Articles

Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Understanding Your Options for Crohn’s Disease Treatment

Written by Dr. Michael Ruscio, DC on May 27, 2021

Written by Dr. Michael Ruscio, DC on May 27, 2021 — Reviewed by Hilary Watts

How Diet, Lifestyle Changes, and Other Treatments Can Help With Symptoms

• About Crohn’s Disease|
• Symptoms|
• Diagnosis|
• Causes|
• Dietary and Lifestyle Changes|
• Medication|
• Other Treatments|
• Treatment Plan|
• Recommended Products|

If you have Crohn’s disease (which is characterized by a range of digestive symptoms and inflammation throughout the digestive tract), you’re probably wondering about the best way to treat your symptoms and feel better. Crohn’s disease treatment includes dietary and lifestyle changes, medication, and more.

Your Crohn’s disease treatment will depend on you and your individual symptoms. Still, there are a few basic ways anyone with Crohn’s disease can approach treating their condition. Many of these are similar to how other digestive diseases are controlled or treated. In general, you can treat your Crohn’s disease by:

1. Eating an anti-inflammatory diet
2. Supporting your digestion and gut health with probiotics and other digestive supplements
3. Supporting your mental health, especially through mindfulness 
4. Taking other medications, including those prescribed by your doctor 

What Is Crohn’s Disease?

Crohn’s disease (CD) is an inflammatory disease of the intestinal tract that affects every layer of the bowel wall. It is usually triggered by an inappropriate response of the immune system. Crohn’s disease can involve the entire gastrointestinal tract (from the mouth to the rectum), but in general, it affects the small intestine and the right side of the large intestine. 

People with Crohn’s disease usually experience the disease in flare-ups (or periods of time when they experience symptoms). The more flare-ups you have, the more your disease may progress.

Crohn’s disease can be mild or severe. People with severe Crohn’s disease may have fistulas (abnormal passages between layers of the GI tract filled with cell debris, red blood cells, and inflammatory cells) and/or strictures (abnormally narrow parts of the GI tract created by intestinal thickening) [1].

Inflammatory bowel disease (IBD) is a general term for inflammatory digestive disorders that include Crohn’s disease and ulcerative colitis [2]. You can think of Crohn’s disease as a type of IBD. 

Crohn’s Disease Symptoms

Common symptoms of Crohn’s disease include:

• Abdominal pain, especially in the right lower quadrant of the abdomen (colon pain)
• Gas and bloating
• Diarrhea that may include mucus and blood
• Weight loss
• Appetite loss

Non-digestive symptoms may include: 

• Fever
• Canker sores
• Eye inflammation causing redness, swelling, irritation, or blurred vision
• Urinary tract infections
• Fatigue
• Anemia
• Brain fog [1]

How Is Crohn’s Disease Diagnosed?

Diagnosis of Crohn’s disease involves a number of tests to give your doctor more information and to rule out other diseases (like celiac disease and irritable bowel syndrome, or IBS).

You may have blood tests to check for anemia. You may also give a stool sample, which will then be tested in a lab [3] for infections, parasites, or other issues.

It is important to distinguish Crohn’s disease from ulcerative colitis and diverticulitis, as the symptoms of these disorders can be similar. Tests that check anti-neutrophils (a type of white blood cell) and other antibodies can do this, as there are specific antibodies and markers associated with the different conditions. 

CT scans, MRIs, or X-rays can show fistulas or other bowel damage that is typical of Crohn’s disease [1].

Causes of Crohn’s Disease

The exact cause of Crohn’s disease is still unknown, but may involve a combination of genetic and environmental factors, as well as imbalances in the gut. 

Diet and environmental exposures can affect whether or not someone develops Crohn’s disease [2]. Some research has shown that taking antibiotics in childhood is associated with a greater risk of developing IBD later in life [4]. Crohn’s is also linked with leaky gut and SIBO [5, 6, 7].

Gut Health Imbalances and Crohn’s Disease

Leaky gut syndrome (more officially known as intestinal permeability) has been linked to Crohn’s disease. This occurs when the tight junctions between the cells that line your small intestine loosen, letting small particles such as undigested food pass into your bloodstream. It is an inflammatory condition that can affect the body in multiple ways. Some research shows that having a leaky gut can be a precursor to developing Crohn’s later in life [8].

