Inflammatory bowel disease

Inflammatory bowel disease is a chronic disease that causes inflammation in all or part of the digestive tract. The two main types of inflammatory bowel disease are Crohn’s disease and ulcerative colitis, which affect different parts of the digestive tract. The cause of inflammatory bowel disease is not fully understood, but scientists think it is a combination of genetics, the environment, and your immune system. Many studies have shown that there is a link between vitamin D and inflammatory bowel disease. People with inflammatory bowel disease are more likely to have low levels of vitamin D. In inflammatory bowel disease, vitamin D may help the immune system to reduce levels of inflammatory proteins that get overproduced. Although inflammatory bowel disease is not curable, there are ways to manage the symptoms and keep the disease in remission. Having high vitamin D levels may be a way to help manage inflammatory bowel disease, as well as to reduce complications related to the disease, such as hospitalizations, surgeries, infections, and colon cancer. More experiments need to be done to determine just how effective vitamin D might be for inflammatory bowel disease, if at all.  Research hasn’t been able to show yet that low vitamin D levels cause inflammatory bowel disease. Doctors don’t know yet whether taking a vitamin D supplement, or getting more sun exposure, can help to prevent inflammatory bowel disease. If you have inflammatory bowel disease and want to take vitamin D, it is unlikely to make your IBD worse or cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to treat your inflammatory bowel disease. If you have inflammatory bowel disease, you shouldn’t take vitamin D in place of your treatment medications. Talk to your physician for more advice about taking supplements.

What is inflammatory bowel disease?

Inflammatory bowel disease, or IBD, is a chronic or recurring disease that causes inflammation in all or part of the digestive tract. There are different types of IBD. The main types are Crohn’s disease and ulcerative colitis. Ulcerative colitis only causes inflammation in your colon (large intestine) or rectum, while Crohn’s disease can happen anywhere along your digestive tract. Crohn’s disease can also spread deep into the tissues of your digestive tract. Crohn’s disease is usually more severe and causes symptoms more frequently than ulcerative colitis. It is common for people with IBD to have periods of flares, which is when you have worse symptoms, and periods of remission, when the symptoms are better or not there at all. When IBD symptoms are flaring up, the disease is called “active”1.

What are the symptoms of inflammatory bowel disease?

The symptoms for IBD vary by person, depending on where their inflammation is and how severe it is.  In general, symptoms for both Crohn’s disease and ulcerative colitis include1,2:

  • Diarrhea
  • Cramps and abdominal pain
  • Rectal bleeding or bloody stool
  • Fatigue
  • Bloating
  • Skin, joint, or eye inflammation

Some people who have severe cases also experience a loss of appetite, weight loss, and malnutrition from not getting enough nutrients. Ulcerative colitis symptoms usually come on gradually, whereas Crohn’s disease symptoms may come on suddenly. People with Crohn’s disease are also more likely to get small sores or ulcers on the surface of their digestive tract. Sometimes these ulcers can become large and can occur inside the walls of the intestine.

How common is inflammatory bowel disease?

It is estimated that 1.4 million people in the United States have some form of IBD. Most people develop it between the age of 15 and 30, but it can occur at any age. There are some things that can increase your chances for developing IBD, including1,2:

  • Gender. Ulcerative colitis is more common in men, while Crohn’s disease is more common in women.
  • Ethnicity. IBD is more common in Caucasian and Ashkenazi Jewish people.
  • Family history. You have a higher risk of developing IBD if your parent or sibling has it.
  • Smoking.

What causes inflammatory bowel disease?

It is not fully understood what causes IBD or how it develops. Researchers think that IBD is caused by a combination of genetics, the environment, and your immune system.  Some researchers think that an invading germ in your digestive tract causes your body to become overly inflamed when your immune system is trying to fight it off. There are things in the environment that might affect the chance of developing IBD, such as where you live, if you smoke, and your diet. People who live in urban areas, industrialized countries, or northern latitudes are more likely to have IBD3,4. Other researchers think that it is an autoimmune disease, which means that your immune system has a hard time telling the difference between your own healthy cells and foreign things like germs, bacteria, or viruses. This causes your body to attack your healthy tissue, which can cause inflammation and pain. Overall, there is some combination of genetics, the environment, and your immune system that causes IBD to develop1,2,5.

What is the link between vitamin D and inflammatory bowel disease?

