Crohn’s Disease Dietary Restrictions and Natural Remedies

Crohn’s disease is an inflammatory bowel disease (IBD) resulting in chronic inflammation of the gastrointestinal tract.  IBD encompasses Crohn’s disease and ulcerative colitis.   Crohn’s disease is associated with distinct granulomas and inflammation which may also affect lymph nodes.1

Ulcerative colitis is a milder disease that is characterized by continuous inflammation affecting the colon.  Both of these conditions lead to extensive epithelial damage.

Inflammatory bowel disease may cause a variety of symptoms including:

  • Loss of appetite
  • Fever
  • Weight loss
  • Diarrhea which may contain blood
  • Abdominal pain and cramping
  • Anemia due to blood loss
  • Urgency to defecate

I thought I would write a post on ways to combat this disease other than the traditional medication therapy. 

Remember, if you suffer from IBD, it is important to visit your physician on a regular basis.  Since bleeding and GI blockages are possible, tests may need to be performed by a professional to keep you as healthy as possible. 

You may require medication depending on how severe your symptoms are.  This disease may also cause a decrease in the absorption of vital vitamins and nutrients the body needs for proper functioning. 

The recommendations in this article should only be considered in combination with the advice of a physician.  I am a strong advocate of yearly check-ups.  Preventative medicine is vital to health.

What Foods Cause Crohn's Disease Flare-ups

Although there is no particular diet that has been scientifically proven to prevent inflammatory bowel disease, there are some trigger foods that may cause flare-ups.  My advice is to keep a food journal and this should help you determine which foods tend to cause problems.  If you find a certain food or food group appearing often before flare-ups, you may consider eliminating that item from your diet.  Some of the possible “problem items” include:

  • Corn, including popcorn
  • Dairy products – if lactose intolerant- consider supplementing with lactase or eliminating
  • Foods that cause increased gas production in the gut (onions, broccoli, cabbage, beans, legumes, lentils, etc.)
  • High fiber foods (chia seeds, avocado, pasta, chickpeas, quinoa, oats, almonds etc.)
  • Fried foods
  • Nuts and seeds, including peanut butter
  • Some raw fruits
  • Coffee and tea
  • Chocolate
  • Fats (butter, mayonnaise, cooking oils)
  • Alcoholic beverages
  • Red meat
  • Pork
  • Spicy foods

As you can see, there are many foods on this list, and others may also cause irritation and flare-ups.  This is why a food journal is essential.  It is worth the effort!

Another strategy is to try an elimination diet.  The way this works is you start by eliminating many foods and if your symptoms improve, you begin to add foods back one at a time.  This can help identify which foods should be avoided in the future. 

There are several elimination diets available today.  The Whole30 is a diet my family and I tried last October.  I have written about this in a separate post if you are interested in the specifics.  I highly recommend trying it.

I was also able to locate a specific diet and cookbook on Amazon written by Patty Catsos, MS, RD, LD.  I have not tried this diet yet, and don’t suffer from IBS, but this book has great reviews.  I do not have any association with this product but will list the link below for your convenience.

https://www.amazon.com/IBS-Elimination-Diet-Cookbook-Low-FODMAP/dp/0451497724

FODMAPs

Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) are short-chained carbohydrates.  These make their way to the end of the intestinal tract where large amounts of bacteria reside.  The bacteria break these substances down causing the release of gas which may lead to digestive issues in some individuals.  These FODMAPs also draw liquid into the intestines which can lead to diarrhea.  Most individuals with IBS are sensitive to FODMAPs and these substances can lead the flare-ups.  Examples of FODMAPs include:

Lactose – Milk sugar contained in dairy products.

Galactans – Legumes have large quantities of these.

Fructose – This is the sugar contained in fruits and vegetables.  You also find this in many packaged products.

Fructans – These are found in many grains including wheat, spelt, barley and rye.

Polyols – These are sugar alcohols and are also used in processed foods as a sweetener.  Examples include sorbitol, mannitol, xylitol and maltitol.

