There are two forms of inflammatory bowel disease (IBD):
- Crohn’s disease (CD)
- Ulcerative colitis (UC)
CD is an inflammatory immune disease of the intestinal tract. It causes thickening of the intestinal wall and inflammation of the intestinal lining (mucous membranes). Symptoms include abdominal pain, diarrhea, fever, and weight loss.
UC is a chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain and cramps. UC also causes loose bowel discharges of pus, blood, and mucus.
Risk factors of IBD include some components of the Western diet:
- Animal protein from meat and fish
- Animal fat
- Dairy products
These dietary components interact with and alter the microflora in the gut. There is increasing evidence that the type of microflora may play a role in risk of IBD.
Sunlight exposure and IBD risk
International researchers have studied sunlight exposure and IBD risk:
- European studies reported higher rates of IBD in areas of higher latitude. Countries farther from the equator have less sunlight and ultraviolet-B (UVB) radiation. The latitudinal effect is stronger for CD than UC.
- In the United States, rates for CD and UC are highest in the Northeast. In this location, summertime solar UVB doses are lowest. Low solar UVB was linked more strongly to CD than to UC.
- A study from India reported lower vitamin D levels in those with CD and lower sun exposure.
These studies suggest that vitamin D may reduce the risk of CD. The evidence is less clear for UC.
Vitamin D and IBD
Vitamin D levels
People with CD often have low vitamin D blood levels. The lower levels may contribute in part to CD. However, CD may also reduce vitamin D absorption from food.
How vitamin D works
Vitamin D lowers the risk of CD by:
- Reducing inflammation
- Maintains a strong mucosal barrier (lining of the intestines)
Studies in varied locations (Europe and the United States) came to similar conclusions. Higher vitamin D levels may reduce the risk of CD and possibly UC. Based on findings for other diseases, Vitamin D levels above 40 ng/mL (100 nmol/L) may provide a good protection.
Vitamin D and calcium
People with CD and low vitamin D levels have an increased risk for osteoporosis. These people should consider taking vitamin D and calcium.
In one study, people who took 1200 international units (IU) (30 mcg)/day of vitamin D3 (cholecalciferol) had half as many CD relapses as those taking a placebo. Vitamin D3 is the form of vitamin D produced by the skin.
IBD is sometimes treated with drugs known as thiopurines. This drug carries a small risk of nonmelanoma skin cancer. People who take thiopurines and want to increase their vitamin D levels should consider using supplements rather than UVB radiation. If choosing UVB light, expose as much of the body as possible for a short period of time. Mid-day sun is best.
This evidence summary was written by:
William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
Complete bibliography of research used in this summary
The research we have cited in our summary is listed below, with links to PubMed abstracts and full-text for those who wish to explore further.
- Abramson, O. Durant, M. Mow, W. Finley, A. Kodali, P. Wong, A. Tavares, V. McCroskey, E. Liu, L. Lewis, J. D. Allison, J. E. Flowers, N. Hutfless, S. Velayos, F. S. Perry, G. S. Cannon, R. Herrinton, L. J. Incidence, prevalence, and time trends of pediatric inflammatory bowel disease in Northern California, 1996 to 2006. J Pediatr. 2010 Aug; 157 (2): 233-239 e1.
- Abreu, M. T. Kantorovich, V. Vasiliauskas, E. A. Gruntmanis, U. Matuk, R. Daigle, K. Chen, S. Zehnder, D. Lin, Y. C. Yang, H. Hewison, M. Adams, J. S. Measurement of vitamin D levels in inflammatory bowel disease patients reveals a subset of Crohn’s disease patients with elevated 1,25-dihydroxyvitamin D and low bone mineral density. Gut. 2004 Aug; 53 (8): 1129-36.
