Crohn’s Disease: Nutritional Considerations of Importance

James P. Meschino, DC, MS, ROHP
Crohn’s disease is an inflammatory condition that usually affects the final part of the small intestine (the ileum) and the first section of the large intestine. It often causes bloody stools and malabsorption problems. The most common symptoms include chronic diarrhea with abdominal pain, fever, loss of appetite, weight loss, and a sense of fullness in the abdomen. 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).

The cause of Crohn’s Disease is not fully known. The management of this condition requires involvement of a trained dietician and a medical doctor, as acute flare-ups of Crohn’s Disease (periods of exacerbation) can have life-threatening consequences, and may require that the patient be hospitalized. Registered dieticians, working in concert with the patient’s physician, play an important role in the dietary management during flare-ups of the condition. They have extensive training in the nutritional management of these cases, and may be able to identify individual food sensitivities that are unique to that patient.

Unfortunately, the conventional management of Crohn’s disease by the medical profession and registered dieticians usually does not emphasize the use of nutritional supplements, some of which have been reported to prevent or reduce the number of flare-ups of the disease, improve the health of the intestinal cells, improve nutrient absorption, and produce other desirable health effects. As such, holistic health practitioners should consider offering Crohn’s Disease patients advice about nutritional supplementation (and dietary practices) for the patient to consider during periods of remission, as a means to prevent recurrence or frequency of flare-ups, and to support the patient’s constitution in general.

Supplement Considerations:

1. High Potency Multi Vitamin and Mineral – studies demonstrate that many individuals with Crohn’s Disease experience decreased absorption of zinc, folic acid (a B-vitamin), vitamin B12, vitamin D, vitamin E and iron, and often demonstrate sub-optimal nutritional status of these nutrients. In some of these patients, the folic acid deficiency is responsible for the development of pain, numbness, and tingling in the fingers and toes. Zinc deficiency is commonly found in Crohn’s disease. Some Crohn’s disease sufferers develop skin conditions such as eczema and psoriasis. Studies show that providing supplemental zinc has been reported to correct both skin and vision problems in Crohn’s disease patients, in many instances. In some studies, patients with Crohn’s disease have been found to have significantly lower levels of vitamin E compared to normal subjects. The nutrients zinc, folic acid, and vitamin B12 are all needed to repair intestinal cells damaged by Crohn’s disease. Vitamin A is needed for the growth and repair of cells that line both the small and large intestine. Thus, a high potency multiple vitamin and mineral should be considered in the nutritional support of such cases. The individual nutrient levels in a high potency multiple vitamin should include:

• B-50 complex – 50 mg of most B-vitamins, along with 400 mcg of folic acid
• Vitamin E – 400 IU (vitamin E succinate)
• Vitamin D – 400 IU (the patient should take an additional 1000-2000 IU of vitamin D separately as well)
• Iron – 6 mg
• Zinc – 15 mg
• Vitamin A -2500 IU
• Vitamin C – 1000 mg

