Complementary therapies for Crohn's disease

Written by: 
Helen Cooke

This page gives a brief overview of the most common complementary approaches in Crohn's disease.

The illness needs careful management by a specialist medical team and complementary therapies should not be seen as a treatment for Crohn's disease in their own right. Most complementary approaches are used by people alongside lifestyle changes such as a healthy diet and stressRelating to injury or concern.-management techniques.

Many of the approaches listed only have a limited amount of scientific evidence to support their use. This is partly because there is a lack of good-quality trials and partly because their effectiveness is difficult to evaluate with many established research methods.

It is important to speak to your doctor before you try any of these approaches, as some, such as herbal remedies, may interfere with conventional treatment.

For further information on nutritional approaches and supplements, please see the Nutrition in IBDAn abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. page.

Summaries about therapies are placed under five standard headings below to indicate what evidence there is for effectiveness:

Important
Speak to your doctor before you try any of these approaches. Some therapies interfere with conventional treatment - for example, herbs may interact with medication you are taking and can present their own side-effects. Herbs should be supplied by a qualified, registered herbalist.

Positive evidence and likely to help

There are currently no complementary approaches listed in this section.

Unclear evidence, but MAY help

Probiotics

The term probiotics describes the use of live 'friendly' lactic-acid producing bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. which, when consumed in adequate amounts, provide health benefits.

Learn more about probiotics.

Some Bifidophilus probiotic strains have been shown to prevent relapses of Crohn's disease symptoms, and to help maintain remission.

More studies are needed to confirm this, but as Probiotics are generally regarded as safe, they are worth trying to see if they help you as an individual. If you are lactose-intolerant, select capsules that do not contain lactose.[1,2]

Unclear evidence and NOT likely to help

There are currently no complementary approaches listed in this section.

Negative evidence

There are currently no complementary approaches listed in this section.

Unclear or lacking evidence and unknown if likely to help

Acupuncture

There is encouraging evidence from randomised controlled trialsStudies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. to show that acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. is beneficial for treating Crohn's disease.

Learn more about acupuncture.

In a single-blind, placebo-controlled trial involving 51 patients with mild to moderately active Crohn's, only the practitioners knew whether each patient was receiving true acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. or sham acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. (in which needles are inserted in areas that were not recognised as acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. points).

In this trial, patients receiving true acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. plus moxibustion (in which heat is applied to the needles using burning herbs) showed a significantly reduced Crohn's Disease Activity Index score compared with the control group receiving sham acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points.. General wellbeing also improved, but there were no differences in the remission rate between the two groups.[3,4] More research is needed to be able to draw any firm conclusions.

Boswellia serrata (Frankincense)

Frankincense is a resin obtained from a tree native to Arabia and India. It contains substances called boswellic acids, which have an anti-inflammatoryAny drug that suppresses inflammation action.

Use of the resin to treat Crohn's disease has shown promising results in one double-blind trial, in which neither the researchers nor the patients knew which group was receiving which treatment until the code was broken at the end of the study.

In this trial, 102 people took either 3.6g Boswellia serrata extracts or the drug, mesalazine for 8 weeks. Both treatments reduced the Crohn's Disease Activity Index by similar amounts. More adverse effectsUndesirable side-effects of medication. occurred in those taking Boswellia serrata, but 13 adverse effectsUndesirable side-effects of medication. were recorded in those taking mesalazine.[5]

These results suggest that Boswellia serrata is at least as effective a treatment as the prescribed drug, but more research is needed to confirm this.

Bromelain

Bromelain, an extract from the pineapple plant, consists of a group of enzymes that can digest protein. In the laboratory, bromelain has been shown to decrease the production of inflammatory substances (cytokines) in colonThe large intestine. biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. cells obtained from people with Crohn's disease.[6] It may therefore be helpful for the treatment of Crohn's, but further studies are needed to confirm whether or not this is the case.[6]

Curcumin

Curcumin is an antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. substance derived from the Indian spice, Turmeric, which has an anti-inflammatoryAny drug that suppresses inflammation action. In a small pilot study involving people with inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis., curcumin was reported to benefit five patients with Crohn's disease [3]. It is not possible to draw any conclusions from this small a number, however.

Devils claw (Harpagophytum procumbens)

The root tuber of Devil's claw contains substances that have an antioxidantA chemical that can neutralise damaging substances called oxygen free radicals., pain-killing action. It  has traditionally been used to treat inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Its antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. action has been confirmed in scientific studies, but its effectiveness in improving Crohn's symptoms remains unknown.[7]

Fish oil

Omega-3 fish oils have an anti-inflammatoryAny drug that suppresses inflammation action that is believed to result from suppressing the production of inflammatory immune substances (cytokines).

Learn more about omega fatty acids.

