Overview

Crohn's disease and ulcerative colitis are inflammatory bowel conditions with a possible auto-immune origin. Crohn's disease may involve any part of the digestive tract, whereas ulcerative colitis only involves the colon and/or rectum).

Low Dose Naltrexone may be particularly effective in treating Crohn's disease. Dr. Weyrich considers this to be the first-line treatment, as it is more cost-effective and has a lower side effect profile than other conventional treatments such as aminosalicylates and infliximab.

Please see conventional, complementary, and alternative medical treatments for important background information regarding the different types of medical treatments discussed on this page. Naturopathic, Complementary, and Alternative treatments that may be considered include:

Etiology

The definitive cause of Crohn's disease is unknown. Keeping in mind that association does not necessarily distinguish between cause and effect, the following factors have been associated with Crohn's disease, in no particular order:
  • The British gastroenterologist Andrew Wakefield has associated Crohn's Disease with the MMR (Measles, Mumps, Rubella) vaccine [Shaw2008].
  • Inflammatory process mediated by estrogen receptors: [Risbridger2007  🕮 ] has pointed out the inflammatory effect of stimulating estrogen-receptor-alpha (ER-alpha) in inflammatory bowel disease, and the anti-inflammatory effect of stimulating estrogen-receptor-beta (ER-beta). Both estriol and the naturally occurring substance genistein have been shown to selectively stimulate ER-beta.
  • Dysbiosis - which is an imbalance in gut bacteria (microbiome) has been reviewed by [Becker2015  🕮 ]. According to [Allegretti2021  🕮 ], "when the microbiomes of patients with IBD have been assessed, overall there is a decrease in certain types of bacteria, specifically Bacteroides and Bacillota (Firmicutes), which are thought to be anti-inflammatory. These patients have also been shown to have decreased amounts of bacteria that make short-chain fatty acids, which are important for anti-inflammatory response."
  • Genetic predisposition - According to [Oyri2015  🕮 ], "The presence of Crohn's-associated variants of NOD2 and ATG16L genes appears to be associated not only with alterations of mucosal barrier functions, and bacterial killing, but the gut microbiota, as well..."
  • Some practitioners have noted an association between colitis and inflammatory process mediated by homocysteine [Rogers2008, pg 9]. Note that the common diuretic hydrochlorothiazide (HCTZ) increases homocysteine levels [Westphal2003  🕮 ].

Diagnosis

  •  >   
    Organic Acid Test (elevated markers for gut dysbiosis)
  •        IgG Food Sensitivity finger-prick testing
  •        Blood tests (anemia or signs of inflammation)
  •        Stool sample (bleeding, dysbiosis, or inflammation in the intestines)
  •        Colonoscopy or capsule endoscopy

Differential Diagnosis

Treatment

Naturopathic, Complementary, and Alternative Treatments

Low Dose Naltrexone (LDN)

The late Dr. Bernard Bihari [Bihari2003], [Bihari2013  🕮 ], who discovered the benefits of low dose naltrexone in 1986, reported extraordinary results treating a variety of autoimmune and neuroinflammatory conditions [Bihari2003], [Bihari2013  🕮 ]. In particular, Low Dose Naltrexone (4.5mg/day) has been shown to have an immune-balancing effect that benefits Crohn's disease, with a 67% remission rate [Farmer1985  🕮 ] [Smith2007  🕮 ] [Smith2011  🕮 ] [Smith2013  🕮 ] [Shannon2010  🕮 ] [LDN]

[LDN_Autoimmune] reports that Dr. Bernard Bihari treated a cohort of eight patients having Crohn's disease with LDN, obtaining remission of symptoms within 14-21 days in all cases.

According to the Low Dose Naltrexone home page [LDN], LDN has also been seen to benefit Ulcerative Colitis.

[Raknes2018  🕮 ] has demonstrated in a retrospective study that adding LDN reduced the utilization of conventionally prescribed medications for treating IBD in 256 patients.

[Lie2018  🕮 ] reports a clinical trial using LDN to treat IBD, in which clinical improvement was observed in 74.5%, and remission in 25.5% of patients.

[Weinstock2014  🕮 ] reports a case series in which 6 out of 12 patients reported positive clinical responses.

[Tawfik2016  🕮 ] reports an animal study of using LDN to treat Crohn's disease.

However, [Segal2014  🕮 ] cautions that additional research is necessary and a Cochrane review noted the poor quality of some of the evidence reported [Parker2018  🕮 ]

The mechanism of action of LDN in treating inflammatory bowel disease appears to be via Toll-like receptor 4 antagonism and/or opioid growth factor antagonism [Toljan2018  🕮 ].

Dr. Weyrich has been trained to use Low Dose Naltrexone (LDN). However, Dr. Weyrich has not treated any cases of Crohn's disease with LDN.

Please see What is Low Dose Naltrexone? for more information.

IgG Food Sensitivity Avoidance Diet

There are different types of food allergies/sensitivities, which arise from different kinds of immune system reactions. The most "famous" kind of allergy response, which is most often tested by conventional allopathic doctors, is a skin scratch test that depends on the IgE part of the immune system. Alternative practitioners also look at the reactions of the IgG part of the immune system, which is more subtle, but which is nonetheless often associated with gut inflammation. Dr. Weyrich and Dr. Gear have had good results in treating a variety of complaints using the IgG food sensitivity test from Go to ImmunoLabsImmunoLabs.

Immune System Balancing

[McCulley2018, pp 28, 33, 60, 89] reports that Crohn's disease is a TH1- and TH17-dominant, localized, autoimmune disorder, and proposes an approach to treating this disease, which should be supervised by a properly trained medical professional. Dr. Weyrich has considerable interest in this topic, but has not treated any cases of Crohn's disease with Immune System Balancing.

Please see What is Immune System Balancing? for more information.

Hormone Balancing

[Risbridger2007  🕮 ] has pointed out the inflammatory effect of stimulating estrogen-receptor-alpha (ER-A) in inflammatory bowel disease, and the anti-inflammatory effect of stimulating estrogen-receptor-beta (ER-B). Both estriol and the naturally occurring substance genistein have been shown to selectively stimulate ER-B. Dr. Weyrich has considerable interest in this topic, but has not treated any cases of Crohn's disease or ulcerative colitis with Hormone Balancing.

Neurotransmitter Balancing

Neuro Research [Hinz2015] reports that Crohn's disease can be benefited by balancing neurotransmitter levels in the body.

Dr. Weyrich has been trained in neurotransmitter balancing protocols, but has not treated Crohn's disease using this technique.

Please see What is Neurotransmitter Balancing? for more information.

Probiotics

[Allegretti2021  🕮 ] reports that probiotics are helpful in treating Crohn's disease. Dr. Weyrich also has one case in which a patient suffering from inflammatory bowel disease benefited from high dose treatment with a certain probiotic formula.

Fecal Material Transplantation

[Allegretti2021  🕮 ] review the use of fecal material transplantation (FMT) as a treatment for Crohn's disease. (As of 2021) the FDA considers most uses of FMT to be experimental.

Sequelae

According to [DeFilippis2016  🕮 ], there may be extraintestinal manifestations of IBD, including liver, joints, skin, and eyes.

Pathophysiology

  • Low-dose naltrexone reduces in-vitro endoplasmic reticulum stress and stimulates wound healing in intestinal epithelial cells [Fuhler2016]
  • Low dose naltrexone: side effects and efficacy in gastrointestinal disorders [Ploesser2010  🕮 ]

References