- Ardizzone, S. Cassinotti, A. Trabattoni, D. Manzionna, G. Rainone, V. Bevilacqua, M. Massari, A. Manes, G. Maconi, G. Clerici, M. Bianchi Porro, G. Immunomodulatory effects of 1,25-dihydroxyvitamin D3 on TH1/TH2 cytokines in inflammatory bowel disease: an in vitro study. Int J Immunopathol Pharmacol. 2009 Jan-Mar; 22 (1): 63-71.
- Armitage, E. L. Aldhous, M. C. Anderson, N. Drummond, H. E. Riemersma, R. A. Ghosh, S. Satsangi, J. Incidence of juvenile-onset Crohn’s disease in Scotland: association with northern latitude and affluence. Gastroenterology. 2004 Oct; 127 (4): 1051-7.
- Asakura, H. Suzuki, K. Kitahora, T. Morizane, T. Is there a link between food and intestinal microbes and the occurrence of Crohn’s disease and ulcerative colitis?. J Gastroenterol Hepatol. 2008 Dec; 23 (12): 1794-801.
- Bartels, L. E. Jorgensen, S. P. Agnholt, J. Kelsen, J. Hvas, C. L. Dahlerup, J. F. 1,25-dihydroxyvitamin D3 and dexamethasone increase interleukin-10 production in CD4+ T cells from patients with Crohn’s disease. Int Immunopharmacol. 2007 Dec 15; 7 (13): 1755-64.
- Bernstein, C. N. Epidemiologic clues to inflammatory bowel disease. Curr Gastroenterol Rep. 2010 Dec; 12 (6): 495-501.
- Bernstein, C. N. Blanchard, J. F. Kliewer, E. Wajda, A. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer. 2001 Feb 15; 91 (4): 854-62.
- Bevenius, J. Caries risk in patients with Crohn’s disease: a pilot study. Oral Surg Oral Med Oral Pathol. 1988 Mar; 65 (3): 304-7.
- Bosch, X. Hypercalcemia due to endogenous overproduction of 1,25-dihydroxyvitamin D in Crohn’s disease. Gastroenterology. 1998 May; 114 (5): 1061-5.
- Bowden, S. A. Robinson, R. F. Carr, R. Mahan, J. D. Prevalence of vitamin D deficiency and insufficiency in children with osteopenia or osteoporosis referred to a pediatric metabolic bone clinic. Pediatrics. 2008 Jun; 121 (6): e1585-90.
- Cantorna, M. T. Mahon, B. D. D-hormone and the immune system. J Rheumatol Suppl. 2005 Sep; 7611-20.
- Cantorna, M. T. Zhu, Y. Froicu, M. Wittke, A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr. 2004 Dec; 80 (6 Suppl): 1717S-20S.
- Carbonnel, F. Jantchou, P. Monnet, E. Cosnes, J. Environmental risk factors in Crohn’s disease and ulcerative colitis: an update. Gastroenterol Clin Biol. 2009 Jun; 33 Suppl 3S145-57.
- Cooke, W. T. Vitamin D deficiency and bone disease in patients with Crohn’s disease. Gastroenterology. 1983 Sep; 85 (3): 785-6.
- Coulombe, F. Divangahi, M. Veyrier, F. de Leseleuc, L. Gleason, J. L. Yang, Y. Kelliher, M. A. Pandey, A. K. Sassetti, C. M. Reed, M. B. Behr, M. A. Increased NOD2-mediated recognition of N-glycolyl muramyl dipeptide. J Exp Med. 2009 Aug 3; 206 (8): 1709-16.
- Dresner-Pollak, R. Ackerman, Z. Eliakim, R. Karban, A. Chowers, Y. Fidder, H. H. The BsmI vitamin D receptor gene polymorphism is associated with ulcerative colitis in Jewish Ashkenazi patients. Genet Test. 2004 Winter; 8 (4): 417-20.
- Driscoll, R. H., Jr. Meredith, S. C. Sitrin, M. Rosenberg, I. H. Vitamin D deficiency and bone disease in patients with Crohn’s disease. Gastroenterology. 1982 Dec; 83 (6): 1252-8.