These substances are resistant to digestion and are passed through the intestinal tract unchanged.  FODMAPs cause an increased hydrogen concentration in the intestines of those with IBS.  They also influence the quantity of methane gas and may cause gastrointestinal symptoms in IBS patients.2

Curcumin for IBS

One of the most effective and popular herbal medicines available is turmeric.  This herb contains curcumin which has many beneficial properties.  Curcumin is known to have a wide range of effects on the gastrointestinal system.  This substance has been shown to inhibit the growth of H. pylori in both mice and on agar plates.3

Curcumin is thought to kill bacteria by inhibiting cell division.4

A study by Niamsa and Sittiwet in 2009, demonstrated the antimicrobial activity of curcumin several commonly encountered pathogenic Gram-negative and Gram-positive bacteria.5

Curcumin has also been shown to regulate the gut microbiota.  This is important because inflammatory bowel disease is partially defined by an altered, pathogenic microbiome.6

 

7

 

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One of the changes that occur in the gut is the increase in adherent invasive E. Coli (AIEC) which can promote gut inflammation.9

 

10

Curcumin has also been shown to inhibit signaling that initiates the inflammatory process in the intestinal tract.11

A study published in 2006 found the addition of curcumin, 1 gram after breakfast and 1 gram after dinner, plus sulfasalazine or mesalamine was more effective than placebo combined with one of these two medications.  The mesalamine group had a 4.65% relapse rate (2/43), whereas the placebo group had a relapse rate of 20.51% (8/39).  A six month follow-up found eight more patients relapsed in the curcumin group and six additional patients relapsed in the placebo group.12

For additional information on curcumin, please refer to my blog post on turmeric below.

Plantago Ovata

Plantago ovata, also known as Desert Indian wheat or psyllim husk has been used as a medicinal plant.  Psyllium is often used as a bulk forming laxative to support normal bowel movements.  Psyllium is marketed as Metamucil.   We also have this product available in capsule form in the Sunshine Store.  There have been studies showing psyllium to be useful in the treatment of UC.13

Probiotics in Inflammatory Bowel Disease

Probiotics would seem to be helpful in IBD.  Ingesting “good” bacterial should fend off some of the “bad” gas-producing bacteria.  At the present time, the studies show that probiotic supplementation is a promising adjuvant treatment in ulcerative colitis.  It is best to use a combination Probiotic such as Probiotic-40 available below.   There is not enough clinical evidence to support the use of probiotics for Crohn’s disease at the present time.14

Inflammatory bowel disease can be a debilitating illness and may be dangerous in some cases.  This condition may lead to a decrease in the absorption of critical nutrients and can also lead to bleeding and/or intestinal obstructions.  I suggest visiting your physician on a regular basis, keeping a food journal, and consider adding nutritional supplements to your medication regimen.  Your physician can tell you if you are deficient in vitamin B-12 or other necessary vitamins or minerals.  I strongly recommend a turmeric supplement.  This is one of the healthiest natural herbs available today.  Psyllium may also be beneficial but caution should be observed as large fiber loads can increase IBS symptoms in some individuals.  Be sure to check with your physician before starting this or any other supplement. 

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 

Turmeric with Bioperine Benefits

 

Should I take a turmeric supplement?

What is turmeric good for?

Is it safe?

What is Bioperine?

Turmeric is a spice many of us use in cooking. It is one of the main ingredients in curry powder. It has a yellow color and is also used as a coloring agent for foods and cosmetics. Turmeric is a plant related to ginger that is grown in Central America, Asia, and India. The rhizomes of this plant are dried and used as dietary supplements for a variety of health conditions.

This plant has been used in Indian and Asian medicine for thousands of years.

Turmeric may be the most effective nutritional supplement available today. The active component of this plant is curcumin. The polyphenol known as curcumin has been widely studied for many health-related benefits. Some of these include inflammation, arthritis, obesity, liver disease, and several types of cancer. It is thought that most of the positive benefits of curcumin are the result of its anti-inflammatory and antioxidant effects.

 

In this post, several health benefits of turmeric are explored. I have started taking this supplement as my father died from cancer and had two different types of cancer during his lifetime. I also have occasional back pain, which seems to respond to this supplement. Only you can determine if this supplement is for you. 

 

 

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Turmeric (Curcumin) for Various Types of Cancer

Probably the most exciting action of curcumin is its effects on various types of cancers. Cancer is the second leading cause of death worldwide. Although the therapy of cancer has progressed, mortality remains high. Many studies have been published on turmeric (curcumin) in the treatment of different types of cancer

 

 

Turmeric (Curcumin) and Breast Cancer

Breast cancer is the leading cause of death among all cancers in women throughout the world.

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The most effective treatment for breast cancer is early detection. Treatment is much more effective if the cancer is discovered in its early stages.

Traditionally, antiestrogen medications have been used for the treatment of breast cancer as more than seventy percent of these are of the estrogen receptor (ER) positive type. It is now known that combination treatment using various medications, surgery, and chemotherapy is the most effective treatment for this cancer type.

