Inflammatory bowl diseaseVitamin D levels

Those with Crohn’s disease (CD) often have low serum 25(OH)D levels123456789 10. Such a finding generally indicates that lower serum 25(OH)D levels contribute to the incidence or severity of the disease. However, in some cases, the existence of the disease results in lower serum 25(OH)D levels.

In CD, absorption of all nutrients is impaired. It was demonstrated that for those with CD, UVB from a tanning bed is a useful way to raise serum 25(OH)D levels11.

Those with CD and low serum 25(OH)D levels are at increased risk for metabolic bone disease12513.

Metabolic bone disease (MBD) is an umbrella term that covers a number of disorders related to the weakening of the bone or impaired systems function caused by an imbalance in vitamin D3, calcium and phosphorus. This imbalance may be caused by a lack of or too much of one of these three essential elements or the failure to provide one or more of them in a bioavailable form.
http://www.anapsid.org/mbd.html

Common forms of MBD include osteopenia and osteoporosis. People with these conditions should consider taking vitamin D supplements1415, along with calcium. However, since absorption of all nutrients is impaired for those with CD16, they should either take higher doses of vitamin D than others or obtain vitamin D from solar17 or artificial UVB11

A study in Japan found that those who had Ulcerative colitis (UC) who subsequently developed colorectal cancer had much lower fraction of vitamin D receptors in their the colorectal mucosal lining compared to normal mucosa (3.4% vs. 58.8%)18.

There is some risk of hypercalcemia for those with CD19.

“Inappropriately high levels of serum 1,25(OH)(2)D (>60 pg/ml) were observed in 42% of patients with CD” in a study in Los Angeles20.

“Crohn’s disease is a granulomatous disorder that is more commonly associated with hypocalcemia caused by poor calcium intake and decreased intestinal calcium absorption related to vitamin D deficiency as a consequence of malabsorption21.”

Thus, those with CD should make themselves aware of the symptoms of hypercalcemia and, if increasing vitamin D intake or production, increase gradually, perhaps by 1000 IU/day for a month at a time until reaching 4000 IU/day.

