- Getting enough exercise;
- Eating a healthy diet;
- Kicking any tobacco habits; and
- Making sure to get your daily vitamin and nutrient requirements (as nutrient absorption can be a proble with crohns disease.
Medical Treatments for Crohn’s Disease
There is currently no cure for Crohn’s disease, and no single treatment exists that works for everyone. The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. It also seeks to improve long-term prognosis by limiting complications. A best-case scenario is that this may lead not only to symptom relief but also to long-term remission.
Anti-inflammatory drugs. Anti-inflammatory drugs are often used as a first step in treating Crohn’s disease and inflammatory bowel disease.
Corticosteroids. These include medications known as prednisone and budesonide, which can help to reduce inflammation in your body. However, they don’t work for everyone living with Crohn’s disease. They are generally used only if you don’t respond to other treatments. Doctors will prescribe prednison for short periods of about three to four months, along with other immune system suppressors, until your symptoms improve.
Immune system suppressors. These target the immune system, which produces the substance that causes inflammation. A combination of these drugs will work better for some people than one drug alone. Some of these drugs work well and might suit you lifestyle. Some examples include:
- Azathioprine, imuran, azasan, mercaptopurine, purinethol and purixan. These are the most widely used drugs to treat inflammatory bowel disease. Your doctor will check your bloods regularly while you are taking them, to see if you are developing any side effects.
- Infliximab (remicade) and adalimumab (humira). These drugs, called TNF inhibitors or biologics, work by neutralising an immune system protein known as tumor necrosis factor.
- Methotrexate (trexall). This drug is sometimes prescribed for people with Crohn’s disease who do not respond to other medication.
- Natalizumab (tysabri) and vedolizumab (entyvio). These drugs work by stopping certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. As natalizumab is associated with a rare but serious risk of progressive multifocal leukoencephalopathy — a brain disease that usually leads to death or severe disability — you must be enrolled in a special restricted distribution programme to use it. Vedolizumab was recently approved for the treatment of Crohn’s disease. While it works in a similar manner to natalizumab, however, it appears not to carry a risk of brain disease.
- Ustekinumab (stelara). This drug is used to treat psoriasis. Studies have shown that it is also useful in treating Crohn’s disease, as well sometimes being used when other medical treatments fail.
- Antibiotics. Taking antibiotics can reduce the amount of drainage required and they can heal fistulas and abbesses that may occur in people living with Crohn’s disease. Antibotics can help reduce harmful intestine bacteria that play a lead role in activating your immune system, thus causing inflammation. The most commonly prescribed antibiotics are ciprofloxacin and flagyl. Some medications help relieve the signs and symptoms of Crohn’s disease.
It is important to always speak to your doctor before you take over-the-counter medications, if you have been diagnosed with Crohn’s disease. Depending on the severity of your condition, your doctor may recommend one of the following:
- Anti-diarrheals. This is a fibre supplement, such as psyllium powder or methylcellulose, which can help relieve mild to moderate diarrhoea by adding bulk to your stool. If your diarrhoea is more severe, your doctor may recommend imodium, which is more effective.
- Pain relievers. While most doctors will advise paracetamol (tylenolo for mild pain), it is very important to check with your doctor if you are taking other pain relief, as some painkillers are likely to make your symptoms worse. They can also cause your Crohn’s disease to flare-up and add to your discomfort and poor well-being.
- Iron supplements. If your intestine starts bleeding, you might have developed iron deficiency anemia, and you may need to take an iron supplement. It is recommended that you always check with your doctor first.
- Vitamin B12 injections. If you are living with Crohn’s disease, you may have a B12 deficiency. This vitamin prevents anemia, aids normal growth and development and helps essential nerve functioning.
- Calcium and vitamin D supplements. Steroids may be used to treat your symptoms. However, as this can increase the risk of developing osteoporosis, you will need to take some calcium supplements and some added vitamin D.
Home Remedies for Crohn’s Disease
Sometimes there will be days when you will feel helpless or your Crohn’s disease will flare-up. Should this happen, this is a good diet that can help your lifestyle, living with the illness and keeping your symptoms under control.
Best Diet for Crohn’s Disease
There is no evidence to suggest that what you eat can cause inflammatory disease. However, a lot of foods can aggravate your Crohn’s disease and can cause flare-ups. It can be helpful to keep a diary to see what you eat throughout your week. If you identify any foods that cause your Crohn’s to flare-up, you should try to eliminate them from your diet. Here are some suggestions that may be of help:
- Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhoea, abdominal pain and gas can improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help.
- Try eating low-fat foods. If you have Crohn’s disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhoea worse. Try avoiding butter, margarine, cream sauces and fried foods.
- Limit fibre, if it’s a problem food. If you have inflammatory bowel disease, high-fibre foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. In general, you may experience more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn. You may be told to limit fibre or go on a low residue diet if you have a narrowing of your bowel (stricture).
- Avoid other problem foods. Spicy foods, alcohol and caffeine may make your signs and symptoms worse.
Other dietary measures
- Eat small meals. You may find that you feel better eating five or six small meals a day rather than two or three larger ones.
- Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhoea worse, while carbonated drinks frequently produce gas.
- Consider multivitamins. Multivitamin and mineral supplements can often be helpful, as Crohn’s disease can interfere with your ability to absorb nutrients and it can also limit your diet. Check with your doctor before taking any vitamins or supplements.
- Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.
Smoking increases your risk of developing Crohn’s disease, and once you have this condition, smoking can make it worse. People with Crohn’s disease who smoke are more likely to have relapses and need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as providing many other health benefits.
Although stress doesn’t cause Crohn’s disease, it can make your signs and symptoms worse and may trigger flare-ups. While it’s not always possible to avoid stress, you can learn ways to help manage it, such as:
- Exercise. Even mild exercise can help reduce stress, relieve depression and normalise bowel function. Talk to your doctor about an exercise plan that’s right for you.
- Biofeedback. This stress-reduction technique may help you reduce muscle tension and slow your heart rate, with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
- Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs to learn how to use these techniques at home.
Alternative Medicine for Crohn’s Disease
Many people with digestive disorders have used some form of complementary and alternative medicine (CAM). However, few well-designed studies are available to date to show that they are safe and effective to use.
Some commonly used therapies include:
- Herbal and nutritional supplements. The majority of alternative therapies aren’t regulated by the Food and Drug Administration. Manufacturers can claim that their therapies are safe and effective but don’t need to prove it. What’s more, even natural herbs and supplements can have side effects and cause dangerous interactions. Make sure to let your doctor know, should you decide to try any herbal supplements.
- Probiotics. While there is some evidence to suggest that some Bifidobacterium preparations may help people with Crohn’s disease to maintain remission, a number of studies have found no treatment benefits associated with probiotics. Further research is necessary to determine their effectiveness.
- Fish oil. Studies carried out on the use of fish oil in the treatment of Crohn’s disease have not shown any benefits.
- Acupuncture. Some people may find acupuncture or hypnosis helpful in the management of Crohn’s disease, but neither therapy has been well-evaluated for use within this context.
- Prebiotics. Unlike probiotics — which are beneficial live bacteria that you can consume — prebiotics are natural compounds found in plants, such as artichokes, that help fuel beneficial intestinal bacteria. Studies have not shown positive results in the use of prebiotics for people with Crohn’s disease.
Coping and Support
Knowledge is power over living with Crohn’s disease. Find the support group that suits you, seek out events so you can source new ideas and learn about new products if your a colostomy user .
Don’t just look for support groups for Crohn’s, get involved in other activities in your area (e.g men’s shed groups, creative writing, music, sports, etc.). Don’t let Crohn’s rule your outlook on life, yes it is good to talk about your Crohn’s in a supported environment, but it is just as important to get involved in other thing in life not connected to your illness. Set your self particular goals.
There are many support groups that will help you deal with living with Crohns disease and help your family to understand and support you. If they are not in your area, check out internet forums, facebook, etc. That help builds awareness so people can better understand Crohn’s.
The following sites provide provide some supports:
Get Your Gut Back On Track!
An estimated 110,000 people consume antibiotics daily in Ireland, between December/March. (Source: Health Protection Surveillance Centre).
We asked Nutritional Therapist Rosanna Davison for her Top Tips to get your gut back on track after an illness.
1. Take time out
Don’t push yourself too quickly. Remember your body needs time to rebuild its reserves and regain strength.
Take more rest than usual. If you need to sleep longer, go to bed earlier.
Cut back on non-essential activities; they can wait until you are feeling 100%.
- Embrace fibre-rich foods full of protective nutrients
Fresh vegetables and fruits are rich in dietary fibre, vitamins and antioxidants. Try eating seven to nine portions over the course of each day. Choose different colours so that you nourish your body with a variety of phytonutrients.
Eat a portion of complete protein at each meal, such as poultry, fish, eggs, beans, pulses or tofu.
Consume essential omega-3 fatty acids daily. Avocados, seeds (flax, chia) and oily fish (mackerel, wild and organic salmon), are naturally rich in anti-inflammatory fats.
- Go ‘fermented’
Fermented foods are rich in ‘friendly’ bacteria. Sauerkraut is simple to make at home or buy kefir or kimchi in your local health store.
- Reduce or eliminate sugary foods
Processed foods often contain refined sugars to enhance taste. Excess refined sugar and processed foods may encourage the growth of ‘unfriendly’ bacteria, so aim to buy and eat fresh food.
If you have a sweet tooth, try eating berries (strawberries, blackberries, blueberries, raspberries). They are rich in antioxidants and naturally low in sugar.
If you need a sweetener, try Stevia which is extracted from plant leaves and doesn’t impact blood sugar levels.
Do vegans need to take supplements?
A varied, wholesome vegan diet provides almost all essential nutrients in sufficient quantities. I hear you shouting ‘Noooo! It provides absolutely everything we need!’ and you may be right, but only if you regularly eat certain fortified foods. The sad truth is that modern food production systems and lifestyles make it more difficult for everyone – vegans or not – to get all they need from diet alone. It doesn’t mean a vegan diet is unnatural or unhealthy, in fact the opposite is true. It means that how we grow, produce and consume food has changed and, with an ever-growing population, the demands on the systems that produce our food are so high that certain nutrients become harder to obtain.
