The diet for Crohn's disease is NOT a cure, but a method of prevention or reduction of acute conditions.
What is Crohn's disease?
Crohn's disease is a disorder that can affect the entire digestive tract, from the oral cavity to the anal orifice. Statistically, the most affected tract is the intestine and, to be precise, the portion of the terminal ileum (final tract of the small intestine) and the large intestine.
Certain complications, manifested in the acute phase, can seriously compromise the metabolism and the organs surrounding the affected area (peritoneum, bladder, urethra, uterus, etc.).
NB. It is very important to underline that, in the non-acute phase, Crohn's disease does not cause major problems; only at the time of the transition to the acute phase, can symptoms and complications occur, which we will discuss later.
Why Does It Arise?
Like ulcerative rectal colitis, Crohn's disease is a chronic and inflammatory disease of which, for the moment, both the precise etiology and the definitive cure are unknown.
The only certainties concern:
- The involvement of the immune system in the mucosa which, inappropriately activated by the presence of physiological bacterial flora, acts negatively by damaging the tissue.
- Genetic predisposition (alteration of the NOD2 gene).
- Some environmental factors including, above all, the use of non-steroidal anti-inflammatory drugs and smoking.
Symptoms and Diagnosis
For further information: Crohn's disease symptoms
Crohn's disease occurs mainly at a young age, but atypical cases of late detection cannot be excluded.
The very first symptoms are: fever, dull pain that worsens on palpation (located in the abdominal area, lower right quadrant) and diarrhea, sometimes with the presence of occult blood.
The diagnosis is not complex and first of all concerns the tactile perception of irregular and painful masses in the right iliac fossa. If associated with other symptoms such as: fever, diarrhea and, in some cases, early signs of malabsorption, it requires an assessment with contrast ultrasound and / or mucosal biopsy.
The diagnosis must necessarily exclude other disorders with similar or overlapping symptoms (ulcerative rectum colitis and infectious appendicitis).
Complications and Therapy
Particularly aggressive Crohn's disease, ignored or not properly treated, can lead to some serious complications.
By affecting the digestive tract, in particular the intestine, it is inevitable that Crohn's disease can have a negative impact on the nutritional status of the carrier, leading to possible deficiencies.
The picture of Crohn's disease induced malabsorption could be:
- Generic: if the disease also involves the small intestine.
- Limited: if it affects only the terminal ileum and the large intestine.
Moreover, as anticipated in the introduction, Crohn's disease can cause anatomical alterations of the digestive tract. These include: stenosis, fistulas, perforation and abscesses, which require surgical intervention.
Skin impairments such as erythema nodosum or others such as arthritis, liver lesions, decreased serum albumin and venous thrombosis are not uncommon.
Returning to the nutritional complications, it is necessary to emphasize that the impairment of the intestinal balance caused by the disease causes watery diarrhea and, sometimes, steatorrhea.
It is therefore deducible that the picture of malnutrition can be quite heterogeneous and lead to various problems, some of which are anything but negligible.
Consequences of Malabsorption
In fact, in addition to the specific shortcomings (which we will deepen later), a serious one intestinal malabsorption caused by Crohn's disease is capable of causing
- Growth retardation in growing subjects.
- Defedation or, in the most serious cases, cachexia.
Mortality from Crohn's disease is estimated at 5-10% and, being a chronic partially idiopathic disease, there is currently no definitive cure.
However, certain derivatives of aspirin, corticosteroids and immune system suppressants are used.
For further information: Medicines for the treatment of Crohn's disease
Vitamin B12 deficiency
The area most affected by Crohn's disease is the terminal ileum, which is the tract in which Vitamin B12 or cobalamin is captured and where the bile salts released by the gallbladder during digestion are reabsorbed.
Being involved in a multitude of cellular metabolic processes, any cobalamin deficiency can have very serious consequences. Together with the so-called intrinsic factor (secreted in the stomach), vitamin B12 makes up the erythrocyte maturation factor, intended for the maturation of red blood cells in the bone marrow.
