Does calcium supplementation improve Crohn's symptoms?

Calcium from Wikipedia

Hypercalcemia from Wikipedia

Hypercalciuria from Wikipedia

"Adequacy of Nutritional Intake in a Canadian Population of Patients with Crohn’s Disease" in Journal of the American Dietetic Association (2007)
"Micronutrient intakes were suboptimal most notably for ... calcium....  In conclusion, in this population sample, a large number of ambulatory patients with Crohn’s disease have suboptimal dietary patterns despite a normal BMI and inactive disease. Dietary counseling and supplementation may be warranted in this patient population."

"Vitamin D-mediated calcium absorption in patients with clinically stable Crohn's disease: A pilot study" in Molecular Nutrition (2010)
"Vitamin D is the critical hormone for intestinal absorption of calcium. Optimal calcium absorption is important for proper mineralization of bone in the prevention of osteoporosis and osteoporotic fractures, among other important functions. Diseases associated with gut inflammation, such as Crohn's disease (CD), may impair calcium absorption. ... There was no significant difference in calcium FCA [fractional calcium absorption] at baseline or after increasing doses of calcitriol between the CD and controls. FCA in the control and CD group was approximately 35% at baseline, which increased to 60% after calcitriol therapy. No subject developed hypercalcemia or hypercalciuria. Our results suggest that CD patients have a normal response to vitamin D in enhancing the efficacy of calcium absorption. This suggests that stable CD patients can follow calcium and vitamin D guidelines of non-CD adults. Other factors independent of vitamin D status may impair intestinal calcium absorption in CD, including the degree and location of inflammation, presence of surgical resection and/or use of glucocorticoids."

"Food intake in patients with Inflammatory Bowel Disease" in ABCD Arq Bras Cir Dig (2011) [full article]

"There was deficiency in food intake in both CD and UC in active and in remission. These deficiencies
are mainly related to the intake of macronutrients, energy and fiber and micronutrients, including calcium...."

Does vitamin K supplementation improve Crohn's symptoms?

Vitamin K from Wikipedia

Vitamin K from the world's healthiest foods
"In terms of inflammatory response, several markers of pro-inflammatory activity - including, for example, release of interleukin-6 (IL-6) - are significantly lowered by healthy vitamin K levels."

"Vitamin K and Vitamin D Status: Associations with Inflammatory Markers in the Framingham Offspring Study" in Am J Epidemiol (2007)
"The observation that high vitamin K status was associated with lower concentrations of inflammatory markers suggests that a possible protective role for vitamin K in inflammation merits further investigation."

"Food intake in patients with Inflammatory Bowel Disease" in ABCD Arq Bras Cir Dig (2011) [full article]

"There was deficiency in food intake in both CD and UC in active and in remission. These deficiencies
are mainly related to the intake of macronutrients, energy and fiber and micronutrients, including ... menadione...."

Are micronutrient levels lower in Crohn's?

"Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements" in Am J Clin Nutrition (2012)
"Except for copper and vitamin E, all plasma micronutrient concentrations decreased with increasing severities of the acute inflammatory response. For selenium and vitamins B-6 and C, this occurred with only slightly increased C-reactive protein concentrations of 5 to 10 mg/L. For each micronutrient, the change in plasma concentrations varied markedly from patient to patient. The magnitude of the effect was greatest for selenium and vitamins A, B-6, C, and D, for which the median plasma concentrations decreased by >40%."


"Adequacy of Nutritional Intake in a Canadian Population of Patients with Crohn’s Disease" in Journal of the American Dietetic Association (2007)
"Micronutrient intakes were suboptimal most notably for folate, vitamins C, E, and calcium. ...  In conclusion, in this population sample, a large number of ambulatory patients with Crohn’s disease have suboptimal dietary patterns despite a normal BMI and inactive disease. Dietary counseling and supplementation may be warranted in this patient population."



"The serum concentrations of zinc, copper and selenium in children with inflammatory bowel disease" in Cent Afr J Med (2002)
"Children with IBD in this study show abnormalities of the trace elements which is probably a result of inadequate intake, reduced absorption, increased intestinal loss due to impairment of the absorption as a result of the inflammatory process. The reduced free radical scavenging action of zinc and selenium as a result of their deficiency may contribute to the continued inflammatory process of IBD. The recommendation of the supplementation of these trace elements in IBD is further supported by the findings of this study in children."

