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Crohn’s Disease

This disease is a very mysterious one, as unfortunately the etiology (or cause) is unknown. Crohn’s Disease is a form of infalmmatory bowel disease (IBD) that can affect any part of the gastrointestinal tract from the mouth to the anus.  It is a chronic and progressive disease in which the tissues become inflamed, form sores (ulcers), bleed, scar and lose the normal smoothness of their inner lining.  Crohn’s disease cannot be cured by drugs or surgery, although both can relieve the symptoms.  Crohn’s disease is unpredictable.  Many people experience “flare-ups” and then “remission” where the disease seemingly goes away for varying lengths of time.

How is this disease diagnosed?

Diagnosing Crohn’s disease is not always easy. It is common to see many of the symptoms mimic those of other inflammatory bowel disease such as irritable bowel syndrome and ulcerative colitis. The most common complaint is typically stomach pain, which tends to localize in the lower right hand side of the abdominal area. Cramping and diarrhea are also known to occur. Sudden dramatic weight loss can also be a sign of this disease due to malnutrition and a loss of appetite.  Other symptoms include fatigue, steatorrhea, fever, anal sores, bloating, joint pain and anal drainage.

Due to the non specific characteristic symptoms of this disease, the most accurate method for diagnosis is to use a procedure called colonoscopy. This procedure uses a thin fiber optic tube, equipped with a camera, and inserts it into the body, examining the digestive tract.

How does the disease affect the body?

This disease can affect the gastrointestinal tract anywhere from the mouth to the anus. Most commonly the areas affected are the bowels by transmural inflammation, meaning that all tissue layers are affected. Instead of the disease affecting a specific area there tends to be segmentation. The inflammation tends to skip portions, so you find healthy sections of the intestines separated by diseased areas.

The inflammation can lead to localized strictures and partial or complete obstruction of the intestinal lumen. These areas are also found to be ulcerated, abscessed and have fistulas present. Due to the severity of these problems surgery is often necessary.

Though surgery can fix the problem at hand it does not mean that the disease is cured. If remission occurs it will happen within three years.

Malnutrition often accompanies this disease for several reasons.  First, food intake is usually decreased as a result of poor appetite, a change in taste, abdominal pain and diarrhea.  Malabsorption may result from low bowel function due to bacterial overgrowth, inflammation, and resection or bypass surgery.  Our intestines absorb nutrients at different areas as our food passes through it. If surgery involves resectioning of the intestine, which means removal of specific areas, varying degrees of malabsorption may occur.  If portions of the ileum are resected there will be a risk of B12 deficiency as this area of the small intestine is the only area where the body can absorb the Vitamin B12. Deficiency of this vitamin can lead to neurological damage. In cases where the ileum is removed some form of parenteral nutrition may be required. This method allows nutrients to be obtained through intravenous methods, delivering nutrients directly into the blood.  Blood, protein, fat, carbohydrate, water, electrolyte and vitamin losses may be increased due to bleeding, infection and loss of bile salts.  As a result there is a risk of malnutrition, weight loss, iron deficiency, inadequate fluid balance and B12 deficiency.   

Dietary Considerations

§ Don’t avoid foods unless you know they tend to cause problems for you.  Diet is very individualized and what bothers one person may not bother another.

§ Common irritants include saturated fats, caffeine, and alcohol.

§ Steam, broil, boil, or bake your food. Try to avoid adding extra and unnecessary fat to your food, during cooking or at your meals. Lower fat diets are better tolerated.

§ Using probiotics like yogurt that contains acidophilus bacteria, can also aid digestion.

§ Drink plenty of liquids, such as distilled water, herbal teas, & fresh juices. Keeping yourself well hydrated will help things pass through the bowels more easily

§ Fiber may need to be restricted in episodes of acute inflammation.  Raw fruits and vegetables can increase diarrhea and gas but restriction for everyone is unnecessary.  Water soluble fibre can help control diarrhea.  Foods such as apple sauce, rice, bananas and oats.  An increase in fiber is recommended to help decrease the incidence of constipation and related symptoms.

§ Some may become sensitive to wheat/gluten and lactose. Try to substitute milk with things like soy milk and substitute wheat/gluten with other grains such as rice.  Sprouted grains also tend to be easier to digest.

§ A diet full of easily digestible fruits and veggies, that are non acidic, is also recommended. Examples of acidic foods would be tomatoes (including their sauces) and citrus fruits.   Note that some people with this disease can be sensitive to cruciferous vegetables (even though they are non-acidic) such as cabbage, Brussels sprouts, and broccoli. Monitor your intake of these vegetables to see how your body tolerates these foods.

§ It is also a good idea to consume a multivitamin and mineral supplement from 1-5 times the recommended daily intake.  B12 injections may be recommended for those with part of the ileum resectioned. 

§ It is suggested to try small frequent meals, throughout the day, as they may be better tolerated than 3 typically large meals.

§ If strictures (scarring causing narrowing of the intestinal lumen) or fistulas (abnormal openings between two organs) are present it is best to consume a low residue diet: reducing things like fiber in the diet. You also want to consume a high amount of calories and increase your protein intake to 1-1.5g of protein for every kg of your body weight.

§ If you are experiencing Steatorrhea which means fat malabsorption and your bowel movements look very white and fluffy, you will need to decrease the amount of fat you are consuming and try to consume medium chain triglycerides (MCT). This is a form of fat, but the body digests it differently and is better tolerated by those with digestive problems. MCT are usually consumed by way of oils and can be purchased in a specially formulated form.