An Overview: Crohn's Disease

What is Crohn’s disease?  

Crohn’s disease is an ongoing disorder that causes inflammation of the digestive tract,  also referred to as the gastrointestinal (GI) tract. Crohn’s disease can affect any area of  the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum. The swelling extends deep into the lining of the  affected organ. The swelling can cause pain and can make the intestines empty  frequently, resulting in diarrheas. 

Crohn’s disease is an inflammatory bowel disease, the general name for diseases that  cause swelling in the intestines. Because the symptoms of Crohn’s disease are similar to  other intestinal disorders, such as irritable bowel syndrome and ulcerative colitis, it can  be difficult to diagnose. Ulcerative colitis causes inflammation and ulcers in the top layer  of the lining of the large intestine. In Crohn’s disease, all layers of the intestine may be  involved, and normal healthy bowel can be found between sections of diseased bowel.  

Crohn’s disease affects men and women equally and seems to run in some families.  About 20 percent of people with Crohn’s disease have a blood relative with some form of  inflammatory bowel disease, most often a brother or sister and sometimes a parent or  child. Crohn’s disease can occur in people of all age groups, but it is more often  diagnosed in people between the ages of 20 and 30. People of Jewish heritage have an  increased risk of developing Crohn’s disease, and African Americans are at decreased  risk for developing Crohn’s disease.  

Crohn’s disease may also be called ileitis or enteritis. 

What causes Crohn’s disease?  

Several theories exist about what causes Crohn’s disease, but none have been proven.  The human immune system is made from cells and different proteins that protect people  from infection. The most popular theory is that the body’s immune system reacts  abnormally in people with Crohn’s disease, mistaking bacteria, foods, and other  substances for being foreign. The immune system’s response is to attack these  “invaders.” During this process, white blood cells accumulate in the lining of the  intestines, producing chronic inflammation, which leads to ulcerations and bowel injury.  

Scientists do not know if the abnormality in the functioning of the immune system in  people with Crohn’s disease is a cause, or a result, of the disease. Research shows that the  inflammation seen in the GI tract of people with Crohn’s disease involves several factors:  the genes the patient has inherited, the immune system itself, and the environment.  Foreign substances, also referred to as antigens, are found in the environment. One  possible cause for inflammation may be the body’s reaction to these antigens, or that the  antigens themselves are the cause for the inflammation. Scientists have found that high  levels of a protein produced by the immune system, called tumor necrosis factor (TNF),  are present in people with Crohn’s disease.  

What are the symptoms?  

The most common symptoms of Crohn’s disease are abdominal pain, often in the lower  right area, and diarrhea. Rectal bleeding, weight loss, arthritis, skin problems, and fever  may also occur. Bleeding may be serious and persistent, leading to anemia. Children with  Crohn’s disease may suffer delayed development and stunted growth. The range and  severity of symptoms varies.  

How is Crohn’s disease diagnosed?  

A thorough physical exam and a series of tests may be required to diagnose Crohn’s  disease.  

Blood tests may be done to check for anemia, which could indicate bleeding in the  intestines. Blood tests may also uncover a high white blood cell count, which is a sign of  inflammation somewhere in the body. By testing a stool sample, the doctor can tell if  there is bleeding or infection in the intestines.  

The doctor may do an upper GI series to look at the small intestine. For this test, the  person drinks barium, a chalky solution that coats the lining of the small intestine, before  x rays are taken. The barium shows up white on x-ray film, revealing inflammation or  other abnormalities in the intestine. If these tests show Crohn’s disease, more x rays of  both the upper and lower digestive tract may be necessary to see how much of the GI  tract is affected by the disease. 

The doctor may also do a visual exam of the colon by performing either a sigmoidoscopy  or a colonoscopy. For both of these tests, the doctor inserts a long, flexible, lighted tube  linked to a computer and TV monitor into the anus. A sigmoidoscopy allows the doctor to  examine the lining of the lower part of the large intestine, while a colonoscopy allows the  doctor to examine the lining of the entire large intestine. The doctor will be able to see  any inflammation or bleeding during either of these exams, although a colonoscopy is  usually a better test because the doctor can see the entire large intestine. The doctor may  also do a biopsy, which involves taking a sample of tissue from the lining of the intestine  to view with a microscope.  

What are the complications of Crohn’s disease?  

The most common complication is blockage of the intestine. Blockage occurs because the  disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the  passage. Crohn’s disease may also cause sores, or ulcers, that tunnel through the affected  area into surrounding tissues, such as the bladder, vagina, or skin. The areas around the  anus and rectum are often involved. The tunnels, called fistulas, are a common  complication and often become infected. Sometimes fistulas can be treated with  medicine, but in some cases they may require surgery. In addition to fistulas, small tears  called fissures may develop in the lining of the mucus membrane of the anus.  

Nutritional complications are common in Crohn’s disease. Deficiencies of proteins,  calories, and vitamins are well documented. These deficiencies may be caused by  inadequate dietary intake, intestinal loss of protein, or poor absorption, also referred to as  malabsorption.  

Other complications associated with Crohn’s disease include arthritis, skin problems,  inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the  liver and biliary system. Some of these problems resolve during treatment for disease in  the digestive system, but some must be treated separately.  

Which foods should I avoid with a Crohn’s disease diet plan?  

