The Crohn's disease diet is NOT a cure but a method of preventing or reducing acute.
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 section is the intestine and, to be precise, the portion of the terminal ileum (final section of the small intestine) and the large intestine.
Certain complications, manifested in the acute phase, can seriously affect the metabolism and the organs surrounding the affected area (peritoneum, bladder, urethra, uterus, etc.).
NB . It is very important to point out 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, the symptoms and complications that we will discuss later can occur.
Why does it arise?
As well as the 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 ignored.
The only certainties concern:
- The involvement of the immune system in the mucosa that, inappropriately activated by the presence of the physiological bacterial flora, intervenes negatively 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
To learn more: Symptoms Crohn's disease
Crohn's disease occurs mainly at a young age, but atypical cases of late detection cannot be ruled out.
The very first symptoms are: fever, dull pain that worsens on palpation (located in the abdominal area, right lower quadrant) and diarrhea, sometimes with occult blood.
The diagnosis is not complex and concerns, in the first instance, 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 mucosa biopsy.
The diagnosis must necessarily exclude other disorders with similar or overlapping symptoms (ulcerative rectal colitis and infective appendicitis).
Complications and Therapy
A particularly aggressive, ignored or not properly treated Crohn's disease can lead to some major complications.
By affecting the digestive tract, particularly 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 malabsorption induced by Crohn's disease may 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 determine anatomical alterations of the digestive tract. These include: strictures, fistulas, perforation and abscesses, which require a surgical surgical intervention.
Cutaneous impairments such as erythema nodosum or others such as arthritis, liver lesions, reduction of serum albumin and venous thrombosis are not uncommon.
Returning to nutritional complications, it is necessary to underline that the impairment of the intestinal balance caused by the disease causes watery diarrhea and, sometimes, steatorrhea.
It can therefore be deduced 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 deficiencies (which we will examine later), a severe intestinal malabsorption caused by Crohn's disease is able to cause
- Growth retardation in growing individuals.
- Defedation or, in the most serious cases, cachexia.
Mortality from Crohn's disease is estimated at 5-10% and, being a partially idiopathic chronic disease, there is currently no definitive cure.
However, certain derivatives of aspirin, corticosteroids and suppressors of the immune system are used.
To learn more: Drugs 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 section in which Vitamin B12 or cobalamin is captured and where the bile salts emitted by the gall bladder are digested during digestion.
Being involved in a multitude of cellular metabolic processes, a possible cobalamin deficiency can have very serious consequences. Together with the so-called intrinsic factor (secreted in the stomach), vit B12 composes 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, vit B12 should be stored in the liver in large quantities; therefore, the shortage would manifest itself only 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 inconvenience of this pathology is the alteration of red blood cells and the aggravating pernicious anemic state; sometimes, if concomitant with iron deficiency, anemia can also be iron deficiency.
Other signs related to vitamin B12 deficiency are: weakness, pallor, jaundice, fatigue, smooth, itchy and very red tongue, tingling, reduced perception of pain, irritability, headache, tendency to depression, reduced mental efficiency, impairment of balance and changes in sleep.
Finally, but certainly not less important, the possible alteration of the fetus during pregnancy. Being a very important cellular metabolic factor in nucleic synthesis, the deficiency of vit B12 increases up to five times the possibility of irreversible malformations.
It turns out that a pregnant woman with Crohn's must necessarily supplement this vitamin more accurately than a normal one.
Other Vitamins
Bile salt reabsorption also occurs in the terminal ileum. To be sure, the failure to capture these liquids does not pose a major health problem; however, remaining in the intestinal lumen, these have the ability to retain most of the fatty food portion, causing steatorrhea and reducing the absorption of other nutrients.
This is why some liposoluble molecules, including mainly vitamins, are continuously expelled, leaving in some cases, a picture of deficiency.
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 bowel compromise). Recall that physiological bacteria are responsible, at least in part, for the production of some vitamins; this is the reason why a possible compromise is able to further worsen the supply of nutrients.
