Crohn’s Disease: Nutritional Management
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Crohn’s Disease: Nutritional Management
Definition
Crohn’s disease is a chronic inflammatory bowel disorder that can affect any part of the gastrointestinal tract from the mouth to the anus. However, it tends to affect the small and large intestines in most of the cases. The disease is sometimes associated with malnutrition. However, it does not have any identifiable causes. Some of the risk factors associated with the disease include genetics and the immune system. A person is more likely to have the disease if his parents or siblings had it. The immune systems of patients suffering from Crohn’s disease have a strong reaction to the substances that are in the intestines such as food and the good bacteria. Patients experience ulcerations and their chronic tissues swell due to the inflammatory toxins produced when the white blood cells invade the lining along the intestines.
People who smoke or who have ever smoked have increased chances of getting Crohn’s disease. Environmental factors are instrumental in determining the prevalence of the condition. People who live in westernized countries are more likely to get the disease compared to those who live in the least developed regions of the world. Although the disease can affect people of different ages, it is more common in young people, aged between sixteen and thirty years. People suffering from the disease need to see a doctor for correct diagnosis. This will help in enabling the patient to receive the right treatment. The condition is similar to ulcerative colitis, which is also an inflammatory bowel disease. The two diseases differ in area of infection. Inflammation occurs in the full thickness of the bowel wall in patients suffering from Crohn’s disease and it can happen in any section of the digestive tract. However, patients suffering from ulcerative colitis only have inflammation on the colon.
Signs and Symptoms
The disease is long-term and patients can go for long periods without experiencing any symptoms. In some cases, the symptoms are severe while in others they may be mild. Some people develop symptoms gradually. However, the symptoms may appear suddenly in some cases. Some of the symptoms and signs of the disease include recurring diarrhea, mucus in stool, and bloody fecal matter. The blood in stool may be from the inflamed tissues, which bleed when food passes through the digestive tract or it may be from the bowel. If the patient continues to bleed, he or she may develop anemia. Patients may have cramps, abdominal pain, and appetite loss. Patients also experience fatigue and extreme tiredness and they lose weight. Inflammation can affect the body’s ability to absorb food and this leads to weight loss.
Other signs and symptoms include constipation, nausea, fever, skin problems, joint pains, ulcers, mouth sores, and delayed growth in children. Complications may occur in patients with severe cases of the disease. The complications are caused by chronic inflammation. Obstruction or blockage of the intestine tends to be the most common complication. It happens when the bowel wall narrows or becomes stiff. This has the possibility of causing malnutrition in the patients since it can lead to constipation and the patients will not be able to absorb nutrients from food well. In some cases, patients develop fissures and fistula. Other complications include arthritis, liver disease, kidney stones, and inflammation of the eyes (CDD, 2009).
Nutritional Management
Nutrition is important for the management of Crohn’s disease. Patients need to eat balanced diets containing adequate measures of micro and macronutrients. Patients suffering from Crohn’s are not able to eat well and benefit from the food they eat. Therefore, they may have deficiency of important nutrients and minerals including proteins, vitamins, and calories. Taking the right nutrition will help patients to control the symptoms. Nutrition is especially important for patients with malnutrition. A patient’s nutrition largely depends on the symptoms he or she has. The way the nutrients are administered in the body can help in controlling inflammation.
In some cases, the physician may recommend enteral nutrition, in which patients are fed through a tube. In some other cases, the doctors may decide to use parentaral nutrition, which involves injecting the nutrients through a vein. These two methods are important for patients who are not able to eat and digest their food because of inflammation. They enable the bowel to rest, improve a person’s nutrition, and cause normal growth in children and adolescents. Enteral nutrition is recommended for children with Crohn’s and for patients with severe malnutrition. This form of feeding enables the patients to get the nutrition they need without putting much strain on their digestive system. It can induce remission in children and adolescents, promote mucosal healing, and lead to the recovery of bone metabolism (Day et al., 2008).
