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Crohn's Disease

Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, affects an estimated 1.6 million Americans (Crohn’s and Colitis Foundation of America, 2014). Crohn’s disease causes major damage to the gastrointestinal system, yet it remains poorly understood and there is no cure. Finding ways to manage symptoms of Crohn’s disease through dietary modification can help you counteract the effects of the disease and may improve your quality of life.

What Is Crohn’s Disease?

Crohn’s disease is a type of inflammatory bowel disease, meaning that it causes inflammation in the lining of the gastrointestinal tract (Mayo Clinic, 2014). The disease can impact any portion of the gastrointestinal tract, from the mouth to the anus. However, the ileum, or end of the small intestine, is the most commonly affected portion of the body. For many people, Crohn’s disease occurs in patches, meaning that it may affect one part of the gastrointestinal tract while other areas remain healthy. Others experience inflammation throughout the length of the gastrointestinal tract.

In many cases, the inflammation associated with Crohn’s disease penetrates deep into the layers of the intestinal tissue. This often leads to significant pain, debilitating symptoms, and potentially dangerous complications.

Despite considerable research into the topic, there is no clear cause of Crohn’s disease. The disease was discovered in 1932 by three physicians who studied 14 patients with unusual gastrointestinal symptoms (Crohn’s and Colitis Foundation of America, 2014). Since that time, many researchers have tried to determine the exact causes of Crohn’s disease. At present, most scientists and physicians believe that the disease arises from a combination of hereditary factors, immune system dysregulation, and environmental triggers (Mayo Clinic, 2014). Having a family member with Crohn’s disease significantly increases your own risk. However, anyone -- even those without a family history -- may develop the disease. Although higher chronic stress and poor diet may exacerbate symptoms of Crohn’s disease, they are not thought to cause the condition.

Symptoms of Crohn’s Disease

The severity of Crohn’s disease symptoms can vary widely both between and within individuals. Some people have relatively mild symptoms, some have severe symptoms, and some have symptoms that fluctuate in severity over time. The most common symptoms of Crohn’s disease include the following (Mayo Clinic, 2014):

  • Diarrhea
  • Intestinal cramping
  • Fever
  • Fatigue
  • Abdominal pain
  • Bloody stool, which may appear bright red or darker
  • Mouth sores similar to canker sores
  • Weight loss
  • Reduced appetite
  • Perianal disease, such as pain or drainage near the anus
  • Inflammation of the liver
  • Skin inflammation
  • Joint pain and inflammation
  • Inflammation of the eyes
  • Stunted growth or delayed puberty (in children)

The course of Crohn’s disease varies widely between individuals. The disease is characterized by active phases in which symptoms are present as well as periods in which symptoms are in remission. Among people who undergo medical or surgical treatment, approximately half will be in remission five years later (Crohn’s and Colitis Foundation of America, 2014). However, at 10 years later, 76% of people have relapsed. This relatively high rate of symptom fluctuation means that it is important for people with Crohn’s disease to carefully manage their symptoms, identify triggers, and maintain a healthy lifestyle.

Because Crohn’s disease is a chronic condition that fluctuates in severity and course, it often results in disease complications. Crohn’s disease patients are at higher risk of the following problems (Mayo Clinic, 2014):

  • Inflammation
  • Bowel obstruction, which may require surgery to treat
  • Ulcers, which may occur anywhere in the digestive tract
  • Fistulas, or a connection between the intestines and the skin or another organ
  • Anal fissure
  • Malnutrition
  • Colon cancer

Differences between Crohn’s Disease and Ulcerative Colitis

Both Crohn’s disease and ulcerative colitis are considered forms of inflammatory bowel disease. Both diseases tend to develop in teenagers and young adults, affect both men and women at similar rates, and share similar symptoms. Additionally, the exact causes of both Crohn’s disease and ulcerative colitis remain unclear.

However, there are some important distinctions between the two conditions (University of California Los Angeles, n.d.). Crohn’s disease may affect any part of the gastrointestinal tract, although most people have inflammation in the small intestine. In contrast, ulcerative colitis only occurs in the colon (or large intestine). While Crohn’s disease can be “patchy,” affecting some areas of the gastrointestinal tract while leaving others untouched, ulcerative colitis is characterized by continuous inflammation throughout the colon. Finally, ulcerative colitis impacts only the inner layer of the colon. In contrast, Crohn’s disease can penetrate deeply to affect all layers of the gastrointestinal tract.

Treatment of Crohn’s Disease

There is no cure for Crohn’s disease, but certain treatments may help to keep symptoms in check. Your doctor may prescribe certain medications that can help with inflammation associated with Crohn’s disease. The most common categories of medication include aminosalicylates (e.g., mesalamine, sulfasalazine) to control inflammation; corticosteroids (e.g., prednisolone, prednisone) for flare-ups; immunomodulators (e.g., methotrexate, azathioprine) to maintain remission; antibiotics (e.g., metronidazole, ciprofloxacin) to treat infections; or biologic therapies (e.g., golimumab, adalimumab, or infliximab) that affect immune system activity (Crohn’s and Colitis Foundation of America, 2014).