The vitamins mainly involved in lipid malabsorption are vitamin K or anti-haemorrhagic and vitamin D or calciferol.
The lack of vitamin K can be associated with a greater difficulty in coagulation, while that of vitamin D, being a hormonal precursor, can cause an alteration of bone metabolism (rickets, osteomalacia and osteoporosis) and increase the risk of cardiovascular disease.
NB . It is necessary to specify that the majority of vitamin D is produced at an endogenous level and that, except in cases where the subject is never exposed to sunlight, rarely Crohn's disease causes very serious deficiency.
Diarrhea
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 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.
Mineral salts
Diarrhea caused by Crohn's disease is often the cause of blood alteration in calcium, magnesium and potassium levels.
This manifests itself with the onset of some nervous (peripheral) and muscular discomforts; in particular, cramping and reduction in contraction efficiency. Rarely do we reach advanced levels of deficiency and risk for health.
In general, the deficiency is compensated by the use of food supplements or parenteral solutions.
Diet for the Acute Phase
The diet to be taken during 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 aid to prevent its occurrence (in the right types and quantities).
In the first case, it is necessary to rest the intestine but, contrary to what happens in the ulcerative rectal colitis, it is not always necessary to adopt a type of parenteral (intravenous) nutrition.
On the contrary, if possible, enteral should be preferred, that is by means of a probe inserted into the digestive tract through the mouth, based on simplified nutrients (balanced distribution); these solutions do not require a significant digestive effort and almost do not call for the discharge 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 used for integration. In particular, the injections are intended for the administration of large quantities of vit B12 and other vitamins, almost all of which are absorbed by the liver; in the most serious cases, the intravenous route (drip) is used to restore the hydrosaline balance.
Some specialists choose to enrich the liquids for enteral nutrition in the acute phase with certain specific elements, so as to provide further support for drug therapy. For example, they are often added:
- Omega 3: for their anti-inflammatory action.
- Glutamine and butyric acid (which is short chain): due to 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 enterocytes (short chain fatty acids and polyamines).
In case the enteral diet is mixed (solutions / suspensions and foods), foods containing:
- 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 (chili capsaicin, pepper piperine, gingerol from ginger, horseradish isothiocyanate, garlic and onion allicin, etc.).
- Partially carbonized molecules (Maillard compounds, acrylamide, acrolein, formaldehyde, etc.).
- Mushroom toxins (many do not know that all mushrooms, even the 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 similar, such as theobromine, teine, etc.).
- Excessive and / or low-quality fats (especially hydrogenated ones, as they are sometimes rich in trans-conformed chains).
- Additives (the term is generic, but mainly refers to those with titanium residues, considered an accelerator of inflammation for Crohn's disease).
- Drugs or residual contaminants (antibiotics, pesticides, etc.).
Diet for the Chronic Phase
The common diet to be taken in case of Crohn's disease does not require particularly difficult precautions.
First, it is essential to clarify how food is processed. Most of the indications specified above, in the context of the acute phase, can be respected by applying appropriate cooking methods.
The most correct systems are: boiling, steaming, pressure cooking, vacuum cooking, low temperature cooking and vasocottura.
To be eliminated completely: frying, grill and plate.
To moderate: stewing and braising, skipping in the pan (except for the use of baking paper), roast in the oven (except for the use of a bag).
In this way it is possible to avoid both excess fat and the introduction of toxic catabolites.
Even during the asymptomatic phase, Crohn's disease requires some minor attention. If responsible for adverse reactions, it is better to exclude milk and dairy products, ie foods that contain significant amounts of lactose.
Limit or reset 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 that guarantee the absence of pollutants, contaminants and pharmacological residues; the same applies to additives, in particular those containing traces of titanium. Many are oriented towards the "Biological" but other disciplines, if fully respected, can be adapted; foods of Italian or European origin are recommended. Better to limit the mushrooms for the reasons already explained.
The energy and the nutritional distribution are the classic ones, like the subdivision of the calories in the various meals.
What must never be lacking in the Crohn's disease diet 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, legumes, fruit and vegetables etc.) which, due to side effects, 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).
