Crohn’s Disease

We don’t understand a lot about Crohn’s disease, but we do know that more and more young people are being diagnosed with it. Crohn’s is a chronic inflammation of the gastrointestinal tract. It strikes mainly adolescents and young adults, and manifests itself as abdominal pain, fever, diarrhea, and weight loss. The small intestine is primarily affected, and the patient develops real problems in absorbing important nutrients. Physicians use the anti-inflammatory drugs sulfasalazine and steroids to reduce the inflammation. As the disease seems to be related to alterations in the immune system, they sometimes add medications to suppress immunity as well. Unfortunately, the disease often progresses despite drug therapy, and surgery is frequently needed for infections and intestinal obstruction.

At WholeHealth Chicago, we believe that a major commitment to lifestyle changes, including strict attention to diet, stress reduction, and taking appropriate supplements, can make a significant difference in the lives of people with Crohn’s disease.

Crohn’s disease, also known as regional ileitis or enteritis, is a chronic inflammatory condition of the intestines. Although the disease usually develops at the end of the small intestine (called the ileum) or in the colon, it can affect any part of the digestive tract, from the mouth to the anus. The condition begins slowly, causing such symptoms as crampy abdominal pain, fever, diarrhea, weight loss, and a chronic feeling of sickness. For unknown reasons, Crohn’s disease tends to flare up and then subside, sometimes for months, before another episode occurs.
Over time, the disease can cause abscesses and ulcers to form, which may then deeply erode the intestinal wall. In especially severe cases, further complications–such as fistulas and anal fissures–can develop. Fistulas are abnormal passages between body organs that allow pus and fluids to drain; in Crohn’s, fistulas form between loops of intestine, or between the intestine and the skin or the intestine and the bladder.

Rarely, Crohn’s-related inflammation and a thickening of the small intestine is so severe that an intestinal obstruction occurs. Such an obstruction, which causes extreme abdominal pain with vomiting, is an emergency that requires immediate medical attention.

About 500,000 Americans–mostly adolescents and young adults–are affected with Crohn’s disease. Some people have only one or two attacks in their lifetime, while others suffer from repeated flare-ups.

Currently, there is no specific cure for Crohn’s disease, but the condition can be managed with medications and, in some cases, surgery. Lifestyle changes–with a special emphasis on diet–and the use of certain supplements can dramatically improve the course of the disease and the quality of life of people who have been diagnosed with it.

Key Symptoms

• Episodes of abdominal pain and cramping, especially on the lower right side of the abdomen
• Diarrhea
• Rectal bleeding
• Fatigue, nausea, and fever
• Appetite loss, weight loss, and general malaise
• Anal abscesses and fissures
• Systemic complications, such as arthritis and skin lesions

What Causes Crohn’s Disease?

The exact cause of Crohn’s disease is a mystery. Heredity may play a role since the condition sometimes runs in families and is more prevalent in certain ethnic groups. Men and women are equally affected. Diet is another possible contributor. In countries where people consume a lot of fiber, Crohn’s disease is not nearly as common as it is in Western countries, where diets tend to be high in fat and sugar and low in fiber.

Other theories on what causes Crohn’s disease include:

• Infection. Perhaps the most popular theory is that infection with a virus or bacterium generates ongoing inflammation in the intestines.
  Autoimmune involvement. Intestinal inflammation appears to get triggered from within, when the body’s own immune system turns on itself and attacks the intestines. Many Crohn’s sufferers are, in fact, found to have immune system abnormalities.
• Food allergies. Numerous nutritionally oriented doctors think that food sensitivities (particularly to dairy and gluten) can contribute to the intestinal irritation that ultimately sets Crohn’s disease in motion.
• Stress. It’s not uncommon for the initial bout of Crohn’s disease to come on the heels of an episode of significant stress, such as the death of a family member. Some doctors, however, point out that there’s no proof at all that the disease is caused by emotional distress, and that claiming that it is puts an unfair burden on the patient.

Conventional Treatments

Doctors generally treat Crohn’s disease with a combination of medications (over-the-counter and prescription) and lifestyle recommendations.

Crohn’s disease is one of the two major conditions that cause a chronic inflammation in the intestines. The other major inflammatory bowel disease (IBD) is ulcerative colitis, which primarily affects the lining of the large intestine (colon). Both conditions damage the intestines in their own way and produce their own set of symptoms. The two diseases can be very challenging to distinguish from one another, based on symptoms alone. Fortunately, the medical management of each disease is similar.

