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    Crohn?s Disease (Holistic)

    Crohn?s Disease (Holistic)

    About This Condition

    A full feeling in your stomach, accompanied by abdominal pain and regular bouts of diarrhea, may be signs of Crohn?s disease. According to research or other evidence, the following self-care steps may be helpful.
    • Fill up on fiber

      Improve stool quality and other symptoms by eating high-fiber fruits and vegetables and by taking fiber supplements such as psyllium or glucomannan

    • Fight back with fish

      Prevent relapses by frequently eating fish high in omega-3 fatty acids, such as salmon, mackerel, or sardines

    • Take a daily multivitamin

      Choose a comprehensive formula containing zinc, folic acid, vitamin B12, and vitamin D to prevent deficiencies caused by poor absorption

    • Discover beneficial bacteria

      Take 250 mg of Saccharomyces boulardii three times a day to help control diarrhea

    About

    About This Condition

    Crohn?s disease is a poorly understood inflammatory condition that usually affects the final part of the small intestine and the beginning section of the colon. It often causes bloody stools and malabsorption problems.

    Symptoms

    Chronic diarrhea with abdominal pain, fever, loss of appetite, weight loss, and a sense of fullness in the abdomen are the most common symptoms. About one-third of people with Crohn?s have a history of anal fissures (linear ulcers on the margin of the anus) or fistulas (abnormal tube-like passages from the rectum to the surface of the anus).

    Healthy Lifestyle Tips

    People with Crohn?s disease are more likely to smoke, and there is evidence that continuing to smoke increases the rate of disease relapse.1

    Eating Right

    The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

    Recommendation Why
    Fill up on fiber, not sugar
    A high-fiber, low-sugar diet has been shown to be beneficial in people with Crohn?s disease. Doctors often suggest eliminating all sugar (including soft drinks and processed foods) from the diet.

    A person with Crohn?s disease might consume more sugar than the average healthy person.2 A high-fiber, low-sugar diet led to a 79% reduction in hospitalizations compared with no dietary change in one group of people with Crohn?s disease.3 Another trial compared the effects of high- and low-sugar diets in people with Crohn?s disease.4 People with a more active disease were reported to fare better on the low-sugar diet than those eating more sugar. Several people on the high-sugar diet had to stop eating sugar because their disease grew worse. While details of how sugar injures the intestine are still being uncovered, doctors often suggest eliminating all sugar (including soft drinks and processed foods with added sugar) from the diets of those with Crohn?s disease.

    Focus on fruits and veggies
    A diet high in animal protein and fat (from foods other than fish) has been linked to Crohn?s disease. People may benefit from eating less meat and dairy fat and more fruits and vegetables.

    A diet high in animal protein and fat (from foods other than fish) has been linked to Crohn?s disease in preliminary research.5 As with many other health conditions, it may be beneficial to eat less meat and dairy fat and more fruits and vegetables.

    Try a hypoallergenic diet
    Hypoallergenic diets have been used as a therapy in people with Crohn?s disease, although more research is needed to confirm any benefit.

    Elemental diets contain amino acids (rather than whole proteins, which can stimulate allergic reactions) and are therefore considered hypoallergenic. They have been used extensively as primary therapy in people with Crohn?s disease,6 , 7 , 8 with remission rates comparable to those of steroid drugs. Nevertheless, diets containing intact proteins derived from dairy and wheat have proven equally effective at controlling the symptoms of Crohn?s disease.9 , 10 , 11 Until more is known, it is premature to conclude that food allergy plays a significant role in the development of Crohn?s disease or that a hypoallergenic diet is any more likely to help than a diet whose protein is only partially broken down.

    Uncover your food allergies
    Some people with Crohn?s disease have improved after avoiding allergenic foods. Common culprits are grains, dairy, and yeast. An elimination diet can help uncover your sensitivities.

    Some people with Crohn?s disease have food allergies and have been reported to do better when they avoid foods to which they are allergic. One study found that people with Crohn?s disease are most likely to react to cereals, dairy, and yeast.12 Increasingly, baker?s yeast (found in bread and other bakery goods) has been implicated as a possible trigger for Crohn?s disease.13 Yeast and some cheeses are high in histamine, which is involved in an allergenic response. People with Crohn?s disease lack the ability to break down histamine at a normal rate,14 so the link between yeast and dairy consumption and Crohn?s disease occurrence may not be coincidental. However, the allergy theory cannot account for all, or even most, cases of Crohn?s disease.