The effects of turmeric (curcumin) on breast cancer cells is complicated. Below are just some of the mechanisms thought to fight this deadly malady.

There is a proinflammatory transcription factor (NF-KB) that controls the genes that regulate proteins resulting in inflammation and the development of cancers. 

Curcumin has been shown to decrease the effect of NF-KB, leading to its possible use in breast cancer.

2   3 

Curcumin may also inhibit human epidermal growth factor receptor 2 (HER2-TK) alone or in combination with its analogs.

 4 

 HER2-TK is a tyrosine kinase receptor. The overexpression of HER2-TK is associated with the progression of many cancer cell types.

 5 

Epidermal growth factor receptor (EGFR) is associated with the development of cancer cells.

 6   7 

 Curcumin inhibits the growth and spread of breast cancer cells by decreasing EGFR signaling.

 8   9 

Curcumin can exert its positive anti-cancer effects on both estrogen-dependent as well as non-estrogen dependent breast cancer cells.

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Turmeric for Prostate Cancer

Prostate cancer is the second leading cause of death from cancer in men. 11

Curcumin has been shown to kill cancer cells and inhibit cancer cell proliferation both in the laboratory and in human subjects. 12

This is achieved by interfering with many cellular pathways including mitogen-activated protein kinase (MAPK), EGFR, and nuclear factor k (NFkB). 13  14

Curcumin has also been shown to activate protein kinase D1 (PKD1), which attenuates the oncogenic signaling by beta-catenin and MAPK. 

This leads to the inhibition of prostate cancer. 15

Turmeric for Colorectal Cancer

The third leading cause of cancer death in men is due to colorectal cancer. 16 

This cancer is removed surgically, and often radiation therapy is prescribed, but over fifty percent relapse. 17

One of the markers for colorectal cancer is prostaglandin E2 (PGE2). PGE2 is a bioactive lipid that causes a wide variety of biological effects associated with inflammation and cancer.  

A study was conducted on fifteen patients with treatment-resistant adenocarcinoma of the colon or rectum. Subjects received between 0.45 and 3.6 g oral curcumin daily for up to four months.

Intact curcumin and its metabolites were found in the plasma at a concentration of 10 nmol/L and also in the urine.

It was found that the 3.6 g curcumin daily dose led to 62% and 57% reductions in PGE2 levels one hour after administration on days 1 and 29.

This has led to a dosage recommendation of 3.6 g curcumin by mouth daily. 18

 

 

Turmeric for the Prevention and Treatment of Alzheimer’s Disease

Alzheimer’s Disease (AD) is the most common cause of dementia. Currently, we only have medications available to slow the progression of this disease.  

Can turmeric help to prevent AD? 

We know that curcumin has many properties that may help prevent the development of Alzheimer’s disease. These include antioxidant, anti-inflammatory, anti-amyloid, and anti-tau actions that may be neuroprotective. 19  20

It is also known that populations that consume curry have a lower incidence of AD, and older people in this group have better cognitive function. 21

A study of 1010 sixty to ninety-year old’s who were occasional or frequent curry consumers found this population had significantly higher Mini-Mental State Examination (MMSE) scores compared to those who either didn’t eat curry or only consumed it rarely. 22 

Animal studies have also shown that curcumin can improve tasks requiring memory and reverse stress-induced reductions in the production of neurons associated with the brain-derived neurotropic factor (BDNF). 23

An article was published in the American Journal of Geriatric Psychiatry in January of 2018, looking at the effects of curcumin on memory in people without dementia. This study, conducted at UCLA, also explored the effect of curcumin on the plaques and tangles in Alzheimer’s patients. 

This was a double-blind, placebo-controlled study of forty adults between 50-90 years of age with mild memory complaints.

Study participants either received 90 mg curcumin or placebo twice daily for eighteen months. All were given cognitive assessments at the beginning of the study and every six months. 

Curcumin blood levels were obtained at the beginning and end of the study. 

Subjects who received curcumin realized a significant improvement in memory and attention. 

The placebo group did not show significant improvement in either. 

The curcumin group improved their memory scores by 28% over the 18-month period. This group also showed less amyloid and tau plaques in the hypothalamus and amygdala regions of the brain than the placebo group.

This research group is planning a follow-up study with a higher number of subjects. Antidepressant effects of curcumin will also be explored in their future study.

Turmeric for Type 2 Diabetes

There have been several studies evaluating the use of curcumin in the treatment of diabetes. 

