Diet and Exercise May Play a Role in Who Gets Crohn's

I've wondered if I could have avoided getting Crohn's disease, if there was something I did or didn't do, ate or didn't eat, that made me one of the 149 in 100,000 with Crohn's disease. I don't have a good answer, although I do have some speculations.

Researchers have noted that Crohn's is more common in U.S. and northern European populations than in others, particularly those in underdeveloped regions of the world. I didn't have any choice about where I was born, so that one's not on me. American Jews of European descent, according to the Crohn's and Colitis Foundation o f America, are four to five times more likely to get Crohn's disease or ulcerative colitis than the rest of us. I'm a Presbyterian from a long line of Presbyterians, so I can't blame it on that, either.

Recently researchers have found a genetic link to Crohn's disease. A mutation in a gene called the NOD2/CARD15 occurs more often - up to twice as often - in people with Crohn's than in the general population. Those same researchers believe that other genes may be involved as well. While no one in my immediate family has or had Crohn's, my father did die of intestinal cancer in 1990. Genetic research has made leaps and bounds since then, so I'll never know if he carried that gene, and there's no real point, other than research, for me to have genetic testing.

Going back for a moment to the fact that inflammatory bowel diseases (IBDs) are more common in western technological countries than in underdeveloped countries should raise a host of questions. Is it climate? In the U.S., Crohn's is less common in the southern states than in the northern ones. It's also more common in cities than in rural areas. I don't think researchers know the answer to that one, but I have an idea.

In the northern city where I grew up, we ate almost exclusively canned vegetables. We rarely had fruit other than apples and bananas. We ate a lot of meat, mostly beef (I live in "cattle country"), and mashed or au gratin potatoes. We ate white bread, pasta, and occasionally white rice. Looking back, it seems that my diet, as I was growing up, was notably lacking in fiber, and filled with animal protein and fat. I also lacked sunshine for much of the year, as winter days in my state are perhaps only half as long as those in Florida. Longer than in Alaska, but still, not long. Sunset is around 4:30 p.m. in January. Lacking sunshine means a lack of vitamin D. Vitamin D is added to milk, which I drank a lot of growing up (whole milk, of course), but recent research suggests that it isn't enough, and that many people living in northern states are malnourished, primarily through a lack of vitamins D and C. Rickets is showing up again.

People in third world, or underdeveloped, countries eat a lot more fresh fruit and vegetables than I did growing up. They also eat more soy and fish than I ever did. They tend to eat complex carbohydrates (fruit, vegetables, and less-processed grains, such as whole grain wheat instead of bleached white flour) rather than the simple carbohydrates that made up much of my diet. Good old Wonderbread. They get more sunshine. They are, in general, more active.

It's too late for me to go back and un-do the diet of my childhood. I do think, however, that the American diet, which generally includes even less vegetables except for those found on double cheeseburgers at a fast food restaurant, and simple carbohydrates, and too much fat, is at least partially responsible for Crohn's disease, and ulcerative colitis as well. I wasn't an active child, and I have never liked vegetables (you wouldn't either, if you'd grown up tasting only what came in a can).

These days, we are barraged with commercials telling us to add fiber to our diet, but not necessarily in the food we eat: we can buy convenient little capsules to get the benefit of fiber. Is that the same as eating fiber-full food? I don't know; but I do know that medical researchers have shown that the vitamins in food are much more easily absorbed by our bodies than the vitamins in supplements, which makes it seem likely that the same may be true of encapsulated fiber. We are also told to eat healthier oils, which seems to me an excellent idea. People in areas where the typical diets include olive oil, safflower oil, and similar types of oil instead of lard or hydrogenated palm kernel oil in general have a lower incidence of Crohn's disease and colon cancer. Diets that include more fish and less beef or other fatty meats also seem less likely to result in Crohn's disease.

Most of us aren't as active as even our grandparents were, and certainly not as active as most people who live in underdeveloped countries. People who live in urban areas aren't, in general, as active as people who live in rural areas in the U.S. We all have reasons why we can't exercise more, why we need to take the elevator instead of climbing at least a couple of flights of stairs, but how valid are those reasons? I think a nation of couch potatoes is going to become an increasingly unhealthy nation, whether it's IBDs that increase, or heart disease.

If I could start over from the age of about three, I'd eat a diet rich in fresh fruits and vegetables, lower in animal protein, and including some fish. I'd make sure to spend at least an hour outside every day. I'd eat complex carbohydrates, like whole grain bread, instead of white bread or rice. I'd eat potatoes with their skins on. And I'd never stop playing. If you watch small children, you'll see with what intensity they play - they're not even aware that it's exercise, it's just fun. If they keep it up, they may never have Crohn's disease.