Extraintestinal Manifestations And Complications
UC is characterized by immune dysregulation and systemic inflammation, which may result in symptoms and complications outside the colon. Commonly affected organs include: eyes, joints, skin, and liver. The frequency of such extraintestinal manifestations has been reported as between 6 and 47%.
UC may affect the mouth. About 8% of individuals with UC develop oral manifestations. The two most common oral manifestations are aphthous stomatitis and angular cheilitis. Aphthous stomatitis is characterized by ulcers in the mouth, which are benign, noncontagious and often recurrent. Angular chelitis is characterized by redness at the corners of the mouth, which may include painful sores or breaks in the skin. Very rarely, benign pustules may occur in the mouth .
UC may affect the eyes. Inflammation may occur in the interior portion of the eye, leading to uveitis and iritis. Uveitis can cause blurred vision and eye pain, especially when exposed to light . Untreated, uveitis can lead to permanent vision loss. Inflammation may also involve the white part of the eye or the overlying connective tissue , causing conditions called scleritis and episcleritis. Uveitis and iritis are more commonly associated with ulcerative colitis, whereas episcleritis is more commonly associated with Crohn’s disease.
Crohns Disease And Ulcerative Colitis And Diet
Diet and food allergies do not cause IBD, and long-term special diets are not effective in treating IBD. However, adjusting your diet can help manage some of your symptoms, and can help IBD medications work better. A person with IBD has to pay close attention to their diet, since they may have malnutrition.
Should People With Ibd Be Concerned About Fluid Intake
Yes. In a condition with chronic diarrhea, the risk of dehydration always exists. If fluid intake does not keep up with diarrhea, kidney function may be affected. Patients with Crohn’s and other diarrheal diseases have an increased incidence of kidney stones, which is related to this problem. Furthermore, dehydration and salt loss create a feeling of weakness. For these reasons, people with IBD should consume ample fluids-especially in warm weather when loss of salt and water through the skin may be high. A good rule of thumb is to drink one half ounce per day for every pound of body weight. That means that if you weight 140 pounds, you should drink at least 70 ounces a day — or eight and three-quarters glasses. Sip your beverages, rather than gulp them. By introducing air into the digestive system, gulping can cause discomfort.
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Outlook And Other Dietary Considerations
Diet may help prevent Crohns flare-ups. However, foods and drinks tend to affect Crohns patients differently. This means that one food might cause flare-ups for some people and not for others. In general, if you know that a certain food aggravates your symptoms, you should take care to avoid it altogether. If you think a food is worsening your symptoms, try eliminating it from your diet and see if your symptoms improve. If you add it back in later and symptoms resume, it would likely be best to avoid it too. Smaller, more frequent meals can also reduce the work of the digestive tract.
New areas of research in Crohns include:
- the use of probiotics
- a high-fiber enteral diet
Its important to consider that its not just what you eat that can aggravate your symptoms. The way you cook and process your food can also make a difference. Fried, fatty foods are commonly reported as flare-up culprits, so opt for baked and broiled items instead. Crohns disease can make the digestion of fats difficult, worsening diarrhea and other symptoms.
Diet can play a crucial role in overall Crohns management, but its a multi-factorial, complex disease. It often requires many supporting treatment methods, not just diet alone.
Continue to see your doctor for treatment and follow-ups. Be sure to discuss any differences in symptoms. Nutrition counseling may also improve the efficacy of your medications and overall quality of life.
Crohn’s Disease And Probiotics
Some experts believe that probiotics can help restore the good bacteria imbalance in microbiome, which can help to subdue the immune response in the gut and reduce Crohns Disease symptoms. These experts maintain that adding probiotics reduces intestinal inflammation, which alleviates frequent symptoms such as diarrhea and upset stomach.
However, although some scientists believe that probiotics can help, very little research has been done to establish a direct link between probiotic consumption and improved Crohns Disease symptoms. The research that does exist has only been conducted on a very small number of people. Consequently, it is hard to generalize these results to everyone who suffers from Crohns Disease. One of these small studies showed improvements in the barrier function of the intestine and an increase in anti-inflammatory compounds in the gastrointestinal tract. These findings led the researchers to conclude that probiotics are promising as a treatment for Crohns Disease.
Read our full discussion of the benefits of Probiotics for Crohn’s Disease here.
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What Is Nutritional Support
Because IBD, especially Crohn’s disease, may improve with nutritional support, it may be necessary to provide nutrition by delivering a nutrient-rich liquid formula directly into the stomach or small bowel. Known as enteral nutrition, this type of feeding is given overnight through a tube, most commonly from the nose to the stomach. This is called a nasogastric tube. This method ensures that patients receive nutrition while sleeping. In the morning, they remove the tube and go to work or school and generally pursue their normal activities. In this way, patients receive all the nutrition they need and are free to eat normally — or not — throughout the day.
Enteral feedings can also be given through a gastrostomy tube . A gastrostomy is a surgically created opening through the abdominal wall, leading directly into the stomach. The feeding tube is passed through this opening. The feedings are most commonly given overnight, but they can also be given intermittently throughout the day. Some patients prefer this approach because it avoids the discomfort of passing a tube down through the nose.