Moreover, cobalamin is involved in the synthesis of nucleic acid DNA and regulates the metabolism of carbohydrates, lipids and proteins.
Recall that, in a healthy subject, vitamin B12 should be stored in the liver in large quantities; therefore, the deficiency would only manifest itself in the long term. However, contrary to a physiological picture, in Crohn's disease the trophism of these reserves is inexorably compromised; this is why the most frequent nutritional drawback of this pathology concerns the alteration of red blood cells and the worsening pernicious anemic state; sometimes, if concomitant with an iron deficiency, anemia can also be iron deficient.
Others signs related to vitamin B12 deficiency are: weakness, paleness, jaundice, fatigue, smooth, itchy and very red tongue, tingling, reduced pain perception, irritability, headache, tendency to depression, decreased mental efficiency, impaired balance and sleep disturbances.
Last but certainly not least, the possible alteration of the fetus during pregnancy. Being a very important cellular metabolic factor in nucleic synthesis, vitamin B12 deficiency increases the possibility of irreversible malformations up to five times.
It follows that a pregnant woman with Crohn's disease must necessarily integrate this vitamin more accurately than a normal one.
Reabsorption of bile salts also occurs in the terminal ileum. To tell the truth, the lack of uptake of these liquids does not involve a big problem for health; however, remaining in the intestinal lumen, these have the ability to retain a large part of the dietary fat portion, causing steatorrhea and reducing the absorption of other nutrients.
This is why some fat-soluble molecules, including mainly vitamins, are continually expelled, leaving a picture of deficiency emerging in some cases.
NB. In Crohn's disease the alteration of the intestinal bacterial flora is frequent, sometimes excessively stimulated, poorly nourished or even modified (due to steatorrhea and general impairment of the intestine). Remember that physiological bacteria are responsible, at least in part, for the production of some vitamins; this is the reason why any compromise can further worsen the supply of nutrients.
Vitamins mainly involved in lipid malabsorption are vitamin K or antihemorrhagic and vitamin D or calciferol.
Vitamin K deficiency is associated with greater coagulation difficulties, while vitamin D deficiency, being a hormonal precursor, can cause an alteration of bone metabolism (rickets, osteomalacia and osteoporosis) and increase the risk of cardiovascular diseases.
NB. It should be noted that most of the vitamin D is produced endogenously and that, except in cases where the subject is never exposed to sunlight, Crohn's disease rarely causes very serious deficiencies.
The watery diarrhea of Crohn's disease, different from the steatorrhea already described (although both are sometimes present), is mainly caused by the reduction in glucose absorption.
Unabsorbed sugars that remain in the intestinal lumen can cause two distinct side effects:
- Exercise an osmotic power on the mucosa and draw water from the tissues inside the lumen, causing diarrhea and dehydration;
- Increase the proliferation of bacterial flora due to the prebiotic effect of the sugars themselves.
The diarrhea caused by Crohn's disease is often the cause of the altered blood levels of calcium, magnesium and potassium.
This is manifested by the onset of some nervous (peripheral) and muscular discomforts; in particular, cramps and reduced contraction efficiency. We rarely reach advanced levels of deficiency that are more risky to health.
Typically, the deficiency is compensated for by the use of food supplements or parenteral solutions.
Acute Phase Diet
The diet to be adopted in the acute phase is slightly different from that for the normal phase; not so much for the type of nutrients, as for the chemical form of intake.
The only really substantial difference is that of the fiber; to be avoided absolutely in the acute phase, it is instead a valid help to prevent its onset (in the right types and quantities).
In the first case, it is necessary to rest the intestine but, contrary to what happens in ulcerative rectum colitis, it is not always necessary to adopt a type of parenteral (intravenous) nutrition.
On the contrary, if possible, the enteral one is to be preferred, that is through a probe inserted into the digestive system through the mouth, based on simplified nutrients (balanced distribution); these solutions do not require a significant digestive effort and almost do not solicit the pouring of digestive juices. A similar condition is aimed at increasing the absorption potential, at canceling / avoiding some potentially harmful food molecules and, therefore, at reducing steatorrhea, watery diarrhea and malabsorption.
