If you have Crohn’s disease your doctor has probably told you that diet doesn’t matter. You can go ahead and eat whatever you’d like, just avoiding foods that seem to aggravate your symptoms like raw vegetables or spicy foods. If you have strictures, you might be advised to follow a low-residue diet to prevent obstructions, or if you have had surgery resulting in a shortened bowel you might be told to limit sugars or fats to prevent excessive diarrhea. But these dietary interventions do nothing to induce remission or prevent flare-ups and conventional wisdom among most doctors is that only pharmaceuticals can accomplish that with diet only being important in as much as it keeps you generally well nourished.
This is what I was told and believed for much of my 17 year journey with Crohn’s disease. The link between the two may not be definitively proven yet, but evidence is mounting against that conventional wisdom and a lot of smart people are reconsidering the link between Crohn’s disease and diet, particularly when it comes to consuming modern wheat.
Here are four good reasons, all supported by science, to ditch your bread and go gluten-free if you have Crohn’s disease.
#1: It’s all in the family!
Crohn’s disease and celiac disease are related.
Recent research found that there are common genetic variants between people who have Crohn’s disease and those with celiac disease. Three of the four common genes have to do with how the immune system responds to perceived threats. In patients with celiac disease, this is a reaction to gluten in the small intestine, a protein found in wheat. For people with Crohn’s disease it is believed that the faulty immune response may be to gut bacteria and may affect the entire digestive track. Earlier studies have already established that people with celiac disease have a much higher risk of developing Crohn’s disease and vice versa, including this 2004 study that found over 25% of Crohn’s patients also had evidence of celiac disease.
Clearly this doesn’t prove that every person with Crohn’s disease will develop celiac, nor does it even suggest that avoiding gluten can lessen the severity of Crohn’s or induce remission, but it should give us pause, especially since so little is known about what actually causes Crohn’s disease. Perhaps Crohn’s is actually a variant of celiac disease that has other triggering co-factors. If so, it makes sense to avoid ingesting the specific protein that is proven to trigger celiac.
#2 – It tears your gut apart!
Wheat contributes to “leaky gut”
Even if you don’t actually have celiac disease, there is evidence that gliadin, the primary immunotoxic protein found in wheat gluten, is capable of increasing the production of the intestinal protein zonulin, which in turn opens up gaps in the normally tight junctures between intestinal cells. The worse news for Crohn’s patients is that zonulin release seems to be much higher and longer-lasting in in our systems than in healthy patients.
Paul Jaminet writes about the role wheat plays in increased intestinal permeability (commonly known as “leaky gut”) in his book The Perfect Health Diet and expands on this concept in a 2010 post on his blog. According to Jaminet’s interpretation of the scientific data, “Leaky gut is a prerequisite for development of autoimmune disease. Wheat seems to create a transient, mild leaky gut in nearly everyone, but in Crohn’s disease the gut becomes chronically and severely leaky in response to wheat consumption.”
#3 – It feeds the nasty bacteria!
Damaged intestines can’t break down polysaccharides
And if leaky gut is not scary enough, consider this: wheat and other grains are comprised of polysaccharides that the damaged intestines of a person with Crohn’s disease can not cannot fully digest and absorb, instead remaining in the gut to become food for microbes that can overgrow and contribute to a worsening cycle of gas and acid production and even more damage, as described by Elaine Gottschall in the scientific basis for the Specific Carbohydrate Diet (SCD). The only way to break that vicious cycle so the bacteria balance can go back to normal is to stop feeding them. This is particularly a concern for people like me who have had damage to or surgical removal of the ileocecal valve, making them prone to Small Intestinal Bacterial Overgrowth (SIBO).
#4 – It isn’t your great-grandmother’s loaf of bread anymore.
Modern wheat is lower in nutrients and higher in gut irritants than its ancestor
Dr. William Davis, author of the best-selling book Wheat Belly, describes modern wheat as a “perfect chronic poison” and points out that it is “an 18-inch tall plant created by genetic research in the ’60s and ’70s.” It was designed to increase yield per acre and did a marvelous job doing so, even leading to a Nobel Peace Prize for agronomist Norman Borlaug who pioneered its development and fed millions in developing countries. Unfortunately, this genetic tinkering also produced a plant with an increase in the specific proteins that shown to provoke celiac disease and at the same time dramatically decreasing mineral density . You could get around some of this poor nutrient density by eating artificially enriched flour, but the other problems remain.
My personal experience
I cut gluten out of my diet in the context of eliminating all grains when I started following the Specific Carbohydrate Diet (SCD). I saw some immediate improvement in my bowel symptoms and a colonoscopy less than 2 months later showed that I only had patches of inflammation in the lowest part of my colon and rectum that were “consistent with resolving Crohn’s disease.”
My biggest concern at the time, however, was ongoing anemia that none of my doctors could explain or fix, despite getting regular and repeated iron infusions and even blood transfusions when my hemoglobin and hematocrit got dangerously low. The clue for me that diet could potentially be a factor came in reviewing my medical records: the only time in my entire adult life when I was consistently not anemic and the only colonoscopy I’d ever had that showed no active Crohn’s disease was during the time that I was between surgeries and on TPN for my total nutrition. That led me to ask for another test for celiac disease (it was negative) and then to investigate alternative diets for inflammatory bowel disease.
Just a few weeks after starting SCD, the numbers on my CBC started to steadily improve. Four months after I started, I had my first normal results and they have stayed in the normal range ever since, even though my bowel symptoms still hadn’t completely resolved.
In order to address those lingering symptoms, I have now started to move beyond SCD and am currently following a diet that more closely resembles the paleo auto-immune protocol, based on research by Loren Cordain, and expanded upon by Sarah Ballantyne on her science heavy website The Paleo Mom. Eliminating dairy, legumes, and nuts returned my bowel functioning to near normal and I have started to add back in some of the starchy vegetables forbidden on SCD. I may one day also experiment with some of the other so-called “safe starches” like white rice, but after learning all that I have outlined in this post, I don’t plan on ever touching gluten again.
The bottom line
Wheat is likely very dangerous for people with Crohn’s disease, even if you test negative for celiac disease and your doctor says you can eat whatever you like. Consider doing a 30-90 day elimination diet and see if your symptoms improve. What have you got to lose?