The Impact of Nutrition on Crohn’s Disease
Millions of people worldwide are suffering from inflammatory bowel disease (IBD): more than one million in America, nearly 200,000 in Canada, and over 2.5 million in Europe (Kaplan, 2015). The incidences of the IBD are on the rise (Torres et al., 2016). Crohn’s disease (CD), as the major type of the IBD, occurs when a patient’s portion of the immune system is overactive. The immune system is responsible for fighting diseases as it attacks foreign substances in the body. CD, however, makes the immune system overactive. This causes disease-fighting cells to either fail or slow down enabling foreign intruders in the body to attack the lining of the gastrointestinal tract. Due to the foreign intruders in the body, patients experience crampy stomach pain, diarrhea, fever, loss of appetite, and weight loss. They can also see traces of blood in the stool. The patients, therefore, have to visit the washroom frequently as it infects their digestive system. The research will discuss the CD, its causes, and symptoms and the way nutrition influences patients’ efforts to manage this disease.
CD is found in small and large intestines crucial in carrying food from the stomach and turning it into waste before it is eliminated as stool from the body through the anus (Stein & Bott, 2015). While digesting, water and nutrients are transferred to the body through the intestines. Patients suffering from CDs, therefore, can look malnourished as water and nutrients are poorly absorbed due to a damaged GI tract. Furthermore, diarrhea and blood loss through the stool causes a deficiency of water and nutrients. The weight loss due to inflammations and ulcerations consequently makes the patients reduce food intake as they feel pain during and after eating. As a result, loss of nutrients increases, especially among children and teens leading to poor growth and failure to thrive. The symptoms can include the patient suffering from skin and mouth sores, red and inflamed eyes, sore joints, and feeling tired. Patients developing IBD are often at the most important period of their lives. The patients include students or young adults at the beginning of their careers, developing relationships and making lifelong friends. Ultimately, the disease affects patients at the age of attaining a sense of which they are.
The Digestive System
The digestive system is made up of a digestive tract, which is a long tube extending from the mouth to the anus (Stein & Bott, 2015). The liver and pancreas are of vital importance in the digestion process. Patients suffering from CD, therefore, should know the names of the specific areas of the digestive tract as it can help them play an active role in attaining digestive health. Small intestines are the duodenum, jejunum, and ileum. The terminal ileum opens up into the colon, as it is the last part of the small intestines. Thus, patients should be aware of the fact that terminal ileum is the area of the digestive system that is likely to be affected by the CD.
Symptoms of CD
A patient suffering from active CD should acknowledge that they have lost control of the illness (Torres et al., 2016). The symptoms they may be experiencing, therefore, cannot go away or get better on their own. As a result, they should seek treatment. The symptoms include abdominal pain. The patients suffering from CD experience deep, throbbing and cramping feeling in their gut that can get intense within minutes or hours after eating. Before bowel movements, the stomach ache can increase. Ultimately, abdominal pain associated with CD is beyond normal tummy aches. The patients can also start to experience nausea. Consequently, they suffer from unexplained loss of appetite coupled with vomiting and diarrhea.
The onset of CD can be dramatic (Kane, 2010). Alarming symptoms of the CD include unusual amounts of sores in the patient’s mouth. Furthermore, the patient can experience unexplained and unintentional weight loss and failure to gain it back. Teenagers can experience a delayed entry into puberty. Adults and teens can also experience drainage of pus and/or abscess of pus-filled sores near the anus. Consequently, they can suffer from anemia, which is a blood condition causing the patient to experience fatigue and feeling generally weak due to heavy blood loss and lack of dietary iron. Rectal bleeding or blood in the stool is also an alarming symptom as it causes patients to experience unexplainable fevers lasting more than three days. Eventually, the patients’ eyes become red and sore, bowel habits change, and the intensity of joint pain increases. Finally, the patients cannot keep food and drinks down due to intense nausea and frequent vomiting.