Many people with Crohn’s disease also require surgery. This typically involves removal of part of the gastrointestinal tract. Although surgery can help to manage symptoms, it does not always result in long-term remission of the disease.

In addition to these treatments for Crohn’s disease, most patients must also make lifestyle changes. Altering the diet is an important component of combating the symptoms of Crohn’s disease and may help to maintain disease remission.

Dietary Considerations for Crohn’s Disease

There is no evidence to support the idea that Crohn’s disease is caused by a poor diet or that dietary modifications can completely treat the disease (Crohn’s and Colitis Foundation of America, 2015). However, your diet may trigger active symptoms or exacerbate symptom severity. Thus, paying attention to the foods you eat can result in symptom relief. Although there is no “one size fits all” approach to a Crohn’s disease diet, many patients find the following recommendations helpful:

  • Identify trigger foods. Certain foods may trigger your gastrointestinal symptoms. Although these vary from person to person, some common trigger foods include beans, cabbage, carbonated beverages, raw vegetables, or dairy products. Keeping a food journal is a good way to track your dietary patterns and how they affect symptoms.
  • Consider a low residue diet. Certain foods add extra residue to the stool, which may be difficult for people with Crohn’s disease to pass. Avoiding corn hulls, nuts, seeds, raw fruits, vegetable skins, whole-grain breads, and bran cereals may alleviate your symptoms. These foods tend to be hard and chunky, which makes them more difficult to digest and pass. Eliminating these foods from your diet increases the amount of time stool spends passing through the intestinal tract, which may improve absorption and decrease painful symptoms of Crohn’s disease.
  • Ensure appropriate fluid intake. When you have chronic diarrhea, you are at risk of dehydration. Be ultra aware of your fluid intake, aiming to get at least ½ ounce per pound of body weight (Crohn’s and Colitis Foundation of America, 2015). This means that a 160-pound person should drink 80 ounces of fluid, or 10 glasses, per day. This might include water, fruit juices, decaffeinated tea, or sports beverages.
  • Reduce consumption of greasy or fried foods. It is more difficult for people with Crohn’s disease to digest fats. Avoiding butter, cream, pork products, and fried foods decreases saturated fat consumption and may help with symptoms.
  • Limit caffeine consumption. Caffeine often exacerbates gastrointestinal symptoms and can increase your risk of dehydration. If possible, completely eliminate coffee, black tea, soda, and other caffeinated foods from your diet. Alternatively, consume only small amounts of these beverages at a time to avoid triggering symptoms.
  • Find solutions to manage active diarrhea symptoms. When you experience diarrhea or abdominal cramping, there are specific foods that can help. Follow the “BRAT” diet: bananas, rice, applesauce, and toast. These foods are easily digestible and can ease your pain. Consuming fruit juices, broth, Gatorade diluted with water, plain pasta, crackers, skinless potatoes, smooth peanut butter, cheese, and steamed fish are other good ways to manage these symptoms.

Risk of Nutritional Deficiencies with Crohn’s Disease

Because Crohn’s disease affects nutrient absorption, people with this condition have an elevated risk of nutritional deficiencies (Donnellan, Yann, & Lal, 2013). Crohn’s disease makes it particularly difficult to absorb enough vitamin A, vitamin C, vitamin E, folate, calcium, iron, and zinc. Since vitamin B12 is absorbed in the lower ileum, people with Crohn’s disease affecting this portion of the gastrointestinal tract may have difficulty getting enough of this vitamin.

The best way to get enough of these vitamins and minerals is through whole foods. Iron and vitamin B12 are found in turkey, poultry, fish, and beef products. Eating foods rich in vitamin C, such as citrus fruits, can improve absorption of iron from dietary sources (Iron Disorders Institute, 2009). When Crohn’s disease symptoms significantly impair absorption of key vitamins and minerals, it may be helpful to take supplements to prevent any nutritional deficiency.

References

Crohn's and Colitis Foundation of America (2014). The facts about inflammatory bowel diseases. Retrieved from http://www.ccfa.org/assets/pdfs/updatedibdfactbook.pdf

Crohn's and Colitis Foundation of America (2015). Diet and nutrition. Retrieved from http://www.ccfa.org/resources/diet-and-nutrition.html

Donnellan, C.F., Yann, L.H., & Lal, S. (2013). Nutritional management of Crohn's disease. Therapeutic Advances in Gastroenterology, 6(3), 231-242.

Iron Disorders Institute (2009). Achieving iron balance with diet. Retrieved from http://www.irondisorders.org/diet/

Mayo Clinic. (2014). Crohn's disease. Retrieved from http://www.mayoclinic.org/diseases-conditions/crohns-disease/basics/definition/con-20032061

University of California Los Angeles. (n.d.). Ulcerative colitis vs Crohn's disease. Retrieved from http://gastro.ucla.edu/body.cfm?id=169