Hi i was just wondering if you have any information on Crohn's Disease. I have a client who wants to increase his weight and tone up but i am not entirely sure which exercises to prescribe. Moreover, he has been told by his doctor to consume cakes, and take aways to increase his calorie intake as his metabolic rate is apparently 3 times faster than a 'normal' individual. Is this the best way to get a balanced diet for someone with this disease? Any help would be much appreciated.

ANSWER:
Here is a quick definition of Crohn’s from www.wikipedia.com:

Crohn's disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). Crohn's disease is a type of inflammatory bowel disease (IBD) and can affect any part of the gastrointestinal tract from mouth to anus; as a result, the symptoms of Crohn's disease vary between affected individuals. The main gastrointestinal symptoms are abdominal pain, diarrhea (which may be bloody) or constipation, and weight loss.

Let me first start out with this, you are going to need more than just training to help a client with a dysfunction such as this. You need to take the lead and start getting a team together or developing relationships with other people in the field in order to help this client. Your best bet would be to work along with a Holistic Nutritionist (CHEK Nutrition and Lifestyle Coach, HHP, someone at the Poliquin Institute), a Chinese Medicine Doctor and someone who practices Functional Medicine to do some lab testing with (www.biodia.com).

I will start by giving you some basic nutrition and lifestyle recommendations that will help with a client such as this. These are things that you can RECOMMEND in order to facilitate healing. The bottom line is that this client needs to be assessed nutritionally, needs their lifestyle to be assessed, as well as needs some lab work (GI stool testing for parasites, bacteria, fungus sIgA, dysbiosis, C-Diff, and so forth). If you refer to the article series by Paul Chek called You are What you Eat series 1-3, this should help you get started. I would also refer them out as well to get further assessments, testing and nutrition and lifestyle recommendations.

You can also begin the 4R (remove, replace, reinocculate and repair) Program with your client. Each phase is about 3 months long.

1. Remove: This entails eliminating anything in their life that may create parasites, bacteria, fungus, etc. As well, any environmental derived toxic substances, including conventional foods, plastic, microwaves, hygiene and cleaning products. There is always organic!
2. Replace: This entails replenishing enzymes and other digestive factors which may be limiting healing. The key ingredients are pancreatic, digestive and liver enzymes.
3. Reinocculate: This entails reintroducing good microflora back into the gut. This means pre and probiotics. Prebiotics are synergistic flora and mucosal cell regeneration.
4. Repair: This entails providing nutritional support for regeneration and healing of the GI mucosa. You can also add in glutamine, fish oils, zinc and pantothenic acid. This will reduce inflammation and regenerate the mucosa of the gut.

As far as training goes, you don’t want to create more stress for this client. Stress creates inflammation and inflammation is one thing that you want to get rid of with a client with Crohn’s. The first thing I would do would be to assess your client. You need to know what is short (so you can stretch it) and what is elongated (so you can strengthen it). That is the bottom line when writing a program. From there, you need to take your client through the basic stability-strength-power paradigm. Depending on the client, you might have 1-3 phases within each of the above.

While your client is getting his gut back in order, which will increase his immune system as well (75% of the immune system is housed in the GALT system in the gut), I would start by having him do some simple daily Qi Gong. This will pull him more into a parasympathetic state. This will decrease inflammation and allow for repair to take place. As well training wise, I would keep him in a Base Conditioning Phase for someone who has what is called a High Physiological Load.

You would use the exercise examples below with your client:
1. Light cardio (conversation level)
a. light walking
b. aqua walking
2. Tai Chi, Yoga, or Qi Gong
3. Flexibility routine
4. Light corrective exercises (Primal Patterns, LA #1, prone cobra, supine bridging on floor, forward ball roll, supine lateral ball roll to name a few). You would just want to make sure that these are not too challenging (increasing internal stress) and that put the variables as follows:
a. rest +70 seconds
b. intensity –2reps
c. reps 8-12
d. tempo 2-1-2,2-0-2, 3-0-3, 2-1-1, or breathing pace (slow)

There are many pieces to the healing puzzle. You need to figure out which ones your client needs, but also in what order. Training is important, but it might not be first on the totem pole of importance.

Good luck!
Joshua Rubin