The Ambivalent Role of Food in Crohn’s Disease: An IDI Perspective

Abstract

Being astute interpreters of experiments-in-nature (diseases), ancient physicians thought of food as medicine. Food selection formed a significant part of their pharmacopeia. The pathogenesis of Crohn’s disease has now put into evidence food’s ability to both induce one of the major chronic diseases of industrialized nations and its ability to induce
prolonged remission (and potentially permanent remission) of the very same disease that it had created.

The induced addiction to therapy via pharmacopeia has obscured what ancient healers of men understood: food is medicine. With Crohn’s disease, food demonstrates its ambivalent potential. It is the first major chronic disease.

For surgeons, the lesson is anatomical: the uncinate process is among the most technically demanding regions of the pancreas, and tumor location not tumor size determines whether enucleation is safe. When a lesion in this region lies in close proximity to the main pancreatic duct and the superior mesenteric vessels, pancreaticoduodenectomy is not  an escalation of treatment but the anatomically correct response. Framing this choice accurately prevents both under-treatment and unnecessary patient anxiety about receiving a ‘bigger operation’ than expected.

Insulinoma is a curable disease. The diagnostic and surgical tools to cure it exist and are accessible. What this case demonstrates is that multidisciplinary awareness spanning emergency medicine, endocrinology, radiology, and surgery is the non-negotiable prerequisite for translating those tools into outcomes.