All of these things can lead to serious deficiencies of certain essential vitamins and minerals that you need to stay healthy, including iron, calcium, vitamin B12, folate, and vitamin D. Here’s why these vitamins and minerals are so important to maintain optimal health — and what you can do about any deficiency.
1. Iron Deficiency Can Leave You Tired and Dizzy
Iron deficiency can happen to people with Crohn’s because of blood lost through bowel movements or because inflammation makes it hard to absorb the nutrient. This can lead to anemia, when you don’t have enough red blood cells to carry sufficient oxygen to the tissues, which can result in fatigue and shortness of breath when you exercise. Blood loss may not always be obvious, so it might require a stool test, says William Sandborn, MD, chief of gastroenterology and director of the inflammatory bowel disease (IBD) center at the University of California in San Diego. “When patients have a flare-up of Crohn’s, they can have anemia,” says Dr. Sandborn. “In some cases your iron can’t be absorbed from the small intestine, even if you take supplements, so we sometimes have to give iron as an intravenous infusion.” The liver produces a protein called hepcidin that can further complicate iron absorption. During inflammation, when hepcidin levels may be high, it can prevent the body from absorbing iron. A diet that includes leafy greens, such as spinach, beans, lentils, peas, and meats, will help, but it’s also important to be monitored by a physician to see if it’s necessary to take iron supplements. When iron deficiency is chronic, your diet may not be able to keep up, so it will require an iron supplement. Calcium is essential to make and sustain bones, and it’s also needed for the heart and muscles to work properly, which puts people with Crohn’s at risk of osteoporosis, bone fractures, weak muscles, and irregular heart rhythm. “The trick is to not restrict your diet too much, or avoid dairy products,” says Sandborn. “But if dairy is exacerbating your Crohn’s symptoms, then over-the-counter calcium supplements are good.” If the albumin level gets low, treating the flare up with biologic drugs will correct the albumin, which will in turn help correct calcium levels.
3. Resection Surgery Can Make It Hard to Absorb Vitamin B12
Vitamin B12 is the most common deficiency among people with Crohn’s, says Sandborn. Severe cases can lead to nerve damage, resulting in tingling or numbness in the fingers and toes. Vitamin B12 is absorbed in the body in the ileum, the lower portion of the small intestine that leads to the large intestine. But if the end portion of the ileum has been surgically removed, as happens in people with Crohn’s, the vitamin does not properly absorb in the body, which results in a deficiency. Like iron, this vitamin is important to maintain a sufficient level of normal red blood cells. “Your doctor needs to periodically monitor vitamin B12 in your blood. Patients will typically need lifetime replacement if they’ve had corrective surgery for Crohn’s,” says Sandborn. This vitamin is mostly found in animal products, such as eggs, milk, fish, poultry, and other meats. Fortified breakfast cereals can also provide sufficient vitamin B12. But if the terminal ileum has been removed, Sandborn explains that the vitamin will have to be given as a shot, typically once a month, or alternatively as an intranasal formulation.
4. Lack of Folic Acid in the Diet Causes Folate-Deficiency Anemia
Folate deficiency is less common in Crohn’s patients, but occurs most often if you’re taking methotrexate or sulfasalazine. Typically when IBD specialists prescribe either of these drugs, they will also prescribe a folic acid supplement to compensate for folate loss. Folate is a B-complex vitamin, found in beans, green leafy vegetables, asparagus, rice, and fruits. It is key to producing red blood cells, for protein synthesis and skin health. Deficiency can result in skin inflammation or dermatitis. Pregnant women, including women with Crohn’s, are advised to take folic acid to prevent birth defects in their babies.
5. Vitamin D Insufficiency Can Trigger Flare-Ups
Vitamin D deficiency is very common in people with Crohn’s. “Just having Crohn’s seems to be an additional risk factor for vitamin D deficiency, but it’s not well understood why,” says Sandborn. The two main ways to get vitamin D are through exposure to sunlight and via a supplement. Vitamin D is also found in certain foods, including eggs, fortified milk, fatty fish, and butter, but not in high enough levels for optimal health. Vitamin D is essential for bone health, and some research has suggested that people with this deficiency may actually have more flare-ups of Crohn’s disease. Talk to your doctor if you’re concerned about vitamin D deficiency so he or she can run tests and determine your current levels. “There is still a lot of research to be done in Crohn’s disease,” Sandborn says. “Restricted diet is a common practice but I think this does a lot of harm, because there’s not enough science behind some of these restrictions. Many patients don’t need so many restrictions. Eating a healthy, well-balanced diet is probably the best thing you can do.”
