Crohn’s Disease
A form of inflammatory bowel disease (IBD), Crohn’s disease occurs in the digestive system, causing swelling throughout the intestinal tract. The causes of it remain unknown, though it generally evolves out of the immune system responding adversely to otherwise normal intestinal bacteria. The primary symptoms are stomach pain and intense bouts of diarrhea, though some people may also experience anal fissures, organ fistulas, and rapid weight loss.
The frequency of symptom occurrence varies with each patient; in some cases one may be symptom free for a long period before experiencing a short but visceral bout, while others may suffer from regular, painful symptoms. Several factors can account for the fluctuations including changes in hormone level as well as smoking. In addition to the above mentioned symptoms one should consult their physician if they are running a regular fever, experiencing chills, or vomiting regularly. Based upon these symptoms, your physician will most likely schedule you to undergo one of the following procedures to confirm a Crohn’s diagnosis: colonoscopy, stool analysis, or a biopsy.
If you are diagnosed with Crohn’s Disease
To lower the inflammation levels brought on by Crohn’s in the intestinal tract, the primary method of treatment is medication, proscribed by your physician. Consistent dosages help to reduce the swelling and keep the other associated symptoms at bay. Along with a regular medication regimen they are several important lifestyle choices which greatly assist in reducing the pain of Crohn’s disease. Staying active, eating a healthy, calorie rich, and protein diet (to make sure your body absorbs needed nutrients), as well as living smoke free are practical, effective steps to take in managing your Crohn’s.
In some severe cases, when medication is unable to alleviate the pain, surgery is an option. The most common procedure is a Bowel Resection in which the affected part of the intestinal tract is removed and the healthy sections are stitched together. It should be noted, however, that surgery is not an end all cure. Unfortunately the inflammation can often return to affect the remaining sections of the intestines.
A Whole Health Perspective
Looking at Crohn’s disease through a Whole Health model, we will explore the individual’s unique presentation from the 5 Aspects of Whole Health™ perspective.
Physical – There is a genetic component of Crohn’s, and children of those with CD have about an 8% higher risk of developing CD. About 20% of people with Crohn’s have a family member with CD, and incidence of CD is higher among those of European or Jewish decent.
The inflammation of CD is shown by research to be triggered by substances in the intestine that the body mistakenly identifies as foreign or invading substances (known as antigens). Normally, the immune system causes a temporary inflammation in response to antigens, but in CD, there is a disruption in the system and the inflammatory process is not turned off. Therefore, inflammation continues much longer and causes continued damage to the GI tract.
There are many medications available to control the symptoms of CD, and though they cannot cure CD, they may help bring on remission of the disease. Medicines commonly used to treat CD include anti-inflammatories, corticosteroids, immune system suppressors, antibiotics and antidiarrheal medicines. In addition to medication, there are a variety of complementary and alternative therapies that have shown to provide some symptom relief to some CD patients, including certain herbs, homeopathy, and acupuncture.
Nutritional – Nutritional deficiencies with CD are common. Decreased food intake due to loss of appetite and depressed mood can contribute to malnourishment. Damage to the intestines from CD may also affect absorption of needed nutrients. One study of 74 patients with CD showed consistent failure to meet recommended daily intake of many nutrients. Intake of vitamins A, C, E, folate, calcium and zinc were of particular concern. Iron deficiency anemia was the most common with inflammatory bowel disease in general, with prevalence rates ranging from 36-88%.
A malnutrition screening tool, such as the MUST (Malnutrition Universal Screening Tool) can be used to identify possible malnutrition, and all CD patients should have access to dieticians for nutritional support and therapy to address symptom control. A doctor may order other nutritional tests if deficiencies are detected, and my recommend vitamin, mineral or probiotic supplements if needed.
Certain foods may also aggravate the symptoms of CD, with the most common offenders being dairy, fats, and spicy foods. Recognizing personal dietary triggers of symptoms and avoiding those foods can decrease symptoms. Other foods known to be irritants to the GI tract such as caffeine and alcohol can also be avoided.
Helpful foods include those rich in antioxidants, such as fruits, vegetables, and berries. Though a low fiber diet may contribute to the development of CD, some people with CD find that high fiber foods are not well tolerated, so lower fiber fruits and vegetables may be needed. Foods that are high in B vitamins, calcium, and magnesium such as whole grains (if not bothered by fiber), dark leafy greens and sea vegetables are also beneficial. Eating 5-6 small meals versus 3 large meals daily may be best tolerated. If CD symptoms are severe, an elemental (a doctor prescribed liquid diet) may be recommended.
Emotional – Many people with Crohn’s Disease report that stress makes symptoms worse. As demonstrated through the work of Hans Selye, we also know that chronic stress depletes many of the same nutrients that CD patients are already lacking, so stress may further promote nutritional deficiencies. Therefore, stress management may be beneficial for minimizing the symptoms of CD. Relaxation techniques such as yoga, tai chi, mediation, or progressive muscle relaxation may be helpful. Some studies also suggest that hypnosis may improve immune function, increase relaxation, reduce stress, and calm anxiety.
Environmental – Smoking is associated with more flares, more complications, and worsening of the disease. For smokers, quitting may be very helpful. A number of other environmental risk factors in CD have been explored but not clearly defined, such as infections, use of antibiotics, use of oral contraceptives, and childhood hygiene. Since the stress reaction of the body plays a role in immune function, environmental stresses such as lack of safety, toxic substances, air and water pollution, etc. may also play a role in the development and management of CD. Lifestyle habits that promote general health such as regular exercise or activity can reduce stress, decrease depressive symptoms and promote overall health and wellbeing.
Spiritual – Religious and spiritual beliefs and practices have been shown to influence pain perception and tolerance because psychological states are potential modulators of the pain experience. How individuals view the world and connection to self and others has an affect on ability to cope with challenges such as chronic illness. Connecting with God and others in religious worship services, spiritual meditation and prayer have all been associated with positive coping and pain tolerance.
To find a doctor with expertise on Crohn’s Disease, contact the Crohn’s and Colitis Foundation of America or seek a referral for a Board Certified Gastroenterologist near you.