I get a lot of questions about supplements and understand why people are confused. Over the years, I’ve worked on many vegan research projects and as science and population studies reveal ever more data, the guidelines and recommendations change and evolve. Hence, what we were told 10 years ago may no longer be up-to-date and that’s why different opinions arise, depending on where and when we got our information. It’s my job to keep up-to-date, so hopefully I can bring some clarity to the supplement discussion!
So what’s needed? The trio of nutrients to keep a close eye on are vitamin B12, vitamin D and iodine. You may not need to supplement with all these, all year long, but it depends on several factors. Read on…
Vitamin B12 naturally comes from bacteria in the soil and both people and animals would traditionally have got it from eating unwashed plants. However, we not only wash vegetables before we eat them (and for good reasons), but food production is now so sanitised that most vegetables are washed in chlorine, or other sterilising solutions, so there’s not a trace of B12 left.
People are not generally aware that most farmed animals are given B12 supplements and this is how the vitamin eventually ends up in their flesh. So, the argument that meat is a natural source of B12 doesn’t really stack up as meat-eaters essentially consume B12 supplements recycled by the animals that were given them!
It is absolutely necessary that we have a reliable source of vitamin B12 for our bodies. We need it to make red blood cells, for a healthy heart and circulation, and it’s essential for the nervous system. It takes years to develop a B12 deficiency, so on one hand, you don’t need to worry about not having taken B12 for a while. On the other hand, you do need to pay attention, as when symptoms develop, it’s usually serious.
To ensure adequate intake, you should have at least 5µg (micrograms) daily from supplements or fortified foods. The B12 used in both foods and supplements is produced commercially by growing bacterial cultures in large vats – and it’s always suitable for vegans.
There are two forms of B12 in supplements – cyanocobalamin (cheap) and methylcobalamin (expensive). Cyanocobalamin is the stable ‘inactive,’ form of B12 and is used in supplements and to fortify foods and drinks. Once ingested, it’s activated by your body so it can be used. Methylcobalamin is the ‘active’ form of vitamin B12 as it does not require any metabolic reactions to be activated. It costs more and is not so stable.
So which one to choose? Unless you’re a heavy smoker, have kidney failure or any other serious condition affecting your metabolism, cyanocobalamin – the cheap form of B12 – is perfectly fine. Intakes up to 2,000µg a day are safe and you can take either a lower dose daily or a higher dose a couple of times a week.
We need vitamin D for healthy bones, teeth and muscles and it also performs other essential functions in our metabolism. It is produced in the skin when exposed to sunlight and this is the main source of vitamin D for most people. However, if you always use sun-block, cover most of your skin or live in a country, like the UK, where we don’t get enough sunlight over the winter, you need a supplement, whether you’re vegan or not.
The UK Government now recommends that we all take a supplement from October to April and, if you protect your skin ferociously over the sunnier spring and summer months, you should take a supplement all year long. Otherwise, just 20 minutes of sunlight on the face and arms is all that is required by the body to manufacture sufficient vitamin D.
Fortified breakfast cereals, bread, plant milks and vegan margarines can be useful sources if exposure to sunlight is not practicable, but may not be enough. When it comes to supplements, there are two types and your body can use both, but it’s advisable to check the source – vitamin D2 is always vegan, but vitamin D3 can be of animal origin. Many vegan foods are fortified with vitamin D2 and labelled so, but if not specified, especially on cereal products, vitamin D tends to be of animal origin. If you choose to supplement your diet, there’s a range of quality and affordable vegan supplements with vitamin D2. There are also those made from algae or mushrooms that contain D3 and these are recommended if you need a higher dose. When deciding on your dosage, 10µg per day is enough and you shouldn’t go above 25µg.
Iodine has been a hot topic lately, especially with plenty of tabloid ‘experts’ warning that vegans are missing out. This mineral is necessary for thyroid function and helps to regulate how energy is produced and used in the body.
The amount of iodine in plants depends upon the iodine content of the soil in/on which they are grown. The closer to the sea, the more iodine and therefore vegans can get enough from plant foods, but there’s no guarantee. Seaweed, which of course grows in seawater, is always a good source and includes nori, laver, dulse and the kelp family (kombu, arame, wakame). But be warned – kelp absorbs far more than other seaweeds and you can get too much iodine from it. So, while seaweed consumption is encouraged, kelp should be used only sparingly.
It’s best to use a kelp supplement so you know exactly how much iodine you’re taking – it’s cheap, reliable and you don’t have to worry about taking too much. The recommended daily intake is 140µg and intakes up to 500µg are considered safe. In many countries, iodised salt is commonly used to ensure iodine intake, but it’s not the norm in the UK.
The dairy industry has been boasting about the iodine content of cow’s milk. What they don’t tell you is that it’s not a natural component of milk, but comes from iodinated cattle feed, supplements, iodophor medication, iodine-containing sterilisers of milking equipment, teat dips and udder washes. Cow’s milk is neither a natural nor the best source of iodine, so we can happily leave all that dairy out of our diet.
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