Introduction
Crohn’s
disease is a disease of the bowel that is closely related to
ulcerative colitis. The two are grouped in a category called inflammatory bowel
disease (IBD) because they both involve inflammation of the
digestive tract.
The major symptoms of Crohn’s disease include fever, nonbloody or bloody
diarrhea, abdominal pain, and fatigue. The rectum may be severely affected,
leading to fissures, abscesses, and fistulas
(hollow passages). Intestinal obstruction can occur, and over time fistulas may
develop in the small bowel. Other complications include gallstones,
increased risk of cancer in the small bowel and colon, and pain in or just below
the stomach that mimics the pain of an ulcer. Arthritis, skin sores, and liver
problems also may develop.
Crohn’s disease tends to wax and wane, with periods of remission punctuated by severe flare-ups. Medical treatment aims at reducing symptoms and inducing and maintaining remission.
Sulfasalazine is one of the most commonly used medications for Crohn’s disease.
Given either orally or as an enema, it can both decrease symptoms and prevent
recurrences. Corticosteroids such as prednisone are used similarly,
sometimes combined with immunosuppressive drugs such as azathioprine. In severe
cases, partial removal of the bowel may be necessary.
Another approach involves putting people with Crohn’s disease on an elemental diet. This involves special formulas consisting of required nutrients but no whole foods. After some time on such a diet, whole foods often can be restarted, but only one item at a time.
Principal Proposed Natural Treatments
People with Crohn’s disease can easily develop deficiencies in numerous
nutrients. Malabsorption, decreased appetite, drug side effects, and
increased nutrient loss through the stool may lead to mild or profound
deficiencies of protein; vitamins A, B12, C, D, E, and K; folate;
calcium; copper; magnesium; selenium; and zinc. Supplementation to restore
adequate body supplies of these nutrients is highly advisable and may improve
specific symptoms and overall health. It is recommended that one work closely with
a physician to identify any nutrient deficiencies and to evaluate the success of
supplementation to correct them.
Other Proposed Natural Treatments
Several natural treatments have shown promise for Crohn’s disease, but none
have been proven effective. In a ten-week, double-blind, placebo-controlled study,
the use of the herb wormwood appeared to successfully
enable a reduction of drug dosage in people with Crohn’s disease. This German
trial enrolled forty people who had achieved good control of their symptoms
through the use of steroids and other medications. One-half were given an herbal
blend containing wormwood (500 milligrams [mg] three time daily), while the other
one-half were given placebo. Beginning at week two, researchers began a gradual
tapering down of the steroid dosage used by participants. Over subsequent weeks,
most of those given placebo showed the expected worsening of symptoms that the
reduction of drug dosage would be expected to cause. In contrast, most of those
receiving wormwood showed a gradual improvement of symptoms. No serious side
effects were attributed to wormwood in this study.
Although these findings are promising, many treatments that show promise in a single study fail to hold up in subsequent independent testing. Additional research will be needed to establish wormwood as a helpful treatment for Crohn’s disease. In addition, there are concerns that wormwood might have toxic effects in some people.
The herb boswellia is thought to have some anti-inflammatory effects. An eight-week, double-blind, placebo-controlled trial of 102 people with Crohn’s disease compared a standardized extract of boswellia with the drug mesalazine. Participants taking boswellia fared at least as well as those taking mesalazine, according to a standard method of scoring Crohn’s disease severity.
Fish
oil also has anti-inflammatory effects. However, the evidence
suggests that it is not helpful for Crohn’s disease. A one-year double-blind trial
involving seventy-eight participants with Crohn’s disease in remission who were at
high risk for relapse found that fish oil supplements helped keep the disease from
flaring up. A smaller study also found benefit. In contrast, a one-year,
double-blind, placebo-controlled trial that followed 120 people with Crohn’s
disease did not find any reduction of relapse rates. Moreover, two well-designed
trials, enrolling 738 persons, convincingly failed to find any benefit for omega-3
fatty acid supplementation in the prevention of Crohn’s disease relapse.
One preliminary double-blind study found indications that the probiotic yeast
Saccharomyces boulardii may be helpful for reducing diarrhea
in people with Crohn’s disease. However, two studies failed to find
diarrhea-reducing benefit with Lactobacillus probiotics, and in
an analysis of eight randomized, placebo-controlled studies, probiotics were
ineffective at maintaining remission in persons with Crohn’s disease.
Lactobacilli have also failed to prove effective for helping
to prevent Crohn’s disease recurrences in people who have had surgery for the
condition.
Some evidence hints that probiotics might reduce the joint pain
that commonly occurs in people with inflammatory bowel disease. Also,
glutamine has been suggested as a treatment for Crohn’s
disease, but the most meaningful of the reported studies on its potential benefits
failed to find it helpful. Some evidence hints that acupuncture
might be helpful for Crohn’s disease. Preliminary investigations hint that
food
allergies might play a role in Crohn’s disease. However,
there is no meaningful evidence that avoiding allergenic foods can improve Crohn’s
symptoms.
Herbs and Supplements to Use Only with Caution
Various herbs and supplements may interact adversely with drugs used to treat Crohn’s disease.
Bibliography
Bousvaros, A., et al. “A Randomized, Double-Blind Trial of Lactobacillus GG Versus Placebo in Addition to Standard Maintenance Therapy for Children with Crohn’s Disease.” Inflammatory Bowel Disease 11 (2005): 833-839.
Feagan, B. G., et al. “Omega-3 Free Fatty Acids for the Maintenance of Remission in Crohn Disease.” Journal of the American Medical Association 299 (2008): 1690-1697.
Marteau, P., et al. “Ineffectiveness of Lactobacillus johnsonii La1 for Prophylaxis of Postoperative Recurrence in Crohn’s Disease.” Gut 55 (2006): 842-847.
Omer, B., et al. “Steroid-Sparing Effect of Wormwood (Artemisia absinthium) in Crohn’s Disease.” Phytomedicine 14 (2007): 87-95.
Rahimi, R., et al. “A Meta-analysis on the Efficacy of Probiotics for Maintenance of Remission and Prevention of Clinical and Endoscopic Relapse in Crohn’s Disease.” Digestive Diseases and Sciences 53 (2008): 2524-2531.
Romano, C., et al. “Usefulness of Omega-3 Fatty Acid Supplementation in Addition to Mesalazine in Maintaining Remission in Pediatric Crohn’s Disease.” World Journal of Gastroenterology 11 (2006): 7118-7121.
Van Den Bogaerde, J., et al. “Gut Mucosal Response to Food Antigens in Crohn’s Disease.” Alimentary Pharmacology and Therapeutics 16 (2002): 1903-1915.
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