Multiple factors including intake of processed foods and chronic antibiotic use may contribute to both leaky gut and Crohn’s disease [9, 10, 11, 12].  

Small intestine bacterial overgrowth (SIBO) can also be a factor in developing Crohn’s disease. In 2019, a systematic review concluded that incidence of SIBO was higher in people with IBD (as compared to controls) [7]. 

Diet and Lifestyle Changes for Crohn’s Disease

There are a number of diet and lifestyle changes that can make a huge difference in your Crohn’s symptoms. Let’s take a look at these research-backed approaches:

Dietary Changes

Eating an anti-inflammatory diet can help reduce inflammation in your digestive system and control your Crohn’s symptoms. Avoiding foods that can irritate or inflame your digestive tract can help you feel better and reduce flare-ups. 

Paleo and Autoimmune Paleo Diets

A Paleo diet is an example of an anti-inflammatory diet that can help reduce Crohn’s symptoms. A Paleo diet involves eating foods that would have been available to our Paleolithic ancestors. Objectively inflammatory foods (like sugar and processed foods) are avoided, as well as common triggers of inflammation (including gluten and dairy products). 

The Autoimmune Paleo Diet (commonly referred to as AIP or the Autoimmune Protocol) can also be a beneficial diet approach for Crohn’s treatment. This diet is essentially a more restrictive version of the Paleo diet that focuses on eating nutrient-dense foods and avoiding inflammatory foods like grains, gluten, sugar, dairy, eggs, alcohol, and caffeine. Some studies have indicated that an elimination diet like AIP can improve symptoms for people with IBD [13, 14].

If following a Paleo diet doesn’t help to reduce symptoms, a more specialized diet, like the low FODMAP diet, might help. 

Low FODMAP Diet

A low FODMAP diet can benefit people with Crohn’s disease. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are complex natural sugars and starches that can feed bacterial overgrowths and be hard for some people (especially those with digestive diseases) to digest. 

Specifically, some research has shown removing high FODMAP foods can improve symptoms for Crohn’s patients. One randomized controlled trial showed that a low FODMAP diet, compared with a control diet, improved symptoms and reduced the loss of microbes thought to regulate the immune response [15].

Other research indicates that a low FODMAP diet is generally beneficial for people with inflammatory bowel disease [16, 17].

Elemental Diet

An elemental diet, a powdered meal replacement formula that is hypoallergenic, anti-bacterial, and anti-inflammatory, can be incredibly effective when it comes to soothing Crohn’s symptoms. 

The elemental diet is intended to be used as a short-term meal replacement in order to give your gut a chance to rest and heal while still providing essential nutrients. 

The elemental diet has been shown to be an effective treatment for Crohn’s in numerous clinical trials, decreasing inflammation, reducing autoimmunity, and preventing relapses [18, 19, 20, 21, 22, 23]. 

In my clinical experience, this is one of the most beneficial treatments for stubborn symptoms of Crohn’s disease. 

Digestive Support Supplements for Crohn’s Disease

Another Crohn’s disease treatment option is digestive support supplementation. Taking digestive support supplements can help support your gut, reduce flare-ups, and improve your overall quality of life. 

Probiotics

Probiotics have been shown to reduce inflammation and to improve various aspects of gut health for people who have IBD [24, 25].

• One clinical trial found that Saccharomyces boulardii, a beneficial yeast, helped to improve symptoms and the composition of the gut microbiome for those with IBD [24]. 
• Probiotics have been shown to reduce levels of inflammation in general [26]. 
• Numerous studies have shown that probiotics help to improve SIBO, which may be an underlying cause of IBD [27].

Some research on probiotics for Crohn’s disease specifically has found benefits to be minimal [28, 29]. However, supporting a healthy gut and reducing inflammation is likely to be valuable for you as a patient with Crohn’s disease. In my practice, I find probiotics to be one of the most helpful treatments for those with digestive disorders. 