Many studies have shown that there is a link between vitamin D and IBD. People with IBD are more likely to have low levels of vitamin D. Some researchers think that low vitamin D levels may be a consequence of having IBD because the symptoms may cause you to stay indoors more and eat less. However, studies have found that even people who are newly diagnosed with IBD tend to have low vitamin D levels. This means that low vitamin D levels may be a risk factor for developing IBD3. Vitamin D receptors are found on the surface of a cell where they receive chemical signals. By attaching themselves to a receptor, these chemical signals direct a cell to do something, for example, to act in a certain way, or to divide or die. There are vitamin D receptors found on cells in the digestive tract and the immune system, and vitamin D can bind to these receptors. In IBD, vitamin D works in the immune system by reducing levels of inflammatory proteins that get overproduced. One of the proteins that vitamin D can lower is called tumor-necrosis factor, or TNF.  One of the medications to manage IBD involves blocking TNF production. Therefore, researchers think that vitamin D may be a natural way to block TNF and help reduce inflammation in the digestive tract4,6. While it is thought that there is a link between low vitamin D levels and IBD, more experiments need to be done to figure out whether or not taking vitamin D supplements can help to prevent or manage IBD.

What does the research say in general about vitamin D and inflammatory bowel disease?

Preventing inflammatory bowel disease

Not many studies have been done about preventing IBD. However, it has been shown that there is a difference in the risk of developing IBD based on where you live and the amount of sun exposure you get. People who live in northern latitudes with less sunlight have an increased chance of developing IBD. Vitamin D is made in the skin from sunlight, so researchers think that low vitamin D levels may be a factor that increases IBD risk in these populations7.

Managing inflammatory bowel disease

Although IBD is not curable, there are ways to manage the symptoms and keep the disease in remission. Having high vitamin D levels may be a way to help manage IBD, as well as reduce complications related to IBD, such as hospitalizations, surgeries, infections, and colon cancer8. However, it is not known for sure yet that vitamin D can help to prevent these outcomes. Some studies have found that people with IBD who have higher vitamin D levels tend to have lower disease activity, meaning their symptoms are less severe or they are in remission more9,10. People with IBD are more likely to have low bone density, which increases the risk for osteoporosis and fractures. People with IBD tend to have lower bone density for different reasons, including long-term use of steroid medications, low nutrient intakes, and changes in bone formation from too much inflammation. Since vitamin D helps to strengthen bones, researchers think that low vitamin D levels may be one of the reasons why people with IBD tend to have low bone density11. Although many studies have shown a link between low vitamin D levels and increased IBD severity and complications, most of the research has been observational, meaning that we can’t say for sure whether or not vitamin D can help to manage IBD.

What does the recent research say about vitamin D and inflammatory bowel disease?

An experiment published in 2013looked at a small group of 18 adults in the United States with mild or moderate Crohn’s disease. All of the patients started with taking 1,000 IU of vitamin D every day for 2 weeks, and then they increased the dose every 2 weeks until it reached 5,000 IU per day. The total treatment time was 24 weeks. The researchers looked at their vitamin D levels, quality of life, and disease activity score throughout the study. They found that12:

  • Vitamin D levels increased greatly after 24 weeks. The people who started with the lowest vitamin D levels saw the biggest improvement.
  • All but 1 person had lower disease activity scores and higher quality of life after treatment.
  • Sixty-seven percent of the people went into remission.

The researchers conclude that 5,000 IU per day of vitamin D may help to lower disease activity and improve quality of life in people with Crohn’s disease, but more experiments need to be done to say for sure. A 2010 experiment from Denmarklooked at adults who were in remission from Crohn’s disease. The researchers gave them either 1,200 IU of vitamin D plus 1,200 mg calcium every day or a dummy pill and calcium. After one year, the researchers found that13:

  • People in the vitamin D group had fewer relapses into active Crohn’s disease compared to people in the dummy pill group.

The researchers conclude that vitamin D might help to keep people in remission from Crohn’s disease. A study published in 2013 in the United Statesrecruited a large group of people with IBD and looked at their vitamin D levels and various outcomes related to IBD. The researchers found that8,14:

  • People who had low levels of vitamin D were more likely to be hospitalized or have surgery related to IBD, compared to people with high levels of vitamin D.
  • People who had low levels of vitamin D were more likely to get cancer than people with higher levels.
  • For every 1 ng/mL increase in vitamin D levels, there was a 6% decrease in risk of colorectal cancer.

Negative outcomes like surgeries, hospitalization, and colon cancer are common for people with IBD. The researchers conclude that having higher levels of vitamin D may help to protect against these outcomes. A study in 2013 in the United Stateslooked at people with IBD who were on a specific treatment medication. The researchers wanted to know if vitamin D levels before treatment started would have an effect on how the treatment went. They found that15:

  • People who had low vitamin D levels before treatment started were 3 times more likely to stop treatment early compared to people with high vitamin D levels.
  • The people who stopped treatment early did so because they weren’t getting better or seeing a response.