Diagnostic Tests Affirming CD
Diagnostic tests provide health care teams with crucial information on how the body is functioning. Various diagnostic tests, therefore, should be conducted to guide treatment of CD and assist patients in getting and staying better faster (Slavin, 2008). They should be conducted using either one or more investigative techniques for the gastroenterologist to understand the health status and causes of the CD. Consequently, they can create a treatment plan meeting the patients’ specific needs. Foremost, blood tests should be conducted regularly. Patients suffering from CD should undertake blood tests as they can show any active inflammations in the bowel. They can also help a health practitioner determine if a patient is anemic or suffering from nutritional or vitamin deficiencies. Blood tests are also crucial as they can identify more specific and vital changes in a patient’s bodily function (Slavin, 2008). People suffering from CD, therefore, should undergo regular blood tests which are quick with minimal discomfort to determine measures that can keep the illness in remission.
Secondly, the patients should undergo stool tests as they are used to look for parasite and bacterial infections, including Yersinia, clostridium difficile, and salmonella (Slavin, 2008). The tests can also indicate the presence of inflammations and ulcerations. Stool tests, however, can be messy. As a result, health practitioners should help patients in collecting viable samples for lab technicians to analyze the specimen for any infections. Urine samples can also assist but the patients ought to provide the clean and uncontaminated specimen for the accurate and viable results. The best results from either a stool or urine sample can be acquired even a patient presents the specimen as soon as they have been collected. Conversely, lab technicians should avoid mixing and contaminating the samples and results.
Radiology tests can include x-rays and barium tests (Kane, 2010). X-rays are often quick in determining any blockages or holes in the intestines. They can also indicate if a patient is constipated. They, however, are taken if a patient visits a hospital emergency room. A barium test is a chalky liquid used with an x-ray to help doctors see the organs in the GI tract clearly. The barium liquid is swallowed for the upper GI series or small bowel follow-through tests to be completed. The metallic compound liquid is seen as a white area on the x-ray machine. In case of abnormal conditions of the GI tract, the barium liquid highlights the areas affected. For example, it can highlight either narrow or enlarged bowel, ulcerations, or fistulas. Fistulas are abnormal links between diverse parts of the bowel. The upper GI series test, however, should be conducted after the patient has fasted for at least four hours before consuming a large cup of barium. Consequently, x-rays of the stomach and intestines should be taken at regular intervals by a radiologist. Magnetic Resonance Imaging (MRI) tests or scans provide detailed images of the GI tract without exposure to radiation (Kane, 2010). They can detect CD in the intestines and indicate how the illness affects the areas. They can also determine the thickness of the bowel wall, perianal, abscesses, and fistulas. MRI scans should be taken after a patient fasts for at least six hours.
How Nutrition Affects CD?
According to Gibson and Shepherd (2010), the illness is serious but manageable. Persons suffering from the CD should, therefore, undergo various tests providing them with knowledge on their body and the illness before they can identify how to manage it. Thus, patients should be informed, proactive, and involved in managing the illness. As a result, they should first undergo the tests discussed above to affirm the presence of the disease before looking for solutions and seeking treatment. There are two primary goals applied in treating and managing the disease. The first one involves controlling the inflammations of the GI tract to put CD in remission. The second goal is to maximize nutrition to attain overall good health and ensure stable growth. Medications can help patients attain the two goals. Long-term measures of managing the disease, however, are more applicable (Stein & Bott, 2015). As a result, patients should consider embracing dietary changes that can keep the illness in remission.
Maintaining adequate nutrition can be challenging for patients suffering from CD (Gibson & Shepherd, 2010). The patients, however, should strive to deliver important nutrients to their bodies. Enteral nutrition support can also help patients, especially teens, to grow and attain healthy development. Enteral nutrition involves patients focusing on receiving nutrition from special liquid diets. The liquid diets should contain nutrients necessary for patients’ bodies without burdening the digestive system. Enteral nutrition is also known as the elemental or polymeric formula. It should be undertaken between six and eight weeks by patients keen to attain extra calories and nutrients to promote growth and development (Gibson & Shepherd, 2010). The diet can also ease bowel movements and reduce blood loss through the stool and urine.
Enteral formulation nutritional diet ought to be delivered through small and flexible tubes known as nasogastric (NG) feeding tubes (Gibson & Shepherd, 2010). The tubes should be passed through patients’ noses to the esophagus into the stomach. Patients are advised to insert the tubes before retiring to bed as they can receive the formula while sleeping without feeling the discomfort and remove them in the morning. The schedule can also ensure patients’ daily routine is not interrupted. More so, the likelihood of complications can be reduced, especially among patients combining the therapy with medications. Patients, however, can suffer from sore throats, nosebleeds, sinusitis and aspiration or formula entering the lungs (Gibson & Shepherd, 2010). Some patients also experience stomach cramping, diarrhea, and bloating. Health care professionals, therefore, should assist patients, especially children and teens, to insert the tubes and keep watch for the side effects.