2. Essential Fatty Acids (borage seed, flaxseed and fish oil: 1200-3600 mg per day) – Some studies report that patients with Crohn’s disease are low in omega-3 fatty acids. In clinical studies (where omega-3 fat supplementation was used), supplementing with Omega-3 fats has been shown to decrease the recurrence rate of Crohn’s Disease in some trials. Essential fatty acids are converted into hormones that suppress the inflammatory process. This is how the combination of borage seed, flaxseed and fish oil are thought to help suppress the inflammatory process associated with a number of conditions
3. Natural Anti-Inflammatory Agents – the combination of white willow bark extract, curcumin, ginger and boswellia, has been shown to block the synthesis inflammatory prostaglandins and leukotrienes that play a key role in all inflammatory conditions. Additionally, curcumin and the active ingredients in ginger (gingerols) have been shown to block the secretion of nuclear factor kappa beta, a premiere transcription factor that promotes the release of inflammatory cytokines in most autoimmune diseases. Curcumin has also been shown to suppress the over-secretion of tumor necrosis factor alpha by macrophages and other immune cells. Tumor necrosis factor alpha is a culprit in virtually all inflammatory and autoimmune conditions. There are no drugs that can claim the multi-modal, and non-toxic effects provided by this combination of natural anti-inflammatory agents, and thus, taking 2-4 capsules per day of a supplement containing all four of these natural agents (standardized to yield the optimal amount of medicinal ingredients), is a desirable way to help keep inflammation in check.
4. Digestive Enzymes and Prebiotics – Some reports suggest that a high potency, full spectrum blend of digestive enzymes, in conjunction with the prebiotics FOS and Inulin, is an important consideration in many gastrointestinal disorders. Digestive enzymes help the body more completely break down food to improve absorption of nutrients and thereby, help prevent the build-up of partially digested food matter in the intestinal tract where it can act as an irritant. The prebiotics FOS and inulin foster the growth of the friendly gut bacteria, which are also known to improve digestion and elimination functions within the bowel, and help better regulate the body’s immune system. Improving the health of the microflora has been shown to improve various autoimmune and inflammatory conditions, via its effects as a bio-regulator of immune function.
5. 5. L-Glutamine (500 mg, 3 times per day) – The gastrointestinal tract is the largest user of the amino acid L-glutamine in the body. The cells of the small intestine absorb more L-glutamine than any other organ, which they use as a primary energy source. Thus, L-glutamine supplementation can help build healthier intestinal cells, as a consideration in these cases.
6. Glucosamine Sulfate – (500 mg, three times daily) – Animal studies reveal that a lack of glucosamine-dependent materials in the body may allow inflammatory bowel conditions to become worse. Glucosamine is required to make substances in the body that help seal blood vessels to prevent abnormal leakage of blood into surrounding tissues. Leakage of blood into the intestinal tract is a common feature of inflammatory bowel diseases. Anecdotal reports and experimental evidence suggest that glucosamine supplementation may reduce recurrence of inflammatory bowel episodes by providing the body with the raw material from which it can better seal blood vessels through the synthesis of a type of cement substance that supports blood vessels.

Taking a glucosamine sulfate supplement that also includes natural anti-inflammatory agents (i.e. Bromelain, Quercetin, MSM), may be useful in helping to suppress the inflammatory aspect of this condition, while strengthening the blood vessels in the intestinal area.

Other Considerations
In addition to these supplementation considerations, it is advisable for these patients to reduce their intake of foods that contain high amounts of inflammation-promoting arachidonic acid (and linoleic acid, which can be converted into arachidonic acid), and foods that promote the secretion of inflammatory cytokines. Therefore the patient should be instructed to consume a low animal fat diet (with the exception of fish), and to also avoid foods high in transfats as well as pan-fried and deep fried foods. They should also avoid the use of corn oil, sunflower seed oil, safflower seed oil, mixed vegetable oils, which should be replaced with olive oil and/or canola oil.

It may be beneficial, as well, to have the patient avoid foods that contain gluten, as some patients report improvement in their condition on a gluten-free diet.

Summary
During the acute phase of Crohn’s disease, patients should be taken off all nutritional supplements. It should also be noted that during this phase the management of the case requires intensive supervision by the patient’s physician (specialist) and registered dietician. During periods of remission, holistic health practitioners can augment the medical management of these cases by introducing the patient to additional dietary supplements and nutritional modifications, which have been shown to reduce the number of flare-ups of the disease and improve the patient’s overall health and constitution. The use of dietary supplements as outlined in this article should be staged-in over a number of weeks to months, allowing the patient to introduce one additional supplement each week, provided they did not have an adverse reaction to the supplement introduced the week prior. It is important not to shock or overwhelm the patient’s intestinal tract by introducing the total gamut of supplements all at once, as this approach can potentially cause intestinal irritation with subsequent flare-up of the patient’s condition.

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