Is a ‘back to basics’ dietary approach the best – and most scientific – way forward in Crohn’s disease?

Justin’s story

Mainstream medicine has very few treatment options for the debilitating inflammatory gastrointestinal condition known as Crohn’s disease. If the symptoms don’t respond to powerful anti-inflammatory and immune-suppressing drugs, which are prescribed along with antibiotics and a host of other potential pharmaceutical options, patients may progress to intestinal failure. At this point, mainstream care pathways call for surgery to remove the diseased portion of intestine. 

If Justin’s story is anything to go by, mainstream dietetic advice puts the patient on a lifelong high-calorie, low-volume diet once they leave hospital minus a portion of intestine. In other words, “Fatty, high salt, refined carbohydrate foods, such as white bread and cakes”! The idea is to compensate for the impaired absorption capacity of the shorter gut. Calorie intake is also boosted and accompanied by a specialised nutrition programme, which may be administered intravenously.

Diet and lifestyle, anyone?

What all this boils down to is that mainstream medicine doesn’t spend much time considering dietary and lifestyle triggers for Crohn’s disease – although there are exceptions. This seems to go against all common sense, which would suggest that a disease of the digestive system must be at least partially related to the history of the patient’s diet! The ‘common sense’ view might implicate trigger foods, such as wheat, sugar, dairy, spicy foods, high-lectin leguminous vegetables and pulses, solanaceous fruits and veg, such as tomatoes and aubergine, and alcohol, in the development of Crohn’s. In addition, emotional state and stress are known to play an important role in digestive capacity and inflammation. Conditions that prevent the development of adequate gut microflora, such as suboptimal intake of soluble fibre found in particular fruits and vegetables, could be yet another factor affecting long-term gut health.

It is interesting to note that the post-intestinal surgery diet recommended by dieticians avoids most typical trigger foods but is awash with sugar, wheat and dairy – a recipe for serious future health problems on top of major intestinal surgery.

Current mainstream thinking on Crohn’s describes it as an autoimmune response to disruptions in the gut flora of genetically predisposed individuals. Other proposed risk factors include smoking, younger age, being white or Ashkenazi Jewish, family history and a Western lifestyle. Only in the latter case is diet fleetingly mentioned.

Science of common sense

There are intriguing signs, however, that that the increasing body of research and clinical evidence implicating particular diets and lifestyles in both the causation and resolution of diseases like Crohn’s is beginning to influence mainstream medicine. A recent review of the literature confirms that certain foods do increase the risk of Crohn’s, while others reduce it – and that lack of evidence for a dietary component in Crohn’s is probably due to a paucity of decent research. Elsewhere, a mouse study recently showed that altering the diet can influence the gut microbiome, so triggering the development of clinical signs of disease.

Is it possible, therefore, that eating certain foods – especially in genetically susceptible populations – can trigger changes in gut flora that then lead to the autoimmune response theoretically responsible for Crohn’s? It’s an elegant theory, supported by more than one line of emerging evidence.

Taming the fire within through diet and lifestyle

It rather looks as though stories like that of Caitlin’s husband, whose Crohn’s has disappeared thanks to a change in attitude and some frankly delicious-looking recipes, are entirely scientifically plausible. A ‘back to basics’ approach like the paleo diet, which cuts out all grains and processed foods in favour of fresh fruit and veg, lean meat and seafood, also cuts out all the trigger foods commonly associated with Crohn’s while nurturing those vital gut bacteria. And guess what? People are getting results!

In fact, this theory cloesly mirrors the long-standing treatment approaches used for Crohn's and other inflammatory bowel disorders (IBDs) by the most experienced clinicians in the field of functional medicine. Leo Galland MD, a leading functional medicine practitioner, draws attention to the, "Interplay of antecedents, triggers and mediators" that is involved in IBDs. Antecedents may be broadly defined as risk factors, while "Triggers are entities or events that provoke an illness or the, emergence or exacerbations of symptoms [such as] physical or psychic trauma, microbes, drugs, allergens, foods [and more]." Combined with an understanding of the mediators, "Intermediaries that contribute to the manifestations of disease [such as] hormones, neurotransmitters, neuropeptides, free radicals, fear of pain or loss, poor self-esteem [etc.]", Dr Galland draws together the research strands covered previously into a comprehensive and rational treatment protocol.

Let’s hope that mainstream treatment protocols take notice of this new, common-sense science as soon as possible.

Call to action

• If you suffer from Crohn's disease, or another IBD, read Dr Galland's treatment protocol to learn more about the many factors that can contribute to your condition
• For further help and guidance in managing your condition, contact a functional medicine practitioner in your country. In the USA, the Institute for Functional Medicine can help you. In other countries, you should be able to find experienced and qualified functional medicine practitioners via a web search

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