A New Path to Conquering Crohn’s and Colitis

Addressing the root cause of intestinal disease helps sufferers achieve symptom-free lives

When Meghan Telpner was diagnosed with Crohn’s disease in August of 2006, her doctor told her there was no known cure and nothing she could do would help her heal. She envisioned a future that included going in and out of hospitals, unable to make plans for fear of a flare-up.

This bleak prognosis is all too familiar for the estimated 3 million Americans who have been diagnosed with Inflammatory Bowel Disease (IBD), the two most commons forms of which are Crohn’s disease and ulcerative colitis (UC).

IBD is characterized by chronic inflammation in the lining of the gastrointestinal tract caused by an autoimmune response in the body, meaning the immune system mistakenly attacks the body’s own tissues, causing pain, cellular damage, and lesions. Ulcerative colitis affects only the large intestine, but in Crohn’s disease, inflammation and ulcerations can appear anywhere in the digestive tract, from the mouth to the anus.

Though the exact cause of these diseases is not known, several factors play a role, including genetics, autoimmune reactions, and environmental factors.

Dr. Gerard Mullin, MD, spoke at the 2018 Institute for Functional Medicine (IFM) Annual International Conference, where he explained that the immune cells in the digestive tract make up 70-80% of the body’s total immune tissue, and in IBD “there is misprogramming,” which causes these cells to “overreact to things they shouldn’t react to.”

Since inflammation can occur anywhere in the digestive tract, symptoms vary among individuals but commonly include unexplained weight loss, fever, abdominal pain, frequent diarrhea, and bleeding. If untreated, IBD can lead to nutrient deficiencies and life-threatening medical emergencies such as bowel perforation and gastrointestinal obstruction. Crohn’s disease and ulcerative colitis are characterized by periods of relapse and remission. During remission, patients experience no physical problems at all, but a relapse, or “flare,” will unexpectedly trigger symptoms.

Though the exact cause of these diseases is not known, several factors play a role, including genetics, autoimmune reactions, and environmental factors. About 20% of people with Crohn’s have a family member, usually a sibling or parent, with Crohn’s or UC. Epidemiological data has linked environmental factors with an increased risk for IBD, including use of certain medications such as NSAIDs (non-steroidal anti-inflammatory drugs), antibiotics, and oral contraceptives. Several studies have shown that exposure to certain antibiotics in childhood greatly increases the risk of IBD, causing a critical disruption to the child’s developing immune system. The research indicates a linear relationship between the number of antibiotic doses received in childhood and the incidence of IBD in adulthood.

Diets high in fat or sugar have also been implicated in IBD risk. A new study published in Science Translational Medicine found that high fructose corn syrup caused more severe symptoms of ulcerative colitis in mice. The mice that were given sugar exhibited a thinning of the protective mucus layer of the large intestine and significant changes to the gut microbiome. Research has also shown an increased incidence of Crohn’s disease in emigrants to countries with westernized diets, offering evidence that diet may be an environmental factor in the rising incidence of IBD.

Diets high in fat or sugar have also been implicated in IBD risk.

Ms. Telpner’s diagnosis of Crohn’s disease back in 2006 prompted her to research how she could change her lifestyle to help her heal. She is not alone in wanting to find ways to get better without relying on the approach advised by her doctor, which was essentially to “wait and see” and use pharmaceutical and surgical interventions, if necessary. A 2012 National Health Interview Survey found that complementary medicine is used by about one-third of adults, including many IBD patients.

Conventional medical treatments of IBD have traditionally been focused on addressing and suppressing symptoms, but there is a growing body of evidence that IBD can be effectively managed with a combination of allopathic and complementary therapy options. Both functional and integrative medicine approaches focus on addressing the root causes of inflammation in order to support the body’s natural healing mechanisms.

Specialized testing, such as blood tests, comprehensive stool studies, and food sensitivity testing, can help identify specific inflammation triggers that cause or worsen symptoms. These triggers may include disturbances in the gut microbiome such as bacteria, yeast, parasites, or viruses. A 2017 study found significantly higher levels of certain fungi and bacteria in the microbiome of Crohn’s patients than in those of their healthy family members. Other triggers may be certain foods, insufficient beneficial gut bacteria, or increased gut permeability.

The results of these patient-specific tests can guide an individualized plan of care to control the inflammatory process and balance the immune system, correct any nutritional deficiencies developed, and relieve symptoms. If the patient is severely inflamed, physicians in the fields of functional medicine and integrative health and medicine will most often control the inflammation with anti-inflammatory drugs. Once the inflammation is under control, the patient will be given a personalized plan that emphasizes lifestyle changes such as nutrition, exercise, supplements, and mind-body practices with the goal of extending the remission period and preventing future flare-ups.