Gastroenterologists are also required to assist persons suffering from CD in making good food choices (Kane, 2010). Foremost, they should identify foods causing discomfort. Thus, health professionals should assist patients in identifying foods their bodies can tolerate during healthy and flare periods. For example, most people suffering from CD avoid eating nuts, popcorns, and seeds when strictures have a problem. Consequently, they should try new foods that are nutritionally beneficial. The patients should be advised to visit a registered dietitian to help plan a dietary regimen comprising of foods they enjoy and provide the nutrients their bodies need.
According to Stein and Bott (2015), a healthy balanced diet is vital for healthy and sickly people. Thus, people suffering from the Crohn’s illness should strive and eat well by adapting healthy meals with extra vitamins and special food supplements. They, however, should ensure the nutrients are absorbed into their bodies. The nutritional diet should also minimize blood loss and prevent anemia (Stein & Bott, 2015). As a result, they should keep a food diary noting down the foods with positive and negative impacts for future references. For example, many patients have a difficult adapting to a diet with a lot of fiber. Each patient, therefore, should use the food diary to determine if they ought to decrease or increase fiber intake depending on their individual condition. Spicy foods should be avoided as they trigger the CD. Persons with strictures should avoid spicy and hard to digest foods as they can cause a blockage (Slavin, 2008).
According to Kane (2010), symptoms of CD lead to loss of nutrients, blood, water, magnesium, potassium, sodium, and phosphorus among other electrolytes. Patients also suffer from reduced appetite, making it difficult to consume calories. Consequently, they fail to obtain sufficient nutrients. Moreover, absorption of amino acids, fats, and carbohydrates can be challenging for patients’ digestive system leading to malabsorption. Their small intestines should be checked for inflammations in the ileum. The affected areas should be removed in case it is a significant portion but the absorption of vitamins A, B12, D, E, and E can be adversely affected. Bile acids and salts can also be malabsorbed causing excessive secretion of fluids.
As a result, patients are to embrace good eating habits to gain adequate nutrients, including vitamins, nutrients, and minerals like calcium, proteins, carbohydrates, and fiber (Gibson & Shepherd, 2010). The following foods can help keep CD in remission: carbohydrates such as fish, dairy products, and poultry coupled with fruits, vegetables, oils, and fats. They represent a balanced diet, maintaining adequate nutrition for the patients to promote immunity, enhance healing, increase energy levels, and decrease gastrointestinal symptoms.
In conclusion, it is evident that CD can be managed by ensuring patients embrace a nutritional diet that does not burden the digestive system. A particular nutritional diet or food causing, preventing, or curing the disease, however, does not exist due to lack of scientific evidence. Each patient, therefore, should be keen to identify foods either increasing or decreasing the symptoms of the disease. Consequently, they should embrace a nutritional diet neither irritating nor overburdening their digestive system. More importantly, every patient should strive to consume fast or junk foods in moderation.
Gibson, P., & Shepherd, S. (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology, 25(1), 252-258.
Kaplan, G.G. (2015). The global burden of IBD: From 2015 to 2025. Nature Reviews Gastroenterology & Hepatology 12, 720-727.
Kane, S. (2010). Inflammatory bowel disease (IBD) self-vanagement: The AGA guide to Crohn’s disease and ulcerative colitis. AGA Press Review, 1(1), 143-175.
Slavin, J. L. (2008). American Dietetic Association Positions Committee workgroup. Position of the American Dietetic Association: Health implications of dietary fiber. Journal of American Diet Association, 108(1), 1716-1731.
Stein, J., & Bott, C. (2015). Diet and nutrition in Crohn’s disease and ulcerative colitis. Freiburg, Germany: Falk Foundation.
Torres, J., Mehandru, S., Colombel, J-F., & Peyrin-Biroulet, L. (2016). Crohn’s disease. The Lancet, pii: S0140-6736(16)31711-1. doi: 10.1016/20140-6736(16)31711-1.