- El-Matary, W. Sikora, S. Spady, D. Bone Mineral Density, Vitamin D, and Disease Activity in Children Newly Diagnosed with Inflammatory Bowel Disease. Dig Dis Sci. 2010 Aug 20;
- Engel, P. Fagherazzi, G. Mesrine, S. Boutron-Ruault, M. C. Clavel-Chapelon, F. Joint Effects of Dietary Vitamin D and Sun Exposure on Breast Cancer Risk: Results from the French E3N Cohort. Cancer Epidemiol Biomarkers Prev. 2011 Jan; 20 (1): 187-98.
- Ezzat, Y. Hamdy, K. The frequency of low bone mineral density and its associated risk factors in patients with inflammatory bowel diseases. Int J Rheum Dis. 2010 Aug; 13 (3): 259-65.
- Fernandes de Abreu, D. A. Eyles, D. Feron, F. Vitamin D, a neuro-immunomodulator: Implications for neurodegenerative and autoimmune diseases. Psychoneuroendocrinology. 2009 Jun 20;
- Gilman, J. Shanahan, F. Cashman, K. D. Determinants of vitamin D status in adult Crohn’s disease patients, with particular emphasis on supplemental vitamin D use. Eur J Clin Nutr. 2006 Jul; 60 (7): 889-96.
- Grant, W. B. The likely role of vitamin D from solar ultraviolet-B irradiance in increasing cancer survival. Anticancer Res. 2006 Jul-Aug; 26 (4A): 2605-14.
- Grant, W. B. Hypothesis–ultraviolet-B irradiance and vitamin D reduce the risk of viral infections and thus their sequelae, including autoimmune diseases and some cancers. Photochem Photobiol. 2008 Mar-Apr; 84 (2): 356-65.
- Grant, W. B. Garland, C. F. The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates. Anticancer Res. 2006 Jul-Aug; 26 (4A): 2687-99.
- Hessov, I. Mosekilde, L. Melsen, F. Fasth, S. Hulten, L. Lund, B. Sorensen, O. H. Osteopenia with normal vitamin D metabolites after small-bowel resection for Crohn’s disease. Scand J Gastroenterol. 1984 Jul; 19 (5): 691-6.
- Hugot, J. P. Chamaillard, M. Zouali, H. Lesage, S. Cezard, J. P. Belaiche, J. Almer, S. Tysk, C. O’Morain, C. A. Gassull, M. Binder, V. Finkel, Y. Cortot, A. Modigliani, R. Laurent-Puig, P. Gower-Rousseau, C. Macry, J. Colombel, J. F. Sahbatou, M. Thomas, G. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn’s disease. Nature. 2001 May 31; 411 (6837): 599-603.
- Inohara, N. Ogura, Y. Fontalba, A. Gutierrez, O. Pons, F. Crespo, J. Fukase, K. Inamura, S. Kusumoto, S. Hashimoto, M. Foster, S. J. Moran, A. P. Fernandez-Luna, J. L. Nunez, G. Host recognition of bacterial muramyl dipeptide mediated through NOD2. Implications for Crohn’s disease. J Biol Chem. 2003 Feb 21; 278 (8): 5509-12.
- Jahnsen, J. Falch, J. A. Mowinckel, P. Aadland, E. Vitamin D status, parathyroid hormone and bone mineral density in patients with inflammatory bowel disease. Scand J Gastroenterol. 2002 Feb; 37 (2): 192-9.
- Jorgensen, S. P. Agnholt, J. Glerup, H. Lyhne, S. Villadsen, G. E. Hvas, C. L. Bartels, L. E. Kelsen, J. Christensen, L. A. Dahlerup, J. F. Clinical trial: vitamin D3 treatment in Crohn’s disease – a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther. 2010 Aug; 32 (3): 377-83.