Does vitamin D supplementation improve Crohn's symptoms?

"Vitamin D: The alternative hypothesis" in Autoimmunity Reviews (2009)

"Emerging molecular evidence suggests that symptomatic improvements among those administered vitamin D is the result of 25-D's ability to temper bacterial-induced inflammation by slowing VDR activity. While this results in short-term palliation, persistent pathogens that may influence disease progression, proliferate over the long-term."

"Article Commentary: Clinical Trial: Vitamin D3 Treatment in Crohn’s Disease: A Randomized Double-Blind Placebo-Controlled Study" in Nutr Clin Pract (2011)
Conclusions: "Oral supplementation with 1200 IE vitamin D3 significantly increased serum vitamin D levels and insignificantly reduced the risk of relapse from 29% to 13%, (P = 0.06). Given that vitamin D3 treatment might be effective in Crohn’s disease, larger studies are required in order to elucidate this matter further."

Primal Body, Primal Mind: Beyond the Paleo Diet for Total Health and a Longer Life by Nora T. Gedgaudas (2011)"When Vitamin D supplementation is determined to be necessary, care, in my opinion, must be taken to supplement with a vitamin D complex containing the vitamin's numerous cofactors in relative balance, or rather, with vitamin A in its true state, as found in beef liver, grass-fed butter and ghee, and what is called "high vitamin" cod-liver oil (rich in both vitamins A and D)--not simply beta-carotene.  Taking a "vitamin D pill" may not necessarily be the best option.  Emulsified, liquid forms of supplemental vitamin D may be a better choice for some people, as they are far better absorbed by most people and are much safer.  Emulsification improves the vitamin's water solubility, so excesses can be more readily excreted."


"Vitamins A & D Inhibit the Growth of Mycobacteria in Radiometric Culture" in PLoS ONE (2011)
"Vitamins A and D cause dose-dependent inhibition of all three mycobacterial species studied. Vitamin A is consistently more inhibitory than vitamin D. The vitamin A precursor, β-carotene, is not inhibitory, whereas three vitamin A metabolites cause inhibition."

"Food intake in patients with Inflammatory Bowel Disease" in ABCD Arq Bras Cir Dig (2011) [full article]

"There was deficiency in food intake in both CD and UC in active and in remission. These deficiencies
are mainly related to the intake of macronutrients, energy and fiber and micronutrients, including ... cholecalciferol...."

Is vitamin D deficiency a cause of CD symptoms?

Are Crohn's patients deficient in vitamin D because they have Crohn's Disease?  Or do they have Crohn's Disease because they are deficient in vitamin D?

"Hypovitaminosis D in Adults with Inflammatory Bowel Disease: Potential Role of Ethnicity" in Digestive Diseases and Sciences (2012)
"A significantly higher percentage of South Asians had hypovitaminosis D when compared to Caucasians. Disease severity trended towards an inverse relationship with vitamin D status in all South Asian and Caucasian CD patients, although most patients in this study had only mild to moderate disease. We suggest that vitamin D supplementation should be considered in all adult IBD patients."


"Vitamin D Deficiency in Patients With Inflammatory Bowel Disease" in JPEN (2011)
"Vitamin D deficiency is common in IBD and is independently associated with lower HRQOL and greater disease activity in CD. There is a need for prospective studies to assess this correlation and examine the impact of vitamin D supplementation on disease course."


"High Prevalence of Vitamin D Inadequacy and Implications for Health" in Mayo Clinic Proceedings (2006)
"Supplemental doses of vitamin D and sensible sun exposure could prevent deficiency in most of the general population. The purposes of this article are to examine the prevalence of vitamin D inadequacy and to review the potential implications for skeletal and extraskeletal health. "

