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.
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.
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.