Crohn’s Disease Crohn’s disease is a poorly understood inflammatory disease that affects the final part of the small intestine and the beginning section of the colon. It often causes bloody stools and malabsorption problems.
Dietary changes that may be helpful: People with Crohn’s disease eat more sugar than others.1 While details of how sugar injures the intestine are still being uncovered, many doctors suggest eliminating all sugar (including soft drinks and processed foods with added sugar) from the diets of those with Crohn’s.
A high animal protein and high fat diet (other than fish) has also been linked to Crohn’s disease.2 As with many other health conditions, it may be beneficial to eat less meat and dairy fat and more fruits and vegetables.
When those with Crohn’s disease avoid foods they are allergic to, they fare much better. One study reported that people with Crohn’s are most likely to react to cereals, dairy, and yeast.3 Yeast and some dairy (cheese) are both high in histamine, which is part of the allergenic response. Those with Crohn’s lack the ability to break down histamine at a normal rate.4 It would probably be helpful to identify potential allergies and avoid those foods with the help of a nutritionally oriented doctor.
Lifestyle changes that may be helpful: People with Crohn’s disease are more likely to smoke, and there is evidence that continuing to smoke aggravates disease progression.5
Nutritional supplements that may be helpful: Crohn’s disease often leads to malabsorption. For this reason, it may be helpful to take a high potency multiple-vitamin/mineral supplement. In particular, people with Crohn’s tend to be deficient in zinc, folic acid, vitamin B12, and iron.6 Zinc, folic acid, and vitamin B12 are needed to repair intestinal cells damaged by Crohn’s disease. Some doctors recommend 25-50 mg of zinc (balanced with 2-4 mg of copper), 800 mcg of folic acid, and 800 mcg of vitamin B12. Iron status should be evaluated by a nutritionally oriented doctor before considering supplementation.
Vitamin A is needed for the growth and repair of cells that line both the small and large intestine.7 Over the years, reports of those with Crohn’s responding to vitamin A have appeared in medical journals.8 9 For adults with Crohn’s disease, some nutritionally oriented doctors recommend 50,000 IU per day. A dose this high should never be taken without qualified guidance, nor should it be given to a woman who is or could become pregnant.
Vitamin D malabsorption is common in Crohn’s,10 which can lead to a deficiency.11 Successful treatment with vitamin D for osteomalacia (bone brittleness caused by vitamin D deficiency) triggered by Crohn’s disease has been reported.12 A nutritionally oriented doctor can evaluate vitamin D status and suggest the right level of vitamin D supplements.
Crohn’s disease is considered one of the two major forms of inflammatory bowel disease. EPA and DHA, the omega-3 fatty acids found in fish oil, have anti-inflammatory activity. Supplementing with a combination of EPA and DHA at 2,700 mg per day may reduce the recurrence rate of Crohn’s.13 Using an enteric-coated, “free fatty acid” form of EPA/DHA may lead to better results.
Individuals with Crohn’s disease may be deficient in pancreatic enzymes, including lipase.
Are there any side effects or interactions? (Refer to the individual supplement for complete information.) Women who are or could become pregnant should not take more than 10,000 IU (3,000 mcg) per day of vitamin A, to avoid the risk of birth defects. For other adults, intake above 25,000 IU (7,500 mcg) per day can—in rare cases—cause headaches, dry skin, hair loss, fatigue, bone problems, and liver damage.
Excessive vitamin D intake can cause several symptoms, including headaches, weight loss, and kidney stones. Patients with sarcoidosis or hyperparathyroidism should not take vitamin D without consulting a physician.
Side effects from EPA and DHA include nose bleeds (because of reduced blood clotting), gastrointestinal upset, and “fishy” burps.
Lipase is safe and does not produce side effects.
Herbs that may be helpful: A combination of herbs has been used to help soothe inflammation throughout the digestive tract. The formula contains marshmallow, slippery elm, wild indigo, goldenseal, echinacea, and cranesbill. Marshmallow and slippery elm are mucilaginous plants that help soothe inflamed tissues. Wild indigo and goldenseal help inhibit growth of abnormal gut bacteria and also have astringent effects. Cranesbill is another astringent. Echinacea promotes normal immune function.
Are there any side effects or interactions? (Refer to the individual herb for complete information.) Goldenseal should not be used during pregnancy or lactation. Echinacea is essentially non-toxic when taken orally. People should not take echinacea without consulting a physician if they have an autoimmune illness, such as lupus, or other progressive diseases, such as tuberculosis or multiple sclerosis. Those who are allergic to flowers of the daisy family should take echinacea with caution. There are no known contraindications to the use of echinacea during pregnancy or lactation. Slippery elm is quite safe, with no known side effects or interactions with any other medicines.
Higher intakes of wild indigo can cause nausea and vomiting. Long-term use as well as use of greater amounts is not recommended.
Cranesbill tea should not be used continuously for long periods of time. Some people will find that rather than improving stomach ailments, it can cause an upset stomach.
Checklist for Crohn’s Disease
Nutritional Supplements
Herbs
Homeopathic Remedies
Multiple Vitamin/Mineral (folic acid, B12, iron) Marshmallow No homeopathy commonly used for this condition References:
1. Mayberry JF, Rhodes J. Epidemiological aspects of Crohn’s disease: a review of the literature. Gut 1984;886-99.
2. Shoda R, Masueda K, Yamato S, Umeda N. Epidemiologic analysis of Crohn’s disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn’s disease in Japan. Am J Clin Nutr 1996;63:741-5.
3. Riordan AM, Hunter JO, Cowan RE, et al. Treatment of active Crohn’s disease by exclusion diet: East Anglian Multicentre Controlled Trial. Lancet 1993;342:1131-4.
4. Wantke F, Gotz M, Jarisch R. Lancet 1994;343:113 (letter)..
5. Cottone M, Rosselli M, Orlando A, et al. Smoking habits and recurrence in Crohn’s disease. Gastroenterol 1994;106:643-8.
6. Imes S, Plinchbeck BR, Dinwoodie A, et al. Iron, folate, vitamin B-12, zinc, and copper status in out-patients with Crohn’s disease: effect of diet counseling. J Am Dietet Assoc 1987;87:928-30.
7. Dvorak AM. Vitamin A in Crohn’s disease. Lancet 1980;i:1303-4.
8. Rachet AJ, Busson A. Treatment of ulcerative rectocolitis by vitamin A. Paris Medical 1935;1:308-11.
9. Skogh M, Sundquist T, Tagesson C. Vitamin A in Crohn’s disease. Lancet 1980; i:766 (letter).
10. Leichtmann GA, Bengoa JM, Bolt MJG, Sitrin MD. Intestinal absorption of cholecalciferol and 25-hydrocycholecalciferol in patients with both Crohn’s disease and intestinal resection. Am J Clin Nutr 1991;54:548-52.
11. Harris AD, Brown R, Heatley RV, et al. Vitamin D status in Crohn’s disease: association with nutrition and disease activity. Gut 1985;26:1197-1203.
12. Driscoll RH, Meredith SC, Sitrin M, Rosenberg IH. Vitamin D deficiency and bone disease in patients with Crohn’s disease. Gastroenterol 1982;83:1252-8.
13. Belluzzi A, Brignola C, Campieri M, et al. Effect of an enteric-coated fish-oil preparation on relapses in Crohn’s disease. N Engl J Med 1996;334:1557-60.
Copyright © 1998 Virtual Health, LLC
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 physician, nutritionally-oriented health care practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.The information presented in HealthNotes Online is for informational purposes only.