Crohn’s disease (CD) is a form of inflammatory bowel disease (IBD) characterized by chronic relapse and inflammation along the intestine.1 CD is an autoimmune disease exhibiting an exaggerated immune response followed by a lowered tolerance towards food antigens and bacteria native to the gut.1(3899) Such processes eventually manifest as a chronic inflammatory response1(3899) Other factors also contribute to the manifestation of CD including intestinal microbiota, smoking, exposure to antibiotics, age, gender, and nutrition.1(3899) When CD has been diagnosed, it is paramount that nutritional and lifestyle modifications are made to control such a condition. As such, the following will consider the use of zinc (Zn) and its affects upon CD.
Sturniolo et al.2 stated that Zn supplementation (including food sources) has been efficacious in improving intestinal permeability within experimental malnutrition studies. Furthermore, individuals with IBD tended to have depleted/lowered levels of Zn from increased turnover, impaired absorption, and reduced availability at inflamed sites along the intestinal tract.2(94)As such, replenishing Zn levels would be reasonable, regardless of its affects upon mitigating CD, due to its requirements in over 300 enzymes within the human body.3 Furthermore, low zinc has also been associated with hypogonadism, low testosterone, low free T4, and low IGF-1 substantiating the need to maintain normal Zn levels.3(94)
Sturniolo et al.2(94) conducted an experiment in which 12 patients, consisting of 8 males and 4 females with subsided CD, enrolled in the Zn study. The presence of CD was diagnosed using clinical, histological, endoscopic, and radiological criteria with disease activity determined by a CD activity index known as CDAI.2(94) Participants were included in the study only of CDAI was below 150 for a minimum of 3 months and altered intestinal permeability was observed on 2 separate occasions within a 4-week period of time.2(94) The average lactulose/mannitol ratio for the group was 0.041 indicating intestinal permeability (normal findings for a healthy individual is <0.03).2(94),3(246)
After baseline measurements were gathered for each subject, participants were provided with 25 mg of elemental Zn for each tablet and instructed to consume 3 tablets a day (75 mg total/day) over an 8-week period; subjects also had routine plasma and urine tests at week 4 and week 8 to measure Zn levels (to confirm compliance).2(95) Results indicated that 75 mg of elemental Zn caused a significant reduction in increased intestinal permeability of CD patients in remission.2(96) Furthermore, in 10 subjects, the lactulose/mannitol ratio returned to normal followed by a significant decrease in permeability to lactulose.2(96) Such changes are supported by associations of Zn deficiency and structural and functional changes in the intestinal morphology. Such changes include abnormal gut permeability, villous architecture, and disaccharide content.2(97) Ultimately, the study of Sturniolo et al.2(97) suggests that Zn supplementation might help reduce relapse of CD patients in remission.
In conclusion (CD) is a form of inflammatory bowel disease (IBD) characterized by chronic relapse and inflammation along the intestine. CD is an autoimmune disease exhibiting an exaggerated immune response followed by increased gut permeability and a lowered tolerance towards food antigens and bacteria native to the gut. Interventions such as Zn supplementation, especially as an adjunct to a larger intervention, may help reduce rates of CD relapse while also improving gut permeability markers and overall health.
References
1. Carvalho A, Bishop K, Han DY, Ellet S, Jesuthasan A, Lam WJ, Ferguson. The role of vitamin D level and related single nucleotide polymorphisms in Crohn’s disease. Nutrients. 2013;5(10):3898-3909. doi:10.3390/nu5103898
2. Sturniolo GC, Di Leo V, Ferronato A, D’Odorico A, D’IncàR. Zinc supplementation tightens “leaky gut” in Crohn’s disease. Inflamm Bowel Dis. 2012;18(2):E399-E399. doi:10.1002/ibd.21926
3.Lord RS, Bralley, JA. Laboratory Evaluations for Integrative and Functional Medicine (2nded.). Duluth, GA: Genova Diagnostics; 2012.
-Michael McIsaac