Patients should strive to eat small amounts of food throughout the day, as opposed to a large meal in one setting. They should ensure that they take enough fluids to keep their bodies hydrated. This is especially when they are suffering from diarrhea and constipation. Taking enough fluids when one has diarrhea will replace what is lost. Consuming adequate fluids when a person has constipation will help a patient to loosen the stool. The recommended fluid in this case is water. Patients suffering from diarrhea should avoid drinks with too much sugar as this may worsen their condition. Patients should also strive to consume drinks that do not have caffeine. They should also limit their intake of alcohol and carbonated drinks. Milk and milk products such as cheese and yoghurt are recommended for patients who are lactose intolerant. They are beneficial since they provide adequate amounts of calcium and protein.
Patients should avoid high fiber foods. Patients who have narrowed bowels can experience cramping and abdominal pain if they eat foods that are high in fiber. Moreover, since the foods are not digested well in the small intestines, they can cause diarrhea. Such foods include most vegetables such as cauliflower, cabbages, broccoli, and mushrooms among others. Most fruits contain fiber and patients should avoid them. However, they can take peeled apples, melons, and ripe bananas. Patients can get the required nutrients from fruits by consuming fruit juices that do not have any pulp. However, they should consume canned fruits and juices that do not have heavy syrup to avoid worsening the diarrhea. Grains are healthy but they have high fiber. Therefore, patients should avoid taking grains such as brown rice, whole-wheat products, and beans and other grain foods containing nuts and seeds. However, they can take foods made from refined flour since they do not have much fiber.
Patients should eat bland foods and avoid consuming fatty and spicy foods. They should avoid butter, margarine, sour and heavy creams, and other forms of fat. They should limit their consumption of fried foods. They can consume tender meat that is well cooked but it should not be fried or contain additional fats. It is important for patients to increase their intake of proteins. They can take different forms of animal products such as poultry, fish, and eggs. There is need for patients to get sufficient amounts of calcium and vitamin D to strengthen their bones and reduce their chances of developing osteoporosis. Vitamin D is also important for adequate metabolism of calcium in the body. Some of the medications used in the treatment of the condition can increase the risk of bone loss and this can be countered by taking the minerals and vitamins in nutrition form.
Some of the symptoms such as diarrhea lead to loss of some minerals in the body. Patients may need to take iron supplements especially when they have blood loss. Vomiting and diarrhea can cause potassium deficiency and patients need to take supplements. In addition, patients taking prednisone may need to increase their potassium by taking supplements. Patients suffering from the disease need to take vitamin B12 replacements (Donnellan et al., 2013).
Crohn’s is an
unremitting disease that affects both men and women below the age of thirty-five.
However, it can affect individuals at any age. It can affect any part of the
digestive tract. Although there is no known defined cause, some of the risk
factors include genetics and environmental factors such as smoking. The most
common symptoms of the disease include diarrhea and abdominal pain. Patients
have different symptoms. In some cases, the symptoms are severe while in other
cases they are mild. Patients may go for a long time without experiencing any
symptoms. it is possible to manage the disease and control the symptoms through
nutritional management. Patients need to know the foods that are most
appropriate for them and the ones they should avoid, especially when they are
experiencing flare-ups. In some cases, patients may need to be fed through
tubes. This is the most beneficial way for patients with severe symptoms and
for children with stunted growth.
References:
Baumgart, C. D. (2012). Crohn’s disease and ulcerative colitis: From epidemiology and immunobiology to a rational diagnostic and therapeutic approach. New York, NY: Springer Science & Business Media
CDD (2009). Crohn’s disease. Centre for Digestive Diseases. Retrieved from http://www.cdd.com.au/pages/disease_info/crohns_disease.html
Day, A. S., Whitten, K. E., Sidler, M., & Lemberg, D. A. (2008). Systematic review: Nutritional therapy in paediatric Crohn’s disease. Alimentary Pharmacology & Therapeutics, 27(4), 293-307
Donnellan, F. C., Yann, H. L., & Lal, S. (2013). Nutritional management of Crohn’s disease. Therapeutic Advances in Gastroenterology, 6(3), 231-242