Table of Contents
Staying on top of your vitamin D levels is important when you have Crohn's disease, ulcerative colitis, or microscopic colitis. Vitamin D deficiency is associated with worse disease outcomes while normalization of vitamin D may help improve outcomes and quality of life. In this article, we cover some of the surprising ways that Vitamin D affects IBD.
What is vitamin D?
Vitamin D is an essential vitamin and nutrient that your body needs to promote calcium and phosphate absorption. Vitamin D is found in some foods and may be added to others (such as milk or juice) but is more readily accessible as a supplement. Your body naturally produces Vitamin D when exposed to sunlight.
What is a vitamin D deficiency?
A vitamin D deficiency is when your body does not have enough of vitamin D to function properly which may lead to loss of bone density, osteoporosis, and fractures. Studies have reported that 30-40% of people with IBD may be deficient in vitamin D1 and that approximately 68% of people are vitamin D deficient at diagnosis2. Compared to healthy people, those with Crohn’s or colitis are 64% more likely to have a vitamin D deficiency3.
What happens if you’re deficient in vitamin D?
In people with Crohn’s disease and ulcerative colitis, a vitamin D deficiency has been associated with4
- Longer duration of active disease
- Higher levels of certain tests that measure inflammation (fecal calprotectin, ESR, CRP)
- Increased pain
- Hospital admissions
- Trips to the emergency room
Who’s at risk of a vitamin D deficiency?
If you have any of the following characteristics, you may be at an increased risk of having a vitamin D deficiency1,5
- Non-white ethnicity
- Diagnosis of Crohn’s disease
- If you have active disease
- If you’ve had an IBD-related surgery
- If you’ve taken to steroids (prednisone)
- If you are female
- If you are pregnant
Benefits of normalizing vitamin D levels (supplementing vitamin D)
Studies suggest that bringing your vitamin D levels back to their recommended levels through supplementation may4:
- Reduce the risk for IBD-related surgery
- Improved quality of life
- Decrease health care utilization
- Improve anxiety and depression scores
Vitamin D may also help certain biologics work better
While more research is needed to draw any definitive conclusions, some research suggests that vitamin D may be associated with improved outcomes with certain biologics such as infliximab (Remicade). Recent studies suggest4:
- Vitamin D supplementation improved the efficacy of infliximab (Remicade) in Crohn’s disease patients (especially for those deficient in vitamin D).
- Crohn’s patients receiving high doses of vitamin D were less likely to need dose escalation of Infliximab.
- Vitamin D supplement while on biologics may decrease skin issues associated with biologic use.
- Vitamin D levels may be positively correlated with trough levels (level of medication in your body) in those on Infliximab.
- Adults and children with low vitamin D levels may be less likely to achieve clinical remission regardless of the biologic they’re on.
How to correct a vitamin D deficiency
Work with your Crohn's or colitis dietitian nutritionist to make sure you're meeting the recommended intake of vitamin D and prior to starting any supplement.
- Gubatan J, Moss AC. Vitamin D in inflammatory bowel disease: more than just a supplement. Curr Opin Gastroenterol. 2018 Jul;34(4):217-225. doi: 10.1097/MOG.0000000000000449. PMID: 29762159.
- Santucci NR, Alkhouri RH, Baker RD, Baker SS. Vitamin and zinc status pretreatment and posttreatment in patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2014 Oct;59(4):455-7. doi: 10.1097/MPG.0000000000000477. PMID: 25000354.
- Del Pinto R, Pietropaoli D, Chandar AK, Ferri C, Cominelli F. Association Between Inflammatory Bowel Disease and Vitamin D Deficiency: A Systematic Review and Meta-analysis. Inflamm Bowel Dis. 2015 Nov;21(11):2708-17. doi: 10.1097/MIB.0000000000000546. PMID: 26348447; PMCID: PMC4615394.
- Wu Z, Liu D, Deng F. The Role of Vitamin D in Immune System and Inflammatory Bowel Disease. J Inflamm Res. 2022 May 28;15:3167-3185. doi: 10.2147/JIR.S363840. PMID: 35662873; PMCID: PMC9160606.
- Shi S, Feng J, Zhou L, Li Y, Shi H. Risk Factors for Vitamin D Deficiency in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Turk J Gastroenterol. 2021 Jun;32(6):508-518. doi: 10.5152/tjg.2021.20614. PMID: 34405817; PMCID: PMC8975355.