Total parenteral nutrition is delivered through a catheter placed into a large blood vessel, usually one in the chest. Although it bypasses the intestine and thereby allows the bowel to rest, parenteral nutrition may create more complications than enteral nutrition. It is also more expensive than the other methods of nutritional support and requires more specialized training to use.
Vegetable And Fruit Juices
Vegetable and fruit juices are low in fiber and high in some vitamins and minerals. Manufacturers also fortify some juices.
It is best to avoid sugar during a CD flare-up, but a daily glass of diluted fruit juice that contains no added sugar can help boost a persons nutrient intake.
Vitamin C from fruit juice can also help the gut absorb iron.
Foods that are high in fat can worsen or prolong symptoms during a CD flare-up.
However, protein and other nutrients from animal products can help prevent malnutrition.
Skinless chicken and turkey are good examples of lean meats. If a person is purchasing red meat, such as pork, they should select the leanest cut available and trim any excess visible fat.
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Where Is Crohns Disease Located In The Body
Like ulcerative colitis, it is triggered by an abnormal immune response that causes too much inflammation. This affects the full thickness of the bowel wallnot just the inner lining, as seen in ulcerative colitisand causes ulcers.
That sounds like a substantial area that is affected, but with Crohns disease, there can be healthy patches of the intestine mixed in between diseased patches.
Crohn’s Disease And Body Pain
Crohns Disease pain originates from inflammation in the digestive tract and can spread systemically throughout your body.
Most people . Additionally, some people may also experience pain in peripheral parts of the body such as their joints and eyes.
Each person perceives pain differently, and thus describes their pain in different ways. We list common pain descriptors below:
- A Charley Horse in your gut
While not all people with Crohns Disease will experience pain in other areas, almost all people with Crohns Disease will experience GI pain at some point in their life especially if the condition is not treated.
Read more about general body pain and Crohn’s Disease in our full write up.
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How Do Crohn’s Disease And Ulcerative Colitis Interfere With Digestion
To get a better idea of how diet affects people with IBD, here’s a brief explanation of the way in which the body processes the food you put into it.
The real work of the digestive system takes place in the small intestine, which lies just beyond the stomach. In the small intestine, digestive juices from both the liver and the pancreas mix with food. This mixing is powered by the churning action of the intestinal muscle wall. After digested food is broken down into small molecules, it is absorbed through the surface of the small intestine and distributed to the rest of the body by way of the bloodstream. Watery food residue and secretions that are not digested in the small intestine pass on into the large intestine . The colon reabsorbs much of the water added to food in the small intestine. This is a kind of water conservation or “recycling” mechanism. Solid, undigested food residue is then passed from the large intestine as a bowel movement.
In ulcerative colitis, only the colon is inflamed the small intestine continues to worknormally. But because the inflamed colon does not recycle water properly, diarrhea can be severe.
Risk Factors For Ulcerative Colitis And Crohns Disease
An estimated 3 million adults have ulcerative colitis or Crohns disease. Both conditions affect men, women, and children, and can occur at any age.
Ulcerative colitis is most often diagnosed in people in their mid-30s. Crohns disease is usually diagnosed between ages 20 and 30.
You might think that the conditions are related to food intolerances , but thats not the case.
Research is ongoing, but for now experts know there are a few factors that increase the risk of developing either disease.
First, theres the immune system. Normally, the immune system is on our side, attacking and killing viruses, bacteria, and other microorganisms we dont want in our bodies. But in ulcerative colitis and Crohns disease, the immune system doesnt retreat. Instead, it stays in the attack and kill mode, which results in excessive inflammation.
Second, family history is a risk factor. People who have inherited inflammatory bowel disease genes are more susceptible to it. The genetic risk is greater in Crohns disease about 15 percent of people with Crohns have a first-degree relative with the disease.
Third, unknown environmental factors may trigger the overzealous immune response.
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What Else Is Important In A Crohn’s Disease Diet Plan
Limiting some food triggers may help control your symptoms during disease flares. But don’t restrict yourself so much that you make malnutrition, which often accompanies Crohn’s disease, worse. You’ll need to find other sources to replace calories, protein, carbohydrates, and fats that are in the foods you eliminate. To do that, you’ll need to focus on adding nutrient-dense foods in your diet plan.
While fast foods should normally be avoided in a healthy diet plan, sometimes they can give your diet a needed boost when used sparingly. Some fast foods can offer a valuable supply of key nutrients and calories. For instance, pizza offers calories, protein, and nutrients such as calcium and vitamins A, B, C, and D. A milkshake is high in calories and calcium. Of course, if you are lactose-intolerant, you need to remember to take the proper medication before drinking a milk product.
