Crohn's & Colitis
Inflammatory Bowel Disease

Inflammatory bowel disease is a common cause of discomfort and misery for tens of thousands of people in the United States. The two major types of inflammatory bowel disease are Crohn’s disease and ulcerative colitis. Because Crohn’s disease and ulcerative colitis are comparable and treated similarly, they have been combined in this chapter.

As the name implies, inflammatory bowel disease is characterized by inflammation within the gastrointestinal tract. In Crohn’s disease, the inflammation can extend to any part of the gastrointestinal tract, from the mouth to the anus. Up to 55 percent of people have Crohn’s disease that affects both the small and large intestines. In Crohn’s disease, diseased portions of the intestine often alternate with healthy intestinal areas. By contrast, ulcerative colitis is limited to the colon.

Both Crohn’s disease and ulcerative colitis typically have active periods followed by periods of remission. Conventional medical therapy relies on anti-inflammatories to provoke a remission and for remission maintenance. In serious cases, surgery may be necessary.

Fortunately, both diseases offer excellent opportunities for nutritional therapy. It is important that patients with these diseases pay careful attention to their nutritional intake, making sure to maintain healthy levels of nutrients. Many people with inflammatory bowel disease almost completely stop eating during flare-ups. Also, malabsorption of nutrients is a significant problem (especially in Crohn’s disease), making it doubly important to use supplements. Finally, a number of nutrients have been shown to reduce inflammation and possibly reduce symptoms associated with these difficult conditions.

No definitive cause has been uncovered for inflammatory bowel disease, although there is clearly an interaction among genetic, environmental, nutritional, and inflammatory factors (Marteau P et al 2004; Prehn JL et al 2004; Soderholm JD et al 2004).

Symptoms range with the severity and extent of the disease.  Most patients have crampy, loose stools which are often mixed with blood, mucous or pus.  Cramping can be intense and often associated with spasms of pain.  Patients may feel urgency to have a bowel movement and may have difficulty controlling their movements.  Often, patients report the lack of relief or feeling empty as with normal bowel movements.  Exacerbations followed by variable periods of remission are common. There may be symptoms outside of the GI tract such as rash, joint pain and swelling, muscle spasms and visual alterations.  Anemia and nutritional deficiencies are common as an inflamed gut does not absorb nutrients very well and many patients lose their desire for food during exacerbations.

Diagnosis is based on history and symptoms.  Confirmation requires a colonoscopy or flexible sigmoidoscopy and biopsy.  Even though Crohn’s and Colitis share many similar features, it is important to distinguish between the tow diseases as this impacts treatment and prognosis.  There is no blood test to diagnose inflammatory bowel disease.

The goals of conservative or non-invasive therapy are to control inflammation, correct nutritional deficiencies, and relieve symptoms such as abdominal pain, diarrhea, and rectal bleeding. Therapy may include drugs, nutritional supplementation, surgery, or a combination of approaches. Traditional treatments for inflammatory bowel disease depend on the disease’s location and severity, complications, and response to prior treatments.  In severe case, hospitalization and/or surgery may be required and can be life saving.

Conventional therapies usually consist of drugs to reduce inflammation such as, aspirin containing compounds, steroids and anti-metabolites (drugs that suppress cell function).  Unfortunately, conventional therapy does not address the causes of the inflammation which may be an imbalance in the normal bacterial “flora” resulting in toxins produced by pathogenic (bad) bacteria, nutritional deficiencies in the cells lining the bowel and other systemic causes of inflammation and nutritional deficiencies.

At the Monaco Center, we used a Functional Medicine approach to inflammatory bowel disease which addresses some of these causes and deficiencies.  It is known as the 4-R Therapy.

Remove all suspicious foods from the patient's diet that precipitate inflammation.

Repair of the damaged lining is crucial to restore normal function and prevent further damage.  The lining of the intestine is often permeable or “leaky” and allows waste products and toxins to be reabsorbed into the circulation thus creating problems in other areas of the body as well.

Replace nutrients that are often lacking and are necessary for proper function of the bowel.

Reinoculate means to restore the normal bacterial environment by reintroducing healthy bacteria into the gut. Healthy bacteria supply nutrients and protection to the lining of the intestines and are critical for normal function.

Inflammatory bowel disease also has a significant emotional component.  Exacerbations are often associated with times of increased stress.  It is important to address all areas associated with this disease: correct bowel damage, nutritional support and replacement and stress reduction.  We offer all of these modalities and feel that this offers the best chance for improvement and living a productive life.

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