In contrast, there is a third extremely common intestinal ailment called irritable bowel syndrome (IBS), which causes cramping and diarrhea but not bleeding or inflammation. Although quite uncomfortable, IBS does not pose a danger to a person’s overall health, nor does it lead to either ulcerative colitis or Crohn’s disease.

Nutritional issues

Because the small intestine is involved with the absorption of food and nutrients, careful attention to the diet is important for anyone with Crohn’s disease because vitamin and mineral deficiencies can develop.

Preliminary findings reported in the February 2001 European Journal of Gastroenterology and Hepatology indicate that a diet designed to minimize soil contaminants and such chemicals as titanium dioxide and aluminosilicates may even lead to the remission of the disease in some patients. More research is needed, however.

Although they recognize that nutrition can be problematic, most conventional physicians do not believe that dietary changes will affect the overall course of Crohn’s. They do caution patients to reduce their fiber intake in order to prevent an intestinal blockage if there is X-ray evidence of a significant narrowing of the small intestines.

Surgery is generally reserved for complications of the disease rather than for treating it directly. A bowel obstruction, the formation of a severe fistula, or the perforation of the intestinal wall would merit surgery, for example. Surgical treatments are not very helpful in altering the progression of Crohn’s disease, however.

Medications

Researchers have made significant advances in finding medications that can help relieve pain and control inflammation in people with Crohn’s disease.

For mild attacks, over-the-counter antidiarrheal medications or pain-relievers may be recommended.

For chronic illness or flare-ups, drugs containing a substance called mesalamine (sulfasalazine and various 5-ASA agents) are often prescribed to help control inflammation.

Corticosteroids are also used to manage inflammation, but studies have shown no benefit in continuing to take them once a remission has occurred. This is because the cost of long-term steroid use, in terms of side effects, can be high. In addition, long-term use of either steroids or sulfasalazine has not been shown to reduce the recurrence rate of Crohn’s disease.

Drugs to suppress the immune system, such as azathioprine and mercaptopurine, are prescribed for both acute flare-ups and to prevent recurrences. As an added benefit, these medications can reduce the overall activity of the disease, causing fistulas to close and abscesses to heal, and reducing the need for corticosteroids.

Currently, gastroenterologists generally start patients on sulfasalazine for acute episodes, and move on to steroids if this drug fails. Immunosuppressive drugs are added if the first two are not working; they may then be used as maintenance (allowing the steroids to be reduced or even discontinued) in order to prevent a relapse.

Tests and Procedures

A thorough physical examination and a series of tests are needed to properly diagnose Crohn’s disease.

Colonoscopy with possible biopsy is the single most useful test to diagnose any inflammatory bowel disease. To get a clear view of the large intestine (think colon in colonoscopy), your doctor may well order this test. A flexible lighted tube called an endoscope is inserted into the anus and passed through the full length of the colon. The tube is attached to a camera that enables the examiner to visually inspect the area for inflammation or bleeding. In some cases, the doctor may take a sample of tissue (a biopsy) from the intestinal lining to inspect under a microscope in the laboratory.

X-ray imaging of the bowel can provide essential information for the diagnosis of Crohn’s disease. An X ray of the stomach and small intestine is especially important because the small intestine cannot be reached by a colonoscopic examination. You are given some liquid barium to swallow, and when the barium reaches the small intestine, the radiologist will look for unique changes characteristic of Crohn’s. Sometimes, the doctor may also order computerized imaging (CT scan) of the abdomen, to check for thickened loops of intestine and abscesses.

Standard blood tests will not help in the diagnosis of Crohn’s but are useful in determining the effect of the disease on your overall health. For example, a low red cell count (anemia) could indicate bleeding from the intestines or a vitamin deficiency. A high white blood cell count could suggest inflammation somewhere in your system. Electrolyte abnormalities are common when significant diarrhea is present, while low levels of albumin usually indicate poor nutrition.

Blood tests for food sensitivity. Most nutritionally oriented physicians will suggest blood tests for IgE and IgG antibodies to commonly eaten foods. They believe that when high levels of antibodies are present, your body is perceiving certain foods as the “enemy.” Because Crohn’s disease could be a reaction to this hypersensitivity, they will recommend total elimination of any offending foods. This is controversial, however, because most gastroenterologists do not believe that specific food sensitivities are of any significant concern, either in the cause or in the treatment of Crohn’s disease.

Blood tests for nutritional status. Because the absorption of vital nutrients can be impaired in Crohn’s disease, nutritionally oriented physicians may recommend measuring the levels of vitamins, minerals, and essential fatty acids in your blood. Based on your results, they plan an individualized program of nutritional supplementation.