Ask your doctor or dietitian about vitamin and mineral supplementation. For example, many people with Crohn’s disease have a vitamin D deficiency. A study published in the American Journal of Preventive Medicine reported that higher doses of vitamin D may be good for you, particularly in reducing the risk of colorectal cancer, which may be higher in people with IBD. The National Academy of Sciences has established that a dose of 2,000 IU/day of vitamin D is safe. But it’s still important that you check with your doctor to see what dosage is ideal for you.
Is Crohn’s Disease Contagious
Whether you are in an active flare or remission, Crohns disease is not contagious and cannot be spread to others. To further understand why Crohns is not contagious, lets look deeper into what causes Crohns disease.
Researchers currently believe that genetic factors may influence the onset of Crohn’s Disease. Further, environmental factors such as stress also play a role in developing symptoms. There is a third theory that certain pathogens may be linked to Crohn’s Disease.
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Crohn’s Disease And Eye Function
Although Crohns Disease is known for causing digestive problems, it can also affect other areas of your body. Individuals with Crohns may experience skin complications, joint pain, and eye problems. About 10 percent of individuals with Crohns have problems with their eyes at some point.
Different conditions require different treatments.
- Episcleritis is treated with cold compresses or topical steroids to relieve inflammation.
- Scleritis is treated with eye drops or oral medications.
- Uveitis is treated with topical or systemic steroids to clear inflammation, or medications to dilate the pupil.
- Keratopathy is treated with lubricating fluid or gel. If the condition does not resolve, prescription eye drops are used.
- Dry eyes are treated with eye drops or warm compresses.
- Optic neuritis may resolve on its own, but if it does not, IV medications, injections, and steroids are all treatment options.
In general, treating Crohns disease and reducing inflammation will also alleviate eye problems. Additionally, avoiding Crohns flares also reduces the risk of developing eye problems in the future.
Whats The Role Of Fiber In Crohns
Dietary fiber is important for your overall health. It can help you keep your cholesterol, blood pressure, and weight at healthy levels. And getting about 23 grams of fiber a day can cut your risk of a Crohnâs flare by as much as 40%. But while youâre having a flare, high-fiber foods can aggravate your symptoms.
The best fiber choices when you have Crohnâs are foods that contain soluble fiber. Soluble fiber soaks up extra fluid in your gut. Foods rich in soluble fiber can help you slow down your digestion and ease diarrhea. The other kind of fiber, insoluble fiber, can boost the amount of water in your gut. Youâll digest foods quickly. That can lead to watery diarrhea, stomach cramps, or gas. At worst, too much insoluble fiber can cause a blockage.
Foods that come from plants are the best source of fiber. This includes fruits, vegetables, grains, beans, and nuts. Most plant-based foods contain both soluble and insoluble fiber. Remove peels, skin, and seeds of fruits or veggies to cut down on insoluble fiber. And check labels for added fiber in foods you wouldnât expect, like dairy products.
During times when you donât have active Crohnâs symptoms, choose whole grains and a variety of fresh fruits and vegetables.
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What To Eat During Remission
There is no single diet plan for Crohns disease because the illness and symptoms manifest in so many different ways. In general though, you’ll want to avoid processed foods that can trigger gut inflammation, and primarily follow a Mediterranean Diet of whole grains, vegetables, fruits, healthy fats, lean meats, fish, beans, and eggs. Nourishing your body during the good times means youll be in better shape to handle the flares and surgical procedures, if necessary. When youre in remission, focus on eating these nutrient-packed options:
Dairy Intake As Risk Factor For Ibd
The European Investigation into Cancer and Nutrition study found that individuals that consumed milk had significantly reduced odds of developing CD , suggesting a protective effect with dairy product consumption . Individual dairy products consisted of milk, yogurt, and cheese with varying fat content . This is supported by a case-control study in children that demonstrated that consumption of dairy products was not associated with CD . Overall, the consumption of dairy products is not a risk factor for IBD.
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Peeled Or Poached Fruit
Removing the skin or peel from a piece of fruit can reduce the amount of insoluble fibers, such as lignin and cellulose.
Poaching and preserving fruit can also decrease the amount of fiber. Generally, the more processing fruit goes through, the easier it is for the body to digest.
Canned and cooked fruits are often low in fiber, but they can contain high amounts of sugar, so eat them in moderation.
What Vitamins And Mineral Supplements Should I Take
Crohns raises your risk for nutritional deficiencies because your body doesnt digest food properly, meaning important nutrients may be expelled rather than put to good use. Flares, severe symptoms, surgeries, and other complications add to the difficulty of getting proper nutrition. Not helping matters, some medications you need to take can inhibit nutrient absorption, including prednisone, sulfasalazine, and methotrexate. Your doctor will do bloodwork and may prescribe supplements to help alleviate these deficiencies and prevent you from becoming malnourished.
Common deficiencies seen in Crohns patients are:
Anemiaa condition in which you lack the healthy red blood cells needed to carry oxygen to the bodys tissuesis a common issue when iron levels are low.
Its important to not take any supplements without the approval of your doctor, since some may contain ingredients like lactose, artificial colors, sugar alcohols or preservatives that can aggravate your Crohns disease symptoms.
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