Crohns Disease
CD is an Inflammatory disease that can affect any part of the gastrointestinal tract. The condition often affects the lower part of the small intestine ‘distal iluem’ and the large intestine ‘colon’. Inflammation may spread throughout the bowel causing ulceration of the mucosa (fistula), and thickening of the intestinal wall from scar tissue (stenosis). The scar tissue can form an obstruction symptomised by cramping and abdominal pain. The damage to the intestinal wall may lead to increase intestinal permeability and an open area for bacterial infection.
Symptoms
· Diarrhoea sometimes with apparent blood in the stools with faecal occult blood (the blood that is not visible)
· Lethargy
· Abdominal pains and cramping
· Loss of appetite and weight loss
· Long lasting fever
· Skin conditions
· Ulcers in the mouth
Pathophysiology
The condition can be due to genetic factors, increased intestinal permeability, food allergies, dysbiosis and poor detoxification.
An up-regulated immune response has been associated to TH1 being out of balance with TH2. The TH2 cells release pro-inflammatory cytokines (TNF-alpha and and iFN-y) in response to what should be innocuous allergens binding at the receptor sites of antigens in the lumen.
Medical Management
A diagnosis is made from tests such as colonoscopy, blood tests, small bowel enema (SBE), CT scans and MRI scans. To treat the inflammation medications
such steroids, immunomodulators and aminosalicylates, and antibodies
combined with enzymes are often used. 25% of people experience an allergic
response to the combination of enzymes with antibodies. Other side effects
from the medications may be lethargy, headaches, muscle aches and nausea.
If the condition cannot be controlled with medication surgery is suggested.
Clinical Considerations
· Liquid vitamins and minerals may be taken sublingually to reduce digestive activity
· Consider liver support due to toxins from poor digestion and dysbiosis
· Regular blood tests are advised to monitor iron, folate and B12 levels as blood loss may cause anaemia
Nutritional Interventions
· Vitamin C-Serum and leucocyte ascorbate levels are low in adult and pediatric patients with CD, both in active disease and in disease remission[i],[ii],[iii] · Vitamin D - to support the absorption of calcium through the intestinal lining for bone health.
· Omega 3- reduce the inflammatory response of the colonic mucosa [iv] · Probiotics-down-regulate the inflammatory response of IgA, and TNF-α[v}
· Raw vegetable juices to provide antioxidant support and natural digestive enzymes
· Green leafy vegetables such as cabbage may help encourage the growth of healthy bacteria
· Slippery elm and aloe vera juice may help soothe the digestive tract and help inhibit bacterial growth
· Meditation and yoga may help to relieve stress
· Remove citrus from the diet as it may irritate the digestive tract
· Dairy may form additional mucous to the lining along the gastrointestinal tract affecting the uptake of nutrients
[i] Filippi J, Al-Jaouni R, Wiroth JB, et al. Nutritional deficiencies in patients with Crohn’s disease in remission. Inflamm Bowel Dis 2006; 12: 185–191. [ii] Wendland BE, Aghdassi E, Tam C, et al. Lipid peroxidation and plasma antioxidant micronutrients in Crohn disease. Am J Clin Nutr 2001; 74: 259–264. [iii] Reifen R, Nur T, Matas Z, Halpren Z. Lycopene supplementation attenuates the inflammatory status of colitis in a rat model. Int J Vitamin Nutr Res. 2001;71(6):347-51 [iv] Calder PC (2006) n-3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr 83, 1505–1519[iii] Hoffenberg EJ, Deutsch J, Smith S, et al. Circulating antioxidant concentrations in children with inflammatory bowel disease. Am J Clin Nutr 1997; 65, 1482–1488. [v] Matsumo S. Anti-inflammatory effects of probiotic Lactobacillus casei strain Shirota in chronic intestinal inflammatory disorders. Int J Probiotics Prebiotics 2008; 3: 149-152
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