    Look at certain foods
    Nuts, raw fruit, and tomatoes were reported in one study to be problematic for people with Crohn?s disease, though other reports have uncovered reactions to different foods.

    In one trial, people with Crohn?s disease were asked which foods aggravated their symptoms.15 Those without ileostomies found nuts, raw fruit, and tomatoes to be most problematic, though responses varied from person to person, and other reports have displayed different lists.16 (Ileostomies are surgical passages through the wall of the abdomen into the intestine that allow the intestinal contents to bypass the rectum and drain into a bag worn on the abdomen.) People with Crohn?s disease wishing to identify and avoid potential allergens should consult a doctor.

    Avoid fast food
    People who eat fast foods at least two times per week may more than triple their risk of developing Crohn?s disease.

    There is preliminary evidence that people who eat fast foods at least two times per week more than triple their risk of developing Crohn?s disease.17

    Supplements

    What Are Star Ratings?

    Our proprietary ?Star-Rating? system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    Supplement Why
    3 Stars
    Vitamin D
    1,000 to 1,200 IU daily under medical supervision
    Vitamin D malabsorption is common in Crohn?s and can lead to a deficiency of the vitamin. Supplementation can help prevent bone loss in cases of deficiency.

    Vitamin D malabsorption is common in Crohn?s18 and can lead to a deficiency of the vitamin.19 Successful treatment with vitamin D for osteomalacia (bone brittleness caused by vitamin D deficiency) triggered by Crohn?s disease has been reported.20 Another study found 1,000 IU per day of vitamin D prevented bone loss in people with Crohn?s, while an unsupplemented group experienced significant bone loss.21 In addition, in a double-blind trial, vitamin D supplementation (1,200 IU per day for 12 months) prevented relapses in patients with Crohn's disease in remission. The patients in that study had normal vitamin D status prior to receiving vitamin D supplementation.22 In a preliminary study of patients with mild-to-moderate Crohn's disease, vitamin D supplementation for 24 weeks was associated with an improvement in disease activity. The amount used in that study was 1,000 to 5,000 IU per day, based on blood levels of the vitamin.23 A doctor should be consulted to determine the right level of vitamin D for supplementation.

    2 Stars
    DHEA
    Take under medical supervision: 200 mg daily
    In a preliminary trial, six of seven people with Crohn?s disease went into remission after taking DHEA for eight weeks.

    In a preliminary trial, six of seven people with Crohn?s disease went into remission after taking 200 mg per day of DHEA for eight weeks.24 This large amount of DHEA has the potential to cause adverse side effects and should only be used under the supervision of a doctor.

    2 Stars
    Fish Oil
    2.7 grams daily omega-3 fatty acids in enteric-coated capsules
    Fish oil helps relieve the inflammation of the gut that occurs in people suffering from Crohn?s disease.

    Inflammation within the gut occurs in people suffering from Crohn?s disease. EPA and DHA , the omega-3 fatty acids found in fish oil , have anti-inflammatory activity. Though research is conflicting, there is some evidence that fish oil improves Crohn's disease symptoms. A two-year trial compared the effects of having people with Crohn?s disease eat 3.5 to 7 ounces of fish high in EPA and DHA per day or having them eat a diet low in fish.25 In that trial, the fish-eating group had a 20% relapse rate compared with 58% among those not eating fish. Salmon, herring, mackerel, albacore tuna, and sardines are all high in EPA and DHA.

    In a double-blind trial, people with Crohn?s disease who took supplements providing 2.7 g of EPA/DHA per day had a recurrence rate of 26% after one year, compared to a 59% recurrence rate among those taking placebo.26

    2 Stars
    Multivitamin
    Follow label instructions
    People with Crohn?s disease may benefit from taking a high potency multivitamin-mineral supplement to offset the deficiencies caused by Crohn?s-related malabsorption.

