Crohn's Disease vitamins, herbs, supplements, natural and alternative treatment, remedy review of diet and foods
July 14 2016 by
Ray Sahelian, M.D.

Crohn's disease is a chronic inflammatory condition involving the small intestine, most often the lower part called the ileum. However, inflammation may also affect the entire digestive tract, including the mouth, esophagus, stomach, duodenum, appendix or anus. It is also called ileitis or enteritis and affects about half million Americans, many aged 15 to 35 years.

Diet and food - does what we eat influence this condition?
Although diet may affect symptoms in patients with Crohn's disease, it is unlikely that diet is responsible for causing the illness. Children who don't consume enough vegetables and fruits are more likely to have severe problems than those who eat a good amount of fresh produce. Some studies show children who eat lots of vegetables, fruits, fish and dietary fiber are significantly more protected compared with those with the lowest intake of these foods. Reducing intake of concentrated milk fats could provide benefits. It may be a good idea to reduce sugar and fried food intake, and, in general, any type of fast or junk foods. It may be also a good idea to reduce intake of meat if that happens to be a large part of one's diet.

Exercise benefits Crohn's disease patients, regular physical activity
Light exercise such as walking may be helpful for some people. People with mild Crohn's disease who take a walk a few times per week notice an improved sense of well-being and quality of life.

Supplements that may be helpful
Research regarding the use of dietary supplements in the treatment of Crohn's disease is limited. I continue to update this page as I come across more studies regarding the natural treatment of this condition.

Curcumin is an extract found in turmeric which has anti-inflammatory properties.
Fish Oils have beneficial fatty acids called EPA and DHA but research has not provided consistent results.
Vitamin D - many patients with Crohn's disease are deficient in vitamin D and may benefit from supplementation or sun exposure of half an hour a day. John White, an endocrinologist at the Research Institute of the McGill University Health Centre, led a team of scientists from McGill University and the Université de Montréal who present their findings about the inflammatory bowel disease in the January 2010 Journal of Biological Chemistry. "Our data suggests, for the first time, that Vitamin D deficiency can contribute to Crohn's disease," says Dr. John White, a professor in McGill's Department of Physiology, noting that people from northern countries, which receive less sunlight that is necessary for the fabrication of Vitamin D by the human body, are particularly vulnerable to this condition.
Probiotics may be helpful in some people. The combination of prebiotics such as inulin and probiotics could offer some relief for patients with Crohn's disease.
Vitamin B12 abnormalities are common in patients, especially those with a prior ileal or ileocolonic resection are at particular risk for vitamin B12 deficiency.
Mastic could be considered.

Curcumin and Crohn's disease
Curcumin therapy in inflammatory bowel disease: a pilot study.
Dig Dis Sci. 2005. Holt PR, Katz SR. St. Luke's Roosevelt Hospital Center, Columbia University and Strang Cancer Center Research Laboratory, New York, New York.
Curcumin has been shown to have anti-inflammatory and antioxidant properties in cell culture and animal studies. A pure curcumin preparation was administered in an open label study to five patients with ulcerative proctitis and five with Crohn's disease. All proctitis patients improved, with reductions in concomitant medications in four, and four of five Crohn's disease patients had lowered CDAI ( crohn's disease activity index ) scores and sedimentation rates.

Fish oil and Crohn's disease
Omega 3 fatty acids for maintenance of remission in Crohn's disease.
Cochrane Database Syst Rev. 2009.
The anti-inflammatory effects of n-3 (omega-3 fatty acids, fish oil) have been suggested to be beneficial in chronic inflammatory disorders such as inflammatory bowel disease. To systematically review the efficacy and safety of n-3 for maintenance of remission in Crohn's disease (CD). Databases were searched from their inception without language restriction. Randomized placebo-controlled trials (RCT) of n-3 for maintenance of remission in CD were included. Studies must have enrolled patients of any age group, who were in remission at the time of recruitment, and were followed for at least six months. The intervention must have been fish oil or n-3 given in pre-defined dosage.  Omega 3 fatty acids are safe but probably ineffective for maintenance of remission in CD. The existing data do not support routine maintenance treatment of Crohn's disease with omega 3 fatty acids.

Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn's disease.
Am J Clin Nutr. 2004.
Crohn's disease is associated with osteoporosis and other extraintestinal manifestations that might be mediated by cytokines from circulating (peripheral blood) mononuclear cells (PBMCs). Fish oil rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) reduces disease activity in patients with Crohn's disease. We investigated the effect of fish oil plus antioxidants on cytokine production by PBMCs from patients with Crohn's disease with raised C-reactive protein concentrations or erythrocyte sedimentation rates (>/=18 mm/h). A randomized placebo-controlled trial of fish oil (2.7 g EPA and DHA/d) or placebo (olive oil) for 24 weeks was conducted in patients with Crohn's disease. The fish-oil group additionally received an antioxidant preparation (vitamins A, C, and E and selenium). Exclusion criteria included corticosteroid use. Fish-oil plus antioxidant dietary supplementation was associated with higher EPA and DHA incorporation into PBMCs and lower arachidonic acid and lower production of IFN-gamma by mitogen-stimulated PBMCs and of PGE(2) by lipopolysaccharide-stimulated PBMCs. Dietary supplementation with fish oil plus antioxidants is associated with modified PBMC composition and lower production of PGE(2) and IFN-gamma by circulating monocytes or macrophages. The response of extraintestinal manifestations of Crohn's disease should be investigated in a randomized controlled trial.

