When diagnosing and treating patients with acute or chronic gastrointestinal (GI) symptoms, licensed naturopathic doctors (NDs) address the whole person—including body, mind, emotions, genetics, environmental exposures, and socio-economic status. NDs employ a variety of diagnostic approaches to pinpoint the underlying causes of distress. Trained rigorously in clinical nutrition, behavioral medicine, botanical medicine, and conventional pharmaceuticals, NDs draw on a broad and deep spectrum of treatments, expanding options for patients with Crohn’s disease and/or ulcerative colitis.
What Are Crohn’s Disease and Ulcerative Colitis?
Crohn’s disease (CD) and ulcerative colitis (colitis or UC) are the most common disorders in a group of auto-immune GI diseases referred to as inflammatory bowel diseases (IBDs). Crohn’s may develop anywhere in the digestive tract; ulcerative colitis is limited to the large intestine and rectum.
Thought to be caused by your body’s immune system having an abnormal reaction to normal bacteria in your intestine, both diseases are chronic, lifelong, and often debilitating. Intestinal pain, dangerous obstructions, blockages, abscesses, and ulcers are all possible complications. 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 flares of Crohn’s disease.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?
Crohn’s and ulcerative colitis can be hard to diagnose because symptoms vary from person to person, and are similar to those of other diseases. For example, the most common symptoms of Crohn’s are intense abdominal pain and diarrhea. However, a person with Crohn’s disease can have constipation and diarrhea and sometimes blood in the stool, although some people with constipation will not have any diarrhea or blood in the stool. In addition, the typical symptoms of Crohn’s can be identical to those of small intestinal bacterial overgrowth. With ulcerative colitis, symptoms typically include bloody diarrhea, frequently accompanied by abdominal pain and weight loss.
The Need for Proper Diagnosis
Given the complexities of Crohn’s and ulcerative colitis, a correct diagnosis is essential for effective treatment. There is no single definitive test for Crohn’s disease. Testing is determined by the suspected location, small vs. large bowel. In addition to a comprehensive health history and an in-office exam, a naturopathic doctor may order stool testing to assess gut bacteria, markers of inflammation, and immune markers. NDs may also order blood testing for food sensitivities/allergies, celiac antibodies, folic acid deficiency, and inflammatory indicators such as C-reactive protein.
An ND may expand diagnostic testing for Crohn’s to assess gut bacteria, markers of inflammation such as C-reactive protein and fecal calprotectin, immune markers, food sensitivities, celiac antibodies, and folic acid deficiency.
Diagnosis usually involves endoscopic or imaging studies in patients with compatible clinical history. Naturopathic doctors refer patients to gastroenterologists for this vital testing. A colonoscopy is the most appropriate first test for a patient presenting with diarrhea and suspected large bowel CD. Wireless capsule endoscopy is increasingly being used for evaluating suspected small bowel CD. Imaging studies are generally considered more appropriate for those with abdominal pain and to evaluate the small bowel. These can include upper GI radiography with barium, computed tomography or computed tomography with enterography, magnetic resonance imaging (MRI), and magnetic resonance enterography. Diagnosis can also be supported by specific findings such as perianal skin tags or abdominal tenderness.
Naturopathic doctors also frequently test fecal calprotectin,4Bjarnason I. The use of fecal calprotectin in inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2017;13(1):53-56 an inflammatory substance produced by neutrophil white blood cells. Measuring calprotectin is helpful in establishing that there is inflammation in the lower intestinal tract.
Natural Treatment for Crohn’s and Colitis
Once a patient has been diagnosed with Crohn’s, ulcerative colitis, or another IBD, a naturopathic doctor will create a tailored treatment plan based on the patient’s individual symptoms and overall health and lifestyle. While there are no well-documented cures for either disease, the goal is to help prevent flare-ups, achieve and maintain remission, and heal as much of the underlying inflammation (even in periods without symptoms) as possible. Specific treatments a naturopathic doctor may recommend include:
- Elimination/challenge diets or other approaches to reducing food triggers (including elemental diets5Hunter J. Elemental diet and the nutritional treatment of Crohn’s disease. Gastroenterol Hepatol Bed Bench. 2015;8(1):4-5.) to prevent or curtail flare-ups.
- Curcumin in tincture, capsule, or whole turmeric powder form to reduce inflammation. However, there are contraindications to the use of turmeric. For instance, turmeric should be avoided in patients who readily form calcium oxalate kidney stones.
- Probiotics modulate the immune system and prevent flare-ups.
- Stress reduction through various techniques.
- 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
To treat Crohn’s and ulcerative colitis, NDs address the whole person and all contributing factors: the body, mind, emotions, genetics, environmental exposure, and socioeconomic status.
Diet, Lifestyle, and Medicine
Research shows that a naturopathic medical approach emphasizing diet and other lifestyle changes can be used to successfully manage Crohn’s and colitis, and may potentially eliminate the need for prescription drugs.
Because they are lifelong conditions, Crohn’s and ulcerative colitis must be carefully monitored and managed, with more aggressive interventions necessary during flare-ups. Research shows that a naturopathic medical approach emphasizing diet and other lifestyle changes can be used to successfully manage these conditions. Naturopathic therapies may eliminate the need for prescription drugs (such as prescription anti-inflammatory medications, immune system suppressors, and antibiotics) or surgery, which have the potential to cause more side effects and long-term problems.
If natural approaches are not successful, naturopathic physicians do not hesitate to prescribe palliative medications (when state licensure allows) or refer patients for treatment with various medications, biologic drugs, or surgery. A naturopathic medical approach has the added benefit of focusing on engaging patients in managing their own health—a crucial component of living a long and healthy life with these challenging conditions.
A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM). The AANP and the INM would like to acknowledge 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 (N Y). 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