- Joseph, A. J. George, B. Pulimood, A. B. Seshadri, M. S. Chacko, A. 25 (OH) vitamin D level in Crohn’s disease: association with sun exposure & disease activity. Indian J Med Res. 2009 Aug; 130 (2): 133-7.
- Kappelman, M. D. Rifas-Shiman, S. L. Kleinman, K. Ollendorf, D. Bousvaros, A. Grand, R. J. Finkelstein, J. A. The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007 Dec; 5 (12): 1424-9.
- Koutkia, P. Lu, Z. Chen, T. C. Holick, M. F. Treatment of vitamin D deficiency due to Crohn’s disease with tanning bed ultraviolet B radiation. Gastroenterology. 2001 Dec; 121 (6): 1485-8.
- Kumari, M. Khazai, N. B. Ziegler, T. R. Nanes, M. S. Abrams, S. A. Tangpricha, V. Vitamin D-mediated calcium absorption in patients with clinically stable Crohn’s disease: a pilot study. Mol Nutr Food Res. 2010 Aug; 54 (8): 1085-91.
- Kuwabara, A. Tanaka, K. Tsugawa, N. Nakase, H. Tsuji, H. Shide, K. Kamao, M. Chiba, T. Inagaki, N. Okano, T. Kido, S. High prevalence of vitamin K and D deficiency and decreased BMD in inflammatory bowel disease. Osteoporos Int. 2009 Jun; 20 (6): 935-42.
- Lamb, E. J. Wong, T. Smith, D. J. Simpson, D. E. Coakley, A. J. Moniz, C. Muller, A. F. Metabolic bone disease is present at diagnosis in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2002 Nov; 16 (11): 1895-902.
- Leicht, E. Schmidt-Gayk, H. Langer, H. J. Sneige, N. Biro, G. Hypomagnesaemia-induced hypocalcaemia: concentrations of parathyroid hormone, prolactin and 1,25-dihydroxyvitamin D during magnesium replenishment. Magnes Res. 1992 Mar; 5 (1): 33-6.
- Leichtmann, G. A. Bengoa, J. M. Bolt, M. J. Sitrin, M. D. Intestinal absorption of cholecalciferol and 25-hydroxycholecalciferol in patients with both Crohn’s disease and intestinal resection. Am J Clin Nutr. 1991 Sep; 54 (3): 548-52.
- Leslie, W. D. Miller, N. Rogala, L. Bernstein, C. N. Vitamin D status and bone density in recently diagnosed inflammatory bowel disease: the Manitoba IBD Cohort Study. Am J Gastroenterol. 2008 Jun; 103 (6): 1451-9.
- Long, M. D. Herfarth, H. H. Pipkin, C. A. Porter, C. Q. Sandler, R. S. Kappelman, M. D. Increased risk for non-melanoma skin cancer in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2010 Mar; 8 (3): 268-74.
- McCarthy, D. Duggan, P. O’Brien, M. Kiely, M. McCarthy, J. Shanahan, F. Cashman, K. D. Seasonality of vitamin D status and bone turnover in patients with Crohn’s disease. Aliment Pharmacol Ther. 2005 May 1; 21 (9): 1073-83.
- Miheller, P. Muzes, G. Hritz, I. Lakatos, G. Pregun, I. Lakatos, P. L. Herszenyi, L. Tulassay, Z. Comparison of the effects of 1,25 dihydroxyvitamin D and 25 hydroxyvitamin D on bone pathology and disease activity in Crohn’s disease patients. Inflamm Bowel Dis. 2009 Nov; 15 (11): 1656-62.
- Naderi, N. Farnood, A. Habibi, M. Derakhshan, F. Balaii, H. Motahari, Z. Agah, M. R. Firouzi, F. Rad, M. G. Aghazadeh, R. Zojaji, H. Zali, M. R. Association of vitamin D receptor gene polymorphisms in Iranian patients with inflammatory bowel disease. J Gastroenterol Hepatol. 2008 Dec; 23 (12): 1816-22.