The parenteral route is instead used for integration. In particular, the injections are intended for the administration of large quantities of vitamin B12 and other vitamins, almost all of which are taken up by the liver; in severe cases, the intravenous route (drip) is used to restore the salt and water balance.
Some specialists choose to enrich the liquids for enteral nutrition in the acute phase with certain specific elements, in order to provide further support to drug therapy. For example, they are often added:
- Omega 3: for their anti-inflammatory action.
- Glutamine and butyric acid (which is short-chain): for their ability to nourish intestinal cells (enterocytes).
- Prebiotics: to maintain the trophism of the saprophytic bacterial flora; in this regard, not everyone knows that, in addition to acting as a barrier against infections, these microorganisms produce vitamins and molecules that nourish the enterocytes (short-chain fatty acids and polyamines).
If the enteral diet is mixed (solutions / suspensions and foods), foods that contain:
- Lactose (milk and dairy products).
- Sugar and table salt (refined sucrose and sodium chloride).
- Poorly digestible and potentially fermentable elements (whole or whole fruit, vegetables, cereals and legumes).
- Stinging elements (capsaicin from pepper, piperine from pepper, gingerol from ginger, isothiocyanate from horseradish, allicin from garlic and onion, etc.).
- Partially carbonized molecules (Maillard compounds, acrylamide, acrolein, formaldehyde etc.).
- Mushroom toxins (many do not know that all mushrooms, even edible ones, produce a small amount of poisonous substance; moreover, these foods, especially those collected, can contain significant traces of pollutants).
- Ethyl alcohol and stimulating molecules (alcoholic beverages and beverages or foods that contain caffeine or analogues, such as theobromine, theine, etc.).
- Excess and / or low quality fats (especially hydrogenated ones, as they are sometimes rich in trans-conformation chains).
- Additives (the term is generic, but mainly those with titanium residues, considered an inflammation accelerator for Crohn's disease).
- Residual drugs or contaminants (antibiotics, pesticides, etc.).
Diet for the Chronic Phase
The common diet to be adopted in case of Crohn's disease does not require particularly difficult measures to respect.
First of all, it is essential to clarify how the food is processed. Most of the indications specified above, in the context of the acute phase, can be respected by applying suitable cooking methods.
The most correct systems are: boiling, steaming, pressure cooking, vacuum cooking, low temperature cooking and pot cooking.
To be totally eliminated: frying, grilling and grilling.
To be moderated: stewing and braising, sautéing (unless using parchment paper), roasting in the oven (unless using a bag).
In this way it is possible to avoid both the excess of fats and the introduction of toxic catabolites.
Even during the asymptomatic phase, Crohn's disease needs some little attention. If responsible for adverse reactions, it is better to exclude milk and dairy products, i.e. foods that contain significant quantities of lactose.
Limit or eliminate the use of sugar and table salt, stinging spices, alcoholic beverages, and foods or beverages that contain stimulants.
Being able to choose, it is better to focus on products with good traceability and which guarantee the absence of pollutants, contaminants and pharmacological residues; the same applies to additives, especially those containing traces of titanium. Many are oriented on the "Organic" but also other disciplinary, if fully respected, can be adequate; we recommend foods of your country or European origin. Better to limit the mushrooms for the reasons already set out.
Energy and nutritional breakdown are the classic ones, such as the breakdown of calories in the various meals.
What must never be missing in the diet for Crohn's disease is a good dose of prebiotic molecules, necessary for the trophism of the intestinal bacterial flora. Among these, different types of carbohydrates and soluble fibers stand out; on the contrary, it is better to pay attention to insoluble ones (bran, peel of legumes, fruit and vegetables, etc.) which, due to a side effect, can increase the risk of diarrhea, meteorism and abdominal pain. The same is true for omega 3 essential fatty acids (for their anti-inflammatory capacity) and for natural antioxidants (very useful in the fight against free radicals, inflammation and neoplastic transformation).