This is an interesting one for me because it really seems a super straightforward, well-known condition that is often misdiagnosed, missed entirely, or poorly understood and I am a bit befuddled as to why. While I have a number of perplexing client cases, let me share my own to demonstrate how confusing this can be for some individuals.
When I was early in my career, I was really struggling with my gut health. I was missing work, often bloated and had intense stomach #cramps. There were a few times I passed out in the operating room, even in the locker room preparing for my shift, and it was often related to severe cramps in my gut. I knew where every restroom was no matter where we went when leaving the house. If you know, you know.
After having previously been diagnosed with Irritable Bowel Syndrome, I met with a gastroenterologist and she diagnosed me with Crohn's disease. She offered me leave from work, as needed, and in spite of my asking, stated that neither a #colonoscopy or a biopsy was necessary for diagnosis, because my "incidents" often happened at night, waking me from my sleep which is not consistent with irritable bowel disease.
A few decades later, into my own clinical practice, I ordered the Mediated Release Testing on myself and discovered that beef was my primary trigger. Not diary. Not gluten. Not corn. Only #beef, well, and goat cheese. These two things eliminated from my completely transformed my life, resolving all my symptoms now for nearly a decade. I hadn't realized just how much my life revolved around this problem until the problem was gone. My suspicion, of course, is that I never in fact, had Crohn's disease or maybe I did, but either way, the inflammation resolved. I had a food sensitivity that was difficult to identify. Even when genetics play strongly into this diagnosis, something is causing that inflammation. Identifying that trigger can be profound.
If functional medicine has done one thing for our profession, it is bringing light to the growing issue of digestive pathologies. From bloating and indigestion, to irritable bowel and small intestinal overgrowth, to Candida overgrowth to inflammatory bowel disease, we have a plethora of issues here that conventional medicine is just not resolving. Crohn's disease specifically, is one of the more serious issues, as it is an inflammatory bowel disease, and although diagnosis can be a tough hurdle to jump, once diagnosed this can become your identity in that it can consume your life. You may feel hopeless and that there's nothing more that can be done, but I am here to tell you, there are steps for improving your digestion and reducing your inflammation.
What is Crohn's Disease?
Crohn's disease is a rare inflammatory bowel disease that can greatly affect one's quality of life. Any part of the bowel may become inflamed, from the mouth to the anus, but more often it is the large and small intestines. Unlike ulcerative colitis, Crohn's disease does not usually involve the rectum. This intestinal lesions of Crohn's are characterized by a "skip" pattern where segments of inflamed tissue are separated by segments of apparent normal tissue, and this inflammation extends through the entire thickness of the intestinal wall.
This inflammation typically leads to abdominal pain, severe #diarrhea, blood or mucous in the stool, fatigue, weight loss, and malnutrition. In more severe cases, abscesses, intestinal blockage, hemorrhages, and severe vitamin and mineral deficiencies can lead to neurological problems.
There are several forms of Crohn's disease, with different types affecting different sections of the gastrointestinal tract - resulting in different symptoms and complications. This disease though, typically has the pattern of remissions and exacerbations, which can be mild or severe.
It's been understood that Crohn's disease has no cure, but many individuals are able to significantly reduce their symptoms and regain their health independence through a personalized, #holistic approach. Functional medicine looks at Crohn's disease through a different lens than conventional medicine. By seeking to address chronic inflammation with a long-term, sustainable solution, individuals are able to improve their health without the constant crutch of prescription medications or invasive surgeries.
What are the Signs & Symptoms of Crohn's Disease?
Generally, the signs and symptoms of Crohn's disease progress after first appearing in the second decade of life. Some do experience a sudden onset of symptoms, but more commonly individuals notice a progression of diarrhea, with fever and #fatigue. Abdominal pain and cramping are common, then blood in the stool. Others experience sores in their mouth. There may be weight loss and even pain around the anus from inflammation, which can progress, becoming a fistula. When more advanced, inflammation can also occur on the skin, in the eyes and joints, even in the liver or bile ducts. Kidney stones may result, or #anemia, even delayed growth of the sexual organs.
Sometimes Crohn's presents more as a fear of eating. Sores and abscesses around the anus may also be the more prominent symptom. Hot, red, tender lumps or nodules over the skin may also occur. Night sweats and greasy stools are additional symptoms. Diagnosis may also be discovered through evidence of anemia on blood tests, low vitamin B12, low potassium, low albumin, low calcium, and elevated erythrocyte sedimentation rate and elevated C-reactive protein. Confirmation of diagnosis is through identification of ulcers, lesions, and strictures via an endoscopy or colonoscopy.
Why does Crohn's Happen?
Like most diseases, there is still much to be better understood, but Crohn's does have a genetic component. Recent research has shown that people who have the NOD2/CARD15 gene have an increased immune response to certain bacteria and yeasts that live in the gastrointestinal tract. This immune response causes inflammation that leads to destruction, ulcers and scarring of the intestines.
Conventional pharmacology largely involves the use of anti-inflammatory drugs and chemotherapeutic agents, yet these lack specificity, impose adverse side effects, and create drug resistance. This has created a growing desire for utilizing nutraceuticals, which we will explore a bit, but our initial approach is to understand the why.
Crohn's is an autoimmune disease so triggers are important. Smoking, stress, a poor diet, and nonsteroidal anti-inflammatory medications are known triggers, but we have had incredible success with mediated release testing as well, which helps identify 370 different food, chemical and dye sensitivities. Not only are sensitivities identified though, so are foods which are not, which is how this therapy is so successful. We create a meal plan from the foods which are not triggers, and only these foods, and then know that nothing that enters the gut is causing reaction. This allows for healing so we can start to introduce new foods, one at a time. It also allows the right foods to be eliminated rather than guessing and having to avoid significant foods unnecessarily.
