Crohn's Disease Supportive Care Protocol

Gastrointestinal/AutoimmuneModerate Evidence

supplements

Primary

Supporting

Grade A

Studies

Primary Stack

Core supplements with strongest evidence

Vitamin DB

2000-4000 IU daily (higher doses may be needed based on levels)

Deficiency very common; supports immune modulation and bone health

15 studies1,000 participants

Supporting Studies (1)

PMID: 28750270 - Vitamin D in inflammatory bowel disease: meta-analysis (2017)

Omega-3 Fatty AcidsB

2-4g EPA+DHA daily

Anti-inflammatory; may help maintain remission

12 studies800 participants

Supporting Studies (1)

PMID: 27840029 - Omega-3 for Crohn's disease: Cochrane review (2017)

Supporting Stack

Additional supplements for enhanced results

ProbioticsC

10-50 billion CFU daily (specific strains like Saccharomyces boulardii)

May help with gut microbiome balance; evidence mixed for Crohn's specifically

12 studies600 participants

Supporting Studies (1)

PMID: 24045160 - Probiotics for inflammatory bowel disease: Cochrane review (2013)

IronB

If deficient: 27-65mg elemental iron daily; IV iron if oral not tolerated

Anemia common due to blood loss and malabsorption

8 studies400 participants

Supporting Studies (1)

PMID: 18989142 - Iron supplementation in IBD: guidelines (2015)

Vitamin B12B

1000mcg daily or as injections if severe deficiency

Deficiency common with ileal disease or resection

6 studies300 participants

Supporting Studies (1)

PMID: 22566526 - Micronutrient deficiencies in Crohn's disease: review (2012)

ZincC

15-30mg daily

Deficiency common; supports immune function and wound healing

5 studies200 participants

Supporting Studies (1)

PMID: 26845419 - Zinc in inflammatory bowel disease: review (2016)

How This Protocol Works

Simple Explanation

Crohn's disease is a type of inflammatory bowel disease (IBD) that can affect any part of the digestive tract, most commonly the end of the small intestine (ileum) and beginning of the colon.

KEY FEATURES:

•Chronic, relapsing-remitting course

•Can affect any part of GI tract (mouth to anus)

•Inflammation is transmural (affects full bowel wall)

•May cause strictures, fistulas, abscesses

SYMPTOMS:

•Abdominal pain and cramping

•Diarrhea (may be bloody)

•Fatigue

•Weight loss

•Reduced appetite

•Fever

•Mouth sores

•Perianal disease

NUTRITIONAL DEFICIENCIES (common):

•Vitamin D

•Vitamin B12 (especially with ileal disease)

•Iron

•Zinc

•Folate

•Calcium

MEDICAL TREATMENTS:

•Aminosalicylates (mild disease)

•Corticosteroids (flares)

•Immunomodulators (azathioprine, methotrexate)

•Biologics (anti-TNF, vedolizumab, ustekinumab)

•Surgery (for complications)

NUTRITION:

•No single diet works for everyone

•Identify and avoid personal trigger foods

•Adequate calories and protein

•Correct deficiencies

•Low-residue diet during flares

* Vitamin D deficiency is very common - check and correct.

* B12 monitoring especially with ileal involvement.

* Work with GI specialist for medical management.

Expected timeline: Disease requires lifelong management. Supplements address deficiencies and may provide modest supportive benefit.

Clinical Perspective

Crohn's Disease: Transmural inflammation; can affect any GI tract segment; skip lesions. Complications: strictures, fistulas, abscesses. Extra-intestinal manifestations: arthritis, uveitis, pyoderma gangrenosum.

Nutritional deficiencies very common: vitamin D (50-70%), B12 (ileal disease/resection), iron (blood loss, malabsorption), zinc, folate. Screen and replace. Omega-3 may have modest anti-inflammatory benefit. Probiotics: evidence stronger for UC than Crohn's; S. boulardii may help. Exclusive enteral nutrition can induce remission (especially pediatric). Supplements adjunctive to medical therapy.

* Vitamin D (B-grade): Common deficiency. Meta-analysis: (PMID: 28750270). 2000-4000 IU daily.

* Omega-3 (B-grade): Anti-inflammatory. Cochrane: (PMID: 27840029). 2-4g EPA+DHA daily.

* Probiotics (C-grade): Microbiome. Cochrane: (PMID: 24045160). 10-50B CFU daily.

* Iron (B-grade): Anemia common. Guidelines: (PMID: 18989142). IV if oral not tolerated.

* Vitamin B12 (B-grade): Ileal disease. Review: (PMID: 22566526). 1000mcg daily or injection.

* Zinc (C-grade): Wound healing/immune. Review: (PMID: 26845419). 15-30mg daily.

Protocol notes: Monitoring: check vitamin D, B12, iron/ferritin, CBC regularly. B12: if ileal disease or resection >20cm, likely lifelong replacement. Iron: IV iron often better tolerated and more effective. Bone health: DEXA; steroids accelerate bone loss. Malnutrition: dietitian involvement; consider enteral nutrition. Smoking: CRITICAL - smoking worsens Crohn's; cessation essential. Biologics: discuss supplements with provider (timing, interactions). Surgery: doesn't cure; recurrence common at anastomosis.

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