50,000 IU per day, however pregnant women should take no more than 5,000 IU daily to avoid the risk of birth defects. CAUTION: High does of vitamin A over months can cause migraines and other serious side effects.  See a qualified practitioner.                                                                                                                                                    
  11. ZINC
    Zinc is usually deficient in Crohn’s patients due to impaired absorption. Zinc is needed for healing a compromised immune system. Zinc levels seem to decrease in accordance with disease activity. Zinc deficiency is associated with impaired metabolism of protein, vitamin A deficiency, and excess levels of copper. Dosage: 25-50 mg per day. 
  12. VITAMIN K
    Vitamin K levels were found to be significantly lower in Crohn’s patients. Vitamin K is necessary for a healthy colon and deficiencies of vitamin K can lead to early bone loss (osteopenia). Dosage: As directed by a doctor. 
  13. N-ACETYL GLUCOSAMINE
    N-acetyl glucosamine is an enzyme that helps to preserve the protective mucous and barrier layer of the intestinal lining. Dosage: As directed on package. 
  14. BOSWELLIA
    This famous Indian herb has significant anti-inflammatory activity. Patients supplementing with boswellia have exhibited a significant decrease in symptoms. Dosage: See package. 
  15. ALOE VERA
    Aloe vera liquid is beneficial for patients suffering from Crohn’s since it helps to soften the stool, prevent constipation, and helps to heal the lining of the digestive tract. Dosage: 1-2 ounces once or twice daily. 
  16. DHEA (DEHYDROEPIANDROSTERONE)
    The hormone DHEA has been found to be low in patients with Crohn’s. Because of the deficiency there can be an inhibition of pro-inflammatory enzymes in the body. Dosage: 25-50 mg daily or higher doses if under the supervision of a qualified practitioner. 
  17. IRON
    Iron deficiency is common in Crohn’s patients and it is thought to be due to decreased dietary intake or chronic GI bleeding. But due to extensive side effects associated with conventional supplementation with iron, each individual patient’s status should be evaluated by a nutritionally-oriented doctor before supplementing.  Dosage: As determined by blood testing.
  18. BERBERINE (GOLDENSEAL, OREGON GRAPE)
    These anti-inflammatory herbs help to decrease the inflammatory aspects of cytokine-IL-8, an enzyme associated with Crohn’s disease. Dosage: As directed. 
  19. MARSHMALLOW ROOT and SLIPPERY ELM
    These mucilaginous plants may help soothe inflamed tissue. They also help loosen the stool and help heal the gut.  Dosage: As directed on package.

 

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