Crohn's Disease-Causes and Coventional and Natural Treatments

Crohn's disease is an inflammatory bowel disorder of unknown origin[1].

It is also known as ileitis or enteritis and usually affects the lowest portion of the small intestine though it can occur in other parts of the small intestine [1].

Causes or Aetiology and Incidence

-affects men and women equally

-tends to run in families (10 times the risk of developing Crohn's disease if have a relative with the disease)

-Doctors believe there is a genetic basis but that it does not appear until triggered by presence of bacteria or virus that provokes an abnormal activation of the immune system

-many microorganisms like fungi, bacteria, viruses, mycobacteria, pseudomonas-like organisms and chlamydia

-multiple factors are involved

-antigenic reactions may result from 'leaky gut syndrome' wherein minute particles of undigested or partially digested food pass through the swollen and inflammed mucosal wall into the bloodstream and cause reactions (treatment with butyric acid, a monounsaturated short chain fatty acid reduces inflammatory conditions, reduces seepage of undigested food particles and aids in the repair of the mucosal wall)

-onset of Crohn's disease can be dramatic, with alarming symptoms like sudden high fever, sudden weight loss of more than five pounds in a few days, significant rectal bleeding, severe abdominal pain that persists for more than an hour at a time and persistent vomiting accompanied by cessation of bowel movements

-affects all age groups though onset usually occurs betweem ages fifteen and thirty or betwen sixty and eighty

-children with this disease may suffer delayed development and stunted growth due to nutritional deficiencies

-causes inflammation that extends deep into the intestinal wall lining

-frequently causes cramping abdominal pain, diarrhoea, rectal bleeding, appetite loss and weight loss

-a common complication is blockagr of the intestine caused by scar tissue that narrows the passageway

-may also cause ulcers or sores that break through to surrounding tissues. These tunnels are called fistulas which can be treated by medication but surgery is sometimes warranted

-suffer from nutritional deficiencies

-symptoms may appear intermittently, occurring every few months to every few years for some

-in rare cases, symptoms may appear once or twice and not return

-if condition continues for many years, bowel function gradually deteriorates and if left untreated, it can become extremely serious and even life threatening. It can also increase the risk of cancer by as much as twenty times

-may be difficult to diagnose as its symptoms are similar to those of other intestinal disorders especially ulcerative colitis (another inflammatory bowel disease which only affects the colon)

-a series of tests may be needed to confirm Crohn's disease and blood tests to check for anaemia and/or high white blood cell count

-upper gastrointestinal X-ray series to look at the small intestine or a Colonoscopy where the doctor inspects the interior of the large intestine using a long flexible lighted tube linked to a computer and monitor. Also X-rays of upper and lower digestive tract to find out extent of disease

Treatment

Conventional [1,2]

-There is no cure for Crohn's disease thus treatment goals are to control inflammation, relieve symptoms and correct nutritional deficiencies which can all help keep Crohn's disease in remission

-two thirds to three quarters of patients with Crohn's disease will require surgery at some point. Surgery becomes necessary when medications can no longer control symptoms or to correct complications like blockage, perforation, abscess or bleeding in the intestine

-surgery to remove part of the intestine can help people with Crohn's disease but is not a cure

-it is not uncommon for people with Crohn's disease to have more than one operation because inflammation tends to return to the area next to where the diseased intestine was removed

-Drugs like Corticosteroids (such as Budesonide)and Sulfasalazine are prescribed for inflammatory bowel disease.

*Corticosteroids depress protein synthesis and inhibit normal calcium absorption by increasing Vitamin C excretion in the urine. Deficiency of other nutrients like Zinc, Potassium, Vitamin B6, Folic acid and Vitamin D, decrease bone formation and slow healing

*Sulfasalazine inhibits the transport of folic acid and iron, thus causing anaemia

- Cholestyramine (Questran) is prescribed to bind bile in the gastrointestinal tract to prevent its resorption in those that have had part of their intestine removed. Questran can increase the need for nutritional supplements.

-Drugs that depress the immine system are also used but these can increase the susceptibility of infections. Currently, Methotrexate and Cyclosporin are being tried along with other traditional immunosuppressive drugs. Some of these drugs may be enhanced with 3 grams of Fish oil containing 400mg EPA and 200mg of DHA

-An accelerated program utilising a genetically engineered product known as Remicade (infliximab), an intravenously administered drug for those with moderate to severe Crohn's disease whom have not responded to traditional treatments. Remicade works by specifically targetting a protein that promotes inflammation and has shown to decrease intestinal inflammation. One dose in drug trials relieved many of the symptoms for two to four weeks after which benefits waned. Scientists are still looking into better defining risks and benefits

-interleukin 10, a cytokine that suppresses inflammation has shown some promise

-growth hormone seems to help adult patients to increase their activity levels. This must be dond under Doctor's supervision. Side effects include headaches and swelling which resolved within the first month of treatment

Diet and Lifestyle[1]

