The Link Between Diet, Lifestyle and Crohn’s Disease

November 2, 2023 10 mins to read
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I think it’s safe to say that diet and lifestyle play a significant role in development of the autoimmune Crohn’s Disease…but just how significant, and what are some of the contributing factors? In this article I go over Crohn’s Disease, and different diet or lifestyle factors that may help reduce the risk of developing Crohn’s, as well help to support the health of those suffering from this autoimmune disease.

Unraveling the Mystery Through Research

Very little was known about Crohn’s disease, but that has changed over the last few decades, thanks to extensive research, which has shown connections to the Standard American Diet (SAD). Let’s explore some of the compelling evidence that demonstrates certain foods which can cause harm to the gastrointestinal tract’s lining, key to it’s immune function. This begs the question: can we find a way out by simply changing our eating habits? or could we at least find ways to reduce risk of developing this debilitating autoimmune disease?

Plant-Based Diets & Crohn’s

Japanese studies has demonstrated the positive health effects of plant-based diets, especially for their potential to lower the relapse of Crohn’s symptoms. This doesn’t mean no meat…but more gearing towards a diet rich in whole plant-based foods, with some healthy grass-fed meat mixed in and less ultra-processed foods. More recent research further supports the crucial role of diet, highlighting the links between Crohn’s disease and ultra-processed foods, as well as yeast.

Industrialized Food & Crohn’s

The rise of inflammatory bowel diseases (IBD) like Crohn’s and ulcerative colitis especially in the west, seems to march hand-in-hand with industrialization and shifts in what and how we eat. While some might point to socio-technological changes, the growing body of research indicates that our diets are a significant factor in the surge of these diseases in developed countries. As the Journal of Clinical Medicine noted in early 2023, the growing prevalence of IBD in newly industrialized countries mirrors the trends observed in Western countries during the 1990s. So what does this mean? and what can you do about it?

You Are What You Eat?

This emerging research data reinforces the old mantra “you are what you eat,”…though it’s important to note that like any disease many different factors can be involved, and although diet is certainly a big part, it’s certainly not all of it. But a better diet may help reduce risk and even help improve the health of those with Crohn’s. There’s growing optimism that Crohn’s patients see tangible benefits from a holistic approach that includes diet as a part of the foundation, for an anti-inflammatory lifestyle. This could be a welcome alternative to conventional options like drug therapy and surgery, which can be costly and don’t always address the underlying inflammation.

The Modern Origins of Crohn’s Disease

Nearly 1 in 100 Americans are diagnosed with Irritable Bowel Disease (IBD), according to the Crohn’s and Colitis Foundation. The condition, first described in 1932, can affect any part of the GI tract, unlike ulcerative colitis, which typically only impacts the colon and rectum. The autoimmune nature of Crohn’s leads to excessive and prolonged inflammatory responses, causing symptoms that vary widely between individuals.

Beyond Genetics

While IBD does affect genetically susceptible individuals that is only a piece of the puzzle. Environmental risk factors, especially diet, play a crucial role as well. We also know through the study of epigenetics that a complex array of factors can influence gene expression and methylation, which could play a role. Recent genetic studies have shed light on why Crohn’s patients may struggle to recover from gut damage from foods like gluten, food sensitivities and excessive sugar intake (to name a few), pointing to impaired intestinal barrier function, or “leaky gut,” among other factors.

“Leaky Gut” is characterized by a loosening of the tight junctions in the gut – part of it’s immune system – which can allow proteins and pathogens to leak through. The body can respond to these leaked proteins and pathogens as foreign and mount an immune response against them. Part of the theory here, oversimplified, is that the body may then confuse certain of your own bodily tissues as matching this foreign matter, and mount an attack against your own tissues.

Diet’s Role in Disease Onset

Recent research, including a meta-analysis published in Clinical Gastroenterology and Hepatology, indicates a strong link between diets high in ultra-processed foods and the development of Crohn’s disease. Another study in Nature Medicine highlighted the potential role of yeasts in driving immune cell reactivity in Crohn’s patients. Ultimately this highlights how a more whole-foods plant based diet, is beneficial for gastrointestinal and over-all health, including risk of GI connected autoimmune diseases, like Crohn’s.

The Impact of Diet & Microbial Diversity

Westernized diets, often deficient in dietary fiber, and high in inflammatory omega 6 fats, have been shown to reduce gut microbial diversity, indicating dysbiosis or imbalance. This is often associated with more disease-causing “bad” bacteria in the gut. On the other hand, diets high in soluble plant polysaccharides, associated with microbial diversity, have been noted to curb harmful bacteria.

More on the Gut & Fiber

The gut houses billions of “gut flora”, a community carefully balanced between good and bad bacteria. Roughly 70-80% of your immune system is housed in your gut…to oversimplify, your gut is your immune system! And you produce nearly the same amount of neurotransmitters in your gut as in your health; it can massively affect your brain/mental health, memory and cognitive performance.

Fiber is a huge part of a healthy gut. There are some great companies with mixed fiber supplements. Personally my favorite go to foods include:

*Org = organic

  • Org. Brown rice products – (like flour) in place of simple carbs/wheat products (like bread or paste).
  • Org. Flax Seed Powder– which is one of the best forms of fiber because it is also high in anti-inflammatory Omega 3 Essential Fatty Acids (EFAs). Sprinkle onto most foods just like you would a spice or mix into soups and smoothies. You do want to opt for the powder here, as seeds can make issues worse e.g. can worsen diverticulitis or diverticulosis.
  • Cassava Flour – a fiber rich alternative to wheat based flours for baking most goods. I usually do a mixture of cassava with brown rice flour or a gluten free-blend.

