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.