Updated on April 13, 2023
Even when taking medication, individuals suffering from Crohn’s disease shoulder a heavy burden of symptoms and side effects that can significantly reduce their quality of life. In addition to the physically uncomfortable symptoms associated with Crohn’s, individuals often experience self-consciousness, anxiousness, and even depression as they struggle to cope with the disease’s impact.
Additionally, the Crohn’s disease medication individuals take to control flare-ups or maintain remission can have profound physiological and emotional consequences and, in many cases, set individuals on a collision course with even more severe side effects after long periods of treatment.
For both individuals and clinicians, it is critical to understand the nuances of the medications available and carefully consider the potential impact on both short and long-term well-being. Each class of medications has a different therapeutic niche, different side effects, and a different efficacy profile. Ultimately, finding the right medication regimen might be a process of coming to terms with the side effects that individuals can bear while controlling their symptoms as much as possible.
It is also important to be aware of options that go beyond conventional pharmaceuticals. For many, combining existing medications with advanced nutritional supplements might be a possible way forward, allowing individuals to preserve their long-term health without additional side effects.*
Although controlling inflammation is key to controlling Crohn’s symptoms, over-the-counter solutions like NSAIDs are typically insufficient. Instead, individuals with Crohn’s disease usually take two classes of specialized anti-inflammatory medications: aminosalicylates and corticosteroids.
Both are considered first-line treatments, although their therapeutic niches differ; the aminosalicylates are intended for daily use to control background inflammation, whereas the corticosteroids are used when inflammation flares up and begins to spiral out of control. Between these two classes of medication, most individuals with Crohn’s can experience a relatively normal quality of life. Nonetheless, there is substantial room for improvement concerning these therapies.
Although aminosalicylates might provide some individuals with durable remission, they are not curative. Furthermore, aminosalicylates might not be very effective in their role. A recently published literature review of 20 studies indicates that many of the clinical trials supporting the use of aminosalicylates are methodologically flawed or fail to show they are more effective than a placebo in preventing flare-ups.
To identify the studies to be included in the review, researchers examined every academic journal article published about the efficacy of aminosalicylates for mild to moderate Crohn’s disease. Across these studies, the review reports that after six weeks of treatment only 23 percent of aminosalicylate users entered remission in comparison to 15 percent of participants taking a placebo.
And, after 17 weeks of treatment, 45 percent of participants taking aminosalicylates experienced remission in comparison to 29 percent of participants taking a placebo. These results indicate that aminosalicylates take a long time to induce remission, and might not ever do so when used in isolation for a majority of participants.
Additionally, 33 percent of users will experience persistent side effects of aminosalicylates, regardless of whether their symptoms are driven into remission. Aminosalicylate-class anti-inflammatories such as mesalazine can cause immune suppression, rash, fever, hair loss, anemia, headache, nausea, and diarrhea.
These side effects are typically of mild intensity and tend to resolve in the hours after the user takes their dose. The gastrointestinal side effects of mesalazine are dose-dependent, whereas the majority of the others are inconsistent from user to user. Critically, the efficacy profile of mesalazine and other aminosalicylates remains stable and their side effects do not become more difficult to bear over time.
Individuals can thus take aminosalicylates as a maintenance therapy without worrying about detrimental long-term effects causing damage to their bodies. However, up to 22 percent of users discontinue aminosalicylates as a result of the side effects and many others continue to struggle with side effects despite choosing to continue treatment.
Although most individuals with Crohn’s disease take aminosalicylates, periods of remission maintained via daily aminosalicylate use might be disrupted by severe flare-ups without warning, a risk that individuals with incomplete remission face in higher proportions. After a flare-up of inflammation, corticosteroids are typically used in concert with aminosalicylates to restore remission. Medications in this class, such as prednisone, can drastically reduce inflammation by triggering short-term genetic changes to the immune system.
Corticosteroid therapy is highly effective; an early clinical trial of 71 participants describes a 27 percent to 48 percent reduction in the Crohn’s Disease Activity Index (CDAI) after six weeks of treatment. However, corticosteroids exhibit a difficult side effect profile that grows in scope and severity with prolonged use. Nearly all participants experience asymptomatic high blood sugar, fluid retention, fatigue, dry mouth, indigestion, hunger, and other relatively minor short-term side effects when they take corticosteroids.
A substantial subset of participants also experiences acute depression or anxiety, joint pain, confusion, severe acne, weakened executive functions, weight gain, blurry vision, thigh and bicep atrophy, hyperactivity, and headaches. Most individuals will have at least one of these less-common symptoms during short-term corticosteroid use. Longer term, corticosteroid use can become quite dangerous. Severe weight gain, mineral insufficiency, glaucoma, depression, type 2 diabetes, dementia, psychosis, immunosuppression, vomiting, and dying bone tissue can become serious risks for individuals who take corticosteroids for longer than 21 days.
Although some have taken corticosteroids for several months without becoming debilitated by these side effects, other issues still preclude long-term use except in extraordinary circumstances. Significantly, corticosteroids very rapidly cause biological dependence; after as few as seven days of taking corticosteroids, the body’s ability to produce anti-inflammatory molecules of its own begins to be down-regulated as a result of disuse.
