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Alternative and Complementary Treatments for Crohn's Disease

Some Supplements Have Evidence To Support Their Use In IBD While Others Do Not

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Updated July 09, 2012

Many people with inflammatory bowel disease (IBD) search for complementary and alternative treatments to help ease their symptoms. As many as half of all people who have Crohn's disease may turn to these types of treatments. Many of these remedies have not been researched, but a few complementary and alternative treatments for Crohn's disease that have been studied include slippery elm and omega-3 fatty acids.

Omega-3 Fatty Acids

Omega-3 fatty acids are not made by our bodies, but are necessary for good health and have anti-inflammatory properties. Omega-3 fatty acids are found in seafood such as salmon, herring, mackerel, albacore tuna, and sardines, as well as walnuts, flax, canola oil, pumpkin seeds, and soy. They can also be found in supplement form, most often as a fish oil capsule.

Studies on the benefits of omega-3 fatty acids in IBD have had mixed results. In two randomized, double-blind, placebo-controlled studies, a total of 738 people with Crohn's disease were given either omega-3 free fatty acids or a placebo. The omega-3 group and the placebo group had roughly the same percentage of relapses, leading the authors to conclude omega-3 free fatty acids aren't effective at preventing Crohn's flare-ups. In another study, 38 pediatric patients with Crohn's patients in remission were given either enteric-coated omega-3 fatty acid capsules or a placebo of olive oil, along with a 5-ASA drug. The patients receiving the omega-3 fatty acids had fewer incidences of flare-ups over the study period of one year.

In general, omega-3 fatty acids are a healthful addition to the diet, as they have been shown to reduce the risk of heart disease. Side effects from fish oil supplements can include foul-tasting belches and diarrhea, but time-release capsules may help alleviate these problems.

Boswellia

Boswellia, also known as frankincense, is an herb that is not very well known, but has been studied for use in a variety of conditions, including Crohn's disease. In one German study, 102 patients with Crohn's disease were given either boswellia or the drug mesalazine. The researchers found that boswellia was not any better or worse than mesalazine in terms of efficacy, but may be "superior" in a comparison of the benefits to the risks. Boswellia is not approved as a treatment for any particular condition, but is sold as a dietary supplement in vitamin and health food stores.

Slippery Elm

Slippery elm (Ulmus fulva) has long been used as a remedy to treat gastrointestinal distress. Slippery elm supplements are actually made from the inner part of the bark of an elm tree, and comes in a variety of forms such as tablets, capsules, powder, tea, or lozenges. It has not been studied extensively for use in Crohn's disease, but the authors of one study did find that slippery elm has enough antioxidant effects that it warrants further studies.

Bromelain

Bromelain is an enzyme that is found in a very common place: pineapples. The stems and juices of a pineapple contain this substance that has been used for a variety of conditions, including digestive complaints, and is approved for treating sinusitis in Germany. There is no evidence to support its use in Crohn's disease, as research is just starting to be done, and there are no studies on humans yet. One study tested the effect of bromelain on biopsies taken from the colons of people with Crohn's disease and ulcerative colitis. The colon tissue treated with bromelain had fewer IBD markers than tissue that was not treated. There is one case report that bromelain was effective in inducing remission for two patients with ulcerative colitis who did not respond to other treatments.

Remember to consult your health care team before deciding to try any supplements for Crohn's disease. Even "natural" supplements can interact with medications or cause allergic reactions.

Sources:

Feagan BG, Sandborn WJ, Mittmann U, et al. "Omega-3 Free Fatty Acids for the Maintenance of Remission in Crohn Disease." JAMA Apr 9 2008;299;1690-1697. 4 Jun 2009.

Gerhardt H, Seifert F, Buvari P, Vogelsang H, Repges R. "Therapy of active Crohn disease with Boswellia serrata extract H 15." Z Gastroenterol Jan 2001;39:11-17. 4 Jun 2009.

Hawkins EB and Ehrlich SD. "Omega-3 fatty acids." University of Maryland Medical Center 1 May 2007. 4 Jun 2009.

Kane S, Goldberg MJ. "Use of bromelain for mild ulcerative colitis." Ann Intern Med 18 Apr 2000;132:680. 5 Jun 2009.

Langmead L, Dawson C, Hawkins C, Banna N, Loo S, Rampton DS. "Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease: an in vitro study." Alimentary Pharmacology & Therapeutics Feb 2002;16:197-205. 4 Jun 2009.

Onken JE, Greer PK, Calingaert B, Hale LP. "Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro.." Clin Immunol Mar 2008;126:345-352. 5 Jun 2009.

Romano C, Cucchiara S, Barabino A, Annese V, Sferlazzas C. "Usefulness of omega-3 fatty acid supplementation in addition to mesalazine in maintaining remission in pediatric Crohn's disease: a double-blind, randomized, placebo-controlled study." World J Gastroenterol 7 Dec 2005;45;7118-7121. 4 Jun 2009.

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