Page last edited: 06 May 2011

References

  1. Driscoll, R. H., Jr. Meredith, S. C. Sitrin, M. Rosenberg, I. H. Vitamin D deficiency and bone disease in patients with Crohn’s disease. Gastroenterology. 1982 Dec; 83 (6): 1252-8.
  2. Harries, A. D. Brown, R. Heatley, R. V. Williams, L. A. Woodhead, S. Rhodes, J. Vitamin D status in Crohn’s disease: association with nutrition and disease activity. Gut. 1985 Nov; 26 (11): 1197-203.
  3. Jahnsen, J. Falch, J. A. Mowinckel, P. Aadland, E. Vitamin D status, parathyroid hormone and bone mineral density in patients with inflammatory bowel disease. Scand J Gastroenterol. 2002 Feb; 37 (2): 192-9.
  4. Kuwabara, A. Tanaka, K. Tsugawa, N. Nakase, H. Tsuji, H. Shide, K. Kamao, M. Chiba, T. Inagaki, N. Okano, T. Kido, S. High prevalence of vitamin K and D deficiency and decreased BMD in inflammatory bowel disease. Osteoporos Int. 2009 Jun; 20 (6): 935-42.
  5. Leslie, W. D. Miller, N. Rogala, L. Bernstein, C. N. Vitamin D status and bone density in recently diagnosed inflammatory bowel disease: the Manitoba IBD Cohort Study. Am J Gastroenterol. 2008 Jun; 103 (6): 1451-9.
  6. Pappa, H. M. Gordon, C. M. Saslowsky, T. M. Zholudev, A. Horr, B. Shih, M. C. Grand, R. J. Vitamin D status in children and young adults with inflammatory bowel disease. Pediatrics. 2006 Nov; 118 (5): 1950-61.
  7. Sentongo, T. A. Semaeo, E. J. Stettler, N. Piccoli, D. A. Stallings, V. A. Zemel, B. S. Vitamin D status in children, adolescents, and young adults with Crohn disease. Am J Clin Nutr. 2002 Nov; 76 (5): 1077-81.
  8. Siffledeen, J. S. Siminoski, K. Steinhart, H. Greenberg, G. Fedorak, R. N. The frequency of vitamin D deficiency in adults with Crohn’s disease. Can J Gastroenterol. 2003 Aug; 17 (8): 473-8.
  9. Tajika, M. Matsuura, A. Nakamura, T. Suzuki, T. Sawaki, A. Kato, T. Hara, K. Ookubo, K. Yamao, K. Kato, M. Muto, Y. Risk factors for vitamin D deficiency in patients with Crohn’s disease. J Gastroenterol. 2004 Jun; 39 (6): 527-33.
  10. Sanchez-Cano, D. Ruiz-Villaverde, R. Callejas-Rubio, J. L. Perez, C. C. Garcia, M. G. Centeno, N. O. [Vitamin D deficiency and bone mineral density in Crohn’s disease.]. Med Clin (Barc). 2010 Dec 22;
  11. Koutkia, P. Lu, Z. Chen, T. C. Holick, M. F. Treatment of vitamin D deficiency due to Crohn’s disease with tanning bed ultraviolet B radiation. Gastroenterology. 2001 Dec; 121 (6): 1485-8.
  12. Lamb, E. J. Wong, T. Smith, D. J. Simpson, D. E. Coakley, A. J. Moniz, C. Muller, A. F. Metabolic bone disease is present at diagnosis in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2002 Nov; 16 (11): 1895-902.
  13. Vogelsang, H. Ferenci, P. Woloszczuk, W. Resch, H. Herold, C. Frotz, S. Gangl, A. Bone disease in vitamin D-deficient patients with Crohn’s disease. Dig Dis Sci. 1989 Jul; 34 (7): 1094-9.
  14. Siffledeen, J. S. Fedorak, R. N. Siminoski, K. Jen, H. Vaudan, E. Abraham, N. Steinhart, H. Greenberg, G. Randomized trial of etidronate plus calcium and vitamin D for treatment of low bone mineral density in Crohn’s disease. Clin Gastroenterol Hepatol. 2005 Feb; 3 (2): 122-32.
  15. Vogelsang, H. Klamert, M. Resch, H. Ferenci, P. Dietary vitamin D intake in patients with Crohn’s disease. Wien Klin Wochenschr. 1995; 107 (19): 578-81.
  16. Silvennoinen, J. Relationships between vitamin D, parathyroid hormone and bone mineral density in inflammatory bowel disease. J Intern Med. 1996 Feb; 239 (2): 131-7.
  17. Joseph, A. J. George, B. Pulimood, A. B. Seshadri, M. S. Chacko, A. 25 (OH) vitamin D level in Crohn’s disease: association with sun exposure & disease activity. Indian J Med Res. 2009 Aug; 130 (2): 133-7.
  18. Wada, K. Tanaka, H. Maeda, K. Inoue, T. Noda, E. Amano, R. Kubo, N. Muguruma, K. Yamada, N. Yashiro, M. Sawada, T. Nakata, B. Ohira, M. Hirakawa, K. Vitamin D receptor expression is associated with colon cancer in ulcerative colitis. Oncol Rep. 2009 Nov; 22 (5): 1021-5.
  19. Bosch, X. Hypercalcemia due to endogenous overproduction of 1,25-dihydroxyvitamin D in Crohn’s disease. Gastroenterology. 1998 May; 114 (5): 1061-5.
  20. Abreu, M. T. Kantorovich, V. Vasiliauskas, E. A. Gruntmanis, U. Matuk, R. Daigle, K. Chen, S. Zehnder, D. Lin, Y. C. Yang, H. Hewison, M. Adams, J. S. Measurement of vitamin D levels in inflammatory bowel disease patients reveals a subset of Crohn’s disease patients with elevated 1,25-dihydroxyvitamin D and low bone mineral density. Gut. 2004 Aug; 53 (8): 1129-36.
  21. Tuohy, K. A. Steinman, T. I. Hypercalcemia due to excess 1,25-dihydroxyvitamin D in Crohn’s disease. Am J Kidney Dis. 2005 Jan; 45 (1): e3-6.