Crohn’s disease is a transmural, recurring pathology of the intestinal tract. It frequently affects the ileocaecal junction area though it can span from the esophagus to the rectum. It’s defined by the appearance of wounds that will often get deeper and deeper and that can even perforate the intestinal walls (fistulas). There is currently no healing treatment available and prognosis is often not very good, with almost 30% of patients undergoing surgery for removal of some part of their intestine after 20 years of disease. Standard therapy consists in the use of antibiotics (funny, right?), cortisone and immunosuppressors such as Humira or Remicade. Due to the transmural nature of the disease, 5-ASA isn’t as effective as in Ulcerative Colitis.
Dan O’Bannon, the director of the Alien movies, suffered from this disease (which ended up claiming his life) and he actually reflected it in a very well-known scene in the history of cinema. It’s a very explicit image of what this disease represents.
As in ulcerative colitis, the pathogenesis of Crohn’s is not yet known. What is certain is that it falls under the category of autoimmune diseases. While it’s believed that in UC the body attacks its own gut flora, in Crohn’s it is thought that there might be an exogenous organism involved. So it is that back in the 90s, Ebringer scored a two for one when he attributed the pathogenesis of Crohn’s and ankylosing spondylitis to Klebsiella pneumoniae. As we mentioned in our article about spondylitis, his theories have not been considered valid for some years now, but what’s true is that a diet that cuts starch works both for AS and Crohn’s. Therefore, lets remember that these two are closely linked (we even consider them to be to different manifestations of the same disease). For what the statistics have to say, around 15% of Crohn’s patients will end up developing AS, and more than half will show sacroiliitis in x-rays.
Conventional treatment doesn’t regard any tool other than pharmacology and surgery, which is a real pity given the good results that have been obtained through other treatments and that don’t involve as many secondary effects.
Evolution of the disease: after 20 years 70% of patients have suffered perforation of the intestine. Terrible numbers. Source: Cleveland clinic.
Diet: through his diet, Seignalet brought 86% of his treated patients to remission (97% achieved some noticeable improvement). Wolfgang Lutz obtained similar results (85% of remission) with a low-carb, high-fat diet. The Specific Carbohydrate diet, which is basically the same as Ebringers no-starch diet that’s used for AS produces the same rate of remissions and is supported by serious scientific studies. At the University of Massachusetts medical school they managed to take ALL patients to remission by following an anti-inflammatory diet. Also, the Internet is full of testimonies of people successfully beating this type of diseases through ketogenic, paleo or GAPS diets. We strongly recommend reading both Seignalet’s and Ballantyne’s books, which can be bought in Amazon by clicking the images below:
Vitamin D: supplementing with vitamin D keeps intestinal permeability within a constant range and prevents relapses, say several studies. Patients with Crohn’s typically have very low levels of vitamin D and are exposed to higher risk of osteoporosis due to their high consumption of cortisone. Our favourite Vitamin D brand is sold here.
Curcumin: in one of many studies, 4 out of 5 patients of Crohn’s reached remission after taking curcumin. In another, they maintained remission more effectively with curcumin than with 5-ASA. Buy our favourite brand of Curcumin here.
Boswellia: an excellent study shows that Boswellia is more effective than 5-ASA for the treatment of Crohn’s. On the other hand we also know that the effectiveness of Boswellia for treating ulcerative colitis is well proved in three different studies. Buy our favourite Boswellia brand here.
LDN: In two studies 70% of the patients had marked improvement and 30% of them reached remission, which was subsequently confirmed by later studies. Besides, LDN has no secondary effects, which contrasts with certain AntiTNF therapies such as Humira, that induces remission in 25-30% of patients but has potentially lethal secondary effects.
Probiotics and fecal transplants: evidence regarding probiotic use in Crohn’s disease is scarce and rather out of context, however, this doesn’t mean that they aren’t beneficial for certain patients. With the knowledge we have, we simply can’t recommend any one in particular to all patients in general. Same goes for fecal transplants: 60% of people who try it respond to it, but only those who combine it with dietary changes maintain remission. We therefore do not recommend fecal transplant to people who cannot commit to following a diet. It isn’t very clear why the manipulation of gut flora in this disease is not as effective as in ulcerative colitis. Our theory is that (at least in most of the cases) there is an external agent involved in the pathogenesis that isn’t eliminated by probiotics or fecal transplants.
Spectacular anal fistula seen under stain in a HLA-B27 positive patient with adjacent Behcet disease. Fistulas are characteristic of advanced disease and their treatment is very complex.
Vaccine: for years there has been work in preparation for the launching of a vaccine to fight a bacteria called Mycobacterium avium subsp paratubercolosis, which provoques a disease that is identical to Crohn’s in animals. The problem is that only 50% of the patients with Crohn’s test positive to this bacteria. In the past, studies designed to treat that bacteria with antibiotics have been very successful, thus we are optimistic about it’s future. We believe that some of the ill will benefit from this vaccine. You can follow its development on:
Results of the MAP treatment with antibiotics in Crohn’s patients. A higher effectiveness is expected from the vaccine. Source: The Crohn Infection
Our treatment for Crohn’s disease:
- Hypoallergenic diet such as Paleo, SCD, no-starch, etc, emphasizing on the reduction of carbs. Read this and this book.
- Boswellia: 1600 mg of boswellic acid per day, taken in three times with meals.
- Curcumin: 3000 mg of curcuminoids per day.
- Intermittent fasting 16/8.
- Vitamin D: 2000 U per day, ramping up to 5000 in winter.
Other therapies such as Low-dose Naltrexone, fecal transplants and probiotics must be decided upon depending on each individual case.
As prevention strategies we recommend avoiding giving birth by c-section (as this prevents good bacteria passing from the mother to the child), avoiding antibiotics and promote a long breastfeeding period (at least 18 months). All these factors have been linked to Crohn’s disease. It is especially shocking that Crohn’s patients have on average used four times as many antibiotics as the healthy population.
The most effective drugs are in our opinion Sulfasalazine for milder cases and Humira for the more serious ones.
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