B12 and IBD

Vitamin B12 plays a very important part in the body as it helps to keep the nervous system healthy and also is needed to make new cells in the body. A lack in it can be a cause of pernicious anaemia which leads to a reduction of oxygen being carried around the body in the blood. 

The most common symptoms of vitamin B12 deficiency include:

·         Tiredness

·         Lethargy

·         Feeling faint

·         Breathlessness

Less common symptoms include:

·         Headaches

·         Heart palpitations

·         Taste being altered

·         Loss of appetite

·         Ringing in the ears also known as tinnitus

·         Looking pale

·         Sore mouth and tongue

If the deficiency is left untreated it can get worse and end up with long term issues such as:

Psychological problems like depressions, confusion and memory problems.

Nerve problems like numbness, pins and needles, vision changes and unsteadiness.

A simple blood test from your doctors or hospital can indicate if you have a B12 deficiency.

Pernicious anaemia is very common in people who have been diagnosed with an autoimmune disease such as Crohn’s disease and Ulcerative colitis. Vitamin B12 is absorbed in the end of the small intestine in the ileum. People with Crohn’s disease in this area may not be able to absorb B12 very well. People who have had to have surgery to remove the stomach or the end of the small intestine may also struggle to absorb vitamin B12.

To treat vitamin B12 deficiency, injections are often given to people who have a big deficiency and those who have a mild deficiency are told to purchase vitamin tablets with extra vitamin B12 or to eat foods rich in the vitamin. The injections help to quickly build up stores of the vitamin. Once the stores have been replaced then the doctor will only often maintenance injections depending on the reason behind the deficiency.

Vitamin B12 supplements are available to buy from many places like health food stores like Holland and Barrett’s or in the supermarket like Tesco, Sainsbury’s or Asda. These may be recommended for people if their diet is lacking in B12. Vitamin B12 can be found naturally in certain foods including:

·         Meat

·         Fish

·         Eggs

·         Milk

I had been told by my doctor in my GP surgery that I was low in B12 and to get some supplements even though I had about 6 of the symptoms of a vitamin deficiency. I ended up going into Holland and Barrett’s on my dinner break in work and explained I was lacking B12 and magnesium as that is what my bloods were telling us. I explained to the lady what the doctors have told me and that I also had Crohn’s disease in the ileum. She was a lovely and understanding lady and understood that if I were to take B12 tablets I would not absorb the goodness of the vitamin in my small intestine. She went the whole way through the products in the store and found something which would be better for me to absorb the B12 and magnesium. I have been using both sprays for just over a week now and I can start to feel a difference in myself. I normally need a mid-afternoon nap and the first few days I needed a nap in the afternoon to see me through the rest of the day. Now I am a week in I have not been relying on needing a nap in the afternoon it is now early evening but the longer I hold out the better I sleep at night time. I hope it stays working as there are days the fatigue just knocks me clean out before I even get to lunch time.

Calcium and IBD

Calcium is important for the formation of bones and to keep them strong and healthy. The circulation and nervous systems also rely on calcium to function. Teeth also rely on calcium to keep them strong. 

People who suffer with IBD are at a risk of having calcium deficiency. This is due to the importance of vitamin D as it regulates how much calcium circulates in the bloodstream and how much will be used by bones to maintain healthy structure. If we lack vitamin D our body will not be able to regulate the calcium in our body correctly. 

Our body does not make calcium and relies on us getting it from food we eat. If we do not get the calcium it needs the body with start to break down its own bones (where lots of calcium is stored) to get what it needs. This eventually leads to osteoporosis. 

Symptoms of calcium deficiency are:

·         Muscle aches and cramps

·         Tooth decay

·         Weak or deformed bones

·         Brittle nails and dry skin

·         Kidney stones

·         Osteoporosis

Doctors usually diagnoses calcium deficiency through blood tests. 

The doctors have come up with a few theories over the years why we might be deficient in calcium. They are:

·     Calcium is absorbed in the small intestine so people with Crohn’s disease in this are i.e. ileocolitis, ileitis, gastro duodenal and jejunoileitis will find it harder to absorb the calcium. 

·      Steroid medication such as prednisolone interfere with the absorption of calcium, slow down the process of new bone formation and accelerate the breakdown of old bone. Long term use of steroids can lead to significant bone loss so it is very important that people on steroids are given calcium supplements at the same time. Steroid medication is most commonly used to treat flare-ups with Crohn’s disease and ulcerative colitis as it helps to calm down the flares.

·      Most people with IBD may avoid dairy as it exacerbates their symptoms like myself as it is one of my trigger foods so I mainly use soya based products as an alternative. If we do not get enough calcium in our diet it can lead to a calcium deficiency. 

