Tuesday, March 30, 2010

The Paleo Diet and Crohn's Disease

Q: Can you comment on any reported results in curbing the symptoms of Crohn's Disease with the Paleo Diet. As I am a sufferer, I would love to know.

Thank you,

A: Dear Shannon,

Indeed, inflammatory bowel disease (Ulcerative Colitis & Crohn's Disease) patients usually do very well with The Paleo Diet, as nutrients are one of the main environmental triggers of this condition. Crohn's disease is an autoimmune disease where the immune system mounts an attack against its own tissues - in this case the cells lining the intestine.

For an autoimmune disease to occur we need a genetic predisposition and an environmental trigger. The genetic predisposition depends on genes coding for the Human Leukocyte Antigen (HLA) system. One of the environmental triggers may be nutrition, besides infections, geography (vitamin D deficiency), physical trauma or vaccination.

One of the key points in this process is increased intestinal permeability. This means that the gut barrier allows increased passage of bacterial or food proteins (antigens) into peripheral circulation, skipping a process known as oral tolerance. Once antigens come in contact with the immune system located in the gut associated lymphoid tissue, they may elicit a T-cell mediated immune response against those antigens.

If the molecular structure of the dietary or bacterial antigens is similar to that of the HLA system (part of the immune system representing cellular mechanisms), chances are that a cross reaction between foreign antigens and self antigens (produced by T-cells) occur. This is termed molecular mimicry, and leads to self injury by the adaptive immune system.

Hence, decreasing intestinal permeability is one of the treatment targets. There are several nutrients known to increase intestinal permeability that you may want to avoid, at least until symptoms subside. Here is a list, with the noxious substances in parentheses:

  • Cereal grains (lectins and gliadin)
  • Legumes, including soya and peanuts (lectins and saponins)
  • Tomato (tomato lectin and alpha-tomatin)
  • Potato (lectins and saponins)
  • Chili (capsaicin)
  • Quillaja (foaming substance)
  • Quinoa (saponins)
  • Egg white (lysozyme)
  • Alfalfa sprouts (saponins)
  • Amaranth (saponins)
  • Alcohol

Moreover, some nutrients exert an adjuvant-like activity (they stimulate the immune system), which is something you don't want to if you are suffering from an autoimmune disease. Nutrients containing adjuvants:

  • Quillaja extract, found in root beer
  • Tomato alpha-tomatine

Dairy products and vegetable oils also have deleterious effects upon your immune system.

I hope this helps.


  1. For dietary management, I would recommend a few readings:

    1) "Breaking the Vicious Cycle." Similar to Paleo, but there is some substantial use of well-fermented yogurt. I agree with this approach.

    2) "Life Without Bread." One simple rule: no more than 72 grams/day of carbs. I would suggest this be combined with the Gottschall diet above: no grains, low-carb. Been living this way for 27 months; no meds, and feeling great. My blood panels and fecal calprotectin all came back normal in February, a continuation of a trend that started just 3 months after going on the Gottschall diet.

    3) Think "meat." Animal protein is the one thing that- barring individual allergies- is universally safe for Crohnies. Once you find a stable plateau, start to introduce individual plant items; I find cauliflower is fine, others do not. Carrots make me incredibly sleepy for some reason I cannot explain. Don't go jumping around! Find a select few food items that you do well with, and eat a lot of them. Once you find a stable plateau for a week, introduce a new food item in small quantities. It is a slow, delicate progression, and keeping a food log pays off.

    4) Supplement with selenium (100 mcg/day), and vitamin D (5,000 IU/day, tapering down to 2,000 or 3,000 IU/day after the first month or two. Consume fish oil, at least 1 teaspoon daily. If you feel hungry but don't feel well, eat coconut oil; pop it in the refrigerator first if you wish to eat it solid. Up to 3 tablespoons/day may be tolerated eventually.

    I find nuts are a problem for me, as are peanuts. I used to enjoy them, but now only have them perhaps once a week and find things are greatly improved.

    Think: low carb, no grains. Go from there, and good luck.

  2. Started paleo (have crohn's). Had a flare-up over the weekend...not blaming paleo, the signs have been there for weeks. That said, docs put me on a low residue (fiber) diet in response to the flare, which is anything but paleo. Your thoughts?

  3. To Anon about low fiber diet:
    Paleo can be adjusted to be low fiber, as I have found this a MUST. I also have to leave out "healthy" paleo foods that are high in fructose etc. which is quite a bit. I think meat as well as a mixture of paleo, FODMAP, SCD and no dairy may help :) It's not a fun road taste-wise, but healing is so great! All the best.


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