Comprehensive stool digestive analysis (with added tests for parasites) is often recommended by nutritionally oriented physicians. This test helps determine how well you are digesting and absorbing the foods that you eat. Based on the results, you may be advised to make dietary changes or to begin taking digestive enzymes to enhance absorption.

Treatment and Prevention

While there’s no cure for Crohn’s disease, there is a lot that you can do to control it. Working with your doctor, you may well find a way to manage the intestinal inflammation, lessen abdominal pain and diarrhea, minimize rectal bleeding, and avoid the nutritional deficiencies caused by such problems. In many cases, people with Crohn’s experience months or even years of remission–with no pain or other symptoms.

As a complement to your traditional medical care, there are a number of important things you can do to keep yourself healthy and to minimize the frequency and severity of your flare-ups (See the Self-care Remedies, below). Eliminating foods and beverages that trigger attacks is a good first step. Quitting smoking and reducing the amount of stress in your life can also help.

How Supplements Can Help

The intestinal damage caused by Crohn’s disease can seriously interfere with the body’s ability to absorb important nutrients. Therefore, it is essential to maintain a healthy diet, and nutritional supplements often can play a key part.

Just a reminder: If you have a serious medical condition or are taking medication, always check with your doctor before beginning a program of supplements.

To begin, a daily high-potency multivitamin and antioxidant complex help to rectify the many nutritional deficiencies associated with the disease. It’s useful to have blood tests measuring specific levels of individual vitamins and separate supplements may be necessary. Nutritional deficiencies can develop in the following:

Low levels of vitamin A are common with Crohn’s. This is important because vitamin A affects the function of intestinal cells, including mucus secretion and cell regeneration. Excessive amounts of this nutrient can be toxic, so it should be used with caution.

Deficiencies in vitamins C and E can occur as well. Both have healing properties; vitamin E, a leukotriene inhibitor, can be helpful as an anti-inflammatory agent as well.

Deficiencies in the B vitamins are also common, although the amounts in your multivitamin are probably sufficient. However, folic acid can be inhibited by the commonly prescribed drug, sulfasalazine. Levels of vitamin B12 can also be low because Crohn’s disease often damages that portion of the small intestine where this nutrient is absorbed.

Failure of the intestines to absorb vitamin D occurs frequently, and worsens when steroid drugs are used as part of an anti-inflammatory therapy. Softening of the bones (osteomalacia, often caused by the malabsorption of vitamin D) is a complication of Crohn’s.

The following nutrients can be beneficial in managing Crohn’s disease.

The most significant mineral deficiencies seen in Crohn’s are of zinc and magnesium. If zinc is taken for long periods of time, copper is added as well, since one can impair the absorption of the other.

Deficiencies of the essential fatty acids also occur frequently. Both flaxseed oil and fish oil contain fatty acids that can protect and repair the GI tract. Fish oil has an anti-inflammatory property that Italian researchers discovered can reduce the frequency of flare-ups.

The flavonoid/antioxidant quercetin is well known for its ability to inhibit the release of chemicals associated with inflammation, such as histamine and the leukotrienes. Virtually free of side effects, it is effective for conditions associated with inflammation, such as asthma, psoriasis, and Crohn’s.

One of the most significant nutrients involved in repairing the intestinal lining is the amino acid glutamine, which improves the energy metabolism of these cells and stimulates their regeneration.

Another natural anti-inflammatory is the Indian herb boswellia. The herb is better known for its effect in the treatment of osteoarthritis, where its function is similar to the newly released COX-2 inhibitor drugs. A recent study found that this herb can benefit inflammatory bowel disease as well.

Although never fully studied in placebo-controlled trials, an herbal digestive formula for inflammatory bowel disease (usually sold as Robert’s Formula or Bastyr’s Modification to Robert’s Formula), has long been favored by naturopaths during flare-ups of Crohn’s. Among the herbs in this combination are slippery elm, marshmallow, wild indigo, echinacea, goldenseal, poke root, and geranium.

Certain herbal teas, particularly those made from chamomile and slippery elm, can be very soothing to an inflamed gastrointestinal tract. These herbs also help facilitate digestion.