    Crohn?s disease often leads to malabsorption . As a result, deficiencies of many nutrients are common. For this reason, it makes sense for people with Crohn?s disease to take a high potency multivitamin-mineral supplement. In particular, deficiencies in zinc , folic acid , vitamin B12 , vitamin D , and iron have been reported.27 , 28 , 29 Zinc, folic acid, and vitamin B12 are all needed to repair intestinal cells damaged by Crohn?s disease. Some doctors recommend 25 to 50 mg of zinc (balanced with 2 to 4 mg of copper), 800 mcg of folic acid, and 800 mcg of vitamin B12. Iron status should be evaluated by a doctor before considering supplementation.

    2 Stars
    Probiotics
    At least 250 mg of Saccharomyces boulardii taken three times per day
    In double-blind research, diarrhea caused by Crohn?s disease has partially responded to supplementation with the probiotic Saccharomyces boulardii.

    In double-blind research, diarrhea caused by Crohn?s disease has partially responded to supplementation with the beneficial bacterium Saccharomyces boulardii .30 Although the amount used in this trial, 250 mg taken three times per day, was helpful, as much as 500 mg taken four times per day has been administered in research successfully using Saccharomyces boulardii as a supplement with people suffering from other forms of diarrhea.31

    2 Stars
    Vitamin K
    80 to 1,000 mcg daily
    Taking vitamin K can counteract the deficiency and resulting bone loss that can occur in people with Crohn?s disease.

    In people with Crohn's disease, vitamin K deficiency can result from malabsorption due to intestinal inflammation or bowel surgery, from chronic diarrhea, or from dietary changes necessitated by food intolerance. In addition, Crohn's disease is often treated with antibiotics that have the potential to kill beneficial vitamin K?producing bacteria in the intestines. Vitamin K levels were significantly lower in a group of people with Crohn's disease than in healthy people. Moreover, the rate of bone loss in the Crohn's disease patients increased with increasing degrees of vitamin K deficiency.32 When combined with earlier evidence that vitamin K is required to maintain healthy bones, this study suggests that vitamin K deficiency is a contributing factor to the accelerated bone loss that often occurs in people with Crohn's disease.

    2 Stars
    Zinc
    25 to 50 mg of zinc (with 2 to 4 mg of copper to avoid depletion) per day
    Zinc is needed to repair intestinal cells damaged by Crohn?s disease. Supplementation may offset some of the deficiency caused by Crohn?s-related malabsorption.

    Crohn?s disease often leads to malabsorption . As a result, deficiencies of many nutrients are common. For this reason, it makes sense for people with Crohn?s disease to take a high potency multivitamin-mineral supplement. In particular, deficiencies in zinc , folic acid , vitamin B12 , vitamin D , and iron have been reported.33 , 34 , 35 Zinc, folic acid, and vitamin B12 are all needed to repair intestinal cells damaged by Crohn?s disease. Some doctors recommend 25 to 50 mg of zinc (balanced with 2 to 4 mg of copper), 800 mcg of folic acid, and 800 mcg of vitamin B12 daily. Iron status should be evaluated by a doctor before considering supplementation.

    1 Star
    Agrimony
    Refer to label instructions
    Agrimony is a tannin-containing herb that may be helpful to decrease diarrhea during acute flare-ups and has been used for this purpose in traditional medicine.

    Tannin-containing herbs may be helpful to decrease diarrhea during acute flare-ups and have been used for this purpose in traditional medicine. A preliminary trial using isolated tannins in the course of usual drug therapy for Crohn?s disease found them to be more effective for reducing diarrhea than was no additional treatment.36 Tannin-containing herbs of potential benefit include agrimony (Agrimonia spp.), green tea , oak , witch hazel , and cranesbill . Use of such herbs should be discontinued before the diarrhea is completely resolved; otherwise the disease may be aggravated.

    1 Star
    Aloe
    Refer to label instructions
    Aloe juice has historically been recommended by doctors for people with Crohn?s disease.

    A variety of anti-inflammatory herbs historically have been recommended by doctors for people with Crohn?s disease. These include yarrow , chamomile , licorice , and aloe juice. Cathartic preparations of aloe should be avoided. No research has been conducted to validate the use of these herbs for Crohn?s disease.

    1 Star
    Chamomile
    Refer to label instructions
    Chamomile is an anti-inflammatory herb historically recommended by doctors for people with Crohn?s disease.

    A variety of anti-inflammatory herbs historically have been recommended by doctors for people with Crohn?s disease. These include yarrow , chamomile , licorice , and aloe juice. Cathartic preparations of aloe should be avoided. No research has been conducted to validate the use of these herbs for Crohn?s disease.