-Eat a diet that consists mainly of nonacidic fresh or cooked vegetables like broccoli, Brussel sprouts,cabbage, carrots, celery, garlic, kale, spinach and turnips. Steam, boil, broil or bake your food

-Drink plenty of liquids like dteam distilled water, herbal teas and fresh juices especially cabbage juice which is very beneficial

-Add papaya in your diet. Chewing a couple of seeds aids digestion

-During an acute attack, eat organic baby foods, steamed vegetables and well cooked brown rice, millet and oatmeal

-Try to eliminate all dairy foods including cheese,fish, hard sausage, pickled cabbage and yeast products from your diet and observe if symptoms improve as these foods are high in histamine and many people with Crohn's are histamine-intolerant. Milk and other dairy products also contain carrageenan, a compound extracted from red seaweed that's used to stabilize milk proteins. Carrageenan has been shown to induce ulcerative colitis in laboratory animals

-Avoid alcohol, caffeine, carbonated beverages, corn, nuts, popcorn, eggs, food with artificial additives or preservatives, fried and greasy foods, margarine, meat, dairy products, pepper, spicy foods, tobacco, white flour and all animal products except for white fish from clear waters as these foods irritate the digestive tract

-Avoid mucus forming foods like processed or refined foods and dairy products

-Limit intake of barley, rye and wheat

-Avoid refined carbohydrates

-Check stools daily for bleeding

-make sure bowels move daily but avoid harsh laxatives. Gentle enemas can be made by adding one dropperful of alcohol free herbal extract and 1 teaspoon of non dairy acidophilus powder to 2 quarts of lukewarm water. Avoid rectal suppositories that contain hydrogenated chemically prepared fats

-Use a heating pad to reduce abdominal pain

-Correct nutritional deficiencies to promote healing. Those with inflammatory bowel disorders require 30% more protein than normal. In presence of diarrhoea, consider electrolyte and trace mineral deficiencies. Chronic steatorrhoea(fatty stools due to improper digestion of fats) may cause Calcium and Magnesium deficiencies

-Maintain a generally alkaline bodily pH to reestablish a proper healing environment. One way is to take Chlorophyll liquid 5 to 15mLs once daily in the morning

Herbs and Supplements [1,3]

-N-acetylglucosamine (NAG) prevents leaky gut syndrome. So does treatment with pre and probiotics along with nutritional supplementation to aid the digestive process as well as antioxidants like antioxidant enzymes superoxide dismustase (SOD) and glutathione peroxidase to decrease risk of developing Crohn's

-Aloe vera juice half cup drunk daily will soften stools and has a healing effect on the digestive tract

-Herbs include Burdock root, Echinacea (not to be used for longer than three months), Fenugreek, Goldeseal (avoid using for more than 1 week at a time), Licorice, Marshmallow root, Pau d'arco, red clover, rosehips, enteric-coated peppermint, milk thistle extract & Yerba mate. Best results are achieved when used on an alternating basis

-L-glutamine 500mg twice daily on an empty stomach taken with water or juice nog milk; major metabolic fuel for intestinal cells, maintaibs villi which are the absorption surfaces of the gut

-Vitamin B complex 100mg three times daily plus extra Vitamin B12 1000-2000mcg daily and Folic acid 200mcg; importanf for proper digestion and prevent anaemia. Deficiency aggravates malabsorption

-N-acetylglucosamine taken as directed on label; a major constituent of the barrier layer which protects the intestinal lining from digestive enzymes and other potentially damaging intestinal contents

-Pancreatin plus Bromelain; as directed on label taken with meals; helps break down protein and assists digestion

-Taurine Plus from American biologics, sublingual form 500mg daily on an empty stomach taken with 50mg Vitamin B6 & 100mg Vitamin C for better absorption; an important antioxidant and immune regulator

-Buffered type Vitamin C with bioflavonoids, 1000mg three times daily; prevents inflammation and improves immunity

-Vitamin D 800IU; 68% of Crohn's disease sufferers have a Vitamin D deficiency. Monitor and measure blood levels to ensure correct dose

-Vitamin K, as directed on label; Vital to colon health. Deficiency is common in Crohn's due to malabsorption and diarrhoea

-Zinc, 50mg daily (Maximum 100mg daily from all supplements); needed for immune system and healing

-Inner health plus probiotic capsules (dairy free): 1-2 capsules daily; help prevent leaky gut, immune system and digestion

Prognosis [1]

People with Crohn's disease have a significantly higher risk of developing colon cancer. Thus it is recommended to undergoba colonoscopy at least once every two years, starting 8 to 10 years after diagnosis.

If Crohn's disease continues for many years, bowel function gradually deteriorates and surgery may be indicated to remove the diseased portion of the intestine

References

1) Phyllis A. Balch, Prescription for nutritional healing, Fifth edition, Penguin publishing, New York 2010

2) Australian Medicines Handbook 2014, Pharmaceutical Society of Australia, Adelaide South Australia

3)Clinical Nutrition: A functional approach Second Edition,2004, The Institute for Functional Medicine, Washington US