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Inflammatory Bowel Disease Resource

Common Nutrient Deficiencies in IBD

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Vitamin and mineral deficiencies can be seen with inflammatory bowel disease for a variety of reasons: 

  • Inflammation in the GI tract, especially of the intestines and colon can interfere with vitamin, mineral, and nutrient absorption
  • Dietary modifications – Common dietary restrictions can lead to elimination of food groups putting patients at risk for nutritional deficiencies. Along with avoidance of foods, common symptoms often lead to loss of appetite and decreased intake especially during times of flares.
  • Medications and Surgical Interventions – Including resection or removal or portions of the small intestine or large intestine.

Calcium

Absorption occurs in duodenum

Food Sources: Cows milk, fortified milks (soy, almond), yogurt, cheese, canned fish, leafy greens, and fortified foods (orange juice, cereal, etc)

Supplements: Supplements commonly prescribed as dairy products on commonly avoided with lactose intolerance and leafy greens are not always tolerated. Supplement dose range based on age and deficiency. It is important to also address Vit D deficiency as they work together to maintain bone health.

Functions: Calcium has a variety of roles including muscle function, cell and hormonal signaling, and bone formation.

Risk: Corticosteroids decrease Calcium absorption. Physical inactivity is also a risk factor for osteoporosis

Vitamin D

Absorbed in ileum

Food sources: Vitamin D is found in minimal amounts naturally in the diet (salmon, tuna, and egg yolks). Fortified food sources of Vitamin D include milk and milk alternatives, yogurt, and some orange juice.

Supplements: Available as both Vitamin D2 and Vitamin D3.

Functions: Helps the body absorb calcium and promote bone health, plays a role in cell growth, as well as immune function (source 3).

Risk: Vitamin D deficiency is common in many individuals with IBD affecting 60-70% of IBD patients (source 2). While addition research is still need studies continue to explore how low Vitamin D levels influence IBD with results showing effects on disease activity, immune function, and even susceptibility to c. diff infections (source 2). It is a good practice to have your Vitamin D levels examined annually to assess and treat deficiency.

Vitamin A

Absorption in the ileum

Food Sources: Fortified milk and milk alternatives, eggs, cheese

Supplements: Often included in a daily multivitamin.

Functions: Vitamin A is needed for a variety of functions in the body including vision and immune function.

Risk: Deficiency common when ileum is removed or diseased

Vitamin E

Absorption in the ileum

Food sources: Almonds, sunflower seeds, avocado, wheat germ, leafy greens, egg yolk

Supplements: Often included as part of a multivitamin.

Functions: Several functions include acting as an antioxidant as well as plays a role in immune function.

Risk: Vitamin E is a fat soluble vitamin and should be evaluated if fat malabsorption is present. Deficiency can also be a concern if ileum is removed or diseased

Vitamin K

Absorption in the ileum

Food sources: Leafy greens, green vegetables (broccoli, Brussel sprouts, et)

Supplements: Often included as part of a multivitamin

Functions: Works as a cofactor and has roles in bone maintenance, central nervous system, and vision.

Risk: Increased risk of deficiency if ileum is removed or diseased.

B12 (cobalamin)

Absorption in the ileum

Food sources: Meat, fish, poultry, cheese, milk, eggs. B12 is naturally found in animal foods. It is important for vegetarians and vegans to look for fortified foods such as fortified cereals or fortified milk alternatives (soy or almond milk).

Supplements: Is available in oral supplements, but with deficiency B12 injections can be prescribed to bypass barriers to absorption (Source 3).

Functions: B12 is a water soluble vitamin. Several functions include maintaining nerve cell health, DNA synthesis, helps maintain heart health (decreasing homocysteine levels), helps maintain a healthy level of red blood cells (prevents megaloblastic anemia).

Risk: Increased risk of deficiency if ileum is removed or a significant portion diseased.

Folic Acid (B9)

Absorption in the small intestines.

Food sources: Liver, leafy greens, oranges, seeds, and fortified foods (such as breads and cereals).

Supplements: Supplementation is often prescribed for those taking medications that interfere with folate absorption (such as sulfasalazine or methotrexate. Deficiency is of special concern for women of child bearing age as folate deficiency can lead to increased risk of neural tube defects in babies.

Functions: Folate is a water soluble vitamin that functions as a coenzyme for a variety of process. Several main roles include prevention of megaloblastic anemia, DNA metabolism and cell division, and amino acid metabolism.

Risk: Deficiency can occur with avoidance of folate rich foods, medication interference, and malabsorption.

Zinc

Absorbed throughout the small intestine.

Food sources: Seafood, beef, beans. Noted: phytates and fibers inhibit zinc absorption while animal sources of zinc increase absorption (4)

Supplements: Supplements can be prescribed with prolonged diarrhea or poor wound healing.

Functions: Acts as a cofactor for a variety of enzyme processes including growth and immune function.

Risk: Deficiency can result in poor growth, weakened immune system, increased susceptibility to infection, and poor wound healing.

Iron

Absorption in duodenum

Food sources: Two types of iron include heme iron from animals such as beef, chicken, pork, salmon. Non heme iron is from plant sources such as fortified cereals, dark green vegetables, beans, and pumpkin seeds. Pairing iron rich foods with Vitamin C rich foods will increase absorption.

Supplements: Supplemented can be purchased over the counter or prescribed. Over the counter oral iron supplements can cause GI side effects such as abdominal pain and diarrhea.

Functions: Red blood cells need adequate iron to make hemoglobin. Hemoglobin is a protein in the red blood cells that carries oxygen throughout the body.

Risk: Inadequate intake, blood loss, and poor absorption all contribute to deficiency. Individuals with excessive blood loss such as ulcers or bloody diarrhea are at increased risk as well as with duodenal inflammation.

*As always information provided is general and you should always speak to your physician and medical team before making any adjustments to your health regimen*

Sources:

1.       Pediatric Nutrition Handbook. 6th edition. Ronald Kleinman. 2009.

2.       Vitamin D and inflammatory Bowel Disease. Ashwin N Ananthakrishnan. Gastroenterol Hepatol (NY) 2016 Aug; 12 (8): 513-515.

3.       National institute of Health. https://ods.od.nih.gov/factsheets

4.       Linus Pauling Institute. http://lpi.oregonstate.edu/search/osu/zinc