    1 Star
    Cranesbill
    Refer to label instructions
    Doctors sometimes recommend this astringent herb in combination with several other herbs to sooth the digestive tract. Because it contains tannin, it may help decrease diarrhea.

    Doctors sometimes use a combination of herbs to soothe inflammation throughout the digestive tract. One formula contains marshmallow , slippery elm , cranesbill , and several other herbs.37 Marshmallow and slippery elm are mucilaginous plants that help soothe inflamed tissues. Cranesbill is an astringent. Clinical trials using this combination have not been conducted.

    Tannin-containing herbs may be helpful to decrease diarrhea during acute flare-ups and have been used for this purpose in traditional medicine. A preliminary trial using isolated tannins in the course of usual drug therapy for Crohn?s disease found them to be more effective for reducing diarrhea than was no additional treatment.38 Tannin-containing herbs of potential benefit include agrimony (Agrimonia spp.), green tea , oak , witch hazel , and cranesbill . Use of such herbs should be discontinued before the diarrhea is completely resolved; otherwise the disease may be aggravated.

    1 Star
    Digestive Enzymes
    Refer to label instructions
    Supplementing with enzymes might improve the nutrient malabsorption that is often associated with Crohn?s disease.

    People with Crohn?s disease may be deficient in pancreatic enzymes , including lipase .39 In theory, supplementing with enzymes might improve the nutrient malabsorption that is often associated with Crohn?s disease. However, people with Crohn?s disease considering supplementation with enzymes should consult a doctor.

    1 Star
    Folic Acid
    Refer to label instructions
    Folic acid is needed to repair intestinal cells damaged by Crohn?s disease. Supplementation may offset some of the deficiency caused by Crohn?s-related malabsorption.

    Crohn?s disease often leads to malabsorption . As a result, deficiencies of many nutrients are common. For this reason, it makes sense for people with Crohn?s disease to take a high potency multivitamin-mineral supplement. In particular, deficiencies in zinc , folic acid , vitamin B12 , vitamin D , and iron have been reported.40 , 41 , 42 Zinc, folic acid, and vitamin B12 are all needed to repair intestinal cells damaged by Crohn?s disease. Some doctors recommend 25 to 50 mg of zinc (balanced with 2 to 4 mg of copper), 800 mcg of folic acid, and 800 mcg of vitamin B12. Iron status should be evaluated by a doctor before considering supplementation.

    1 Star
    Green Tea
    Refer to label instructions
    Green tea is a tannin-containing herb that may be helpful to decrease diarrhea during acute flare-ups and has been used for this purpose in traditional medicine.

    Tannin-containing herbs may be helpful to decrease diarrhea during acute flare-ups and have been used for this purpose in traditional medicine. A preliminary trial using isolated tannins in the course of usual drug therapy for Crohn?s disease found them to be more effective for reducing diarrhea than was no additional treatment.43 Tannin-containing herbs of potential benefit include agrimony (Agrimonia spp.), green tea , oak , witch hazel , and cranesbill . Use of such herbs should be discontinued before the diarrhea is completely resolved; otherwise the disease may be aggravated.

    1 Star
    Licorice
    Refer to label instructions
    Licorice is an anti-inflammatory herb historically recommended by doctors for people with Crohn?s disease.

    A variety of anti-inflammatory herbs historically have been recommended by doctors for people with Crohn?s disease. These include yarrow , chamomile , licorice , and aloe juice. Cathartic preparations of aloe should be avoided. No research has been conducted to validate the use of these herbs for Crohn?s disease.

    1 Star
    Lipase
    Refer to label instructions
    People with Crohn?s disease may be deficient in lipase. Supplementing with enzymes might improve the malabsorption that is associated with the disease.

    People with Crohn?s disease may be deficient in pancreatic enzymes , including lipase .44 In theory, supplementing with enzymes might improve the nutrient malabsorption that is often associated with Crohn?s disease. However, people with Crohn?s disease considering supplementation with enzymes should consult a doctor.

    1 Star
    Marshmallow
    Refer to label instructions
    Marshmallow helps soothe inflamed tissues. Doctors sometimes use this herb in combination with slippery elm, cranesbill, and several other herbs to sooth the digestive tract.

