Crohn's disease is a form of inflammatory bowel disease (IBD) characterised by periods of remission and relapses (Owczarek et al., 2016).
It is a chronic condition that can affect different parts of the alimentary tract from the mouth to the anus (Wehkamp et al., 2016). However, the internal parts predominately affected are the ileum and the colon (Geissler & Powers, 2010). This causes the inability to correctly digest, absorb and excrete nutrients, and is also associated with a significant amount of negative health consequences.
Several million people around the world suffer from this condition, especially in developed countries. It is estimated that 1 in 650 people in the UK suffer from Crohn’s disease. The ratio of male and female sufferers is very similar, however it is slightly more commonly found in women. The disease can appear at any stage of life, however the onset of Crohn’s disease tends to be more common between the ages of ten and forty.
What are the causes of Crohn’s disease?
From recent scientific research it would appear that there is a combination of several factors that can determine this condition:
- Genetic factors: In particular individuals who have first degree relatives affected by this syndrome have a higher probability of developing the condition. (Three times greater than the rest of the population).
- Immune system: Excessive reaction of the immune system against gut bacteria.
- Environmental factors: Consumption of antibiotics (Wehkamp et al., 2016), smoking, stress and diet.
In particular there is an important link between smoking and the occurrence of Crohn’s disease. It has been found that smokers have approximately twice the risk of suffering from this condition than non-smokers. Furthermore smokers affected by this ailment have a higher risk of developing more severe forms and having additional serious health complications in comparison to non-smoking patients. Due to this important connection, people suffering from Crohn’s disease are strongly advised to quit smoking. The beneficial effects of quitting smoking become apparent around a year later, and last for a long period of time (Johnson et al., 2005).
What are the main symptoms of Crohn’s disease?
- Abdominal pain and diarrhoea
- Tiredness and fatigue
- Mouth ulcers
- Loss of appetite and weight loss (Owczarek et al., 2016)
Unfortunately there can also be other health complications associated to this illness. At the level of the gut the main difficulties are: strictures, perforations and fistulas. However, also iritis, erythema on the legs and joints problems can also be frequent (Geissler & Powers, 2010).
There are several different methods of diagnosing Crohn’s disease:
- Blood and stool tests
- MRI, CT scans
What are the treatments for the Crohn’s disease?
There are different options that depend on certain factors such as age, disease stage and severity etc. The two primary treatments are:
- Medical treatments. The most common drugs used are anti-inflammatories (to reduce the inflammation), antibiotics (to treat infections), symptomatic drugs (to reduce the symptoms as pain, diarrhoea)
- Surgical treatments
Crohn’s disease and pregnancy
Usually women with this disorder in its inactive form (remissive) do not have problems getting pregnant. However women with an active form of Crohn’s disease can experience issues getting pregnant, especially women with low weight and an insufficient dietary intake. Additionally the severe inflammations of the gut, can also affect the reproductive system further decreasing the likelihood of becoming pregnant. Doctors recommend controlling the Crohn’s disease before attempting conception. By starting the pregnancy in a remissive period it will reduce the risk of having a low weight baby.
Generally male fertility is not affected by this ailment, however men using treatment such as sulphasalazine, could have a reduced fertility during the administration of the medication.
The role of the diet
As is the case for other long term medical conditions, the diet also plays a very important role when controlling Crohn’s disease.
A lot of people suffering from Crohn’s disease are undernourished and can develop different macro or micronutrient deficiencies. This is mainly caused by malabsorption and abnormal intestinal losses. Moreover, the higher metabolic requirements due to the high presence of inflammatory molecules (promoting the catabolic response) can play an important role. Finally, drugs-nutrient negative interactions can also happen (Geissler & Powers, 2010).
Crohn’s disease can cause a reduction in the levels of vitamin A, K, E as well as the level of vitamin D and calcium. Vitamin D deficiency, in particular is very common in people suffering from Crohn’s disease (O’Sullivan, 2016). Because vitamin D and calcium are an essential part of the health and strength of bone tissue , a lot of people suffering from Crohn’s disease can also develop osteoporosis.
People suffering from Crohn’s disease have also been known to suffer from Iron deficiency anaemia. This is due to the iron malabsorption and also attributed to the blood lost in the faeces (Geissler & Powers, 2010).
What is the suggested dietary approach for people suffering from Crohn’s disease?
- Eat a nutritious and a balanced diet, because it helps to maintain weight and strength.
- In particular people with IBD are recommended to consume the correct daily intake of iron, calcium, zinc, folic acid, vitamin D and B12. The maintenance of calcium levels between 1000-1500mg/d is suggested and in the case of lactose intolerance calcium supplements are recommended (Owczarek et al., 2016).
- Drink regularly to remain hydrated.
- Reduce the level of dietary fibres during periods of exacerbation, diarrhoea and abdominal pain (Owczarek et al., 2016).
- Try to avoid foods that are difficult to digest.
- Try to also have snacks throughout the day, or eat small regular meals.
...if you have oral Crohn’s disease:
- Try to avoid carbonated beverages and spicy substances including cinnamon.
The use of alternative medicine
A lot of people suffering from IBD use herbs and natural substances to alleviate their symptoms (Langhorst et al., 2015). Even if further research is needed in this field, there are still some scientific studies that show the efficacy of certain natural remedies to help treat IBD.
The most effective remedies appears to be Curcumin (Parian et al., 2016) and Aloe Vera. Even though they are not included in specific studies on Crohn’s disease, they are still beneficial thanks to their anti-inflammatory properties.
- Geissler, C., & Powers, H. (2010). Human nutrition. Elsevier Health Sciences.
- Johnson, G. J., Cosnes, J., & Mansfield, J. C. (2005). Review article: smoking cessation as primary therapy to modify the course of Crohn's disease. Alimentary pharmacology & therapeutics, 21(8), 921-931.
- Langhorst, J., Wulfert, H., Lauche, R., Klose, P., Cramer, H., Dobos, G. J., & Korzenik, J. (2015). Systematic review of complementary and alternative medicine treatments in inflammatory bowel diseases. Journal of Crohn's and Colitis, 9(1), 86-106.
- O’Sullivan, M. (2016). Is vitamin D supplementation a viable treatment for Crohn’s disease?. Expert review of gastroenterology & hepatology, 10(1), 1-4.
- Owczarek, D., Rodacki, T., Domagała-Rodacka, R., Cibor, D., & Mach, T. (2016). Diet and nutritional factors in inflammatory bowel diseases. World journal of gastroenterology, 22(3), 895.
- Parian, A., & N Limketkai, B. (2016). Dietary supplement therapies for inflammatory bowel disease: Crohn’s disease and ulcerative colitis. Current pharmaceutical design, 22(2), 180-188.
- Webster-Gandy, J., Madden, A., & Holdsworth, M. (Eds.). (2011). Oxford handbook of nutrition and dietetics. OUP Oxford.
- Wehkamp J., Götz M., Herrlinger K., Steurer W., & Stange E.F. (2016). Inflammatory bowel disease: Crohn´s disease and ulcerative colitis. Dtsch Arztebl Int, 113: 72–82.