Crohn's disease is a relapsing systemic inflammatory disease that primarily affects the gastrointestinal tract, with associated extraintestinal manifestations and immune disorders. Together with ulcerative colitis, they are the two main components of inflammatory bowel disease.
It is a disease that mainly affects the gastrointestinal tract and frequently presents with abdominal pain, fever, and clinical signs of intestinal obstruction or diarrhea with the passage of blood or mucus, or both.
What are the causes?
Genetics
Familial aggregation has been known for over 70 years. So far, genome-wide association studies and computer-aided meta-analyses have identified and confirmed 71 susceptibility loci for Crohn's disease on 17 chromosomes.
Environmental factors
In addition to genetics, various causes are possible, mainly related to lifestyle. The importance of the environment is suggested by the increase in incidence rates in previously less affected ethnic groups, such as Asians and Hispanics, and in immigrants moving from low-incidence regions to areas with a traditionally high incidence.
Exposure to air pollution, a Western diet with excessive consumption of processed foods (often containing high amounts of sugar and polyunsaturated fats), and increased tobacco use are some of the factors most implicated.
Crohn's disease often occurs after an infectious gastroenteritis and in individuals with intestinal dysbiosis.
Scientific research on animals suggests that viral infections, as an environmental factor, could also convert genetic susceptibility into the development of the disease.
Microbiota and intestinal health
Crohn's disease appears to result from an altered interaction of the intestinal microbiota, which is normally in a state of symbiotic reciprocity with the human host.
Smoking
Patients with Crohn's disease must stop smoking. Smoking promotes an aggravated course of the disease and a suboptimal response to medical therapy.
Nutrition
Following an alteration of the intestinal mucosa, nutritional deficiencies may often be present and therefore must be addressed and corrected. Let's analyze the various food groups in detail.
Cereals
Research suggests that a high-fiber diet may reduce the risk of developing inflammatory bowel disease (IBD).
But once an IBD diagnosis is received and the disease is active, fiber can be a problem. Insoluble fiber, found in fruit and vegetable skins, seeds, dark leafy vegetables, and whole-grain products, can increase diarrhea and abdominal pain.
According to the Crohn's and Colitis Foundation of America (CCFA), people with Crohn's disease might benefit from a low-fiber, low-residue diet plan to help manage intestinal constriction or acute symptoms.
Fruits and vegetables
These foods can cause problems for the same reason as whole grains: high insoluble fiber content.
However, it is not necessary to eliminate every fruit and vegetable from the diet, but rather to limit some such as:
- apples with skins
- broccoli
- cabbage
- cauliflower
- artichokes
- cherries
- peaches
- plums
Proteins and meat
The selection of proteins should be based on fat content, so meats with a higher fat content should be avoided, such as:
- red meat
- sausages
Dairy products
People with Crohn's disease should limit dairy products or avoid them entirely. This is because lactose intolerance tends to coincide with IBD.
Lactose, milk sugar, can increase the risk of gas or abdominal pain and diarrhea.
Beverages
Considering the nature of Crohn's disease, it is generally a good idea to drink more fluids. The best beverage is undoubtedly still water. Remember that dehydration is often a risk in the case of chronic diarrhea. Instead, avoid drinking:
- coffee
- black tea
- wine, liquor, and beer
Spices
Spicy foods can act as irritants for some and worsen symptoms. As a general rule, you should avoid anything too spicy. On the other hand, turmeric (or curcumin) has been linked to minimizing Crohn's disease flare-ups in preliminary studies.
New areas of Crohn's research include:
- the use of probiotics
- the intake of omega-3s found in fish and flaxseed oil
- fish
- fibrous foods like psyllium that are not digested until they reach the colon
- medium-chain triglycerides found in coconut
- a low-FODMAP diet
It is important to consider that it is not just what you eat that can aggravate symptoms. The way you cook and process your food can also make a difference. Fried and fatty foods are commonly reported as flare-up culprits, so it is better to opt for baked and grilled foods instead.
Bibliography
- Prof Daniel C Baumgart et al. (2012). “Crohn's disease”. Lancet, Volume 380, Issue 9853
- A Franke, DP McGovern, JC Barrett, et al. (2010). “Genome-wide meta-analysis increases to 71 the number of confirmed Crohn's disease e susceptibility loci” Nat Genet
- A Dignass, G Van Assche, JO Lindsay, et al., the European Crohn's and Colitis Organisation (ECCO). “The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: current management” J Crohn's Colitis, 4 (2010)
- Cox et al. (2017). “Fermentable Carbohydrates [FODMAPs] Exacerbate Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease: A Randomised, Double-blind, Placebo-controlled, Cross-over, Re-challenge Trial.” ). J Crohns Colitis.
- Lirong Zeng et al. (2017). “Macronutrient Intake and Risk of Crohn’s Disease: Systematic Review and Dose–Response Meta-Analysis of Epidemiological Studies” Nutrients