Nutrient (substances that provide energy) deficiencies are common in people suffering from inflammatory bowel disease (IBD) particularly Crohn's disease. These deficiencies are more common in kids than in adults and can lead to failure to grow and gain weight in children.
This article will focus problem in adults only. Common deficiencies include water soluble and fat-soluble vitamins, minerals like zinc, calcium and iron and proteins. People with these disorders have reduced intake of food secondary to decreased appetite and worsening of symptoms with meals a lot of times. Because of diarrhea there is poor absorption of food. Their energy requirements are higher because of chronic disease (inflammation). Some patients will need resection of part of their intestines, which can lead to poor absorption of specific nutrients.
Commonly seen nutritional deficiency in people with ulcerative Colitis and Crohn's Disease include:
繚 Hypoalbuminemia (low albumin) 25 - 80% of patients
繚 Vitamin D deficiency 75% of patients
繚 Anemia 60 - 80% of patients
繚 Iron deficiency 39 - 81% of patients
繚 Vitamin B12 deficiency 20 - 60% of patients
繚 Folic acid deficiency 36 - 54 % of patients
繚 Zinc deficiency 40 - 50 of patients
繚 Calcium deficiency 13 of patients
繚 Magnesium deficiency 14 - 33% of patients
People with their disease under control should be able to eat a normal healthy diet and should have the minimal need for any additional supplements outside the daily requirements of nutrients. There are no specific restrictions for people with inflammatory bowel disease. Individuals however may be not able to tolerate certain specific foods and should avoid those items. In general it is a good idea to avoid fried food, red meat as well as excessive oil and cheese containing food.
1. Because vitamin deficiencies are prevalent in patients with IBD, multivitamin supplementation is suggested.
2. Iron deficiency is common and most common cause for anemia in patients with IBD. Patients need to be periodically checked for iron levels particularly if their blood counts are low. Supplements can be given orally or intravenously.
3. Folic acid is usually given to most patients with IBD as supplement.
4. Serum levels of vitamin B12 should be monitored in patients and if needed it can be given as a monthly injection.
5. The recommended intake of vitamin D is 400 to 800 IU daily for adults, the same as for healthy individuals. People with chronic diarrhea may require higher doses of Vitamin D.
6. High dose vitamin E supplementation is not recommended.
7. There is no need for supplementing vitamins A & K.
8. Vitamin A & E excess can cause serious side effects.
9. Zinc supplement with 10-15 mg of elemental zinc daily is recommended. Higher doses have not proven to be beneficial.
10. Negative calcium balance is one of several factors contributing to bone disease in patients with inflammatory bowel disease. The recommended intake of elemental calcium for adults with IBD is 1500 mg daily. Patient requiring steroids frequently or with extensive disease of small bowel may need higher doses.
Your doctors should be periodically checking you for above deficiencies and suggesting appropriate treatment. For more details, discuss with your healthcare providers. For more information go to Dr. Jain's Blog