Biologics for Crohn's Disease Treatment & Alternative Options

When I was first diagnosed with Crohn’s and Colitis, I felt like I got handed a script before I even understood what was going on. The default path was clear: steroids, immunosuppressants, and if things got bad enough, biologics. Back then, I didn’t know what any of that meant. I just knew I didn’t want to be sick for the rest of my life, and I really didn’t want to be dependent on medication.

Over the years, I learned that biologics are often presented as the big solution for people with moderate to severe IBD. They’re advertised as targeted, next-gen therapies and for some people, they do help. But for me, I never felt comfortable with the idea. I didn’t like the risk profile, I didn’t want to suppress my immune system, and I wanted to understand what was causing my symptoms in the first place instead of just silencing them.

So I made a different choice. I kept taking mesalamine, but I never started any biologic drugs. I started looking at my diet, my stress levels, my supplements, my sleep, all the stuff no one really talks about at the doctor’s office. I went deep into trial and error, and over time, I started to see change. It wasn’t overnight, and it wasn’t always easy, but I eventually reached remission without biologics or surgery.

This post walks through both sides, what biologics are, how they work, who they’re for, and why they’re used, and also, what I chose to do instead. If you’re on the fence, or just curious about other options, hopefully this gives you something real to think about.

Biologics are prescription medications made from living organisms. That’s different from most drugs, which are made from chemicals. These drugs are engineered to interfere with specific parts of the immune system. The parts believed to trigger inflammation in Crohn’s disease.

The most common targets are:

• TNF-alpha: a protein that drives inflammation
• Integrins: molecules that help immune cells move into the gut
• Interleukins (IL-12 and IL-23): messengers that fuel the immune response

By blocking these, biologics can reduce inflammation, help with healing, and (in some cases) bring about remission. The idea is precision. Instead of turning off the whole immune system like steroids, biologics are more targeted.

That said, they’re still powerful immune-suppressing drugs. And that’s where the concern comes in.

You’ve probably heard the brand names even if you’ve never taken them. Here are some of the most commonly prescribed biologics for Crohn’s and IBD are:

• Humira (adalimumab) – Self-injected every two weeks. One of the most popular biologics on the market.
• Remicade (infliximab) – Given by IV in a clinic. Requires more monitoring and hospital time.
• Cimzia (certolizumab) – Another injectable option, often dosed once a month.
• Entyvio (vedolizumab) – Targets gut-specific immune activity. IV infusion every 8 weeks.
• Stelara (ustekinumab) – Starts with an IV, then moves to self-injection every 8 weeks.
• Skyrizi (risankizumab) – One of the newer options. Similar process to Stelara.
• Tysabri (natalizumab) – Less common, due to a rare but serious risk of brain infection (PML).

There are also biosimilars, which are cheaper, near-identical versions of the originals. Think of them like generics, but for biologics. They’re regulated for safety and effectiveness.

Most of these drugs are injected either by you at home or by a nurse in a clinic. Some require IV infusions that take a couple hours. The schedule varies, but it usually starts with a few loading doses, then moves to a maintenance schedule every couple of weeks or months.

Unfortunately, they’re not just simple pills you can pop and forget about. It’s a whole treatment routine, and you’re expected to keep up with labs and monitoring to catch side effects early.

This is where I hit pause. Every time biologics were brought up, I looked at the side effect sheet and felt uneasy. Some of the potential side effects are minor, like headaches or fatigue. But others are more serious:

• Increased risk of infection, including tuberculosis and sepsis
• Liver problems
• Heart issues, especially if you already have heart disease
• Certain cancers, including a rare and aggressive lymphoma
• Brain infection (PML) — only linked to Tysabri, but still terrifying
• Allergic reactions, ranging from rashes to difficulty breathing

For me, that was enough. I wasn’t comfortable with the idea of weakening my immune system when my whole goal was to support it.

This isn’t about fear. It’s about informed decisions. I didn’t want to suppress the symptoms if I didn’t understand what was triggering them in the first place. I wanted to fix the foundation, not patch the roof.

I kept taking mesalamine, which I still use to this day. But I started rebuilding my entire life around gut health. I changed how I ate, how I moved, how I slept, how I handled stress. I learned how to calm a flare without medication, and eventually how to prevent one from happening at all.

You can read more about that in my full Remission Roadmap on GutMellow.com. It’s the exact process I used to go from daily symptoms to stable, long-term remission.

So if I didn’t take biologics, what did I do? It wasn’t one thing, it was everything. The whole system had to change. In addition to taking alternative pharmaceutical medicines such as mesalamine (long-term) and prednisone (temporarily), I also made changes to my diet and lifestyle.

Diet

I started with diet and food. I cut out everything that triggered me: gluten, dairy, sugar, caffeine (eg. green tea), alcohol, processed oils, and pretty much all packaged foods. I focused on real, whole foods: meat, vegetables, bone broth, herbs, and anti-inflammatory fats. Cooking became part of my healing. So did simplicity. I repeated meals, kept it clean, and listened to how my body responded.

Supplements

I used a few carefully chosen supplements to help support healing:

• Omega-3s for inflammation
• Ginger for digestion and gut motility
• Vitamin D, zinc, and magnesium to support immunity
• etc.

Lifestyle

I started sleeping better, walking every day, and cutting out stress triggers wherever I could. I stopped overcommitting. I started meditating. I got outside more. I let go of perfection and focused on consistency. When I did all that, my body started responding in ways no drug ever managed to deliver.

Not everyone’s experience is the same. Some people don’t respond to dietary changes, or they’re in a flare that’s gone too far. Others might be dealing with complications like fistulas or strictures that require medical intervention.

Biologics might be a step that makes sense for someone in that situation. It’s not black and white. My goal with sharing all this is to show that biologics aren’t the only path and sometimes, they don’t need to be the first one either.

Biologics are powerful tools. But so is food. So is sleep. So is knowing your body and taking the time to learn what it needs.

I’m not against medication. I just believe in using it wisely, and only when other routes haven’t worked. For me, those other routes, the ones doctors usually skip past, turned out to be the most effective of all.

If you’re exploring your options, curious about going a more natural route, or just want to hear from someone who said no to biologics and still got better, I hope this helped.

You can find everything I used in my own healing journey including meal plans, supplements, food lists, symptom trackers, and more at GutMellow.com. Or read the full story in my book How I Stopped IBD Flare-Ups & Achieved Remission.

Just remember, you’re not alone in this. And you’re not out of options.

After a decade of trial and error, I finally found a combination of strategies that actually worked. I went from constant flare-ups to long-term remission, without biologics or surgery. I created GutMellow to share my experience and help others navigate their own healing journey.

The GutMellow Remission Roadmap includes everything I wish I had when I was first diagnosed. It’s a comprehensive resource that outlines the exact steps I took to regain control of my gut health, including:

This blog is for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. While I am sharing my personal experience, every individual’s health journey is unique. Always consult with a qualified healthcare professional before making any changes to your diet, supplements, medications, or lifestyle. Healing is a personal journey, and what worked for me may not work for everyone.