A 36-week study followed 240 pre-diabetic patients in 2012. The subjects were split into two groups. One group received 1500 mg curcumin daily while the other group received a placebo. At the end of the study, 16.4% of the placebo group developed T2DM, while no patients in the curcumin group developed diabetes.  24 

A study published in 2008 compared curcumin to atorvastatin (Lipitor) in T2DM patients. In this trial, patients received either 300 mg curcumin supplements daily, 10 mg atorvastatin daily, or a daily placebo. 

The curcumin and atorvastatin group showed significant improvement in endothelial function and also a significant decrease in IL-6, TNF-alpha, ET-1, and malondialdehyde. 

These results suggest curcumin has a positive effect on reducing inflammation and oxidative stress similar to that of the prescription medication atorvastatin. 25

Turmeric for Heart Disease

The number one cause of death worldwide is heart disease, according to the World Health Organization. There are several risk factors that increase the chances of having a heart attack. Some are modifiable, while others are not. Some of the most prominent risk factors, according to the CDC are:

  • High blood pressure (HBP): HBP is a significant risk factor for heart disease. On my unit, pharmacists check blood pressure on each patient daily. A blood pressure that is too high affects not only the heart but also the kidneys and brain. HBP is sometimes called the “silent killer” because patients typically do not feel different. Medications, exercise, avoiding alcohol, and smoking are some methods to help decrease blood pressure.
  • High Cholesterol: This substance is made by our liver in sufficient quantities to fulfill our body’s needs. Unfortunately, poor diet leads to a build-up in the walls of the arteries.  There are different types of cholesterol. The low-density type (LDL) is considered “bad” because it can lead to heart disease.  The high-density type (HDL) is “good” because it provides protection from heart disease.  Changing your diet to include more fresh fruits and vegetables, olive oil, nuts, and lean protein can help improve your HDL/LDL ratio. There are also medications available to decrease LDL levels. If you don’t know these “numbers,” please visit your doctor for a blood test. It may save your life.
  • Diabetes: The risk of heart disease is higher in patients with diabetes. 26This disease causes an increased level of sugar in the blood.
  • Obesity: Excess body fat usually occurs with high LDL cholesterol and triglycerides and lower HDL cholesterol levels. Obesity increases the risks of HBP and diabetes. The best way to combat obesity is with diet and exercise. Always visit your physician before starting a new exercise program.

A study utilizing rats conducted in 2012, found curcumin improved cardiac repair and function after reversible cardiac ischemia. Left ventricle dilation was reduced, and wall thickness increased. This led to the conclusion that curcumin may be useful in the treatment of heart failure caused by ischemia. 27

In 2014, a study performed by Cheungsarman et al. found curcumin showed an improvement in inflammatory and metabolic profiles as well as a significant positive impact on an atherosclerosis marker. 28

Curcumin has been shown to improve disrupted cardiac function caused by cardiac fibrosis using various molecular mechanisms. 29

Turmeric for Osteoarthritis

Osteoarthritis is the most common form of arthritis. This condition affects millions of people worldwide. The joints most affected are in the spine, hips, knees, and hands. Pain and swelling are caused when the cartilage in the joints that cushions the ends of the bones wear out.

The best initial treatment for osteoarthritis is exercise. Medications such as NSAIDs can also be utilized, but they cause some significant side effects, especially if used long-term. 

Since it is known that curcumin has anti-inflammatory properties, its use in this disease process has been studied.

A review article published in May of 2019 evaluated curcumin in the treatment of autoimmune and rheumatic diseases. 

Of the sixteen articles reviewed on osteoarthritis treatment with curcumin, fourteen reported significant improvements in several disease patterns. All studies were randomized, placebo-controlled trials. 30

Curcumin utilized in these studies was most commonly isolated from turmeric rhizomes. The average curcumin dosage reported in the clinically effective studies was 834.29 mg daily. 

Clinical outcomes were measured in most of these studies using:

  • Walking distance. 
  • Lequesne’s pain functional index (LPFI). 
  • Knee injury Osteoarthritis Outcome Score (KOOS).
  • Clinical Global Impression Scale (CGI).
  • visual analog scale (VAS).
  • Karnofsky performance scale.

In thirteen of these studies, dietary intake of curcumin resulted in improvement of at least two clinical measures, 31  32  33  34  35  36  37  38  39  40  41  42  43

While seven studies showed improvement in at least three. 44  45  46  47  48 49 50  

The two clinical outcomes which increased most commonly were walking distance and decreased WOMAC scores.