- Nerich, V. Monnet, E. Etienne, A. Louafi, S. Ramee, C. Rican, S. Weill, A. Vallier, N. Vanbockstael, V. Auleley, G. R. Allemand, H. Carbonnel, F. Geographical variations of inflammatory bowel disease in France: a study based on national health insurance data. Inflamm Bowel Dis. 2006 Mar; 12 (3): 218-26.
- Nerich, V. Monnet, E. Weill, A. Vallier, N. Vanbockstael, V. Auleley, G. R. Balaire, C. Dubost, P. Rican, S. Allemand, H. Carbonnel, F. Fine-scale geographic variations of inflammatory bowel disease in France: correlation with socioeconomic and house equipment variables. Inflamm Bowel Dis. 2010 May; 16 (5): 813-21.
- Nguyen, G. C. Steinhart, A. H. Nationwide patterns of hospitalizations to centers with high volume of admissions for inflammatory bowel disease and their impact on mortality. Inflamm Bowel Dis. 2008 Dec; 14 (12): 1688-94.
- Noble, C. L. McCullough, J. Ho, W. Lees, C. W. Nimmo, E. Drummond, H. Bear, S. Hannan, J. Millar, C. Ralston, S. H. Satsangi, J. Low body mass not vitamin D receptor polymorphisms predict osteoporosis in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2008 Apr 1; 27 (7): 588-96.
- Pappa, H. M. Gordon, C. M. Saslowsky, T. M. Zholudev, A. Horr, B. Shih, M. C. Grand, R. J. Vitamin D status in children and young adults with inflammatory bowel disease. Pediatrics. 2006 Nov; 118 (5): 1950-61.
- Paterson, C. R. Moody, J. P. Pennington, C. R. Skin content of 7-dehydrocholesterol in patients with malabsorption. Nutrition. 1997 Sep; 13 (9): 771-3.
- Ross, C. M. Shedding some light on Crohn’s disease: birth month and vitamin D?. Inflamm Bowel Dis. 2005 Sep; 11 (9): 863.
- Sanchez-Cano, D. Ruiz-Villaverde, R. Callejas-Rubio, J. L. Perez, C. C. Garcia, M. G. Centeno, N. O. [Vitamin D deficiency and bone mineral density in Crohn's disease.]. Med Clin (Barc). 2010 Dec 22;
- Sentongo, T. A. Semaeo, E. J. Stettler, N. Piccoli, D. A. Stallings, V. A. Zemel, B. S. Vitamin D status in children, adolescents, and young adults with Crohn disease. Am J Clin Nutr. 2002 Nov; 76 (5): 1077-81.
- Shivananda, S. Lennard-Jones, J. Logan, R. Fear, N. Price, A. Carpenter, L. van Blankenstein, M. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut. 1996 Nov; 39 (5): 690-7.
- Siffledeen, J. S. Fedorak, R. N. Siminoski, K. Jen, H. Vaudan, E. Abraham, N. Steinhart, H. Greenberg, G. Randomized trial of etidronate plus calcium and vitamin D for treatment of low bone mineral density in Crohn’s disease. Clin Gastroenterol Hepatol. 2005 Feb; 3 (2): 122-32.
- Siffledeen, J. S. Siminoski, K. Steinhart, H. Greenberg, G. Fedorak, R. N. The frequency of vitamin D deficiency in adults with Crohn’s disease. Can J Gastroenterol. 2003 Aug; 17 (8): 473-8.
- Silvennoinen, J. Relationships between vitamin D, parathyroid hormone and bone mineral density in inflammatory bowel disease. J Intern Med. 1996 Feb; 239 (2): 131-7.
- Simmons, J. D. Mullighan, C. Welsh, K. I. Jewell, D. P. Vitamin D receptor gene polymorphism: association with Crohn’s disease susceptibility. Gut. 2000 Aug; 47 (2): 211-4.
