I remember a patient from medical school at UNC who had fistulas from her rectum to her vagina and from her rectum to her skin. A fistula is like a tunnel that connects two structures that should not be connected. Suffice it to say, her life was greatly impacted, and due to her embarrassment of these complications, she waited several years before seeking treatment. After a thorough evaluation, she was diagnosed with Crohn’s disease.
We had no good treatment for Crohn’s disease back then (1976), and we have no good treatment now. It was once thought to be an autoimmune disorder, but it is not; it appears to be a gut leakage problem. The prevalence of Crohn’s disease has been steadily increasing since the 1970s for reasons no one understands. However, it is less common in equatorial countries.
There are a number of studies showing individuals with Crohn’s disease have much lower vitamin D levels than healthy people. How much vitamin D should you take if you have Crohn’s disease? The short answer to that question of course is no one knows. But such an answer, or the ever-present calls for more research, do not help those afflicted with Crohn’s disease. For these individuals, the Vitamin D Council wanted to see if there was any evidence vitamin D will help treat the disease.
A recent Chinese study is obliquely helpful in answering this question. Of course, this study did not directly determine whether 5,000 IU (125 mcg) or 10,000 IU (250 mcg)/day of vitamin D will help treat Crohn’s disease. But this study found that severity of Crohn’s disease as determined by endoscopic biopsy was much worse in subjects with low vitamin D levels. If I had Crohn’s disease, this study alone would get me taking high doses of vitamin D.
One very small 12-month study actually investigated if 10,000 IU (250 mcg)/day helps manage Crohn’s better than 1,000 IU/day (25 mcg). We blogged about it at the time but didn’t really communicate the importance of the study.
The authors reported,
“On an intention-to-treat basis (includes data on everyone who entered the study whether they took vitamin D or not), the rate of relapse difference between patients receiving low (1,000 IU/day) – and high-dose (10,000 IU/day) vitamin D3 (68.8 vs 33.3%; NS). In per-protocol analysis (just includes subjects who took vitamin D), clinical recurrence (relapse) of Crohn’s disease was less frequently observed in patients receiving a high dose (0%) compared to those receiving a low dose of 1000 IU daily (37.5%) (p = 0.049). Improvement in anxiety and depression scores and a good safety profile were observed in the group treated with 10,000 IU (250 mcg)/day of vitamin D3.”
Narula N, Cooray M, Anglin R, Muqtadir Z, Narula A, Marshall J. Impact of High-Dose Vitamin D3 Supplementation in Patients with Crohn’s Disease in Remission: A Pilot Randomized Double-Blind Controlled Study. Dig Dis Sci. 2017 Feb;62(2):448-455.
Common sense needs to prevail in diseases like Crohn’s disease. Severity of illness must be weighed against dangers of taking 10,000 IU (250 mcg)/day of vitamin D, which are nonexistent. Do you have Crohn’s disease and supplement with vitamin D? Email us at [email protected] to share your experience with the Vitamin D Council team.
John Cannell, MD. How much vitamin D should individuals with Crohn’s disease supplement with? The Vitamin D Council Blog & Newsletter, January 25, 2018.