Plant-Based Diets Show Promise

Small but significant studies, like one in Japan, have shown that Crohn’s patients who adopt a semi-vegetarian diet, can fare better in both the active stage of the disease and in preventing flare ups (periods of worsening symptoms). This diet typically includes large quantities of: brown rice, miso soup, pickled vegetables, green (matcha) tea, and moderate consumption of eggs (if sensitive to chicken, try duck or quail eggs), yogurt (if sensitive to cows dairy, try goat dairy), vegetables, fruits, legumes, and potatoes (sweet potatoes are my fav as they are also nutrient and fiber rich).

The Toll of Medical Therapy

While medications like infliximab can be costly, more aggressive therapies like surgery might be needed for severe cases. This underscores the financial burden of Crohn’s, estimated at $10.9 billion to $15.5 billion per year in the United States. As an integrative nutrition professional, this highlights the importance of a balanced diet and lifestyle to help reduce the risk of developing Crohn’s and the financial burden it places on the individual and the nation.

Simple, Effective Strategies

More cost-effective strategies that appear beneficial include: lowering stress, reducing alcohol consumption, increasing vitamin D levels (always take K2 with D), and reducing exposure to environmental and ingested toxins. Dr. Amy Beard, a family physician and dietitian, also recommends:

  • Eating real, organic food
  • Aiming for restorative sleep as sleep is the foundation of good health
  • Avoid (or at least limit) alcohol, smoking, and certain drugs (goes without saying)
  • Spending time outdoors – nature walks are a great relaxing exercise
  • Engaging in daily, moderate exercise- even at home with a set of dumbbells or some yoga is beneficial
  • Replacing toxic chemicals in your environment e.g. replacing household cleaners with diluted apple cider vinegar spray
  • Drinking plenty of water (if you can afford it I highly recommend you get a reverse osmosis RO, under counter filtration system (or distiller) to filter out chemicals like chlorine and fluoride which can further damage the gut microbiome.

A Healthy Gut Isn’t Rocket Science

A few rules of thumb like shopping the exterior of the grocery store and opting for a higher ratio of whole (preferably organic) whole foods, balancing meals with more fruits and veggies, and keeping away of ultra-processed packaged food as much as possible, can go a long way to reducing risk of damaging your gut lining and developing gastrointestinal health issues, including autoimmune GI connected issues like Crohn’s. Obviously if you already have Crohn’s you’ll need a much more specialized and comprehensive plan to begin improving your health; you can book an appointment as my patient, to get a professionals help improving your Crohn’s and over-all health. Dr. Beard calls this the fundamentals of functional medicine.

References

  1. Epidemiology of Inflammatory Bowel Diseases: A Population Study in a Healthcare District of North-West Italy
  2. THE HISTORY OF CROHN’S DISEASE by Arthur H. Aufses, Jr, MD
  3. Vishnu Mohanan et al.
  4. C1orf106 is a colitis risk gene that regulates stability of epithelial adherens junctions. Science359,1161-1166(2018). DOI:10.1126/science.aan0814
  5. Gerard E. Kaiko et al.
  6. ,PAI-1 augments mucosal damage in colitis.Sci. Transl. Med.11, eaat0852(2019). DOI:10.1126/scitranslmed.aat0852
  7. Westernized Diet is the Most Ubiquitous Environmental Factor in Inflammatory Bowel Disease
  8. Food Processing and Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
  9. Martini, G.R., Tikhonova, E., Rosati, E. et al. Selection of cross-reactive T cells by commensal and food-derived yeasts drives cytotoxic TH1 cell responses in Crohn’s disease. Nat Med 29, 2602–2614 (2023). https://doi.org/10.1038/s41591-023-02556-5
  10. Review article: evidence-based dietary advice for patients with inflammatory bowel disease
  11. Recommendation of plant-based diets for inflammatory bowel disease
  12. Induction with Infliximab and a Plant-Based Diet as First-Line (IPF) Therapy for Crohn Disease: A Single-Group Trial https://doi.org/10.7812/TPP/17-009
  13. Bhavana B. Rao, Benjamin H. Click, Ioannis E. Koutroubakis, Claudia Ramos Rivers, Miguel Regueiro, Jason Swoger, Marc Schwartz, Jana Hashash, Arthur Barrie, Michael A. Dunn, David G. Binion, The Cost of Crohn’s Disease: Varied Health Care Expenditure Patterns Across Distinct Disease Trajectories, Inflammatory Bowel Diseases, Volume 23, Issue 1, 1 January 2017, Pages 107–115, https://doi.org/10.1097/MIB.0000000000000977
  14. Chiba M, Abe T, Tsuda H, Sugawara T, Tsuda S, Tozawa H, Fujiwara K, Imai H. Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet. World J Gastroenterol 2010; 16(20): 2484-2495 [PMID: 20503448 DOI: 10.3748/wjg.v16.i20.2484]
  15. Chiba M, Abe T, Tsuda H, Sugawara T, Tsuda S, Tozawa H, Fujiwara K, Imai H. Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet. World J Gastroenterol 2010; 16(20): 2484-2495 [PMID: 20503448 DOI: 10.3748/wjg.v16.i20.2484]
  16. De Sousa J, Paghdar S, Khan T M, et al. (May 15, 2022) Stress and Inflammatory Bowel Disease: Clear Mind, Happy Colon. Cureus 14(5): e25006. doi:10.7759/cureus.25006
  17. Alcohol and narcotics use in inflammatory bowel disease
  18. The Role of Vitamin D in Inflammatory Bowel Disease: Mechanism to Management. Nutrients 201911(5), 1019; https://doi.org/10.3390/nu11051019
  19. Adverse health effects of emerging contaminants on inflammatory bowel disease. Front Public Health. 2023; 11: 1140786. Published online 2023 Feb 24. doi: 10.3389/fpubh.2023.1140786

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