Approximately 3 million U.S. adults and around three million more people worldwide have irritable bowel disease (IBD). These numbers are rapidly increasing year after year.
Crohn’s is a type of inflammatory bowel disease (IBD) most commonly diagnosed in patients between 20 and 40 years old.
A functional medicine approach to Crohn’s Disease considers the complex factors involved, including genetics, an altered microbiome, environmental exposures, and a leaky gut.
These imbalances may trigger the immune response to create excess inflammation in the digestive tract. Inflammation is one of the body’s natural ways of protecting itself, but when there is too much inflammation, it can cause extensive damage. This may result in painful ulceration, swelling, and scarring of the intestines. Crohn’s disease can affect any area in the GI tract, but it’s primarily found in the large and the small intestine. Crohn’s is usually chronic with flare-ups of worsening disease in between less symptomatic periods.
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Crohn’s Disease Signs & Symptoms
Crohn’s tends to be chronic, with symptoms coming and going over time. Each flare may cause increasing damage to the gastrointestinal tract. The inflammation in Crohn’s can affect any part and layer of the gastrointestinal tract with normal areas in between inflamed patches.
This leads to a variety of gastrointestinal symptoms, including
- Frequent bowel movements
- Chronic and often bloody diarrhea
- Bloating
- Abdominal tenderness
- Nausea and vomiting,
- Colicky abdominal pain with relief after a bowel movement
- Fever
- Loss of appetite
In Crohn’s, the immune system may attack the gastrointestinal tract, potentially damaging the surface projections that help absorb nutrients. Since the inflamed and damaged intestinal tract may not absorb nutrients as well, symptoms can result throughout the body, such as
- Unintended weight loss
- Nutrient deficiencies
- Fatigue
- Depression
- Brittle nails
- Hair loss
Chronic inflammation can also lead to gallstones and kidney stones. Over time, this inflammation can spread throughout deeper layers of the intestinal tract and lead to complications like bowel blockage or infection.
Adults with IBD are also more likely to have certain chronic health conditions like
- Erythema Nodosum (hot, red, tender lumps or nodules over the shins)
- Eye Inflammation (conjunctivitis, uveitis, scleritis)
- Heart disease
- Stroke
- Arthritis
- Anxiety and Depression
- Kidney and Liver Disease
- Migraines
Crohn’s Disease Possible Causes
While the exact cause is not fully understood, Crohn’s involves an interplay between genetics, environment, and altered gut bacteria. This may lead to dysregulated immune responses and inflammation that damages the gastrointestinal tract.
Genetics
8-12% of Crohn’s patients have a family member with IBD. This may be due to genetics and or shared environmental exposures. Identified genes suggest that Crohn’s involves abnormal immune responses to certain bacteria and yeasts in the intestines.
Environmental
Environmental risk factors for Crohn’s may include smoking, infections, heavy metals, mold, endocrine disruptors, and dietary factors that could trigger an imbalanced immune response. Certain medications, like nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and oral contraceptives, may also contribute.
Gut Microbiome
The gut microbiota plays a key role in Crohn’s. Patients may show imbalanced gut bacteria characterized by decreased Bacteroides and Firmicutes bacteria and increased Gammaproteobacteria, Actinobacteria, and invasive Escherichia coli. The leaky gut barrier may allow bacteria to cross into the bloodstream, where they could provoke inflammation.
Candida
The overgrowth of candida in the GI may weaken the lining of your GI tract leading to increased gut permeability (leaky gut syndrome). Current studies indicate that an overgrowth of candida is also associated with gastric ulcers, ulcerative colitis, and Crohn's disease.
Diet
Dietary factors may alter the risk of Crohn’s by impacting the microbiota, intestinal barrier, and immune system. The intestine walls serve as a separation between the outside world and the bloodstream and are crucial for regulating immunity. A “leaky gut” may allow substances from the gut to enter the body, potentially contributing to chronic inflammation.
A diet including an “excessive consumption of sugar, animal fat, and linoleic acid is considered a risk factor for IBD development.” Whereas a high fiber diet (outside of flares) and citrus fruit consumption may be protective.
Low vitamin D levels and inadequate dietary fiber intake or frequent shifts between high- and low-fiber foods may contribute to poor diversity of gut bacteria and the development of Crohn’s.
On the other hand, an anti-inflammatory Mediterranean diet may reduce the risk of Crohn’s. Similarly, breastfeeding may help strengthen the microbiome's diversity, while antibiotic exposure in childhood may increase the risk due to adverse impacts on gut bacteria.
Functional Medicine Labs to Test for Crohn’s Disease
Traditionally, diagnosis is based on symptoms and confirmation of changes in the intestines via endoscopy biopsy. Functional medicine testing may assess the extent of inflammation in the intestines and the rest of the body along with nutrient deficiencies, anemia, and infections and help identify underlying contributing factors.
CICA
The Celiac, IBS, and Crohn’s Assay (CICA) may measure genetic risk markers and antibodies directed against yeast in the gut (Anti-Saccharomyces Cerevisiae Antibody (ASCA), which is an indicator for the presence and severity of Crohn’s.
