How to Manage Crohn's Disease

By Lisa Cantkier

How to Manage Crohn’s Disease

Many patients say Crohn’s disease is a life-altering illness.

“What makes it so difficult is not just the negative impact on one’s body with respect to pain and daily functioning, but also the mismatch between the personal experience and social understanding,” said Natalie, a Crohn’s patient. “Others cannot always tell when you are suffering. Internally, I am always trying to regulate my emotional response to stress, which cannot always be controlled. It’s not all in my head. What has helped me the most is being able to share my experience without shame.”

There are several treatments—both medical and natural—that can help you live well with Crohn’s. There is no standard treatment that works for everyone, because each patient’s situation is different. Usually, a combination of treatments is needed. Treatment for Crohn’s can include medication, diet and nutrition. Sometimes surgery is needed.

“Know your treatment options: different treatments work for different people. Some work only for a while. Know what is available to you,” said Aida Fernandes, chief scientific and patient programs officer at Crohn’s and Colitis Canada. Your doctor can identify the treatment options most effective for your specific needs.

The following treatments can help you manage and live well with Crohn’s. Always follow the advice of your health-care provider before trying a new treatment.

Medication: Medications used to treat Crohn’s are intended to suppress your immune system, which behaves abnormally when Crohn’s is active. This can offer relief from symptoms and can facilitate healing of your GI tract. Medication also can help you maintain remission.

Several types of medication are commonly used to treat Crohn’s in North America.

Aminosalicylates (anti-inflammatory drugs that decrease inflammation at the wall of the intestine)

Corticosteroids (also referred to as steroids, effective for short-term control of flare-ups)

Immunomodulators (generally used to maintain remission in those who have not responded to other medications or who have responded only to steroids)Antibiotics (used when infections occur)

Biologic therapies (used to treat people with moderately to severely active disease who have not responded well to other therapies). “With the advent of newer medications, gastroenterologists now are avoiding corticosteroids or prescribing them for only a limited time. The newest medications are the biologics, antibodies that block proteins in the immune system that drive inflammation in the body,” said Dr. Gil Kaplan, a Canadian gastroenterologist, epidemiologist and associate professor at the University of Calgary who specializes in Crohn’s disease and IBD.

Surgery: Surgery is necessary if medications can no longer control your symptoms, or if you develop a fistula, fissure or intestinal obstruction. Surgery also can help preserve sections of your GI tract. Unfortunately, even with proper diet and medication, up to two-thirds to three-quarters of Crohn’s patients may need surgery. Although surgery may cause your symptoms to vanish for years, Crohn’s can recurs later in life. “Most patients with IBD require medication to suppress their immune systems, and when these drugs fail they need surgery to removed diseased portions of their bowel,” said Kaplan.

Diet and Nutrition: It is essential to maintain good nutrition, since Crohn’s often reduces appetite while increasing energy needs. Being mindful of your diet may contribute to a reduction in symptoms, replacement of lost nutrients and intestinal healing. Symptoms such as diarrhea can reduce your body’s ability to absorb protein, fat, carbohydrates, water, vitamins and minerals.

“Diet has helped to control the illness through provision of time-limited bowel rest, and I am a long-term user of naturopathic products such as probiotics and fish oil, which seem to offer some protection from relapse,” said Denise, a Crohn’s patient. The dietary information below has been shown to be helpful in treating Crohn’s.

  • The Specific Carbohydrate Diet (SCD): The premise of this diet is that Crohn’s and other digestive disorders are the consequence of an overgrowth and imbalance of intestinal microbial flora, which consists of bacteria that help keep your intestinal flora and immune system healthy. The SCD diet consists of clean eating, strict avoidance of processed foods and the elimination of foods that disrupt the intestinal flora, such as those containing two-sugar disaccharide carbohydrates (such as sucrose, or table sugar) and “many-sugar” polysaccharides (such as starch). Foods containing single sugars (glucose) such as fruit, honey and properly fermented yogurt are allowed. The resulting properly nourished immune system then can assist in overcoming microbial invasion.
  • The Elemental Diet: This has been helpful in treating Crohn’s and other digestive and intestinal problems. It is a liquid diet that must be administered through a tube under a medical doctor’s care. Usually lasting for several weeks, it is typically a short-term treatment used to put Crohn’s into remission, and often is composed of sugar, amino acids, fat, vitamins and minerals. Similar to the specific carbohydrate diet, the elemental diet’s main carbohydrate component is a single sugar (glucose), or monosaccharide. This is the diet’s main source of energy.
  • Probiotics and Yogurt: You have probably heard about fermented foods and probiotics. The specific carbohydrate diet (above) recommends the regular consumption of properly fermented yogurt—natural, unsweetened and fermented for 24 hours—and, in some cases, acidophilus supplements (probiotics) to help repopulate healthy intestinal flora of the GI tract and create balance.  The bacteria in the yogurt breaks down the lactose (disaccharides) into galactose (monosaccharide). Many health professionals advocate for Crohn’s patients to incorporate fermented foods such as yogurt into their diet. There also are dairy-free yogurt options for those who can’t tolerate dairy products.

“Probiotics are becoming increasingly recognized as potential adjuvant therapies for Crohn’s disease. Additionally, a healthy diet that promotes a robust and diverse microbiome may help prevent attacks of Crohn’s,” said Kaplan.

  • Fiber: Research shows an association between a diet that includes fiber and Crohn’s, which has led many health professionals to recommend a high-fiber diet to their Crohn’s patients. Kaplan advocates that a diet rich in fiber (he recommends a minimum of 24 grams of dietary fiber per day, mostly from fruit) is necessary for the prevention and treatment of Crohn’s. A 2013 study published in Gastroenterology showed the long-term intake of dietary fiber, particularly from fruit, is associated with a lower risk of Crohn’s.
  • Natural Therapies: Research published in the World Journal of Gastroenterology found       acupuncture combined with moxibustion is effective in treating Crohn’s. In addition, mindfulness and meditation have been shown to be effective in helping Crohn’s patients manage the stress associated with the disease. “Learning to practice mindfulness helps to keep me focused on (and enjoy) the present moment and it prevents me from worrying about the unknown,” said Danielle, a Crohn’s patient. Your doctor should be able to refer you to resources that offer mindfulness training.

Last Reviewed October 15, 2015

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Lisa Cantkier, CHN is a certified holistic nutritionist and a health and wellness editor.

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

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