There have also been studies conducted comparing the effectiveness of curcumin versus NSAIDs in the treatment of osteoarthritis. 

A study in 2014 compared curcumin to ibuprofen. A total of 367 patients with arthritis of the knee were divided into two groups. 

The Ibuprofen group received 1200mg Ibuprofen daily, while 1500mg curcumin daily was administered to the other group. Treatment lasted four weeks. Both groups showed significant improvement in WOMAC pain and function scores, and the ibuprofen group had more complaints of abdominal pain.  51

A similar study was conducted in 2009. Patients received either 800mg ibuprofen daily or 2 grams curcumin extract daily for six weeks. No difference in adverse effects between the two groups was found, and there were no differences in outcomes except for pain on stairs. 52

Turmeric for Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory bowel disease that causes the formation of ulcers and inflammation in the digestive tract. This disease affects the inner lining of the colon and rectum. Since we know curcumin is useful in the treatment of inflammation, it is expected that this substance would have a positive impact on UC.

The symptoms of UC are diarrhea, abdominal pain, fever, weight loss, fatigue, and rectal pain and bleeding.

If the bleeding becomes severe, this disease can lead to death.

There have been positive and negative studies regarding the use of curcumin in the treatment of UC. 

A study in 2017 by Kedia et al. found no difference in patients receiving 450 mg daily of curcumin and placebo in inducing remission in patients with mild to moderate UC. 

This study spanned eight weeks and found no benefit of curcumin for clinical remission rates, clinical response, or mucosal healing when compared to placebo. It should be noted that the dosage of curcumin was low in this study. 53 

By contrast, a 2015 study by Lang et al. found that UC patients who received 3000 mg curcumin daily for one month, along with mesalamine, saw significant improvement in clinical response, endoscopic remission, and rate of clinical remission as compared to a mesalamine-placebo group. 54 

Another randomized, double-blind study of eighty-nine patients with UC was conducted in 2006. Forty-five subjects received curcumin 1000 mg twice daily, plus sulfasalazine (SZ) or mesalamine. The placebo group consisted of forty-four patients who received a placebo plus SZ or mesalamine. 

The results showed only 4.65% of the curcumin group relapsed, whereas 20.51% of the placebo group relapsed during the study.

A six-month follow-up was performed on both groups who were taking either SZ or mesalamine. Eight addition patients in the curcumin group and six patients in the placebo group relapsed. 55 

Safety

The US Food and Drug Administration considers curcumin to be “generally recognized as safe.”  56 

Turmeric should not be used by women who are pregnant or lactating.  It possesses some uterine stimulant effects.  It should also be avoided in people with gall stones or bile duct obstruction. 57 

Side Effects of Turmeric (Curcumin)

Turmeric is generally well tolerated. I have been taking my Turmeric with Bioperine supplement daily for about one month with no noticeable adverse effects. The side effects reported in several clinical trials were mild. Below is a list in decreasing frequency of side effects that may result:

  • Mild gastrointestinal symptoms (dyspepsia, Bloating, GERD)
  • Nausea and vomiting
  • Edema
  • Loose stools
  • Constipation
  • Increased stool frequency
  • Hot flashes

These effects were not statistically different than those of the placebo groups. 58 

Turmeric Drug Interactions

The drug interactions to be aware of all regard the risk of bleeding.  Caution should be exercised when using tumeric with the following drug classes:

  • Anticoagulant/Antiplatelet Agents:  
  • NSAID’s
  • Salicyclates
  • Thrombolytic Agents

59 

Bioavailability Boost

The substance known as piperine is a major component of black pepper. Piperine is marketed under the trade name Bioperine and is added to some turmeric supplements to increase the bioavailability of curcumin. This substance has been shown to increase bioavailability by 2000%.  60 

Michael Brown pictured with Final Thought written

I am very excited about the information I have learned while researching turmeric. It can be consumed in foods and has been used as a medicine in different parts of the world for centuries.

I have been taking this supplement for about a month with absolutely no side effects.

Our family has also been eating curry several times per week. This is an easy way to decrease the odds of contracting cancer or dementia. Working on a unit with dementia patients has taught me I don’t want to burden my family with this disease.

The curcumin in turmeric also helps reduce inflammation, which helps with my back pain.

I firmly believe this is the most versatile supplement available in my store.

I hope you have enjoyed reading this post. Remember to eat a healthy diet, exercise, get plenty of sleep, and spend as much time with your happiness elements as possible.

Please send me a message if you have any topics you would like for me to cover in my blog.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.