The foods that trigger symptoms differ for each person with Crohn’s disease. To know  which foods to leave out of your diet plan, you’ll need to determine which foods trigger  yours. Many people with Crohn’s disease find that the foods on the following list  aggravate symptoms during disease flares. So it’s likely that at least some of these listed  foods will trigger your symptoms:  

• alcohol (mixed drinks, beer, wine)  
• butter, mayonnaise, margarine, oils  
• carbonated beverages  
• coffee, tea, chocolate  
• corn husks  
• dairy products (if lactose intolerant)  
• fatty foods (fried foods) 
• foods high in fiber  
• gas-producing foods (lentils, beans, legumes, cabbage, broccoli, onions)  • nuts and seeds (peanut butter, other nut butters)  
• raw fruits  
• raw vegetables  
• red meat and pork  
• spicy foods  
• whole grains and bran  

Once you’ve identified foods that cause your symptoms to flare, you can choose either to  avoid them or to learn new ways of preparing them that will make them tolerable. To do  that, you’ll need to experiment with various foods and methods of preparation to see what  works best for you. For instance, if certain raw vegetables trigger a flare, you don’t  necessarily need to give them up. You may find that steaming them, boiling them, or  stewing will allow you to eat them without increased GI symptoms. If red meat increases  fat in the stools, you could try eating ground sirloin or ground round to see if you can  tolerate a leaner cut of beef. Or you might decide to rely on low-fat poultry without skin  and fish as your main sources of protein.  

Crohn’s Diet & Nutritional Supplements  

For some it may be as simple as a change in diet, while for others it may require surgery.  Nevertheless, expanding your understanding of this disease is the first step in over  coming it. Throughout this article, you will find mentions of Eternal products as dietary  supplements that has been included by many individuals as one of their standard  treatment options for Crohn’s disease.  

Suggested Approach to Crohn’s Diet  

Inflammatory Bowel Disease IBD, including Crohn’s Disease and ulcerative colitis, is an  inflammation of the intestines. These diseases cause the intestines to form ulcers and  become inflamed, scarred and easy to bleed. The most common symptoms are diarrhea,  acute abdominal pain, cramping, fever and fatigue. A special diet is very important in  exercising IBD management to prevent malnutrition and extreme weight loss.  

Nutritional Diet for Crohn’s Disease & Colitis  

• Drink lots of fluid (8 – 10 servings daily) to keep body hydrated and prevent  constipation.  
• Your doctor or your registered dietitian may recommend a daily multivitamin mineral supplement (Wholefood according to blood group) to replace lost  nutrients. 
• Eat a high fiber diet when IBD is under control. Some patients find cooking and  steaming the vegetables more tolerable than eating them raw.  
• During a flare up, however, limit high fiber foods and follow a low fiber diet or  even a low residue diet to give the bowel a rest and minimize symptoms.  • Avoid lactose-containing foods such as dairy if you are lactose intolerant.  Otherwise, you may use lactase enzymes and lactase pretreated foods.  • It is very important to continue nourishing your body even during a flare-up. Try  small frequent meals. Eating a high protein diet with lean meats, fish and eggs,  may help relieve symptoms of IBD. Your registered dietitian may recommend  pre-digested nutritional drinks (elemental diet) to give your bowel a rest and  replenish lost nutrients so that your body can repair itself.  
• Limit caffeine, alcohol and sorbitol (a type of sweetener) as these may exacerbate  IBD symptoms.  
• Limit gas-producing foods such as cabbage-family vegetables (broccoli, cabbage,  cauliflower and brussels sprouts), dried peas and lentils, onions and chives,  peppers and carbonated drinks.  
• Reduce fat intake if part of the intestines has been surgically removed. High fat  foods usually cause diarrhea and gas for this group of patients.  
• If the ileum (part of the small intestines) has been resected, a Vitamin B12  injection may be required.  
• Some studies found that fish oil (Man Yoo) helpful in managing IBD. Some also  suggested the role of prebiotics such as psyllium in the healing process.  Furthermore, probiotics (E-Probiotics) may also be helpful in aiding recovery of  the intestines.  

Eating right  

Eating right is the key to good health for everyone. But it is especially important for  people with Crohn’s, since the disease can deplete their bodies of essential nutrients. Just  like everyone else, people with Crohn’s need to take in enough protein, calories, vitamins  (A, D, C, B-12, and folic acid), minerals (calcium, iron, and zinc), and other nutrients to  stay healthy.  

To ensure that you are getting a sufficient amount of nutrients from your diet, it’s best to  eat a balance of foods from the four food groups:  

• Meat (or alternative sources of protein)  
• Dairy  
• Cereal and grains  
• Fruits and vegetables 

The key to formulating a diet that is right for you is paying attention to the way certain  foods affect your body. If they seem to worsen your Crohn’s symptoms, eliminate them  from your diet.  

Vitamins and minerals  

A person with Crohn’s may not get enough nutrients because the disease causes poor  digestion and malabsorption of dietary protein, fat, carbohydrates, water, and essential  vitamins and minerals. Your gastroenterologist or nutritionist may recommend adding a  multivitamin or other dietary supplement, such as vitamin B-12 or folic acid, to protect  against nutritional deficiencies and round out your diet. Crohn’s causes certain symptoms  in your body that may deplete your body of essential nutrients.  

The most commonly recommended vitamin supplements include vitamins B-12 and D  and folic acid, while the recommended mineral supplements include calcium and iron.  However, most people with Crohn’s benefit from simply taking a multivitamin regularly.  

It is important to note that supplements should not take the place of food — they contain  no calories — and that you should consult with your gastroenterologist before you begin  taking any supplements.  

The following table shows sources of important vitamins and minerals, though some  foods may not be right for you. Be sure to talk to your doctor about a diet that is suitable  for you.