- Sonnenberg, A. Demographic characteristics of hospitalized IBD patients. Dig Dis Sci. 2009 Nov; 54 (11): 2449-55.
- Sonnenberg, A. Similar geographic variations of mortality and hospitalization associated with IBD and Clostridium difficile colitis. Inflamm Bowel Dis. 2010 Mar; 16 (3): 487-93.
- Sonnenberg, A. Ehms, H. Sonnenberg, G. E. Strohmeyer, G. 25-hydroxycholecalciferol serum levels in patients with Crohn’s disease. Acta Hepatogastroenterol (Stuttg). 1977 Aug; 24 (4): 293-5.
- Stokkers, P. C. Deley, M. Van Der Spek, M. Verberne, H. J. Van Deventer, S. J. Hommes, D. W. Intravenous pamidronate in combination with calcium and vitamin D: highly effective in the treatment of low bone mineral density in inflammatory bowel disease. Scand J Gastroenterol. 2006 Feb; 41 (2): 200-4.
- Tajika, M. Matsuura, A. Nakamura, T. Suzuki, T. Sawaki, A. Kato, T. Hara, K. Ookubo, K. Yamao, K. Kato, M. Muto, Y. Risk factors for vitamin D deficiency in patients with Crohn’s disease. J Gastroenterol. 2004 Jun; 39 (6): 527-33.
- Tuohy, K. A. Steinman, T. I. Hypercalcemia due to excess 1,25-dihydroxyvitamin D in Crohn’s disease. Am J Kidney Dis. 2005 Jan; 45 (1): e3-6.
- Vagianos, K. Bector, S. McConnell, J. Bernstein, C. N. Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr. 2007 Jul-Aug; 31 (4): 311-9.
- Verway, M. Behr, M. A. White, J. H. Vitamin D, NOD2, autophagy and Crohn’s disease. Expert Rev Clin Immunol. 2010 Jul; 6 (4): 505-8.
- Vogelsang, H. Ferenci, P. Resch, H. Kiss, A. Gangl, A. Prevention of bone mineral loss in patients with Crohn’s disease by long-term oral vitamin D supplementation. Eur J Gastroenterol Hepatol. 1995 Jul; 7 (7): 609-14.
- Vogelsang, H. Ferenci, P. Woloszczuk, W. Resch, H. Herold, C. Frotz, S. Gangl, A. Bone disease in vitamin D-deficient patients with Crohn’s disease. Dig Dis Sci. 1989 Jul; 34 (7): 1094-9.
- Vogelsang, H. Klamert, M. Resch, H. Ferenci, P. Dietary vitamin D intake in patients with Crohn’s disease. Wien Klin Wochenschr. 1995; 107 (19): 578-81.
- Vogelsang, H. Schofl, R. Tillinger, W. Ferenci, P. Gangl, A. 25-hydroxyvitamin D absorption in patients with Crohn’s disease and with pancreatic insufficiency. Wien Klin Wochenschr. 1997 Sep 19; 109 (17): 678-82.
- Wada, K. Tanaka, H. Maeda, K. Inoue, T. Noda, E. Amano, R. Kubo, N. Muguruma, K. Yamada, N. Yashiro, M. Sawada, T. Nakata, B. Ohira, M. Hirakawa, K. Vitamin D receptor expression is associated with colon cancer in ulcerative colitis. Oncol Rep. 2009 Nov; 22 (5): 1021-5.
- Wang, T. T. Dabbas, B. Laperriere, D. Bitton, A. J. Soualhine, H. Tavera-Mendoza, L. E. Dionne, S. Servant, M. J. Bitton, A. Seidman, E. G. Mader, S. Behr, M. A. White, J. H. Direct and indirect induction by 1,25-dihydroxyvitamin D3 of the NOD2/CARD15-defensin beta2 innate immune pathway defective in Crohn disease. J Biol Chem. 2010 Jan 22; 285 (4): 2227-31.