L-glutamine

There is some evidence that supplementing with the amino acid L-glutamine can also help ease Crohn’s disease. A randomized controlled trial found that L-glutamine supplements improved the gut wall integrity (intestinal permeability) in patients with Crohn’s disease [30].

Other Lifestyle Changes

There are other changes you can make in your life to lessen Crohn’s symptoms. 

Avoid taking NSAIDs (such as naproxen and ibuprofen), which can lead to increased inflammation in the long run and may cause flare-ups. 

Improve your mental health by practicing mindfulness. Two studies showed improved symptoms and reduced pain of IBD patients who practiced breathing and relaxation techniques [31, 32].

Medication for Crohn’s Symptoms

Medications are a common Crohn’s disease treatment. You may already be taking medication to improve your Crohn’s symptoms. Most often, these medications are prescribed by a gastroenterologist. Medications are typically aimed at reducing inflammation and symptoms but may also come with side effects, and do not generally address the root cause of the problem. Medications are best used alongside diet and lifestyle strategies that work to address the root cause of the inflammation and heal the gut. 

The most commonly prescribed medications for people who have mild to moderate Crohn’s disease are:

• Corticosteroids (these are only used short-term, ex., during a flare-up). Prednisone is an example of a typical corticosteroid prescribed for Crohn’s disease. 
• Mesalamine (an anti-inflammatory drug)
• Immunomodulators, which are medications that suppress your immune system. These include thiopurines (mercaptopurines, azathioprine), methotrexate, and steroids.
• Sulfasalazine
• Budesonide

For people who have moderate to severe Crohn’s disease, common medications are:

• A combination of immunomodulators and biologics. Biologics are medications made from living organisms.
• Remicade (infliximab), a biologic used for patients who don’t respond to conventional therapies 
• Humira (adalimumab), a biologic used for patients who don’t respond to conventional therapy

Antidiarrheal medications like loperamide are also used by Crohn’s patients, especially during flare-ups. 

Antibiotics and Antimicrobials

Antibiotics and natural antimicrobials may also be used as Crohn’s disease treatments. 

Antibiotics can help to control infections and may also aid in healing abscesses and fistulas caused by inflammation in the digestive tract [33, 34]. However, there are some concerns with the impact of long term antibiotic use on gut health [35].

The most commonly prescribed antibiotics for Crohn’s disease are: 

• Ciprofloxacin 
• Metronidazole (Flagyl)

Metronidazole has been shown to be more effective when Crohn’s affects the colon, but this antibiotic can also come with side effects like gastric distress and a metallic taste [36]. 

Natural antimicrobial medications can also be very helpful in curbing Crohn’s disease. A systematic review of several randomized controlled trials found that two antimicrobial herbs, wormwood and thunder god vine, were better at placebo in preventing recurrence of post-operative Crohn’s  (or, Crohn’s that persists after surgery) [37]. Another systematic review found that antimicrobial herbal medicines were just as effective at treating IBD as the medication mesalamine [38].

Other Crohn’s Disease Treatments

A newer treatment that has shown some promise for inflammatory bowel disease is a fecal microbiota transplantation, sometimes called a fecal transplant. This is when fecal matter from a healthy stool donor is transplanted into the colon. This may happen via a colonoscopy (a tube going into the stomach) or via capsules [39]. More research is necessary when it comes to fecal microbiota transplantation, but some preliminary evidence suggests that it may be helpful for  inflammatory bowel disease.

Other interventions include surgery for bowel obstructions, fistulas, or perforated bowels. Draining of abscesses is also used as a Crohn’s disease treatment.

Crohn’s Disease Treatment Plan for Relief

With the right combination of diet, lifestyle, and medical treatment, you can manage your Crohn’s disease successfully. Adopt an anti-inflammatory diet, such as low FODMAP or AIP. Consider using probiotics and other digestive supports to heal your gut. 

You can find the treatment that is right for you, reduce your Crohn’s flare-ups, and get back to feeling great.

If you need help deciding how to treat your Crohn’s disease, check out my book Healthy Gut, Healthy You, or contact our clinic or our health coach for help and guidance.

Recommended Products