Taking a Functional Approach
Conventional medicine approaches inflammatory medicine with a singular approach, medications for reducing inflammation, reducing drainage, and binding immune protein cells. However, these medications are typically required for your entire lifetime so they are more a band-aide than a cure, and can lead to other bodily damage including hepatitis, osteoporosis renal failure, and pericarditis.
Functional medicine is about empowering individuals with natural, long-term treatment options that do not make individuals dependent upon a medical product or service. By seeking to make holistic living changes and adjustments, individuals are able to have greater control over their day-to-day health. An epigenetic evaluation can help you identify how to optimize your detoxification pathways which will reduce your overall body burden. Our wellness panel can help you identify additional inflammation, malnourishments, and biometric markers. A GI-MAP or Comprehensive GI may also be ordered, which can help identify viral, bacterial, and fungal infections, as well as markers of inflammation through DNA analysis. When I have a client present with Crohn's though, I typically start with a parasite cleanse.
Our focus goes beyond functional and integrative medicine though and has a real passion for wellness, for implementing approaches to healthy living that are attainable. We talk about traumas, creating healthy boundaries, movement, grounding, stress management, and can help you identify which supplements will best support your health without breaking the bank. Yes, #yoga, meditation, and practicing gratitude does improve outcomes.
While MRT & LEAP therapy is our preference, most do well on a low-fiber diet, lean protein, refined grains and fully cooked, non-cruciferous vegetables. Soups, stews, and stir fry are often well-tolerated for those with Crohn's disease. They also do well by reducing lectin-containing foods like beans and legumes, nuts and seeds, gluten, dairy, processed foods and raw vegetables. Alcohol, spicy foods, sorbitol, xylitol, and other sugar alcohols, raw fruits, along with caffeine should also be limited for most. Foods which are healing for those with inflammatory bowel disease are fatty fish, cooked vegetables, dark leafy greens, organic meats, and fruits and veggies. Instead of vegetable oil, use flax seed oil, olive oil, or coconut oil.
Polyphenols are diverse antioxidants, anti-inflammatories, antimicrobials and anti-carcinogenic compounds derived from an array of botanical sources such as tea, wine, olives, grapes, cocoa and turmeric, with catechins, curcumnoids and anthocyanins as the main players of gastro protective effects.
Among the most discussed catechins are the prominent green tea catechins, which have demonstrated a cytotoxicity effect on colon cancer cells by decreasing the COX-2 expression response for the growth of tumors. When combined with the drug, 5-fluorouracil, the two are more effective on chemo-resistant colon cancer cells than when the drug is used alone. Furthermore, when these green tea catechins are consumed after anticancer treatments there seems to be a therapeutic effect.
Unlike the tea catechins, curcumnoids such as curcumin are relatively insoluble in water and oil. Curcumin is antiinflammatory and anti-cancer properties. It can change the expression of proteins and suppress the action of drug degrading enzymes, increasing drug bioavailability. Its proven ability to strongly inhibit the activation of NF-kB makes is a super nutraceutical. When combined with drugs, research has shown lesser relapse than for those who are utilizing drugs alone (Yang et al., 2016).
Anthocyanins are commonly found in pigmented fruits and vegetables such as blackberries, blueberries, grapes, and eggplants. Similar to the curcumnoids, the polyphenols pass through the small intestine into the colon where they are degraded by native microflora. The ability of anthocyanins to further combat degenerative diseases has also been identified, by interfering with signaling pathways and gene regulation. All of this adds to the growing discussion of the extensive benefits in the use of nutraceuticals in treating gastrointestinal diseases
Integrative Therapies
Surveys have suggested that about fifteen percent of people with Crohn's are already using cannabis to help with their symptoms, and two small studies have shown clinical improvements do improve with #cannabis use. If legal in your state, and it is not in Indiana, then maybe consider experimenting with CBD and THC in different doses and ratios (Naftali, 2020).
Acupuncture is another option, a traditional Chinese medicine modality. There are several clinical trials showing promising results, although the research is not yet conclusive on #acupuncture. Fish oils however, have shown to support remission twice as often as those who aren't taking fish oil (Belluzzi, Brignola, Campieri, Pera, Boschi, & Miglioli, 1996).
Treat any deficient vitamins and minerals in your diet or demonstrated in your laboratory evaluation. Specifically address folate, Vitamin B12, Vitamin B6, Vitamin V3, Zinc, Calcium, Selenium, Magnesium Citrate, Chromium, N-acetyl glucosamine, and fish oils. For every 50 mg/day of zinc that you take, add 2 mg/day of copper at a separate time of day. Taking zinc can result in your having too little copper in your body. Probiotics can be used to restore the normal balance in your bowel. If you are taking medications that suppress your immune system, probiotics are not recommended. Lactobacillus GG and Saccharomyces boulardii are great options.
Boswellia serrata (Indian frankincense) 350 mg three times day may prove helpful, as might curcumin 1000 to 1800 mg twice a day with meals, and oral aloe vera gel 100 mL twice daily. Pistacialentiscus resin (mastic gum) 1000 mg twice daily is also helpful.
References
Belluzzi, A., Brignola, C., Campieri, M., Pera, A., Boschi, S., & Miglioli, M. (1996). Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med, 334(24), 1557-1560. doi: 10.1056/NEJM199606133342401
Naftali, T. (2020). An overview of cannabis based treatment in Crohn's disease. Expert Rev Gastroenterol Hepatol, 14(4), 253-257. doi: 10.1080/17474124.2020.1740590
Yang, N., Sampathkumar, K., & Loo, C. J. (2016). Recent advances in complementary and replacement therapy with nutraceuticals in combating gastrointestinal illness. Clinical Nutrition, 36, 968-979.