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The AANP and the INM would like to acknowledge Eric Yarnell, ND, for his contributions to the content of this FAQ.
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 and blockages, abscesses and ulcers are all possible complications. Acute flare-ups can be triggered by foods, stress, anxiety, depression, or acute infections. Tobacco products can also trigger flares of Crohn’s disease.
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 (SIBO). With ulcerative colitis, symptoms typically include bloody diarrhea, frequently accompanied by abdominal pain and weight loss.
Given the complexities of Crohn’s and ulcerative colitis, a correct diagnosis is essential to effective treatment. There is no one 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.
Diagnosis usually involves endoscopic or imaging studies in patients with compatible clinical history, and naturopathic doctors refer patients to gastroenterologists for this vital testing. 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 evaluation of 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 (CT) and computed tomography with enterography (CTE), magnetic resonance imaging (MRI), and magnetic resonance enterography (MRE). Diagnosis can also be supported by specific findings such as perianal skin tags or abdominal tenderness.
Naturopathic doctors also frequently test fecal calprotectin, an inflammatory substance produced by neutrophil white blood cells. Measuring calprotectin is helpful in establishing that there is inflammation in the lower intestinal tract.
Individualized Naturopathic Treatment for Crohn’s and Colitis
Once a patient has been diagnosed with Crohn’s, ulcerative colitis, or other IBDs, a naturopathic doctor will create a tailored treatment plan based on each patient’s individual presenting symptoms understood in context with the patients’ 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 diets) to stop and prevent 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 to modulate the immune system and prevent flare-ups
- Stress reduction by various techniques
- Artemisia absinthium (wormwood) capsules
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. However, if natural approaches are not successful, naturopathic physicians do not hesitate to prescribe palliative medications (when in state scope of practice) or to 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.