Tyler James Williams, the 30-year-old star of ABC’s hit sitcom Abbott Elementary, struggled for years to put on weight and bulk up. Unbeknownst to him, he had a serious medical condition that defied all attempts to put on the pounds. By age 24, his body was near shutting down when he got a diagnosis that changed everything: He had Crohn’s disease, a chronic inflammatory condition that affects the gastrointestinal system.
Williams had to undergo surgery to remove a section of his damaged lower intestine and underwent treatment to undo years of damage. Five years later, his weight is up to 145 pounds, and he has changed his lifestyle to live with the incurable disease.
He no longer eats things that trigger Crohn’s flare ups, such as alcohol, coffee and red meat. His diet consists of small meals of lean protein, steamed vegetables, shakes and green juices, he told Men’s Health. “The doctor was like, ‘Here’s something that’ll keep your system from inflaming. It’ll keep your mind right, and it’ll make you eat.’ And I was like, ‘What is this wonderful drug that we’re talking about?’ And he wrote me a weed prescription,” he adds with a laugh.
Williams lived for years suffering from the effects of Crohn’s without knowing he had it. Here are things to look for to determine whether you have the condition.
Crohn’s disease is a type of inflammatory bowel disease that affects the entire digestive tract, from the mouth to the anus. Crohn’s appears most commonly in the lower part of the small intestine and in the colon. It can affect all four tissue layers of the GI tract.
Ulcerative colitis is the other major form of IBD.
All told, about 3 million people in the U.S. suffer from IBD, and about half of them have Crohn’s, according to Dr. Ramnik Xavier, a professor at Harvard Medical School and a gastroenterologist and director of the Center for the Study of Inflammatory Bowel Disease at Massachusetts General Hospital.
“Crohn’s disease causes inflammation and scarring that impairs the ability of the GI organs to function properly,” Xavier says.
Crohn’s can be mild to severe. For some people, like Williams, the symptoms may be vague enough that a person may be unaware he or she has the inflammatory condition.
“It’s a chronic illness that affects the gastrointestinal tract, your digestive tract, so basically it’s kind of a silent illness,” says Wendy Greenhut, a member of the Board of Trustees of the South Florida Chapter of the Crohn’s and Colitis Foundation. “So that’s why it’s so surprising that so many people have it. Because … it’s not seen. They suffer in silence.”
When symptoms do appear, they may include abdominal pain, diarrhea that may be bloody, rectal bleeding and unintended weight loss. Some symptoms, such as abdominal pain and diarrhea, may go away without treatment. But symptoms can also last for more than a week or become worse.
“It’s different for every patient,” says Dr. Gauree Konijeti, a gastroenterologist at Scripps Clinic’s Division of Gastroenterology and Hepatology. “For some people, it just starts … full-blown. And for others, it starts small and mild, and they may not even realize what’s going on, but then it just gradually progresses.”
More serious symptoms include blood in stools, severe pain, fever, night sweats or dramatic weight loss.
“There are a lot of particulars that figure into or aggravate Crohn’s disease, but the exact cause is still unknown,” says Dr. William A. Faubion Jr., a gastroenterologist with the Mayo Clinic. “It may involve an abnormal immune response against some microorganism in which your tissues are also attacked.”
Crohn’s may run in the family, he adds. “Genetics might also play a role. And it’s true that you’re at higher risk if a first-degree relative has it. But that’s really only seen in about 20 percent of cases,” Faubion says.
Nonsteroidal anti-inflammatory medications, or NSAIDS, such as ibuprofen, naproxen sodium and diclofenac sodium can trigger inflammation of the bowel and make Crohn’s worse. Smoking can also lead to more severe Crohn’s and increase the risk of surgery, Faubion says.
Crohn’s can develop in anyone, from babies to older people. But the most common people affected are in their 20s to 30s, Konijeti says. “It is more common among Caucasians [and] Ashkenazi Jews,” she adds, although “we are seeing it increasing in developing countries as well.”
“If a child was breastfed as an infant, they have about a 30 to 40 percent lower risk of developing IBD later in life,” she says. “If you have had a lot of infections or have taken a lot of antibiotics, you may have a higher risk. There are genetic factors as well. More than 200 genes are associated with IBD, and the bacteria in our intestines also matters, but research has not determined exactly how.”
While the disease is most common among white people, the “incidence is increasing among Black people in North America and the U.K.,” Faubion says.
There is no cure for Crohn’s disease and other forms of inflammatory bowel disease, but there are treatments and lifestyle changes that can reduce the risk of flare-ups or the need for surgery.
Absent such steps, sufferers can develop complications, including fistulas, abnormal connections among the intestines or other internal organs. Crohn’s and other forms of IBD also raise the risk of developing colon cancer, and people with the condition should take more frequent screening tests.
“Treatment depends on several factors, such as the severity of the disease or their medical history,” Konijeti says. “For mild cases, we may start with anti-inflammatory medications for the gut. If the disease is more severe, we may use medications such as targeted immunosuppressives that stop inflammation from happening.
“One of my interests is looking at how we can use diet or other potential triggers of inflammation to reduce the inflammation itself, rather than focusing on drugs,” she adds. “We have done clinical trials looking at the efficacy of various diets to help control the disease.”
People with Crohn’s may want to keep a food diary to identify potential triggers. Beyond that, doctors recommend patients limit dairy products, eat smaller meals, stay hydrated and avoid caffeine, alcohol and carbonation.