Vitamin D and Crohn's disease
Vitamin D status in children and young adults with inflammatory bowel disease.
Pediatrics. 2006. Center for Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA, USA.
Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report the prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration < or = 15 ng/mL) in a large population with inflammatory bowel disease, factors predisposing to this problem, and (3) its relationship to bone health and serum parathyroid hormone concentration. Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn's disease. The long-term significance of vitamin D deficiency for this population is unknown at present and merits additional study.

Prebiotics and probiotics
High dose probiotic and prebiotic cotherapy for remission induction of active Crohn's disease.
J Gastroenterol Hepatol. 2007.
This study assessed the clinical usefulness of combined probiotic and prebiotic therapy in the treatment of active Crohn's disease. Ten active outpatients without history of operation for Crohn's disease were enrolled. Their mean age was 27 years and the main symptoms presented were diarrhea and abdominal pain. Patients' initial therapeutic regimen of aminosalicylates and prednisolone failed to achieve remission. Patients were thus initiated on both probiotics (75 billion colony forming units [CFU] daily) and prebiotics (psyllium 10 g daily). Probiotics mainly comprised Bifidobacterium and Lactobacillus. Patients were free to adjust their intake of probiotics or prebiotics throughout the one year trial. Seven patients had improved clinical symptoms following combined probiotic and prebiotic therapy. Six patients had a complete response, one had a partial response, and three were non-responders. Two patients were able to discontinue their prednisolone therapy, while four patients decreased their intake. High-dose probiotic and prebiotic cotherapy can be safely and effectively used for the treatment of active Crohn's disease.

Boswellia not effective
Inflamm Bowel Dis. 2010. Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn's disease: Good safety profile but lack of efficacy. Department of Gastroenterology, Diabetes and Internal Medicine, Hospital Porz am Rhein, Cologne, Germany.

Cause of Crohn's disease - could it be a bug?
The cause is not fully understood. Perhaps an infection by certain bacteria, such as strains of mycobacterium, may be the cause, but scientists are still trying to find out.
   In Sardinia, Italy, the majority of patients with Crohn's disease harbor Mycobacterium avium subspecies paratuberculosis in their intestinal mucosa, according to a report in the July, 2005 of the American Journal of Gastroenterology. Dr. Leonardo A. Sechi and colleagues from Universita degli studi di Sassari, Italy, detected M. avium subspecies paratuberculosis (MAP) in fresh intestinal mucosa biopsies from 30 patients with Crohn's disease and 29 control patients. Twenty-five patients (83%) with Crohn's disease tested positive for MAP by PCR compared with only 3 control patients (10%). Two additional patients with ulcerative colitis tested negative for MAP. 
   Dr. Kenneth W. Simpson, from Cornell University in Ithaca, New York, and colleagues used DNA analysis to compare the intestinal microbial flora in patients with Crohn's disease and in healthy subjects. They found an increase in the intestinal levels of a new type of infectious Escherichia coli bacteria, along with a depletion of Clostridium bacteria. The severity of the disease in the small intestine was directly related to the number of E. coli present. These findings suggest that a new group of E. coli contains opportunistic pathogens that might be the cause of chronic intestinal inflammation in susceptible individuals, The ISME Journal: Multidisciplinary Journal of Microbial Ecology, July12, 2007.

A bacterium that causes intestinal illness in cattle and sheep could also be responsible for Crohn's disease. Crohn's disease is an inflammation in the small intestine that affects about a million people worldwide. Scientists are not sure what causes it but they suspect it is due to a reaction by the body's immune system to a virus or bacterium. Dr Saleh Naser and researchers at the University of Central Florida in Orlando believe it is due to a bacterium called Mycobacterium paratuberculosis that is found in cattle, sheep and goats suffering from an illness called Johne's disease.

Role of cigarette smoking
The chronic intestinal inflammation that characterises Crohn's disease arises from a complex interplay between host genotype, the immune system, and the intestinal microbiota. In addition, environmental factors such as smoking impact on disease onset and progression. Individuals who smoke are more likely to develop CD, and smoking is associated with recurrence after surgery and a poor response to medical therapy.

Crohn's symptom
Symptoms of this inflammatory bowel disease include digestive problems such as abdominal pain, abdominal cramping, abdominal swelling, abdominal tenderness, nausea and vomiting, diarrhea, gastrointestinal or rectal bleeding, weight loss, fever, and anemia. Patients face a higher risk of both colorectal cancer and small bowel cancer.

