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Crohn's Disease


Crohn’s disease is a chronic inflammatory disease in the family of inflammatory bowel diseases (IBD) that can affect any part of the gastrointestinal tract from the mouth to the anus but most commonly involves the intestines.

 
  • Overview
  • Action Plan
  • Ask The Doctor
  • Read & Watch
  • Success Stories
  • See Also

Overview


Crohn’s disease is a disease that is most common in Westernized areas, such as North America, Australia, and Europe, but is also spreading to developing countries as Western lifestyles, such as poor dietary habits, creep in. In the U.S. alone, it is estimated that the prevalence may be approximately 0.2%,1 and this number is getting higher over time.

Some of the potential explanations of this geographical trend include Westernized factors, such as antibiotic use, hygiene, exposures to certain infections, pollution, and diet. A higher risk follows those with a family history of the disease as well. Intestinal permeability (leaky gut) and altered intestinal bacteria seem to play an important role, but it is still not known exactly what causes Crohn’s disease.

Those with Crohn’s disease may experience some or all of the following symptoms:

  • Diarrhea
  • Malnutrition, bone loss, and weight loss from intestinal malabsorption
  • Nausea, vomiting
  • Rectal bleeding
  • Fever
  • Possible joint pain

For those with Crohn’s disease, improvements in nutrition, lower inflammation, and intestinal bacterial balance can occur with nutritional excellence.

 
References
  1. Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn's disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci 2013, 58:519-525.

Action Plan


Diet

  • Modern Western diets are pro-inflammatory, and higher intake of animal products, fast food, and high-glycemic refined carbohydrates is associated with an increased risk of inflammatory bowel diseases (IBD; Crohn’s disease and ulcerative colitis).1,2 A modified Nutritarian diet may be used to help manage Crohn’s disease.
  • Maximize the intake of high-fiber, immune-system-regulating, anti-inflammatory foods, such as cruciferous vegetables, other vegetables, berries, beans, onions, garlic, nuts, and seeds. Vitamins and minerals are essential for proper immune function, and carotenoids, flavonoids, cruciferous-derived isothiocyanates, and other phytochemicals have anti-inflammatory effects and promote a healthy microbiome. Cruciferous vegetables may be especially beneficial for intestinal immune function.3-7
  • Anti-inflammatory spices such as turmeric, ginger, cayenne pepper, cloves, garlic, and cinnamon should be used in seasoning dishes.8-11 
  • Modifications to the Nutritarian diet may be needed and may need to be personalized, particularly during a flare-up. When experiencing a flare-up, raw and higher fiber (especially insoluble fiber) foods, such as raw vegetables, salads, fresh fruits, and beans, for example, may make symptoms worse. The use of more cooked, soft, starchy vegetables, such as butternut and acorn squash, cooked turnips, parsnips, peas, and carrots are recommended and may be tolerated better. Additional modifications that may be helpful during a flare-up are to blend more food (smoothies and pureed soups) and add vegetable juices.
  • Fruit intake may need to be reduced to low or moderate amounts for some people with Crohn’s disease.
  • During a flare-up, medication may be required to control the inflammation first before increasing raw salads, fresh fruits, and beans, so talk to your doctor. Medically supervised fasting may also be appropriate.
  • Many with Crohn’s disease will find they are sensitive to food additives, gluten, processed foods such as sugar, and animal products, and removing or reducing them over time may help. Other foods may be triggers and may be unique to each person, which may require an elimination diet to discover. 
     

Supplements

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:

  • Additional supplements:

    • Probiotics: Both Crohn’s and ulcerative colitis are associated with alterations in the gut microbiome that are thought to be involved in the disease process.12 Probiotics therefore may be helpful in Crohn’s disease, however, the existing research is limited and benefit has not yet been demonstrated.13Eating foods rich in fiber and resistant starch also helps to maintain a healthy gut microbiome.

    • Omega-3 fatty acids: High-dose DHA and EPA have anti-inflammatory effects that may be beneficial in Crohn’s disease.14,15 Talk to your doctor to find out if high-dose omega-3s are appropriate for you.

    • Curcumin: Curcumin, a collection of phytochemicals from turmeric, has anti-inflammatory effects. Limited evidence suggests absorption-enhanced curcumin supplements help reduce symptoms in Crohn’s disease.1

Read

Find additional help

ONLINE: All members of DrFuhrman.com can search the Ask the Doctor archives for discussions on this topic. Platinum and Diamond members can connect with Dr. Fuhrman by posting questions in the forum. Not a member? Join now.