Calprotectin
Fecal calprotectin is a marker of mucosal inflammation in IBD and can be used to monitor disease activity.
Comprehensive Stool Test
The GI-MAP may assess relative amounts of healthy and unbalanced gut bacteria, inflammation and leaky gut markers, parasites, and yeast overgrowth. Individuals with Crohn’s may frequently have an overgrowth of Candida and Malassezia yeasts that join harmful bacteria to create biofilms that are difficult for the immune system to manage. This can potentially trigger autoimmunity and perpetuate the cycle of inflammation, so detecting and addressing gut imbalances is important.
Micronutrient Testing
Crohn’s may cause nutrient deficiencies that could result in further immune system dysregulation and impaired healing. The damaged intestines may not effectively absorb nutrients, potentially leading to deficiencies in iron, vitamin B12, folate, vitamin D, magnesium, and other nutrients. The functional status of nutrients within the cell can be assessed with a micronutrient panel to target any deficiencies.
Other Labs
Other basic labs to assess contributing factors and complications may include
- complete blood count (CBC) to detect infection and anemia,
- inflammation markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to assess inflammation throughout the body, and
- liver function tests to screen for liver and bile duct problems.
Functional Medicine Considerations for Crohn’s Disease
A functional medicine approach to Crohn’s disease considers underlying factors to help balance the immune system, calm inflammation, and support overall health.
Nutrition
Diet strongly influences the gut microenvironment, impacting microbial composition, function, gut barrier, and immunity. Some foods that may contribute to intestinal inflammation in Crohn’s include poor-quality animal-derived fats, grain-fed animal protein, gluten, processed foods, and emulsifiers. If animal foods are consumed, omega-3-rich wild fish and organically-raised grass-fed meats may be less inflammatory.
The composition of the gut microbiota can change in response to diet. An individualized nutrient-rich, anti-inflammatory diet may help balance inflammation to support gastrointestinal health while optimizing nutrient levels.
During flares, patients may benefit from avoiding:
- Lectin-containing foods like beans, legumes, nuts, and seeds
- Gluten
- Dairy
- Raw vegetables
- Artificial sweeteners
- Alcohol
- Spicy foods
Various elimination diets include an elemental diet, the specific carbohydrate diet (SCD), the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (FODMAP), or a personalized diet Autoimmune Protocol Diet have been investigated to help manage inflammation.
To maintain remission, prioritizing cooked fruits and vegetables and anti-inflammatory spices like turmeric and saffron and incorporating omega-3 fats from foods like salmon and walnuts may support intestinal health. Fish oil supplements can also be considered.
When not in a flare, a high-fiber diet may improve gastrointestinal function. Butyrate is a short-chain fatty acid produced when gut bacteria break down indigestible dietary fibers from legumes, fruits, and vegetables or taken via supplements that may help support digestive health.
A gluten-free diet may be helpful for many IBD patients. Gluten may contribute to weakening the barrier gates between intestinal cells, potentially resulting in permeability and inflammation.
Additives in processed foods may also impact intestinal barrier function and immunity. Common emulsifiers like carboxymethylcellulose, polysorbate-80, maltodextrin, and carrageenan may increase intestinal leakiness and change the microbiome's composition.
Support the Microbiome
A properly balanced gut microbiome is crucial for balanced immune function. A diet rich in unprocessed whole foods that incorporates probiotic-rich foods like miso, kimchi, and sauerkraut combined with prebiotic-rich foods like leeks, artichokes, garlic, and beans that nourish healthy bacteria is critical for supporting the intestinal lining and reducing symptoms. In addition to diet, probiotic supplements like Lactobacillus and Bifidobacterium may help support digestive health.
Manage Stress
Stress may increase cortisol and inflammation in the gut via the “brain-gut axis,” potentially triggering flare-ups. Therefore, stress management practices like yoga, meditation, breathwork, or gratitude practices and addressing emotions and trauma may be helpful.
Exercise
Exercise may decrease the expression of inflammatory substances and encourage repair of the damaged intestines.
Fecal Microbiota Transplantation (FMT)
FMT is an emerging experimental treatment strategy for Crohn’s.
Summary
Crohn’s involves inflammation in the gastrointestinal tract. This inflammation may arise due to a dysregulated immune response in someone with susceptible genetics and exposure to certain environmental factors. The inflammation may damage the gastrointestinal tract anywhere between the mouth and anus, causing abdominal pain, frequent bowel movements, and nutrient deficiencies.
Functional medicine testing may measure markers of intestinal inflammation and disease severity and identify nutrient deficiencies, infections, and imbalances in gut bacteria to address underlying contributing factors.
Management of Crohn’s focuses on controlling symptoms like abdominal pain and diarrhea, reducing inflammation, and supporting mucosal healing. A functional medicine approach to Crohn’s Disease may help balance the immune system and calm inflammation with a whole foods diet, support the microbiome, stress management, and balanced exercise.
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