    Doctors sometimes use a combination of herbs to soothe inflammation throughout the digestive tract. One formula contains marshmallow , slippery elm , cranesbill , and several other herbs.45 Marshmallow and slippery elm are mucilaginous plants that help soothe inflamed tissues. Cranesbill is an astringent. Clinical trials using this combination have not been conducted.

    1 Star
    Oak
    Refer to label instructions
    Oak is a tannin-containing herb that may be helpful to decrease diarrhea during acute flare-ups and has been used for this purpose in traditional medicine.

    Tannin-containing herbs may be helpful to decrease diarrhea during acute flare-ups and have been used for this purpose in traditional medicine. A preliminary trial using isolated tannins in the course of usual drug therapy for Crohn?s disease found them to be more effective for reducing diarrhea than was no additional treatment.46 Tannin-containing herbs of potential benefit include agrimony (Agrimonia spp.), green tea , oak , witch hazel , and cranesbill . Use of such herbs should be discontinued before the diarrhea is completely resolved; otherwise the disease may be aggravated.

    1 Star
    Slippery Elm
    Refer to label instructions
    Slippery elm helps soothe inflamed tissues. Doctors sometimes use this herb in combination with marshmallow, cranesbill, and several other herbs to sooth the digestive tract.

    Doctors sometimes use a combination of herbs to soothe inflammation throughout the digestive tract. One formula contains marshmallow , slippery elm , cranesbill , and several other herbs.47 Marshmallow and slippery elm are mucilaginous plants that help soothe inflamed tissues. Cranesbill is an astringent. Clinical trials using this combination have not been conducted.

    1 Star
    Turmeric
    Refer to label instructions
    Turmeric contains curcumin, which has been reported to have anti-inflammatory activity. In one study, people given turmeric saw an improvement after three months.

    Curcumin is a compound in turmeric (Curcuma longa) that has been reported to have anti-inflammatory activity. In a preliminary trial, four of five people with Crohn's disease had an improvem ent in their condition after supplementing with curcumin for three months. The amount used was 360 mg three times a day for one month, followed by 360 mg four times a day for two months.48

    1 Star
    Vitamin A
    Refer to label instructions
    Vitamin A is needed for the growth and repair of cells that line both the small and large intestine and can improve symptoms in people with Crohn?s disease.

    Vitamin A is needed for the growth and repair of cells that line both the small and large intestine.49 At least two case reports describe people with Crohn?s disease who have responded to vitamin A supplementation.50 , 51 However, in one trial, vitamin A supplementation failed to maintain remission of the disease.52 Therefore, although some doctors recommend 50,000 IU per day for adults with Crohn?s disease, this approach remains unproven. An amount this high should never be taken without qualified guidance, nor should it be given to a woman who is or could become pregnant .

    1 Star
    Vitamin B12
    Refer to label instructions
    Vitamin B12 is needed to repair intestinal cells damaged by Crohn?s disease. Supplementation may offset some of the deficiency caused by Crohn?s-related malabsorption.

    Crohn?s disease often leads to malabsorption . As a result, deficiencies of many nutrients are common. For this reason, it makes sense for people with Crohn?s disease to take a high potency multivitamin-mineral supplement. In particular, deficiencies in zinc , folic acid , vitamin B12 , vitamin D , and iron have been reported.53 , 54 , 55 Zinc, folic acid, and vitamin B12 are all needed to repair intestinal cells damaged by Crohn?s disease. Some doctors recommend 25 to 50 mg of zinc (balanced with 2 to 4 mg of copper), 800 mcg of folic acid, and 800 mcg of vitamin B12. Iron status should be evaluated by a doctor before considering supplementation.

    1 Star
    Witch Hazel
    Refer to label instructions
    Witch hazel is a tannin-containing herb that may be helpful to decrease diarrhea during acute flare-ups and has been used for this purpose in traditional medicine.

    Tannin-containing herbs may be helpful to decrease diarrhea during acute flare-ups and have been used for this purpose in traditional medicine. A preliminary trial using isolated tannins in the course of usual drug therapy for Crohn?s disease found them to be more effective for reducing diarrhea than was no additional treatment.56 Tannin-containing herbs of potential benefit include agrimony (Agrimonia spp.), green tea , oak , witch hazel , and cranesbill . Use of such herbs should be discontinued before the diarrhea is completely resolved; otherwise the disease may be aggravated.