Self-Care Remedies

• Watch what you eat. Maintain a healthful diet, but be careful about adding too much fiber if you have problems with narrowing of the small intestine. Eliminate dairy if you know you are lactose intolerant. Be sure to steam, broil, or bake food rather than frying it. Fried, greasy meals can irritate the GI tract. There is good evidence that cutting back to an allergy-free diet (eliminating all dairy, egg, corn, and wheat) can markedly improve the way that Crohn’s patients feel overall.
• Drink plenty of fluids. These could include water, juice, broth, and herbal teas. It’s important to stay hydrated.
• Cut down on milk products. Carrageenan, a compound used to stabilize milk proteins, has been shown to induce ulcerative colitis (a related condition) in animals. In addition, there may be a link between Crohn’s disease and a bacterium found in cow’s milk (Mycobacterium paratuberculosis).
• Avoid flare-up triggers. Eliminate foods that you may be sensitive to. For many Crohn’s patients, triggers include alcohol, caffeine, and refined sugar.
• Exercise regularly. The endorphins released during exercise will go a long way toward improving your mood, enhancing a positive sense of well-being, and increasing your energy.
• Alternative Therapies Although “curing” this disease is not an option, a number of practitioner-based alternative therapies can help relieve the painful symptoms of Crohn’s, and may be useful to continue on a maintenance basis.
  Mind-body therapies. If you find that stress triggers flare-ups, it may be worth learning relaxation techniques that can help prevent relapses. Try yoga or meditation, which both involve deep breathing; practice 10 minutes morning and evening each day, if possible.
• Traditional Chinese medicine. Finding a qualified practitioner of TCM who uses both herbs and acupuncture may prove beneficial. These therapies can be very effective in reducing stress. Patients themselves report that TCM seems to reduce the severity of their symptoms and prevent flare-ups, but there have been no controlled research studies specifically using TCM in the treatment of Crohn’s.
• Homeopathy. Classical homeopaths believe that on a one-to-one basis, they can prescribe remedies that will contribute to the reduction of Crohn’s symptoms and the prevention of flare-ups. Again, there have been no specific studies using homeopathy for Crohn’s.

When to Call a Doctor

• If you experience sudden abdominal pain and cramping (especially on the lower right side) along with diarrhea
• If you see blood in your stool
• If you run a fever and become nauseous or fatigued
• If you lose your appetite and start to drop weight

Supplement Recommendations

From David Edelberg, M.D. at WholeHealth Chicago: Since Crohn’s disease decreases the body’s ability to absorb nutrients, a daily multivitamin is mandatory for anyone with this condition. In fact, nutritional deficiencies are so common with Crohn’s that you probably need a high-potency vitamin and mineral combination, not just a simple one-a-day tablet. At WholeHealth Chicago we also recommend adding a daily antioxidant combination with extra C as well.
In some people undiscovered food sensitivities can play a significant role in the intensity of their Crohn’s symptoms. A strategy you may want to consider is trying a to help you identify specific food triggers that may be aggravating your flare-ups. These often include milk, eggs, corn, and wheat.

All the supplements listed here can be taken together and also in combination with any medications your doctor prescribes for your Crohn’s.

How to use the supplements

Taking a daily high-potency multiple vitamin will cover most of the deficiencies commonly noted with Crohn’s disease. Especially important in your daily multivitamin formula should be adequate amounts of vitamin A, vitamin D, vitamin E, and folic acid, so read your labels carefully. However, you most likely will need to add extra vitamin B12 (in an under-the-tongue form) because the part of the small intestine that absorbs B12 is often affected by this disease.

A high-potency antioxidant formula is always a good idea to protect your body from damage caused by altered oxygen molecules called free radicals. Although Crohn’s disease is not one of the conditions caused by free-radical damage, the nutritional deficiencies associated with Crohn’s may reduce your own antioxidant protection systems, necessitating added supplements, often extra vitamin C.

Both magnesium and zinc deficiencies occur with such regularity in those with Crohn’s that daily supplementation is recommended. (Because zinc inhibits copper absorption, you’ll need to take extra copper as well.) As a source of the so-called “good fats,” flaxseed oil and fish oil, which also has useful anti-inflammatory properties, should be used daily. (To prevent a fish-y aftertaste and to enhance absorption, try to take the enteric-coated fish oil capsules).

Daily supplementation with both quercetin and boswellia, both natural agents to reduce inflammation, may be helpful as a maintenance strategy. The amino acid glutamine can help repair the cells lining the gastrointestinal tract.

And during a flare-up, consider taking an herbal digestive formula, either Robert’s Formula or Bastyr Formula; follow the instructions on the bottle, which will suggest using the formula several times a day until a remission occurs.

Instead of colas, coffee, and alcohol, enjoy intestinal-soothing healing teas, such as those made with chamomile and slippery elm.

Important:

We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.

For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.

Be well,
David Edelberg, MD