"Low wintertime vitamin D levels in a sample of healthy young adults of diverse ancestry living in the Toronto area: associations with vitamin D intake and skin pigmentation" in BMC Public Health (2008)
Conclusions:  "Our study suggests that the prevalence of low vitamin D levels in young adults living in Canada (Southern Ontario) may be higher than previously described. Our sample included individuals of diverse ancestry, and as such provides a better representation of the multi-ethnic composition of Canadian metropolitan areas than previous studies. Our research also indicates that there are differences in serum 25(OH)D levels and vitamin D intake between population groups and that the currently Recommended Adequate Intake of vitamin D (RAI = 200 IU/day) may not be met by a large proportion of the young adults. Vitamin D intake was particularly low amongst those young Canadians at greatest risk of vitamin D insufficiency. Furthermore, our study suggests that the current vitamin D recommendations in the US and Canada (200 IU/day) are insufficient to ensure optimal circulating 25(OH)D levels, which are defined by most vitamin D experts as 75 nmol/L."

"Vitamin D: a D-Lightful health perspective" in Nutrition Reviews (2008)
TREATMENT FOR VITAMIN D DEFICIENCY
"Vitamin D deficiency requires immediate attention and aggressive vitamin D replacement.13,30 When a person is vitamin D deficient, simply giving them what is now thought to be the required amount of vitamin D3, i.e., 1000 IU/day, will only satisfy what the body requires and will gradually increase the blood levels of 25(OH)D. To quickly correct vitamin D deficiency, 50,000 IU of vitamin D2 once a week for 8 weeks is often effective. In most patients, blood levels of 25(OH)D will rise on average by 100%. For those who are severely deficient, an additional 8-week course of 50,000 IU of vitamin D2 is recommended. Since the individual presented with vitamin D deficiency, it's likely that they will become vitamin D deficient again unless they take an adequate amount of vitamin D either as 1000 IU of vitamin D3/d or 50,000 IU of vitamin D twice a month. An alternative strategy that was found to be effective was to give 100,000 IU of vitamin D3 every 3 months."

Does Vitamin D have a role in CD?

vitamin D from the world's healthiest foods

vitamin D from Wikipedia

"Vitamin D and gastrointestinal diseases: inflammatory bowel disease and colorectal cancer" in Therapeutic Advances in Gastroenterology (2011)
"Over the past 5 years, there has been a rapid resurgence of interest in vitamin D outside of its traditional role in metabolic bone disease. Some nontraditional roles ascribed to vitamin D include anti-inflammatory and immune-modulating effects. These effects have led to possible implications in the pathophysiology of immune-mediated diseases including multiple sclerosis and inflammatory bowel disease (IBD)."

"Effects of Supplemental Vitamin D and Calcium on Biomarkers of Inflammation in Colorectal Adenoma Patients: A Randomized, Controlled Clinical Trial" in Cancer Prev Res (2011)
"These preliminary results are consistent with a pattern of reduction in tumor-promoting inflammation biomarkers with vitamin D3 or calcium supplementation alone and support further investigation of vitamin D3 as a chemopreventive agent against inflammation and colorectal neoplasms."

"Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier" in Am. J. Physiol. Gastrointest. Liver Physiol (2010)
"Emerging evidence supports a pathological link between vitamin D deficiency and the risk of inflammatory bowel disease (IBD). ...VDR [Vitamin D Receptor] plays a critical role in mucosal barrier homeostasis by preserving the integrity of junction complexes and the healing capacity of the colonic epithelium. Therefore, vitamin D deficiency may compromise the mucosal barrier, leading to increased susceptibility to mucosal damage and increased risk of IBD"

"Direct and Indirect Induction by 1,25-Dihydroxyvitamin D₃ of the NOD2/CARD15-Defensin β2 Innate Immune Pathway Defective in Crohn's Disease" in J Bio Chem (2009)
"These studies provide strong molecular links between vitamin D deficiency and the genetics of Crohn disease, a chronic incurable inflammatory bowel condition, as Crohn's pathogenesis is associated with attenuated NOD2 or DEFB2/HBD2 function."

"Vitamin K and Vitamin D Status: Associations with Inflammatory Markers in the Framingham Offspring Study" in Am J Epidemiol (2007)
"The observation that high vitamin K status was associated with lower concentrations of inflammatory markers suggests that a possible protective role for vitamin K in inflammation merits further investigation."

"Reduced plasma half-life of radio-labelled 25-hydroxyvitamin D3 in subjects receiving a high-fibre diet" in Br J Nutr (1983)