Calcium deficiencies can be treated either by taking a supplement like calci-chew which the doctors are only able to prescribe or a supplement from a health food shop or supermarket. Or we can increase the food which contains calcium such as dairy such as, milk, yoghurt and cheese if you are able to tolerate it with your IBD.

Or non-dairy foods:

·         Bok Choy

·         Leafy greens like kale and spinach

·         Oranges

·         Salmon

·         Shrimp

Or there are calcium fortified foods also available such as fresh orange juice.

Vitamin D and IBD

Vitamin D helps to regulate the amount of calcium and phosphate in the body and it is essential for healthy bones. Vitamin D also helps to reduce inflammation and is important for good general health and growth. There has been studies which have shown a correspondence between people with inflammatory bowel disease and low levels of vitamin D. It is one of the most common vitamin deficiencies seen in people with Crohn’s disease. The studies have found people who have low levels of vitamin D had a higher severity of the disease. It has highlighted the importance of monitoring and treating people with IBD.

Vitamin D is essential for absorbing calcium into the body. This means people who lack vitamin D most often lack calcium as well. A small lack in vitamin D may not cause symptoms but can cause:

·         Tiredness

·         Generalised aches and pains

A severe lack in vitamin D can result in:

·         Bone deformities in children i.e. rickets

·         Bone pain and tenderness in adults (osteomalacia)

People who suffer with an IBD are more prone to osteoporosis and other bone diseases which is attributed to the lack of vitamin D.

Vitamin D deficiency can be diagnosed by a simple blood test by the doctor. 

There are a few different theories as to why us IBDers may have less vitamin D. They include:

·         Due to their symptoms they may be more likely to stay inside, near a toilet or resting and then we do not get much access to sunlight to get natural vitamin D. 

·         More IBDers live in the northern areas which has less sunlight.

·         Vitamin D is a fat soluble vitamin and people with active inflammation in their small intestine poorly absorbs fat meaning less fat for vitamin D to be absorbed in. 

Vitamin D is made under our skin due to the reaction to sunlight so increasing your exposure to sunlight can help increase your vitamin D levels. However, you need to make sure you do this safely. In the northern areas which includes the most of Europe there is not thought to be enough sunlight during the winter months to get the sun exposure which is needed. 

It is therefore important to get vitamin D from other sources, such as through your diet or through supplements. It is also found naturally in a small number of foods including:

·         Oily fish such as salmon, sardines and mackerel

·         Eggs

·         Fortified foods with vitamin D such as cereals

If you choose to take an over the counter vitamin D supplement make sure you do not exceed the recommended dose.

Iron and IBD

Low iron or a lack of it commonly causes iron deficiency anaemia. This type of anaemia leads to a reduction in the production of red blood cells and this can mean a reduced amount of oxygen being carried around the body in your blood. Iron deficiency is a common complication for people who suffer from inflammatory bowel disease but it is very easily treated.

The most common symptoms of iron deficiency are:

·         Tiredness

·         Lack of energy

·         Heart palpitations

·         Pale complexion

Less common symptoms include:

·         Headaches

·         Tinnitus

·         Altered taste

·         Itchiness

·         Sore or abnormally smooth tongue

·         Hair loss

·         Desire to eat non-food items like coal

·         Difficulty swallowing

·         Ulcers in the corner of your mouth

·         Spoon shaped nails

If the iron deficiency is left untreated it can lead to:

·         Increased risk of infections

·         Heart and lung problems

·         Restless leg syndrome

Iron deficiency can be diagnosed through a blood test by your doctor.

People who suffer from IBD who lose blood and also iron through bleeding in their stools from their intestines are usually at a higher risk of developing iron deficiency. This can happen in both people who suffer from both Crohn’s disease and Ulcerative Colitis. People with Crohn’s disease in their small intestine in the duodenum are at further risk as this is where the iron is absorbed. If this is where you have your Crohn’s disease you might have an issue absorbing the iron. Some people with IBD and on a restricted diet due to the foods they can eat will not be getting enough iron through their diet. 

Most people with iron deficiency will be able to take and iron supplement orally from the doctor on a daily basis. Others will need to be given iron intravenously. This will help to boost the iron levels in your body. 

Most people find they have side effects from taking iron supplements such as cramping and constipation. 

You can also help boost your iron intake through your diet by eating foods like:

·         Dark green leafy vegetables like kale or spinach

·         Brown rice

·         Pulses and beans

·         Nuts and seeds

·         Meat, fish and tofu

·         Eggs

·         Dried fruit

·         Also some cereals and bread are also fortified with iron.

If you cannot eat all these just eat what you can tolerate to help boost your iron. I know I have dips every so often that I need to get an infusion every so often and it means 2 trips to the hospitals day case unit for a few hours. I do try to eat what I can to prevent me from having to get an infusion by eating the foods I can tolerate like beef, fish, eggs and cereals.