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Does vitamin D deficiency contribute to inflammatory bowel disease?

Posted on: February 23, 2013   by  John Cannell, MD

Does vitamin D deficiency contribute to inflammatory bowel disease?

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Inflammatory bowel diseases are chronic, inflammatory, autoimmune disorders of the gastrointestinal tract. There are two different forms, Crohn’s disease and ulcerative colitis (UC). UC is characterized by ulcers or open sores in the intestinal tract. The main symptom of active disease is usually constant diarrhea mixed with blood, and is of gradual onset. UC is often confused with irritable bowel syndrome, a troublesome but much less serious condition.

Among adults in the USA, it is estimated that a total of 436,000 have Crohn’s disease (CD) and 512,000 have UC, with a lower prevalence in the South compared to the Northeast, Midwest and West. The diseases are also more prevalent in northern Europe than southern Europe. Some but not all studies show a clear seasonal variation in the symptoms of UC, with summertime remissions.

Tysk C, Järnerot G. Seasonal variation in exacerbations of ulcerative colitis. Scand J Gastroenterol. 1993 Jan;28(1):95-6.

Recently, Drs Stacey Blanck and Faten Aberra of the Hospital of the University of Pennsylvania wanted to know if the symptoms of UC were worse in the vitamin D deficient.

Blanck S, Aberra F.  Vitamin D Deficiency Is Associated with Ulcerative Colitis Disease Activity. Dig Dis Sci. 2013 Jan 19.

They studied 34 UC patients in a cross-sectional analysis and found 15 had levels above 30 ng/ml and 19 patients had levels less than 30 ng/ml, with 12 patients having levels less than 20 ng/ml. A six-point questionnaire based on bleeding and stool frequency determined severity.

Vitamin D deficient patients (<30 ng/ml) were statistically more likely to have increased disease activity than patients with levels above 30 ng/ml (p = 0.04), with 68% of deficient patients displaying active disease compared with 33 % in the sufficient group. Not enough patients had levels above 40 ng/ml to know if higher levels helped even more.

There was also a statistically significant association between vitamin D status and need for treatment with steroids, with 47% of the deficient patients requiring steroids, compared with only 7% in the sufficient group (p = 0.02). However, there was no statistically significant association among the use of other immune-suppressants, including infliximab, methotrexate, azathioprine, adalimumab and 6-mercaptopurine.Unlike the above study, there was no association between season of visit and disease activity.

It appears likely that UC may be another autoimmune disorder that vitamin D will help. As it can be a serious disease, I recommend adults with UC, keep their 25(OH)D in the high natural range, about 70-80 ng/ml, and that may require 10,000 IU/day of vitamin D3. I recommend higher natural levels and doses of vitamin D in those who have a serious illness linked to vitamin D for simple common sense reasons: higher doses are safe and they may help more than lower doses. People with serious diseases simply can’t wait for the dosing studies to be done so higher natural levels seem like common sense to me. For the same reason, I advise that children with UC should be given 2,000 IU/25 pounds of body weight/day.

5 Responses to Does vitamin D deficiency contribute to inflammatory bowel disease?

  1. hlahore@gmail.com

    Here is just the summary of a long page on gut at vitaminDWiki
    Celiac disease has a strong genetic component.
    Most, but not all, people with celiac disease have a gene variant.
    An adequate level vitamin D seems to decrease the probability of getting celiac disease.
    Celiac disease causes poor absorption of nutrients such as vitamin D.
    Bringing the blood level of vitamin D back to normal in patients with celiac disease decreases symptoms.
    There are hints that vitamin D may cure the disease. – see video, etc.
    The prevalence of celiac disease, not just its diagnosis, has increased 4X in the past 30 years, similar to the increase in Vitamin D deficiency.
    http://www.vitamindwiki.com/tiki-index.php?page_id=745

  2. sagefemme60

    The increase in Celiac disease seems to parallel the increase in the amount of gluten incorporated into the Standard American Diet. Agricultural marketing research in the 50’s indicated that people will not but crumbled products, so the amount of gluten in baked and processed foods was increased.
    Excess gluten leads to increased bowel inflammation, leads to reduced vitamin D absorption, leads to Celiac, UC, Crohn’s, IBS, and other autoimmune diseases,

  3. Brant Cebulla

    sagefemme60, I read this article this past weekend, you may enjoy it:

    http://www.nytimes.com/2013/02/24/opinion/sunday/what-really-causes-celiac-disease.html

    I have no comment on it, just an interesting read.

  4. showmeaschematic

    Dr Cannell,

    I have been supplementing with Vitamin D for 3 years now, and test my levels regularly. I take 8,000 units per day, and test around 65 to 70 ng/ml…. so I speak as a firm believer .
    I have recently read Dr Kate Rheaume Bleue ‘s book… ” Vitamin K2 and the Calcium Paradox “. It is quite a revelation. It has convinced me to begin co-supplementing my D with K2 … mk7, the bacterially derived variety. I strongly suggest that you read her book, or, better yet, have a chat with her. She has put together a very convincing body of evidence that Vitamin D acts with Vitamins A and K2, and that the potential harm of just taking Vitamin D, without the other two is a very real possibility, especially if one is supplementing at high doses. On the other hand, by supplementing with K2 as well as getting enough Vitamin A in diet, you can reap many more benefits than just taking Vitamin D, and solve some of the puzzling non performances that Vitamin D alone displays.
    Could you please review this information and gives us your thoughts ??

  5. bacsithuy5@gmail.com

    Here in NZ we are battling the introduction of GE soy and my research is showing the changes in bacterial flora from glyphosate/ Roundup, increased levels of mycotoxins from GE and glyphosate and increased levels of lectins and trypsin inhibitors in GE soy which cause damage to the gut lining and dysbiosis. As there are large numbers of VDR’s in the intestinal mucosa this could account for the effects of higher Vit D in auto-immune disease, Ca and Mg absorption, autism etc., etc. I would love for someone to have found a relationship as described above; any takers?

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