It is no surprise to me, a Crohn’s disease patient and someone who had an ileostomy in 2006, that vitamin D and other important B vitamins become deficient when one has the disease. Even before my surgery, I had a B12 deficiency, which caused a significant lack of energy, bordering on something with the unpleasant-sounding name, pernicious anemia. Vitamin B12 has to combine with another substance called ‘intrinsic factor’ which is produced by your stomach lining.
I love dairy products, like milk, cheese, and yogurt, and I also eat a fair amount of fish, and I try to get out in the sun every day (it is hard in the Northeast, where I live, since the daily dose of sunlight is hard to come by, especially during the winter months), so I was lucky that my vitamin D levels remained high enough during my ten years of active Crohn’s disease.
According to a recent study written up in the journal of Inflammatory Bowel Diseases, a Boston University team found vitamin D absorption is diminished in patients with Crohn’s disease. The study examined healthy subjects and those with inactive (quiescent) Crohn’s disease (in this study 50 percent of the subjects were female). The study found that the Crohn’s patients had a 30 percent decrease in their ability to absorb vitamin D2. The researchers found that an oral vitamin D absorption test to be important as a means to determine if the fat soluble vitamin is being properly absorbed.
Vitamin D absorption tests will hopefully become de rigeur in treating all Crohn’s patients–and perhaps a similar study will determine the same for those suffering from ulcerative colitis. Michael Holick, Professor of Medicine, Physiology and Biophysics at Boston University School of Medicine, is the author of The Vitamin D Solution. Dr. Holick has Increased awareness in the pediatric and medical communities regarding vitamin D deficiency pandemic, and its role in causing not only metabolic bone disease, and osteoporosis in adults, but increasing risk of children and adults developing common deadly cancers, autoimmune diseases, including type 1 diabetes and multiple sclerosis and heart disease.
According to Dr. Holick, “vitamin D is not a vitamin but a hormone. It is unique in that it is made in the skin as a result of exposure to sunlight. Photosynthesis of vitamin D has been occurring on earth for more than 750 million years. Some of the earliest life forms that were exposed to sunlight for their energy requirement were also photosynthesizing vitamin D. Both children and adults have in the past depended on adequate sun exposure to satisfy their vitamin D requirement. It is well documented that at the turn of the last century upwards of 80% of children in the industrialized, polluted cities of northern Europe and northeastern United States suffered from the devastating consequences of vitamin D deficiency rickets.”
Vitamin D is found in certain foods, like fortified milk, cod liver oil, eggs and fish; also it is synthesized in the skin through exposure to the sun (ultraviolet-B rays). Deficiencies of Vitamin D can result in weak bones. Adults and children with Crohn’s disease are especially susceptible to Vitamin D deficiencies as the small bowel (which consists of the duodenum, jejunum and ileum) is where the majority of soluable vitamins are absorbed. B12 is also absorbed in the terminal ileum (that was the area that I had removed when I had my bowel resection).
A complex multivitamin and other vitamins such as vitamin D, vitamin K, and vitamin A can be helpful after the colon has been healed and bowel function is normal. Hold off on particular vitamins until the gastrointestinal tract is functioning better and has a better ability to utilize and break down the vitamins. Other basic supplements may be needed in the treatment of Inflammatory Bowel Disease (IBD) due to poor nutrient absorption.
According to Jessica Black, ND, (who is also my co-athor), “proper digestion and absorption are extremely important in overall health. Proper digestion of foods is important because the breaking down of food decreases the food particle size so that nutrients, amino acids, and fats can be taken from the food and absorbed to be utilized by the body. If digestion is altered, decreased nutrient absorption can cause significant vitamin deficiencies, which can relate to various illnesses. Also, prolonged use of NSAIDs (Nonsteroidal anti-inflammatory drugs) can result in larger food particles in the intestine and, when not properly broken down, can cause problems such as arthritis.”
Monitoring diet an fluid intake is also important for keeping your child safe; in particular, it is important to look out for malnutrition in children and adolescents with IBD. Because of signiᴀcant diarrhea resulting from the illness or reactions to medications they may be taking, nutrient loss may occur and can be life threatening if not monitored appropriately. Sometimes vitamin supplements may be required. Anemia and low vitamin D levels are also prevalent among children with inflammatory bowel disease. Supplementation with vitamin D, B vitamins, and iron can help reduce long-term illness of IBD patients.
F.A. Farraye, H. Nimitphong, A. Stucchi, K. Dendrinos, A.B. Boulanger, A. Vijjeswarapu, A. Tanennbaum, R. Biancuzzo, T.C. Chen, M.F. Holick. Use of a novel vitamin d bioavailability test demonstrates that vitamin D absorption is decreased in patients with quiescent crohn’s disease. Inflammatory Bowel Diseases, 2011; DOI: 10.1002/ibd.21595