Eating oily fish has been shown to help people with inflammatory conditions such as rheumatoid arthritisInflammation of one or more joints of the body.. It may therefore also have a beneficial effect on inflammatory bowel diseases such as Crohn's, when added to standard treatment.

Several small, randomised, placebo-controlled studies have shown a beneficial effect of omega-3 fish oils in reducing symptoms of Crohn's, but one large trial involving over 200 patients did not show a significant benefit.[2]

More research is needed to confirm whether or not it is helpful. As it offers benefit against coronaryRelating to the arteries supplying the heart itself. heart disease, however, supplements are worth trying to see if they help you as an individual.

Glucosamine

Inflammatory bowel disease has been linked with reduced activity of an enzymeA protein that speeds up chemical reactions in the body without being used up itself., glucosamine synthetase, which is needed to repair the bowel wall.[8]

In a pilot study, 12 children with chronicA disease of long duration generally involving slow changes., severe (in possible need of surgery, treatment-resistantA microbe, such as a type of bacteria, that is able to resist the effects of antibiotics or other drugs. inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. (ten had Crohn's disease, two ulcerative colitis) received 3g to 6g N-acetyl glucosamine supplements per day, by mouth, divided into three doses. Of the ten children with Crohn's disease, six showed significant improvement and no longer needed surgery. These are promising initial results, but larger trials are needed to confirm these findings in both children and adults.[9]

Homeopathy

Homeopathy is a popular treatment for inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. in several European countries [10]. However, there do not appear to be any published studies to show the effectiveness of treating Crohn's disease with homeopathic remedies.

Hypnotherapy

Hypnotherapy is a popular treatment for conditions in which stressRelating to injury or concern. plays a role. In one study, 15 people with 'severe' or 'very severe' inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis., who had not responded to corticosteroidsA group of hormones that are produced by the adrenal glands, which sit on top of the kidneys., received 12 sessions of gut-focused hypnotherapyAny form of psychotherapy that uses hypnosis.. They were then followed for an average of over 5 years. Thirteen patients responded with four going into complete remission, and nine had their condition downgraded (eight down to 'mild' and one to 'moderate'). Only two patients failed to respond and required surgery.[11] This study suggests that hypnotherapyAny form of psychotherapy that uses hypnosis. may be helpful for people with Crohn's disease, but further research is needed to confirm its effectiveness.

Slippery elm bark

The bark of the slippery elm, a tree native to North America, has traditionally been used to 'soothe' inflammationThe body’s response to injury. in gastrointestinal conditions such as Crohn's disease. Its antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. action has been confirmed in scientific studies, but its effectiveness in improving Crohn's symptoms remains unknown.[7]

Tormentil (Potentilla tormentilla)

The red root of Tormentil, a member of the rose family which grows throughout Europe, has traditionally been used to treat inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Its antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. action has been confirmed in scientific studies, but its effectiveness in improving Crohn's symptoms remains unknown.[7]

References: 
  1. Natural Standard Database. Crohn's disease. Link
  2. Natural Standard Database. Fish oil. Link
  3. Review article: Complementary and alternative therapies for inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Longmead C, Rampton C. Alimentary Pharmacology and Therapeutics. 2006; 23: 341-349.
  4. Acupuncture treatment in gastrointestinal diseases: A systematic review. Schneider A, Streitberger K, Joos S. World Journal of Gastroenterology. 2007; 13(25): 3417-24.
  5. Ernst E. Frankincense: systematic review. BMJ. 2008; 337:a2813.
  6. Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by   colonThe large intestine. biopsies in vitro. Onken JE, Greer PK, Calingaert B, et al. Clinical Immunology. 2008;126: 345-352.
  7. Antioxidant effects of herbal therapies used by patients with inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.: an in vitro study. Langmead L, Dawson C Hawkins N et al. Aliment Pharmacol Ther. 2002;16: 197-205.
  8. Glycosaminoglycan (GAG) deficiency in protective barrier as an underlying, primary cause of ulcerative colitis, Crohn's disease, interstitial cystitis and possibly Reiter's syndrome. Russell AL. Medical Hypotheses. 1999;52(4):297-301.
  9. A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosaminoglycan synthesis in paediatric chronicA disease of long duration generally involving slow changes. inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Salvatore S, Heuschkel R, Tomlin S et al. Alimentary Pharmacology and Therapeutics. 2000; 14(12):1567-79.
  10. Use of complementary and alternative medicine in Germany. A survey of patients with inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Joos, S, Roseman,T, Szecsenyc, J et al. BMC Complementary and Alternative Medicine. 2006: 6:19.
  11. Treatment of inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.: A role for hypnotherapyAny form of psychotherapy that uses hypnosis.. Miller V, Whorwell, P. International Journal of Clinical and Experimental Hypnotherapy 2008; 56(3): 306-17.