    1 Star
    Yarrow
    Refer to label instructions
    Yarrow is an anti-inflammatory herb historically recommended by doctors for people with Crohn?s disease.

    A variety of anti-inflammatory herbs historically have been recommended by doctors for people with Crohn?s disease. These include yarrow , chamomile , licorice , and aloe juice. Cathartic preparations of aloe should be avoided. No research has been conducted to validate the use of these herbs for Crohn?s disease.

    References

    1. Cottone M, Rosselli M, Orlando A, et al. Smoking habits and recurrence in Crohn?s disease. Gastroenterol 1994;106:643?8.

    2. Mayberry JF, Rhodes J. Epidemiological aspects of Crohn?s disease: a review of the literature. Gut 1984;886?99.

    3. Heaton KW, Thornton JR, Emmett PM. Treatment of Crohn?s disease with an unrefined-carbohydrate, fibre-rich diet. BMJ 1979;2(6193):764?6.

    4. Brandes JW, Lorenz-Meyer H. Sugar free diet: a new perspective in the treatment of Crohn disease? Randomized, control study. Z Gastroneterol 1981;19:1?12.

    5. Shoda R, Masueda K, Yamato S, Umeda N. Epidemiologic analysis of Crohn?s disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn?s disease in Japan. Am J Clin Nutr 1996;63:741?5.

    6. O?Morain C, Segal AW, Levi AJ. Elemental diet as primary treatment of acute Crohn?s disease: a controlled trial. Br Med J (Clin Res Ed) 1984;288:1859?62.

    7. Gorard DA, Hunt JB, Payne-James JJ, et al. Initial response and subsequent course of Crohn?s disease treated with elemental diet or prednisolone. Gut 1993;34:1198?202.

    8. Teahon K, Pearson M, Levi AJ, Bjarnason I. Practical aspects of enteral nutrition in the management of Crohn?s disease. JPEN J Parenter Enteral Nutr 1995;19:365?8.

    9. Raouf AH, Hildrey V, Daniel J, et al. Enteral feeding as sole treatment for Crohn?s disease: controlled trial of whole protein v amino acid based feed and a case study of dietary challenge. Gut 1991;32:702?7.

    10. Rigaud D, Cosnes J, Le Quintrec Y, et al. Controlled trial comparing two types of enteral nutrition in treatment of active Crohn?s disease: elemental versus polymeric diet. Gut 1991;32:1492?7.

    11. Park RH, Galloway A, Danesh BJ, et al. Double-blind controlled trial comparing elemental and polymeric diets as primary therapy in active Crohn?s disease. Eur J Gastroenterol Hepatol 1991;32:1492?7.

    12. Riordan AM, Hunter JO, Cowan RE, et al. Treatment of active Crohn?s disease by exclusion diet: East Anglian Multicentre Controlled Trial. Lancet 1993;342:1131?4.

    13. Alic M. Baker?s yeast in Crohn?s disease?can it kill you? Am J Gastroenterol 1999;94:1711 [letter/review].

    14. Wantke F, Gotz M, Jarisch R. Dietary treatment of Crohn?s disease. Lancet 1994;343:113 [letter].

    15. McDonald PJ, Fazio VW. What can Crohn?s patients eat? Eur J Clin Nutr 1988;42:703?8.

    16. Gaby AR. Commentary. Nutr Healing 1998;January:1,10?1 [review].

    17. Persson PG, Ahlbom A, Hellers G. Diet and inflammatory bowel disease: a case-control study. Epidemiology 1992;3:47?52.

    18. Leichtmann GA, Bengoa JM, Bolt MJG, Sitrin MD. Intestinal absorption of cholecalciferol and 25-hydrocycholecalciferol in patients with both Crohn?s disease and intestinal resection. Am J Clin Nutr 1991;54:548?52.

    19. Harris AD, Brown R, Heatley RV, et al. Vitamin D status in Crohn?s disease: association with nutrition and disease activity. Gut 1985;26:1197?203.

    20. Driscoll RH, Meredith SC, Sitrin M, Rosenberg IH. Vitamin D deficiency and bone disease in patients with Crohn?s disease. Gastroenterol 1982;83:1252?8.