Dr. Mullin, who is an associate professor of medicine at Johns Hopkins Medical School, points out that because IBD is considered a digestive disorder, many physicians focus only on the gastrointestinal tract and overlook the nervous system. As a board-certified internal medicine and gastroenterology physician, as well as a nutritionist, he views treatment more broadly: “Many patients end up on biologics and some other heavy medications, and a lot of their needs aren’t being addressed from a holistic, integrative perspective.”

There is a growing body of evidence that IBD can be effectively managed with a combination of allopathic and complementary therapy options.

There are a number of recommended diets for patients with IBD to remove known disease triggers. These include the Specific Carbohydrate Diet for Crohn’s disease, the Low Sulfur Diet for UC, ayurvedic diets, and elimination diets. Dr. Mullin has found that patients with active Crohn’s symptoms who followed an elimination diet demonstrated an 18% higher probability of inducing remission than patients who received no diet intervention. These and other recommended diets restrict inflammatory foods such as diary, sugar, flour, red meat, poultry, alcohol, and caffeine, which are known to further irritate the lining of the digestive tract. Eating an anti-inflammatory and nutrient-rich diet high in fruit and vegetables, fish, fiber, and omega-3 fatty acids is generally recommended.

Stress has been shown to alter gut permeability and impact the modulation of the immune system. Several studies have shown a positive association between the perception of stressful events and IBD flares. Dr. Mullin emphasizes the importance of measuring stress levels and sleep quality, saying “stress through the sympathetic nervous system will increase the inflammatory response, especially in people with genetic and microbiome susceptibilities.”

Lifestyle modifications that reduce stress can decrease inflammation and promote health. Exercise and mind-body practices such as meditation, tai chi, and yoga have been shown to lessen stimulation of the body’s sympathetic nervous system, also known as the “flight or fight” response. Yoga is known to decrease anxiety in children with IBD, and relaxation techniques such as imagery and deep breathing can be helpful as well. A 2008 study found a reduction of corticosteroid requirements after 12 sessions of gut-focused hypnotherapy for Crohn’s patients. These practices allow the body's innate healing systems to function more effectively and can be especially helpful tools for improving quality of life for those with more severe disease.

Research has shown that acupuncture can improve quality of life measures among patients with Crohn’s disease. Acupuncture is believed to impact inflammatory mediators and alleviate pain through the stimulation of points, known as acupoints, that coincide with nerve cells. Studies have shown stimulation of certain acupoints can improve abdominal pain and diarrhea associated with increased intestinal sensitivity; following acupuncture, the intestinal microbial composition begins to normalize and levels of pro-inflammatory molecules are significantly reduced.

These practices allow the body’s innate healing systems to function more effectively.

Certain supplements can be effective in managing IBD. A number of anti-inflammatory agents are known to repair and restore the gut lining, including herbs, spices, nutraceuticals, and botanicals such as omega-3 fatty acids, vitamin D, boswellia, wormwood, ginger, and curcumin, found in turmeric. A systematic review of 26 randomized controlled trials and 3 controlled trials for herbal medicine published in the Journal of Crohn’s and Colitis concluded that the most effective were wormwood herbal therapy for Crohn’s disease and plantago ovata and curcumin herbal therapies for UC. Dr. Mullin liberally prescribes curcuminoids, saying “turmeric is a no-brainer . . . you want at least 2,000 mg a day.”

Omega-3 fatty acid supplements have been shown to significantly reduce relapse of Crohn’s disease when taken by children, along with 5-ASA medications, the first-line pharmaceutical therapies for IBD. Malabsorption of essential nutrients is very common in IBD patients, so Dr. Mullin recommends evaluating levels and supplementing with at least 2000 IU of vitamin D per day if needed.

Evidence for clinical efficacy of probiotics is limited, but preliminary data have shown that certain probiotics may benefit IBD patients by strengthening the intestinal barrier. Clinical trials have found prebiotics and probiotics benefit patients with UC, but research has not shown a similar benefit for Crohn’s patients.

Managing an inflammatory bowel disease such as Crohn’s or ulcerative colitis requires a multi-pronged approach. Dr. Mullin likens addressing IBD to a journey of discovery, determining which tools will best support the individual through the healing process.

After Meghan Telpner’s 2006 diagnosis, she changed her diet and lifestyle and felt better within a few months. The changes she made, adopting an integrative healing protocol, became a sustained way of life for her, and she reports she has lived symptom-free for more than 10 years. Her experience inspired her to become a holistic nutritionist and help others achieve optimal health. She has written two best-selling books and founded the Academy of Culinary Nutrition.

Telpner says, “I am not afraid of Crohn's and should it come back into my life, I won't regret the efforts I have made over the last decade. Health is not a guarantee, but our efforts are insurance. With every deposit in the health bank account, we are building up our resiliency.”