Crohn’s disease (CD) and ulcerative colitis are the most common diagnoses in a group of autoimmune conditions called inflammatory bowel disease (IBD). Crohn’s can develop anywhere in the digestive tract; ulcerative colitis is limited to the large intestine and rectum.
Both diseases are thought to be caused by the body’s abnormal immune reaction to intestinal bacteria. Symptoms are typically chronic and sometimes debilitating, with possible complications including intestinal pain, obstructions, blockages, abscesses, and ulcers. Acute flare-ups can be triggered by food, stress, anxiety,1Bannaga AS, Selinger CP. Inflammatory bowel disease and anxiety: links, risks, and challenges faced. Clin Exp Gastroenterol. 2015;8:111-117. Published 2015 Mar 23. https://doi.org/10.2147/CEG.S57982 depression,2Gaines LS, Slaughter JC, Horst SN, et al. Association between affective-cognitive symptoms of depression and exacerbation of Crohn’s disease. Am J Gastroenterol. 2016;111(6):864-870. https://doi.org/10.1038/ajg.2016.98 or acute infections. Tobacco products can also trigger Crohn’s flares.3Parkes GC, Whelan K, Lindsay JO. Smoking in inflammatory bowel disease: impact on disease course and insights into the aetiology of its effect. J Crohns Colitis. 2014;8(8):717-725. https://doi.org/10.1016/j.crohns.2014.02.002
How are Crohn’s and colitis diagnosed?
Symptoms vary from person to person and can be similar to those associated with other diseases. While intense abdominal pain and diarrhea are the most frequently reported issues with Crohn’s, constipation, diarrhea, and bloody stool are also common. Crohn’s symptoms can be identical to those of small intestinal bacterial overgrowth (SIBO). In ulcerative colitis cases, people may have bloody diarrhea, frequently accompanied by abdominal pain and weight loss.
Why proper diagnosis is essential
Because of the complexities of Crohn’s disease and ulcerative colitis, accurate diagnosis is crucial for effective treatment. There is no single definitive test for Crohn’s. Diagnostic workups are guided by the suspected location of disease (either in the small or large bowel).
A naturopathic doctor (ND) begins with a thorough health history and physical exam, and may order additional laboratory tests:
- Stool testing to evaluate gut bacteria, markers of inflammation (e.g., fecal calprotectin), and immune activity.4Bjarnason I. The use of fecal calprotectin in inflammatory bowel disease. Gastroenterol Hepatol (NY). 2017;13(1):53-56
- Blood testing for food sensitivities and allergies, celiac antibodies, folic acid deficiency, and systemic inflammatory markers such as C–reactive protein.
Diagnosis often requires endoscopic or imaging studies in patients with a compatible clinical history. A colonoscopy is generally the first test for patients presenting with diarrhea and suspected large bowel Crohn’s disease. For suspected small bowel involvement, a doctor may order a wireless capsule endoscopy. Imaging studies (MRI, MR enterography, and upper GI radiography with barium, CT, or CT enterography) are particularly helpful.
Supporting findings, such as perianal skin tags or abdominal tenderness, can further strengthen a diagnosis.
Natural IBD therapies
Although there are no well-documented cures for Crohn’s or colitis, preventing and mitigating flare-ups is possible. Many people achieve and maintain remission. There are various ways to control gastrointestinal inflammation with diet, supplementation, stress management, and lifestyle modification:
- Elimination/challenge diets, including elemental diets5Hunter J. Elemental diet and the nutritional treatment of Crohn’s disease. Gastroenterol Hepatol Bed Bench. 2015;8(1):4-5., to identify food triggers.
- Curcumin is available in tincture, capsule, or powder form to help reduce inflammation. However, there are contraindications for some patients, including those prone to forming calcium oxalate kidney stones.
- Probiotics modulate the immune system and prevent flare-ups.
- Meditation and mindfulness for stress reduction.
- Artemisia absinthium (wormwood) capsules.6Krebs S, Omer TN, Omer B. Wormwood (Artemisia absinthium) suppresses tumour necrosis factor alpha and accelerates healing in patients with Crohn’s disease—a controlled clinical trial. Phytomedicine. 2010;17(5):305-309. https://doi.org/10.1016/j.phymed.2009.10.013
Diet and lifestyle changes can help prevent moderate and severe relapses of IBD and lessen the need for prescription medication, such as anti-inflammatory drugs, immune system suppressors, and antibiotics, which may have side effects and long-term negative health impacts.7García-Mateo S, Martínez-Domínguez SJ, Gargallo-Puyuelo CJ, et al. Healthy lifestyle is a protective factor from moderate and severe relapses and steroid use in inflammatory bowel disease: a prospective cohort study. Inflamm Bowel Dis. 2025 Jan 6;31(1):95-104. https://academic.oup.com/ibdjournal/article/31/1/95/7634209
Other treatment options
When more intensive care is needed, naturopathic doctors may prescribe medication or refer patients to other providers for additional treatment or surgery.
Special thanks to Eric Yarnell, ND, for contributing to this article.
Footnotes
- 1Bannaga AS, Selinger CP. Inflammatory bowel disease and anxiety: links, risks, and challenges faced. Clin Exp Gastroenterol. 2015;8:111-117. Published 2015 Mar 23. https://doi.org/10.2147/CEG.S57982
- 2Gaines LS, Slaughter JC, Horst SN, et al. Association between affective-cognitive symptoms of depression and exacerbation of Crohn’s disease. Am J Gastroenterol. 2016;111(6):864-870. https://doi.org/10.1038/ajg.2016.98
- 3Parkes GC, Whelan K, Lindsay JO. Smoking in inflammatory bowel disease: impact on disease course and insights into the aetiology of its effect. J Crohns Colitis. 2014;8(8):717-725. https://doi.org/10.1016/j.crohns.2014.02.002
- 4Bjarnason I. The use of fecal calprotectin in inflammatory bowel disease. Gastroenterol Hepatol (NY). 2017;13(1):53-56
- 5Hunter J. Elemental diet and the nutritional treatment of Crohn’s disease. Gastroenterol Hepatol Bed Bench. 2015;8(1):4-5.
- 6Krebs S, Omer TN, Omer B. Wormwood (Artemisia absinthium) suppresses tumour necrosis factor alpha and accelerates healing in patients with Crohn’s disease—a controlled clinical trial. Phytomedicine. 2010;17(5):305-309. https://doi.org/10.1016/j.phymed.2009.10.013
- 7García-Mateo S, Martínez-Domínguez SJ, Gargallo-Puyuelo CJ, et al. Healthy lifestyle is a protective factor from moderate and severe relapses and steroid use in inflammatory bowel disease: a prospective cohort study. Inflamm Bowel Dis. 2025 Jan 6;31(1):95-104. https://academic.oup.com/ibdjournal/article/31/1/95/7634209
