Chat log: Crohn's disease, migraines | NDR.de - Guide

As of: October 22, 2024 2:00 p.m. | from the Norddeutscher Rundfunk logo

Dr. Viola Andresen is a nutritional doctor and works at the Hamburger Medizinicum.

Food as medicine: How do I change my diet myself? What helps with migraines – and what can you do with Crohn’s disease? These topics were discussed on Monday, October 21, 2024, from 9 p.m. in episode 76 of the Nutrition Docs. After the broadcast, the internist Dr. Viola Andresen answered viewer questions about the topics of the show in the chat. The protocol to read:

Julia: Dear Dr. Andresen, what can vegans do on the CDED diet? [Crohnʼs Disease Exclusion Diet – Morbus Crohn Auslassdiät] eat instead of chicken and eggs? Is tofu okay?

Dr. Viola Andresen: The CDED diet, as it has been examined in studies, does not exist as a vegan version. Chicken and eggs are a must there.

Susanne: Histamine: Who does a stool and blood test to check histamine breakdown? Is this test a service provided by statutory health insurance companies? A nutritionist suspected I had histamine intolerance. But so far no doctor has addressed the topic of histamine.

Andresen: Although tests for histamine issues are often not ordered or reimbursed, since the tests are not 100 percent conclusive, if histamine intolerance is suspected, you can simply try therapy.

Alexa: Dear Doctor, I have had migraines with aura for over 20 years and am currently having a particularly difficult phase. I also have very loose stools and often have stomach cramps. That’s why I have an appointment for a blood test on Thursday. Which values/titer should I have tested in order to be able to draw conclusions about the causes? Also in order to be able to clarify a disruption in the breakdown of histamine or intestinal problems. Thank you in advance!

Andresen: There are various test procedures for histamine-associated diseases, so-called histaminoses. None of these tests are 100 percent scientifically validated. A positive test does not automatically mean that you have a histamine problem, but a negative test does not rule it out either. The common (but only limitedly informative) tests include the determination of diamine oxidase (DAO) as well as histamine or methylhistamine in the blood, stool or urine.

leene: What do I do if it’s not enough to leave out the histamine classics? And how do I, as a vegetarian, manage to cover my protein needs without foods containing histamine?

Andresen: If you are “only” vegetarian and not vegan, low-fat quark, for example, is a great source of protein. When eating a low-histamine diet, you have to be careful not to restrict yourself too much!

Michael: Hello, how can I make sure that oatmeal is free of pesticides since health food products are also contaminated according to Ökotest?

Andresen: This is of course problematic. Well, if the products have just been tested, then you can perhaps use the results as a guide. Ultimately there is never a guarantee, but organic should usually be cheap.

Ela: Hello Dr. Andresen, I have exactly the same symptoms/problems as the young man in the show. Significant weight loss, very frequent diarrhea, and so on. That’s why I would be very interested in the CDED diet in the first phase. Can you help me here?

Andresen: In the event of weight loss and diarrhea, the exact cause must first be clarified! CDED nutritional therapy has been developed specifically for patients with Crohn’s disease. In addition to nutritional therapy, medication is usually given.

Lori: Crohn’s disease and fistula surgery with injury to the sphincter. Now stool incontinent. The only solution is a stoma? How do you live with that?

Andresen: Stoma care today is often much less problematic than feared. Many patients with incontinence problems are very happy about this step because they regain control over bowel movements. Here I would recommend a consultation at a visceral surgery center that specializes in such operations.

Michaela: Hello Dr. Andresen, I suffer from migraines with and without aura. The triggers are usually stress, changes in the weather and the cycle. I eat very healthily according to the E-Docs recommendations and this has cured my prediabetes. However, I’ve been suffering from more attacks lately. What else can I do? I also do 16:8 interval fasting, which suits me very well, even if it’s not recommended for migraines.

Andresen: Of course, not all recommendations always apply equally to everyone; sometimes you have to try it out individually to see what helps. When you have a headache, it is often helpful to eat several meals and drink enough water. And avoiding histamine triggers would also be worth a try.

Sylba: Regarding Crohn’s disease: I have the question of which diet makes sense or is indicated for intestinal stenosis and what absolutely needs to be paid attention to.

Andresen: If you have a stenosis problem, you should eat a low-fiber diet, i.e. avoid fibrous vegetables such as asparagus, celery and the like. In addition, the food should be chewed very well and, if in doubt, perhaps strained beforehand. If the stenosis is caused by inflammation, it can go away with effective therapy. The CDED diet can support drug therapy well.

Silke: Hello, your LDL values are too high [Lipoprotein niedriger Dichte] and/or a lack of bile is related to Crohn’s disease? Can mesalazine be taken long-term or should it be reduced or stopped if calprotectin levels are below 50?

Andresen: If the last section of the small intestine (the so-called ileum) is affected in Crohn’s disease, bile acid loss syndrome can occur and, as a result, an increased tendency to have diarrhea. This can be treated with bile acid sequestrants. Treatment for Crohn’s disease that is effective is typically given over the long term to achieve remission [Nachlassen der Symptome] also to receive. You just try to taper off systemic cortisone as quickly as possible.

Luzia: I also suffer from migraines. I’m also overweight. How can I lose weight if I have to eat a high-carb diet because of migraines?

Andresen: I would suggest a vegetable-based mixed diet that contains carbohydrates in a long-acting form. And you can avoid carbohydrates completely in individual meals (preferably in the evening) in the sense of an insulin separating diet. And important: drink enough water or tea!

Max: Dear Dr. Andresen, our 17-year-old daughter was diagnosed with lactose and histamine intolerance after a long time of various examinations (gastroscopy, colonoscopy, etc.). In order to avoid the constant stomach pain (cramps), she at some point ate less and the topic of nutrition became so stressful for her that anorexia developed. She avoids carbohydrates and is underweight. At times the skin color turns yellowish. Based on your professional experience, are there any specialists you can turn to? What does meaningful support look like? Thank you in advance for your answer!

Andresen: Anorexia is an eating disorder and absolutely requires psychotherapeutic/psychosomatic treatment! But of course organic causes for the abdominal pain should also be ruled out. Here you can find special clinics for motility disorders [Störungen des physiologischen Bewegungsmusters von Verdauungsorganen] help, for example the Israelite Hospital in Hamburg.

Schwedensuse: Dear Doctor, I (70 years old) have had Crohn’s disease for two years. In July the calprotectin value was 11,000. Two weeks ago, thank God, it was 700. I was very surprised that the cook did that Ketchup made with onions. I’ve banned myself from doing that for two years. Is that wrong?

Andresen: Onions are one of the flatulent foods and are often not well tolerated if you have stomach problems. But they are also good for the intestinal bacteria – so if you can tolerate them, you can eat them.

More information

Which foods have a beneficial effect on my symptoms? Here you can find information and lists – also available for download. more

The Federal Association of German Nutritional Medicine Physicians lists around 80 certified practices for nutritional medicine in Germany on its homepage.
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