Crohn’s Disease: Symptoms, Causes & Treatment

Recently, a 20-year-old college student, I’ll call her Cindy, was visiting a family I know. She and her friend were excitedly getting ready to go rollerblading—they packed up their gear and headed out in the car, only to return about 20 minutes later when Cindy began experiencing cramping in her stomach. Once again, her Crohn’s Disease was disrupting her plans.

One of the toughest things for me as a doctor is that unlike conditions that tend to surface in older patients, Crohn’s disease tends to present itself in young people, like Cindy, who are otherwise active and healthy. Crohn’s Disease is typically diagnosed in adolescents and adults aged 20-30 years old but can appear at any stage of life, and men and women are equally affected.

The good news is that between medical advances and alternative therapies, there’s a lot you can do to keep symptoms at bay.

What Exactly Is Crohn’s Disease?

Crohn’s disease (CD for short) is chronic irritable bowel disease (IBD), which is caused by inflammation in the gastrointestinal tract. While Crohn’s disease can affect any region of the gastrointestinal tract, including the mouth and anus, it most often affects the small intestine.

People with Crohn’s disease have an overactive immune response that causes inflammation which damages and thickens the intestinal walls. This can lead to strictures (a narrowing of the intestinal wall) that affect digestion and elimination.

What Causes Crohn’s Disease?

The exact cause of Crohn’s disease is unknown, but the strongest contributor seems to be genetics since between 5-20% of people with IBD (which can lead to Crohn’s disease) have a close relative who also has it. In fact, Cindy in the example above has an identical twin who also has Crohn’s.

It also affects men and women equally, and evolving research is suggesting that there may also be some environmental contributors, including bacteria and viruses.

Signs and Symptoms of Crohn’s Disease

Crohn’s disease presents itself differently in different patients and symptoms can vary depending upon the location of the inflammation.

The cardinal symptoms of Crohn’s disease include:

• Abdominal pain and cramping
• Diarrhea (with or without bleeding)
• Fatigue
• Weight loss

Depending on the severity of the disease, duration, location of inflammation, use of medication, and risk factors, other symptoms may present, including:

• Nausea
• Bloating and/or flatulence
• Fever
• Skin disorders
• Arthritis
• Eye involvement
• Constipation (especially if a stricture, meaning a narrowing, is present)
• Fistulas (sores or ulcers)
• Stunted growth in children

How Crohn’s Disease is Diagnosed

Once other conditions have been ruled out, like Celiac disease, for example, your doctor may run additional tests. Currently, there is no test or imaging specific for diagnosing Crohn’s disease, but your doctor may run some of the following tests to help make a diagnosis.

• C-reactive protein (CRP)—your body’s marker of inflammation
• Comprehensive blood count (CBC)—to check for anemia and inflammation
• Fecal Calprotectin or Transferrin
• Iliocolonoscopy with biopsy
• Endoscopy or video capsule endoscopy—to view the upper GI tract
• MRI or MRE (magnetic resonance enterography)
• Barium enema followed by X-ray—to see inside the digestive tract
• Abdominal CT

Your doctor may also assess nutrient values by running vitamin B12, folate, or vitamin D, which can be low due to malabsorption secondary to intestinal inflammation. 

How Crohn’s Disease Is Treated

Those with a mild form of Crohn’s disease can experience flairs that eventually calm and lead to remission without long-term medication use. Other more severe cases can require long-term medication use to get the inflammation under control.

There are four main drug therapy classes that doctors typically recommend for getting symptoms under control, listed in order of strength:

• 5 aminosalicylates (e.g sulfasalazine)
• Glucocorticoids (e.g. budesonide, prednisone)
• Immune modulators (e.g. methotrexate)
• Biologics (e.g. Remicade)

With any of these medical interventions, it’s important for the patient to take a proactive role—and tell their doctor if they begin to experience symptoms. In moderate to severe cases, surgery and other higher intervention therapies may be necessary. 

Natural Remedies for Crohn’s Disease

When treating Crohn’s disease, a multifactorial approach is necessary and usually includes the following:

• Dietary changes
• Stress reduction
• Lifestyle modification
• Exercise or movement
• Targeted nutritional therapies including vitamins, minerals, and botanical medicines

Depending on the severity of symptoms and type and comfort level of practitioner you see, he or she may recommend higher tier therapies including IV therapy, Low Dose Naltrexone (LDN), detoxification therapies, and even in some folks something as radical as a fecal microbial transplant (FMT). 

The Importance of Healthy Food Choices in Crohn’s Disease

I’m always perplexed when gastroenterologists don’t really consider diet an important part of treatment, or acknowledge for that matter, how a substance that someone is putting into their mouth may affect the health of the intestines. 

Of course, food allergies and intolerances, and eating poor quality processed foods, are not the only triggers for Crohn’s disease, but they do play a big role in intestinal health. When I see a patient with Crohn’s disease the first thing I’ll do is put them on an anti-inflammatory diet, which may be similar to a Paleo type diet, which is free of grains, dairy, and sugar.

This is not to say that everyone who follows Paleo will experience benefit, nor does it imply free rein with eating meat, but I do find that many people notice symptom improvement within 4-6 weeks by making the following dietary changes:

Eliminating inflammatory foods:

• Dairy
• Gluten
• Processed foods
• Sugar

Increasing the intake of anti-inflammatory foods:

• Fresh vegetables and fruits
• Salmon and other omega-3-rich fish
• Nuts and seeds
• Healthy oils, such as olive oil

In instances of acute flair, I also suggest temporarily eliminating alcohol and caffeine. For those that are vegetarian and who do want to eat meat, there is also evidence that a plant-based diet may help with irritable bowel disease.

Other Lifestyle Changes & Remedies

Along with diet, I’ll work with patients on lifestyle modification, making sure patients are sleeping consistently 7-9 hours per night, incorporating some form of mind/body meditation, and moving their body on a daily basis.  

Although these recommendations may on first glance appear too basic to help, I cannot overemphasize the importance of these practices as acute and chronic stress can play a large role in Crohn’s disease. 

Finally, I will usually suggest targeted natural remedies and other treatments such as the following which all have good supporting research:

• Turmeric
• Boswellia
• Glutamine
• Omega-3s
• Probiotics
• Acupuncture6
• Fasting mimicking diet (i.e. calorie restriction)

Please do work with your doctor while incorporating natural medicines into your protocol and let him or her know about any changes in your symptoms.