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References
  1. Schreiner P, Martinho-Grueber M, Studerus D, et al. Nutrition in Inflammatory Bowel Disease. Digestion 2020, 101 Suppl 1:120-135. doi: 10.1159/000505368
  2. de Castro MM, Pascoal LB, Steigleder KM, et al. Role of diet and nutrition in inflammatory bowel disease. World J Exp Med 2021, 11:1-16. doi: 10.5493/wjem.v11.i1.1
  3. Hoensch HP, Weigmann B. Regulation of the intestinal immune system by flavonoids and its utility in chronic inflammatory bowel disease. World J Gastroenterol 2018, 24:877-881. doi: 10.3748/wjg.v24.i8.877
  4. Li Y, Innocentin S, Withers DR, et al. Exogenous stimuli maintain intraepithelial lymphocytes via aryl hydrocarbon receptor activation. Cell 2011, 147:629-640. doi: 10.1016/j.cell.2011.09.025
  5. Kaulmann A, Bohn T. Bioactivity of Polyphenols: Preventive and Adjuvant Strategies toward Reducing Inflammatory Bowel Diseases-Promises, Perspectives, and Pitfalls. Oxid Med Cell Longev 2016, 2016:9346470. doi: 10.1155/2016/9346470
  6. Kaulmann A, Bohn T. Carotenoids, inflammation, and oxidative stress--implications of cellular signaling pathways and relation to chronic disease prevention. Nutr Res 2014, 34:907-929. doi: 10.1016/j.nutres.2014.07.010
  7. Higgins JA, Brown IL. Resistant starch: a promising dietary agent for the prevention/treatment of inflammatory bowel disease and bowel cancer. Curr Opin Gastroenterol 2013, 29:190-194. doi: 10.1097/MOG.0b013e32835b9aa3
  8. Mazidi M, Gao HK, Rezaie P, Ferns GA. The effect of ginger supplementation on serum C-reactive protein, lipid profile and glycaemia: a systematic review and meta-analysis. Food Nutr Res 2016, 60:32613. doi: 10.3402/fnr.v60.32613
  9. Zhu C, Yan H, Zheng Y, et al. Impact of Cinnamon Supplementation on cardiometabolic Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Complement Ther Med 2020, 53:102517. doi: 10.1016/j.ctim.2020.102517
  10. Singh S, Aggarwal BB. Activation of transcription factor NF-kappa B is suppressed by curcumin (diferuloylmethane) [corrected]. J Biol Chem 1995, 270:24995-25000. doi:
  11. Aggarwal BB, Yuan W, Li S, Gupta SC. Curcumin-free turmeric exhibits anti-inflammatory and anticancer activities: Identification of novel components of turmeric. Mol Nutr Food Res 2013, 57:1529-1542. doi: 10.1002/mnfr.201200838
  12. Morgan XC, Tickle TL, Sokol H, et al. Dysfunction of the intestinal microbiome in inflammatory bowel disease and treatment. Genome Biol 2012, 13:R79. doi: 10.1186/gb-2012-13-9-r79
  13. Limketkai BN, Akobeng AK, Gordon M, Adepoju AA. Probiotics for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2020, 7:CD006634. doi: 10.1002/14651858.CD006634.pub3
  14. Barbalho SM, Goulart Rde A, Quesada K, et al. Inflammatory bowel disease: can omega-3 fatty acids really help? Ann Gastroenterol 2016, 29:37-43. doi:
  15. Marton LT, Goulart RA, Carvalho ACA, Barbalho SM. Omega Fatty Acids and Inflammatory Bowel Diseases: An Overview. Int J Mol Sci 2019, 20. doi: 10.3390/ijms20194851
  16. Sugimoto K, Ikeya K, Bamba S, et al. Highly bioavailable curcumin derivative ameliorates Crohn's disease symptoms: A randomized, double-blind, multicenter study. J Crohns Colitis 2020. doi: 10.1093/ecco-jcc/jjaa097

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

I noticed that the newsletter on inflammatory bowel disease doesn’t mention beans or nuts and seeds (except for walnuts in phase 1). Are they generally introduced at some point?

I was diagnosed with Crohn’s and am following the Eat to Live 6-week plan. I am eating lots of beans, nuts and seeds, fruit, and raw vegetables. I’m not having any adverse reactions, and my symptoms have disappeared, although they were fairly mild to begin with.

A.

They are not excluded, but nuts/seeds should be soaked and chewed very well or blended, and beans should be eaten in small amounts (well chewed) only and then increased gradually as tolerated. There is no problem with them unless people are having problems with them.

 
Q.

My son was recently diagnosed with Crohn’s disease. I am trying to determine the proper diet for him. Based on the reading I’ve done, it seems he should stay away from fresh veggies, fruit, seeds, nuts, etc., however, your books seem to say that this is exactly what he needs for good health. At what point should he start to eat the right foods instead of a simple carb diet that most recommend?

A.

First, read my newsletter on inflammatory bowel disease where I discuss a patient’s diet with active Crohn’s or colitis.

I think the diets prescribed by conventional medicine are medieval. He should never be on a simple carb diet.

He should not avoid vegetables or seeds/nuts, however, they should be steamed/soaked and pureed.

Steamed zucchini, steamed and pureed squash, artichoke hearts, peas and turnips, soft cooked and pureed black rice, seeds and nuts smoothly ground into nut butters, and avocado are all good options.

He should be started on high dose EPA and VSL#3 too.

 
Q.

I have Crohn’s disease. My doctor recommended animal protein to deal with low albumin. How do you feel about this? Is there a specific protocol I should be following for my condition?

A.

Crohn’s disease is a common cause of low albumin. The protocol I use involves VSL#3, high dose fish oil, both juicing and blending, and, of course, avoidance of all oil and animal fats. No protocol can be precisely right for every person, but you can find a newsletter in the member center here that contains the general autoimmune protocol and one that contains my protocol for inflammatory bowel disease. Your albumin will rise as your inflammation decreases and the problem is in better control. In the meantime, to help improve it, also add ground hemp seeds, sunflower seeds, Mediterranean pine nuts, and one cooked egg white daily to your meals.