Medical treatment
Clin Colon Rectal Surg. 2013. Medical Management of Crohn Disease. CD is one of the major subtypes of inflammatory bowel disease and can occur in any segment of the alimentary tract. There have been significant advances in the medical therapy of CD over the past several decades. For mild CD, the oral corticosteroid derivative budesonide has demonstrated superior efficacy compared with traditional therapies such as 5-aminosalicylic acid, and can be used concurrently with these agents. For the management of moderate to severe disease, the immunomodulators azathioprine, 6-mercaptopurine, and methotrexate, as well as the antitumor necrosis factor-alpha (TNF-α) agents infliximab, adalimumab, and certolizumab pegol, have become the mainstay of therapy, with growing interest in combining these agents for maximal effect. Immunomodulators and anti-TNF-α agents have also demonstrated benefit in fistulizing CD. There has been growing evidence suggesting that both of these agents, along with the antibiotics metronidazole and ornidazole, are also effective in preventing postoperative recurrence of CD.

Diagnostic test
Results from two studies in 2016 further validated neutrophil CD64 as a highly specific biomarker for Crohn's disease severity in children and adolescents.

Studies
According to a study published in the American Gastroenterological Association journal Clinical Gastroenterology and Hepatology, the addition of popular bone building drugs to calcium and vitamin D therapy to treat bone loss associated with Crohn's disease is not beneficial. Moreover, the study shows that calcium and vitamin D treatment alone can improve bone mineral density (BMD) in Crohn's patients by 3 to 4 percent per year. "Patients often suffer loss of bone mass and an increased number of bone fractures due to treatment with corticosteroids, poor nutrition, active inflammation and calcium and vitamin D deficiencies," said Charles Bernstein, MD, author of an editorial appearing in this month's journal. "Calcium and vitamin D have long been used to enhance bone mass in people with Crohn's, and findings of these studies show it to be sufficient in maintaining BMD in these patients." Crohn's disease is an inflammatory bowel disease that causes chronic inflammation of the intestinal wall. While the cause of Crohn's is relatively unknown, it usually starts during the teenage years or early adulthood and is characterized by pain in the abdomen, diarrhea and weight loss. According to results of the study from researchers at the University of Alberta, adding the bone-building drug etidronate (Ditronel) to calcium and vitamin D therapy to treat bone loss adds no additional benefit.

Emails
Is there any research that mangosteen extract is good for Crohn's disease?
   As of 2014, I have not seen any studies that mangosteen extract has been tested for this medical condition.

I suspect the disease is caused - at least in some people - by an imbalance in the microbial flora. Specifically, it starts with Mycobacterium avium ssp. paratuberculosis, as you note (there are simply too many similarities with Johne's disease to ignore it), but somewhere along the lines, other bacteria get involved- I think. Anyway- net upshot: too much sugar, and the wrong types of carbohydrates. See also: Elaine Gottschall's "Specific Carbohydrate Diet," written in "Breaking the Vicious Cycle." A similar diet, the Paleolithic Diet, excludes many oligosaccharides and eschews added sugar. The main difference is that the Specific Carbohydrate Diet strongly encourages home-made yogurt (which has a number of obvious benefits, but has also been shown to reduce problems on a cellular level- the probiotics are tumor necrosis factor inhibitors, same as the nasty injectibles like Humira and Remicade but without the gross side-effects like, er, death), while the Paleolithic Diet eschews fermented foods. Note too that the Atkins diet reportedly worked for 85% of the people Atkins studied; I do not think he published this anywhere, but the reason is obvious: removal of the excess sugars from the diet. I think it is consistent with the concept that the disease is- at least in some Crohn's sufferers- rooted in a microbial imbalance. Starve the bacteria of their carbohydrates (no wheat, no corn, no potatoes, no rice, no bread, etc.), and the inflammation- mimicking an autoimmune response, same as celiac disease- is greatly reduced. Not all do well on this diet, but for the ones that do, there are some who are driven into a deep remission given enough time and an abstemious diet.
   I can't see any harm in reducing sugar intake which benefits many health conditions. Excess sugar causes inflammation.

I was diagnosed with Chron's in March 2008; I think I have had mild Chron's disorder for some time now. But the symptoms were never that severe that I had to be hospitalized until when I had to go for urgent care on weekend and 4 weeks after that, hospitalization. I have been reading various books, articles, any and every information that I can get, including SCD, Jini Patel, HSO, etc. Every website claims others to be wrong and them to be right. I found many opinions on alternative medicine and diet and HSO and various patients' experiences with different drugs and frustration.

Can noni juice aid in the healing of Cron's disease?
   I have not come across such research as of 2014.

Do soil organism supplements help with Crohn's disease symptom relief?
   See soil organisms for a review.

Some people inaccurately spell it as Cron's or Chron's disease