The Ward Protocol

Faecalibacterium prausnitzii — the gut's primary anti-inflammatory, butyrate-producing bacterium — is the single most replicated microbiome finding in Crohn's specifically: it's consistently depleted in Crohn's patients (Sokol et al., PNAS 2008; confirmed Fujimoto 2013). Two common emulsifiers deplete the exact same species. Polysorbate-80 measurably reduces F. prausnitzii abundance at just 0.1% concentration — well within normal food-additive exposure (Microbiome, 2021, PMID 33752754). Carboxymethylcellulose (CMC) did the same in a human RCT: 15g/day for 11 days lowered F. prausnitzii and gut microbial richness in healthy adults (Gastroenterology, 2021, PMID 34774538). This isn't a general "processed food is bad" claim — it's a direct mechanistic overlap with Crohn's own core pathology. Separately: smoking is a confirmed, Crohn-specific risk factor — it worsens onset risk, post-surgical recurrence, and medication response. This is the opposite of ulcerative colitis, where smoking is protective, so "it's fine because it helps some gut conditions" does not apply here.

Two German double-blind, placebo-controlled RCTs on Wormwood (Artemisia absinthium) in Crohn's, run on top of existing steroid treatment, not instead of it: in the first (n=40, 5 centers), patients tapering off steroids on 3×500mg/day wormwood for 10 weeks reached near-complete remission in 65% of cases, with only 10% needing to restart steroids — versus 80% in the placebo group. A follow-up trial (n=10, 3×750mg/day, 6 weeks) directly confirmed suppression of TNF-alpha, the central inflammatory cytokine in Crohn's. Separately, Boswellia serrata (Frankincense) extract H15 was tested head-to-head against mesalazine in active Crohn's (Gerhardt 2001 RCT, n=102): non-inferior on disease activity score, with a better side-effect profile. Boswellia is for active flares only — a later placebo RCT found no benefit for preventing relapse once in remission. Don't carry it into Step 3 expecting a maintenance effect it doesn't have.

Once the active flare settles, the barrier itself needs rebuilding — the mucilage layer and the fuel source for the colon cells that maintain it. Slippery Elm (or Marshmallow Root, the same mucilage mechanism) forms a mechanical, protective gel film over irritated mucosa on contact — a broadly documented mechanism, though not tested in a Crohn's-specific trial. Microencapsulated sodium butyrate directly replaces what F. prausnitzii would normally supply: an 8-week observational study in ileocecal Crohn's (4g/day, enteric-coated) found 69% clinical response and 53% remission, with measurably lower NF-kB activity and IL-1b. Formulation matters here more than dose — pediatric trials using non-microencapsulated butyrate found no benefit, while microencapsulated, colon-release forms (the type used in the positive trials) performed consistently better. Vitamin D deficiency is present in roughly 58% of Crohn's patients; correcting a confirmed deficiency is worthwhile basic care — but a high-dose postoperative trial found no effect on preventing surgical recurrence, so don't oversell this as more than deficiency correction.