Also indexed as: Granulomatous Ileitis, Ileocolitis, Regional
Enteritis
A full feeling in your stomach, accompanied by abdominal pain and
regular bouts of diarrhea, may be signs of Crohn’s disease. According to research or
other evidence, the following self-care steps may be helpful:
Fill up on fiber
Improve stool quality and other symptoms by eating high-fiber
fruits and vegetables and by taking fiber supplements such as psyllium or glucomannan
Fight back with fish
Prevent relapses by frequently eating fish high in omega-3 fatty
acids, such as salmon, mackerel, or sardines
Take a daily multivitamin
Choose a comprehensive formula containing zinc, folic acid,
vitamin B12, and vitamin D to prevent deficiencies caused by poor absorption
Discover beneficial bacteria
Take 250 mg of Saccharomyces boulardii three times a day
to help control diarrhea
Say goodbye to smoking
Kick the habit to reduce the risk of disease relapse
Go with a low-sugar diet
Reduce symptom severity by avoiding soft drinks, sweets, and
sugar-filled processed foods
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full Crohn’s disease
article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and
dietary and lifestyle changes that may be helpful.
Crohn’s disease is a poorly understood inflammatory condition that usually affects
the final part of the small intestine and the beginning section of the colon. It often causes
bloody stools and malabsorption problems.
Reliable
and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies
suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal
or no scientific evidence. For a supplement, little scientific support and/or minimal health
benefit.
What are the 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 people with Crohn’s have a history of anal fissures
(linear ulcers on the margin of the anus) or fistulas (abnormal tube-like passages from the
rectum to the surface of the anus).
Dietary changes that may be helpful
A person with Crohn’s disease might consume more sugar than the average healthy person.1 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.2 Another trial compared the effects of high- and low-sugar
diets in people with Crohn’s disease.3 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.
A diet high in animal protein and fat (from foods other than fish) has been linked to Crohn’s disease in
preliminary research.4 As with many other health conditions, it may be beneficial
to eat less meat and dairy fat and more fruits and vegetables.
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.5
Increasingly, baker’s yeast (found in
bread and other bakery goods) has been implicated as a possible trigger for Crohn’s
disease.6 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,7 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,8910 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.111213
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.
In one trial, people with Crohn’s disease were asked which foods aggravated their
symptoms.14 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.15
(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.16
Lifestyle changes that may be helpful
People with Crohn’s disease are more likely to smoke, and there is evidence that
continuing to smoke increases the rate of disease relapse.17
Vitamins that may be helpful
Vitamin D malabsorption is common in
Crohn’s18 and can lead to a deficiency of the vitamin.19
Successful treatment with vitamin D for
osteomalacia (bone brittleness caused by vitamin D deficiency) triggered by Crohn’s
disease has been reported.20 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.21 A doctor should evaluate vitamin D status and suggest the
right level of vitamin D supplements.
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.22 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. 23 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.2425
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.26 Unfortunately,
enteric-coated “free-fatty-acid” fish oil is not commercially available at this
time.
In a preliminary trial, six of seven people with Crohn’s disease went into remission
after taking 200 mg per day of DHEA for eight
weeks.27 This large amount of DHEA has the potential to cause adverse side effects
and should only be used under the supervision of a doctor.
In double-blind research, diarrhea caused
by Crohn’s disease has partially responded to supplementation with the beneficial
bacterium Saccharomyces
boulardii.28 Although the amount used in this trial, 250 mg taken three
times per day, was helpful, as much as 500 mg taken four times per day has been administered
in research successfully using Saccharomyces boulardii as a supplement with people
suffering from other forms of diarrhea.29
In people with Crohn's disease, vitamin K
deficiency can result from malabsorption due to intestinal inflammation or bowel surgery, from
chronic diarrhea, or from dietary changes necessitated by food intolerance. In addition,
Crohn's disease is often treated with
antibiotics that have the potential to kill beneficial vitamin K–producing bacteria
in the intestines. Vitamin K levels were significantly lower in a group of people with Crohn's
disease than in healthy people. Moreover, the rate of bone loss in the Crohn's disease
patients increased with increasing degrees of vitamin K deficiency.30 When combined
with earlier evidence that vitamin K is required to maintain healthy bones, this study
suggests that vitamin K deficiency is a contributing factor to the accelerated bone loss that
often occurs in people with Crohn's disease.
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.313233 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 is needed for the growth and
repair of cells that line both the small and large intestine.34 At least two case
reports describe people with Crohn’s disease who have responded to vitamin A
supplementation.3536 However, in one trial, vitamin A supplementation
failed to maintain remission of the disease.37 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.
People with Crohn’s disease may be deficient in pancreatic enzymes, including lipase.38 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.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
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.39
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.
Curcumin is a compound in turmeric
(Curcuma longa) that has been reported to have anti-inflammatory activity. In a
preliminary trial, four of five people with Crohn's disease had an improvem ent in their
condition after supplementing with curcumin for three months. The amount used was 360 mg three
times a day for one month, followed by 360 mg four times a day for two
months.40
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.41 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.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
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The information presented in Aisle7 is for informational purposes only.
It is based on scientific studies (human, animal, or in vitro), clinical experience,
or traditional usage as cited in each article. The results reported may not necessarily occur
in all individuals. For many of the conditions discussed, treatment with prescription or over
the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist
for any health problem and before using any supplements or before making any changes in
prescribed medications.