    21. Vogelsang H, Ferenci P, Resch H, et al. Prevention of bone mineral loss in patients with Crohn?s disease by long-term oral vitamin D supplementation. Eur J Gastroenterol Hepatol 1995;7:609?14.

    22. Jorgensen SP, Agnholt J, Glerup H, et al. Clinical trial: vitamin D3 treatment in Crohn's disease - a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther 2010;32:377?83.

    23. Yang L, Weaver V, Smith JP, et al. Therapeutic effect of vitamin D supplementation in a pilot study of Crohn's patients. Clin Transl Gastroenterol 2013;4:e33.

    24. Andus T, Klebl F, Rogler G, et al. Patients with refractory Crohn's disease or ulcerative colitis respond to dehydroepiandrosterone: a pilot study. Aliment Pharmacol Ther 2003;17:409?14.

    25. Mate J, Castanos R, Garcia-Samaniego J, Pajares JM. Does dietary fish oil maintain the remission of Crohn?s disease: a case control study. Gastroenterology 1991;100:A228 [abstract].

    26. Belluzzi A, Brignola C, Campieri M, et al. Effect of an enteric-coated fish-oil preparation on relapses in Crohn?s disease. N Engl J Med 1996;334:1557?60.

    27. Imes S, Plinchbeck BR, Dinwoodie A, et al. Iron, folate, vitamin B-12, zinc, and copper status in out-patients with Crohn?s disease: effect of diet counseling. J Am Dietet Assoc 1987;87:928?30.

    28. Sandstead HH. Zinc deficiency in Crohn?s disease. Nutr Rev 1982;40:109?12.

    29. Driscoll RH Jr, Meredith SC, Sitrin M, et al. Vitamin D deficiency and bone disease in patients with Crohn?s disease. Gastroenterology 1982;83:1252?8.

    30. Plein K, Hotz J. Therapeutic effects of Saccharomyces boulardii on mild residual symptoms in a stable phase of Crohn?s disease with special respect to chronic diarrhea?a pilot study. Z Gastroenterol 1993;31:129?34.

    31. Bleichner G, Blehaut H, Mentec H, Moyse D. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A muticenter, randomized, double-blind placebo-controlled trial. Intensive Care Med 1997;23:517?23.

    32. Duggan P, O'Brien M, Kiely M, et al. Vitamin K status in patients with Crohn's disease and relationship to bone turnover. Am J Gastroenterol 2004;99:2178?85.

    33. Imes S, Plinchbeck BR, Dinwoodie A, et al. Iron, folate, vitamin B-12, zinc, and copper status in out-patients with Crohn?s disease: effect of diet counseling. J Am Dietet Assoc 1987;87:928?30.

    34. Sandstead HH. Zinc deficiency in Crohn?s disease. Nutr Rev 1982;40:109?12.

    35. Driscoll RH Jr, Meredith SC, Sitrin M, et al. Vitamin D deficiency and bone disease in patients with Crohn?s disease. Gastroenterology 1982;83:1252?8.

    36. Plein K, Burkard G, Hotz J. Treatment of chronic diarrhea in Crohn disease. A pilot study of the clinical effect of tannin albuminate and ethacridine lactate. Fortschr Med 1993;111:114?8 [in German].

    37. Pizzorno JE, Murray MT. Textbook of Natural Medicine. London: Churchill Livingstone, 1999, 1335?49.

    38. Plein K, Burkard G, Hotz J. Treatment of chronic diarrhea in Crohn disease. A pilot study of the clinical effect of tannin albuminate and ethacridine lactate. Fortschr Med 1993;111:114?8 [in German].

    39. Hegnhoj J, Hansen CP, Rannem T, et al. Pancreatic function in Crohn?s disease. Gut 1990;31:1076?9.

    40. Imes S, Plinchbeck BR, Dinwoodie A, et al. Iron, folate, vitamin B-12, zinc, and copper status in out-patients with Crohn?s disease: effect of diet counseling. J Am Dietet Assoc 1987;87:928?30.

    41. Sandstead HH. Zinc deficiency in Crohn?s disease. Nutr Rev 1982;40:109?12.

    42. Driscoll RH Jr, Meredith SC, Sitrin M, et al. Vitamin D deficiency and bone disease in patients with Crohn?s disease. Gastroenterology 1982;83:1252?8.

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