Crohn’s Disease

What is Crohn's Disease?

Crohn’s disease is a chronic inflammatory disease that can affect any part of the lining of the digestive tract from the mouth to the anus. It commonly appears in the intestines and the colon causing severe pain, diarrhoea and rectal bleeding.

Crohn’s disease and ulcerative colitis are two types of inflammatory bowel disease’s (IBD) estimated to affect more than 75,000 Australians. These numbers are expected to increase in the future, with Australia having one of the highest prevalence in the world.

What are the risk factors?

Some of the factors that contribute to the development of Crohn’s disease include the following:

• Family history of IBD
• Food and/or chemical allergies and intolerances
• Jewish heritage or Caucasians are more susceptible
• Cigarette smoking
• Use of medications which reduce normal intestinal flora
• Intestinal infections, dysbiosis and leaky gut syndrome
• Poor diet including increased sugar consumption, decreased fruit and vegetable intake and increased trans-fatty acid consumption

What are the symptoms

The disease usually follows a pattern of remissions and flare-up’s which vary in severity from mild to severe. Some of the most common symptoms include:

• Rectal bleeding
• Abdominal pain
• Diarrhoea
• Constipation
• Fatigue
• Poor appetite, weight loss and malnutrition
• Fever
• Fistulae and abscesses

Stress worsens symptoms

Stress is often found to exacerbate Crohn’s disease by stimulating inflammation in the intestines through brain-gut interactions.

Ways to reduce stress can be very helpful in reducing the reoccurrence rate. This can include meditation, yoga, exercise and deep breathing.

The Crohn’s diet

Crohn’s disease impairs the absorption of nutrients from foods so a nutritious diet is vital. For some people suffering from Crohn’s an elimination and re-challenge program can be useful in identifying specific irritants in the diet. A low FODMAP, gluten or dairy free diet may also improve symptoms. A recent pilot study has even found the avoidance of lactose and fructose to greatly improve symptoms. These natural sugars found in milk and fruit are sometimes poorly absorbed, increasing water into the bowel which leads to diarrhoea. It is important to avoid refined sugar and trans fats in the diet as this is a risk factor for Crohn’s disease.

What to do during an attack

During an acute attack, it is advisable to eat very simple, easy to digest foods. This includes soft-cooked vegetables, fish and chicken. Red meats are hard to digest and can promote inflammation in the body. Therefore, fish is a great alternative source of protein as it is easy to digest and rich in omega-3 to reduce inflammation in the body. Adequate fluid intake is essential to correct dehydration for loose bowel motions or diarrhoea.

Common nutritional deficiencies

If there is inflammation in the small intestine it can impair the absorption of nutrients. Common deficiencies include iron, zinc, calcium, folate and vitamin B12. Nutrient deficiencies can cause fatigue, anaemia, anxiety, depression, osteoporosis, muscle aches and further digestive problems.

Vitamin D

Vitamin D is essential for calcium absorption and immune system health. In approximately 75% of patients with Crohn’s disease vitamin D deficiency can occur. Supplementation with vitamin D is necessary to improve bone remineralisation and to prevent osteoporosis.

A dose of 1000 IU/day is what is commonly recommended but a higher dose may be necessary in certain individuals.

Iron

Approximately 60-80% of people with Crohn’s disease are anaemic. It’s important to choose the correct form of iron to reduce gastrointestinal side-effects and only take if required. Iron can be taken in liquid form for easy absorption or in a good quality capsule or tablet.

Vitamin B12

It is estimated that 48% of Crohn’s disease patients have a deficiency in B12. Injections are often given but a sublingual spray or tablet is a great alternative. A tablet that dissolves under the tongue reaches the bloodstream quickly— bypassing difficult absorption via the intestines. At least 1000mcg or possible more is required each day if there is a deficiency.

Zinc

Zinc is important for healthy immune function, digestion, absorption and wound healing. A study found that 15.2% of IBD patients tested had low serum levels of zinc. Low levels of zinc, folic acid and vitamin A can predispose the mucosa in the digestive tract to injury.

Folic Acid

If you’re taking methotrexate then supplementation with folic acid is paramount. This medication is a folate antagonist and reduces levels of this important vitamin in the body.

Herbs to seal and heal

Turmeric

Curcumin is the active component of turmeric, can be very beneficial in reducing inflammation in Crohn’s disease. Curcumin reduces a variety of inflammatory mediators involved in Crohn’s disease, most specifically C-reactive protein. It was also found to greatly improve stool quality and frequency was reduced significantly. Two participants in this study could eliminate their medications, whilst the remaining two were able to reduce them.

Wormwood

One randomized controlled trial investigated the effect of wormwood in Crohn’s disease. It was found that when wormwood was supplemented for 6 weeks disease activity and depression was reduced with an increase in quality of life. The study also found a decrease in TNF- α which is a marker of inflammation in the body.

Boswellia

Boswellia can also be an effective strategy for managing Crohn’s disease. It was found to be more effective then mesalazine in reducing the Crohn’s disease activity index (CDAI) in one particular study. The authors concluded that Boswellia is superior to mesalazine due to the reduced side-effects.

Mucoprotective herbs such as slippery elm, aloe vera and liquorice (Glycyrrhiza glabra) help to protect the mucous membranes of the intestines—providing repair and symptomatic relief.

Reducing stress, improving diet and taking supplements to prevent nutritional deficiencies are all important aspects to address in Crohn’s disease. Many herbs have been proven to be of help by reducing inflammation, providing symptomatic relief and promoting repair of damaged mucosal surfaces.

References

1. https://www.crohnsandcolitis.com.au/
2. Hechtman L (2014). Clinical Naturopathic Medicine. Churchill Livingstone, Australia
3. Hollander D. Inflammatory bowel diseases and brain-gut axis. J Physiol Pharmacol. 2003 Dec;54 Suppl :183-90 https://www.ncbi.nlm.nih.gov/pubmed/15075459
4. Massironi S, et al. Nutritional deficiencies in inflammatory bowel disease: therapeutic approaches. Clin Nutr. 2013 Dec;32(6):904-10
5. Langhorst J, et al. Systematic review of complementary and alternative medicine treatments in inflammatory bowel diseases. J Crohns Colitis. 2015 Jan;9(1):86-106
6. https://academic.oup.com/ecco-jcc/article-lookup/doi/10.1093/ecco-jcc/jju007
7. Gerhardt H, et al. Therapy of active Crohn disease with boswellia serrata extract H 15. Z Gastroenterol. 2001 Jan;39(1):11-7 https://www.ncbi.nlm.nih.gov/pubmed/11215357