No, Asacol (mesalamine) is not the cause of your weight gain. Almost certainly, the Asacol is making you feel well enough to increase your food intake. Most weight reduction diets are well-tolerated in Crohn’s disease patients. Q2. My sister has Crohn’s disease. What can be done to encourage her to eat rather than depending on TPN and lipids? She is supposed to hook up to her TPN and lipids daily. The last time that I was home, she only hooked up once. When she does eat, she only eats very low-calorie things like salads, celery and carrots. She walks five miles every day. Is that much exercise good for her while she isn’t eating and is on the TPN and lipids? I am afraid that she has developed anorexia on top of her Crohn’s disease. What can I do to help her? I am afraid that she is going to die from her actions. What upsets me is that she has an 11-year-old son, and she hasn’t even thought about what will happen to him if she dies. Any advice will be greatly appreciated. Total parenteral nutrition (TPN) provides vitamins, minerals and hydration intravenously, avoiding the digestive system altogether. It is only given to Crohn’s disease patients who have intestinal failure and cannot absorb nutrients from food. Usually, people eat while on TPN to enjoy the taste of food, but the essential calories and nutrients are given through TPN and not food. Your sister should be following her doctor’s prescription for how much and how often to take her TPN. She should not be changing the regimen without her doctor’s approval. If she refuses to follow her prescribed regimen, then it is reasonable to consider psychiatric counseling. Encourage her to talk to her doctor. Finally, in answer to your question about her long walks, exercise is good for people with Crohn’s disease and five miles of walking daily does not seem excessive to me. Q3. What do you suggest for an appropriate diet with those who have Crohn’s? Rumor has it that roughage is not a good thing. Recommendations on diet vary from doctor to doctor. In general, you should not eat things that bother you (e.g., milk products, spicy foods, greasy foods). Roughage may be good or bad for you, depending on the nature of your IBD. Q4. I am 59 and was diagnosed with Crohn’s in my mid-40s, after surgery for a blocked bowel and a resection. I have never had any problem with dairy products until now. I know some Crohn’s patients become lactose intolerant. What are the symptoms of lactose intolerance? Lactose is the milk sugar that cannot be digested unless it is broken apart into its components – glucose and galactose – by an enzyme called lactase in the small bowel. Lactase deficiency is very common and is associated with certain ethnic groups and also with Crohn’s disease patients who have had surgery or extensive small bowel disease. Lactase deficiency can also happen as a normal part of the aging process – indeed, a majority of people in the world are lactase-deficient! People with lactase deficiency will have symptoms of bloating, abdominal pain, abdominal gurgling and diarrhea when they eat foods that contain lactose. So the best therapy is to avoid foods that are high in lactose, such as milk, ice cream, cream cheese, sour cream and cottage cheese. However, yogurt and hard cheeses are usually fine for lactase-deficient people since the aging/fermentation process breaks down the lactose. Q5. I have been on 150 milligrams of Imuran for several years for my Crohn’s. In the last year, I have been gaining weight while exercising and dieting. My internist thinks it may be my Imuran but my GI doctor does not. Is this a possible side effect after long-term use? No, Imuran (azathioprine) itself is not causing your weight gain. Perhaps the drug is sufficiently controlling the disease to allow for more complete food absorption. If you’re concerned about your weight, note that most weight reduction diets are well-tolerated in Crohn’s disease patients. Q6. I have had Crohn’s disease for over 24 years. I currently weigh more than 300 pounds and am considering weight loss surgery. I have found a surgeon who says that he can reduce the size of my stomach without hurting my intestines. Is this possible, or am I dealing with someone who does not know much about the effects of Crohn’s disease and surgery? Yes, it is possible to do a bariatric procedure (weight loss surgery) that involves the stomach only. A typical gastric bypass involves closing off the top part of your stomach to create a small pouch, and then diverting the upper portion of the small intestine to connect to the pouch. This dramatically reduces the amount of food your stomach can hold (to about an ounce). Before you go ahead with surgery, I recommend that you seek the opinion of a gastroenterologist experienced with Crohn’s disease therapy to evaluate the extent and severity of your disease. Only then can you know whether bariatric surgery is a safe, advisable option for you. Q7. I had severe Crohn’s in 1996. I had surgery to remove all of the large intestine/rectum. I have been in remission up until just recently. I developed a peristomal wound about two and a half years ago that has yet to heal. After a scope and small bowel follow through it was determined that the Crohn’s has returned in a small area around the stoma, internally. The doctors are contemplating putting me on 6-MP (6-mercaptopurine). I am a little concerned because other than the annoyance of this wound, I really do not have much, if any, other symptoms. I am not sure the cost of taking the medicine (potential short-term and long-term side effects) will be worth whatever benefit may come from the medication. I definitely do not want to feel worse on the meds than I do off of them. I have had a hard time finding other people with an ileostomy who are also on 6-MP and how they have responded. Any advice would be greatly appreciated. With medications to treat Crohn’s disease, there is always a trade-off between risk and benefit. The benefits of 6-mercaptopurine are its effectiveness in controlling the inflammation (in the bowel and the skin) and in preventing additional areas of involvement with Crohn’s disease. The principal adverse effects are pancreatitis (3 percent), allergy (1 percent), and leukopenia or decreased white blood cell count (10 percent). To be certain that you do not get leukopenic, you will need to have blood counts checked periodically. In most patients – including you, I suspect – the benefits of 6-mercaptopurine far outweigh the risks. Q8. How should I make up for the nutrients I lose because of inflammatory bowel disease (IBD)? I feel dehydrated all the time, and I want to make sure my body stays healthy. You are right. Patients with Crohn’s disease and ulcerative colitis are often nutritionally deficient because of intestinal losses of nutrients, avoidance of fruits and vegetables that can exacerbate symptoms, and the use of certain drugs that block the absorption of nutrients. In general, Crohn’s patients and those with other inflammatory bowel conditions should pay careful attention to be certain they eat a balanced diet of carbohydrates, protein, and fat. Fad diets are usually not helpful, but it’s reasonable to take a multivitamin on a daily basis. Also, when you do have diarrhea, you have to pay careful attention to your fluid status and drink liquids throughout the day even if you are not thirsty. For more on how to get the proper nutrients, see Crohn’s Disease and Your Diet. Q9. My 82-year-old mother-in-law was recently diagnosed with Crohn’s disease. I’ve read that raw vegetables will make any digestive symptoms worse, but she insists that raw is healthier. I’ve been trying to steam or boil our veggies thoroughly, but I can’t persuade her to eat them. What can I tell her? Your instincts are correct. Although many patients with Crohn’s disease can handle raw fruits and vegetables, many cannot, and those who can’t may find that their symptoms of bloating, flatulence, and diarrhea increase. If your mother-in-law has been tolerating these foods well, she can continue to eat them. She can switch to cooked vegetables and fruits if she can better tolerate them, although cooking these foods results in the loss of many of their important vitamins and minerals. Also, eating a well-balanced diet and taking a vitamin supplement is very important for most patients with Crohn’s disease. Learn more in the Everyday Health Crohn’s Disease Center.