Once this down-regulation is complete—typically, after three weeks of taking corticosteroids—abrupt cessation of corticosteroids can result in life-threatening withdrawal symptoms that can include severe limb pain, vomiting, fainting, psychosis, and seizures. Because individuals with Crohn’s might not experience sufficient reductions in inflammation after a short course of corticosteroids, they are at high risk of facing these withdrawal syndromes as they pursue longer-term treatment. Thus, practitioners and their patients opt to control flare-ups preventatively as much as possible.
Immunosuppressants might be used to prevent flare-ups by individuals who do not respond to or cannot tolerate aminosalicylate drugs. These medications, such as azathioprine, are used on a continuous and long-term basis, although individuals taking immunosuppressants might still need the help of a corticosteroid to suppress a flare-up.
When a flare-up does occur, however, immunosuppressants tend to make them less severe, potentially minimizing reliance on corticosteroids. Indeed, in a systematic review published in 2016, immunosuppressants helped 64 percent of participants with Crohn’s disease reduce their usage of corticosteroids. The review also found that across 13 clinical trials, 36 percent of participants avoided corticosteroid use entirely when using immunosuppressants instead of aminosalicylates.
Only 10 percent of participants taking an immunosuppressant discontinued them based on side effects, which can include severe allergic reactions, nausea, low white blood cell count, and pancreatitis. However, immunosuppressants were no better than aminosalicylates at helping participants maintain remission over 12 months.
Importantly, immunosuppressants are confirmed carcinogens that are known to cause lymphoma in individuals with inflammatory bowel diseases, which makes their use a calculated risk. Individuals who are at especially high risk for cancer are thus often advised to avoid immunosuppressants even if they might be therapeutically beneficial to maintain Crohn’s remission.
Likewise, individuals with a weakened immune system face a dangerously high chance of infection when they take these medications. But individuals who can benefit from immunosuppression, yet are unwilling to accept the risks can still do so thanks to innovations in using the body’s natural immunosuppressants to control inflammation.
In light of the serious drawbacks associated with the use of immunosuppressant drugs as Crohn’s disease medication, researchers have turned to the body’s set of regulatory chemicals to find an effective immunomodulator that won’t harm individuals. Butyric acid is one such chemical and has been identified as uniquely promising to address the imbalanced inflammatory response associated with Crohn’s.
Butyric acid is a critical short-chain fatty acid produced by the gastrointestinal tract to reduce the activity of the white blood cells. When the white blood cells of the gastrointestinal tract encounter a molecule of butyric acid, they down-regulate their production of proinflammatory molecules, possibly resulting in the mitigation of the symptoms of Crohn’s disease.
Individuals with Crohn’s disease tend to have lower than normal quantities of butyric acid in their guts. Butyric acid supplementation can thus help to provide nutritional support in conjunction with standard Crohn’s disease regimens.*
An in vitro study from 2012 describes the mechanism of butyric acid, indicating that it inhibits the immune cells of the colon from proliferating during periods of immune activation.* Immune activation typically prompts populations of colon-dwelling immune cells to grow by as much as 900 percent, which can cause a significant up-regulation of the body’s normal inflammatory response.
When supplemented with butyric acid, however, researchers documented that the population of immune cells from individuals with Crohn’s disease shrunk by 60 percent.* This means that supplementation with butyric acid could provide important nutritional support in helping maintain a normal inflammatory response in individuals with Crohn’s.*
Although butyric acid has not been used historically for providing nutritional support for individuals with Crohn’s, new formulations, such as those pioneered by Tesseract Medical Research, have enabled this possibility.* Older formulations of butyric acid lacked bioavailability and failed to localize the butyric acid in the gut, meaning that users couldn’t experience its benefits in the location it was needed most.
In contrast, these new formulations are designed to promote optimal absorption, allowing butyric acid therapy to begin exerting its benefits within half an hour and provide its benefits for as long as eight hours.* Importantly, butyric acid’s metabolic profile in Crohn’s disease is not significantly different than in healthy people, and butyric acid doesn’t interfere with the mechanism of action of aminosalicylates or corticosteroids.* This means that it can be safely used in conjunction with these other classes of Crohn’s disease medication while providing its nutritional support in helping to maintain a normal inflammatory response.*
While nutritional supplements like butyric acid can be an important supplementation option for individuals with Crohn’s disease, multimodal therapy will remain necessary for the foreseeable future. Given the high tolerability of butyric acid and its suitability for long-term use, some individuals might find that butyric acid supplementation fits very well when used in conjunction with a standard Crohn’s disease medication regimen.*Additionally, butyric acid is not the only promising supplement for those who want to add nutritional supplementation to their Crohn’s management regimen. Other natural substances derived from the human body, like glutathione, as well as curcumin, have also been linked to helping maintain a normal inflammatory response in individuals with bowel disorders, and it might be possible to combine additional nutritional supplement therapies for greater symptom management.* While research is ongoing, individuals seeking to enhance their Crohn’s management regimen can include innovative, natural therapies in such regimens today.
The power of Tesseract supplements lies in enhancing palatability, maximizing bioavailability and absorption, and micro-dosing of multiple nutrients in a single, highly effective capsule. Visit our website for more information about how Tesseract’s products can help support your gastrointestinal health.*
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Zimmermann MA, Singh N, Martin PM, et al. 2012. American Journal of Physiology and Gastrointestinal Liver Physiology. 302(12):G1405-G1415.