The vitamin D status of people with IBD before starting treatment may affect how well someone responds to treatment. Having a high vitamin D level could make it more likely to see an improvement in symptoms once treatment is started.

Key points from the research

  • People who have IBD tend to have low levels of vitamin D.
  • In IBD, vitamin D may help the immune system in reducing levels of inflammatory proteins that get overproduced.
  • Having high vitamin D levels may be a way to help to manage IBD symptoms.
  • Vitamin D may help to reduce complications related to IBD, such as hospitalizations, surgeries, infections, and colon cancer.
  • Overall, more experiments need to be done to determine if taking vitamin D supplements can help to prevent or manage IBD.

What does this mean for me?

Research has shown that there is a link between vitamin D and IBD. People with IBD are more likely to have low levels of vitamin D and are more likely to experience worse outcomes, like hospitalizations, surgeries, more severe symptoms, and colon cancer. Some studies have shown that having high levels of vitamin D can help to lower the risk of these outcomes. However, more experiments need to be done to determine just how effective vitamin D might be for IBD, if at all.  Research hasn’t been able to show yet that low vitamin D levels cause IBD. Doctors don’t know yet whether taking a vitamin D supplement, or getting more sun exposure, can help to prevent IBD. If you have IBD and want to take vitamin D, it is unlikely to make your IBD worse or cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to treat your IBD. If you have IBD, you shouldn’t take vitamin D in place of your treatment medications. Talk to your physician for more advice about taking supplements.

References

  1. Mayo Clinic. Inflammatory Bowel Disease (IBD). 2012. Web. Accessed at https://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/symptoms-causes/syc-20353315
  2. CDC. Inflammatory Bowel Disease (IBD). 2014. Web. Accessed at https://www.cdc.gov/ibd/.
  3. Ananthakrishnan AN. Environmental triggers for inflammatory bowel disease. Curr Gastroenterol Rep 2013;15(1):1-11.
  4. Cantorna  MT, McDaniel K, Bora S, et al. Vitamin D, immune regulation, the microbiota, and inflammatory bowel disease. Experimental Biology and Medicine 2014;0:1-7.
  5. WebMD. Inflammatory Bowel Disease. 2014. Web. Accessed at https://www.webmd.com/ibd-crohns-disease/inflammatory-bowel-syndrome.
  6. Reich KM, Fedorak RN, Madsen K, et al. Vitamin D improves inflammatory bowel disease outcomes: basic science and clinical review. World Journal of Gastroenterology 2014;20(17):4934-47.
  7. Butcher RO & Limdi JK. Vitamin D status in inflammatory bowel disease: are clinicians seeing the light? Journal of Crohn’s and Colitis 2012;6:1039-1040.
  8. Ananthakrishnan AN, Cagan A, Gainer VS, et al. Normalization of plasma 25-hydroxy vitamin D is associated with reduced risk of surgery in Crohn’s disease. Inflamm Bowel Dis 2013;19:1921-27.
  9. Fu YN, Chatur N, Cheong-Lee C, et al. Hypovitaminosis D in adults with inflammatory bowel disease: potential role of ethnicity. Dig Dis Sci 2012;57:2144-48.
  10. Ham M, Longhi MS, Lahiff C, et al. Vitamin D levels in adults with Crohn’s disease are responsive to disease activity and treatment. Inflamm Bowel Dis 2014;20:856-860.
  11. Abraham BP, Prasad P & Malaty HM. Vitamin D deficiency and corticosteroid use are risk factors for low bone mineral density in inflammatory bowel disease patients. Dig Dis Sci 2014; doi:  10.1007/s10620-014-3102-x
  12. Yang L, Weaver V, Smith JP, et al. Therapeutic effect of vitamin D supplementation in a pilot study of Crohn’s patients. Clinical and Translational Gastroenterology 2013;4:1-8.
  13. Jorgensen SP, Agnholt J, Glerup H, et al. Clinical trial: vitamin D3 treatment in Crohn’s disease- a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther 2010;32:377-383.
  14. Anathakrishnan AN, Cheng S, Cai T, et al. Association between reduced plasma 25-hydroxy vitamin D and increased risk of cancer in patients with inflammatory bowel disease. Clinical Gastroenterology and Hepatology 2014;12:821-827.
  15. Zatar ZA, Cantu SM, Konijeti GG, et al. Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor alpha therapy in inflammatory bowel diseases. JPEN 2014;38:385-392.
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