Lack of vitamin D, folic acid, vitamin B12, and omega-3 is linked to inflammatory bowel disease

The most common inflammatory bowel diseases are Crohn’s disease and ulcerative colitis. Lack of certain nutrients can contribute to the development of these conditions. On the other hand, the diseases and the therapies used to treat them may also impair the body’s ability to absorb or utilize certain nutrients, thereby starting a vicious cycle that can make the disease worse. This was demonstrated in a new Greek study that is published in Nutrients. Chronic inflammatory bowel diseases primarily occur in the Western countries and especially at northern latitudes, which suggests that sun exposure and typically Western diets pay a major role in the development of these diseases.

Our gut flora harbors billions of bacteria that are essential for our general health. Our gut also constitutes a significant part of our complicated immune defense that fights hordes of microorganisms and toxins every single day.
Acute inflammation is a normal and vital response that is carried out in an elaborate teamwork involving proinflammatory cytokines, white blood cells, and antibodies. It is essential, however, for the immune defense not to overreact with a chronic inflammatory response. This may damage healthy tissue and cause oxidative stress, which is an imbalance between free radicals and protective antioxidants. Chronic bowel inflammation may be triggered by bacteria that are normally present in the gut or by a derailed immune defense. This can cause redness, swelling, and sores in the mucosa. There may also be symptoms such as abdominal pain, diarrhea, weight loss, and fatigue. Some people get aching joints, skin diseases, and other symptoms if the inflammation spreads to other parts of the body. In severe cases, the disease leads to more operations, surgical removal of parts of the intestine, and stoma.

Chronic inflammatory bowel disease and lack of certain nutrients

Chronic inflammatory bowel diseases are most common in the Western countries and at northern latitudes, especially among women. The diseases are characterized by a constant imbalance between pro-inflammatory and anti-inflammatory cytokines which derails the immune defense. The presence of chronic inflammation releases cascades of free radicals that cause oxidative stress and peroxidation of lipids like cholesterol, which can be very harmful.
Chronic inflammatory bowel diseases destroy quality of life, and the nutrient deficiencies are associated with prolonged hospitalization, complications during surgery, and increased mortality.
Lack of appetite, unhealthy diets, poor nutrient uptake, and blood loss all contribute to nutrient deficiencies, lack of energy, weight loss, poor muscle strength, and other symptoms.
Patients with chronic inflammatory bowel diseases have an increased risk of lacking vitamin D, folic acid (vitamin B9), vitamin B12, and iron, according to a new study of 89 Greek patients with inflammatory bowel disease. The study is published in Nutrients and supports earlier research, where scientists have focused on nutrients and their role in the development of inflammatory bowel disease.

The link between sunlight, vitamin D, and chronic inflammation

The sun is our primary source of vitamin D. However, at northern latitudes we can only synthesize vitamin D during the summer period when the sun sits sufficiently high in the sky. Many people become vitamin D-deficient during the winter period, and if they fail to get enough sun exposure in the spring and summer their deficiency becomes chronic.
People with chronic inflammatory bowel disease typically live at northern latitudes in the United States and Europe where there is less sun and lack of vitamin D may be a possible cause of such diseases.
Vitamin D regulates around ten percent of our genes. This is important for various on-off switches that are also relevant for the white blood cells of our immune system. Vitamin D is therefore extremely important for our ability to fight germs and pathogens quickly and effectively. Moreover, vitamin D helps prevent the production of pro-inflammatory cytokines.
Lack of vitamin D is linked to an increased risk of infections and chronic inflammatory bowel diseases like Crohn’s disease and ulcerative colitis but also rheumatoid arthritis and other autoimmune diseases.
On the other hand, it appears that supplementation with large doses of vitamin D may help prevent or mitigate these conditions by strengthening the immune defense and inhibiting unwanted inflammation.

Folic acid (vitamin B9) and vitamin B12

Folic acid and vitamin B12 are both important for blood formation. If you lack one or both nutrients it may cause anemia, fatigue, and several other symptoms because the cells do not get enough oxygen. Folic acid and vitamin B12 are also involved in the conversion of homocysteine, a byproduct of protein metabolism. Lack of these B vitamins may therefore result in elevated homocysteine levels in the blood, which is associated with an increased risk of cardiovascular disease.
There is not much focus on vitamin B12’s role in the nervous system, and a deficiency may cause fatigue, dementia-like symptoms, and neurological disorders.
Many people are not aware that B vitamins are important for the immune defense, but studies of mice show that lack of folic acid can actually reduce levels of certain white blood cells in the gut that regulate inflammation. The body absorbs folic acid in the middle part of the small intestine (jejunum) but local inflammation can impair the uptake. Lack of folic acid can also be a result of poor diet habits, alcohol and stimulant abuse, pregnancy, smoking, ageing, and birth control pills. Recent studies suggest that therapies where patients are given methotrexate or sulfasalazine can block the uptake and utilization of folic acid.
The uptake of vitamin B12 in the lower part of the small intestine (ileum) requires the presence of a carrier protein called intrinsic factor. Vitamin B12 deficiencies are quite common among patients suffering from ulcerative colitis because that part of the small intestine is damaged. Lack of B12 may also be a result of eating a strictly plant-based diet. The vitamin is primarily found in food sources of animal origin. Treatment with metformin against diabetes may also cause a vitamin B12 deficiency.
Ulcerative colitis can cause an iron deficiency due to blood loss. Nonetheless, it is important not to take iron supplements unless the physician has detected a deficiency with help from a blood sample.

Diet and chronic inflammation

In connection with the prevention and treatment of chronic inflammatory bowel disease it is also important to get plenty of omega-3. These essential fatty acids have anti-inflammatory properties due to their influence on certain hormone-like compounds called prostaglandins. Oily fish and fish oil supplements contains EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which we humans can easily utilize.
A study from Taiwan has demonstrated that low blood levels of omega-3 fatty acids are associated with pain and other symptoms caused by chronic inflammatory bowel diseases. It is important not to consume too much omega-6 from plant oils, margarine, and ready meals, as omega-6 can promote inflammation. Chronic inflammatory bowel diseases are characterized by oxidative stress and one should therefore make sure to get plenty of antioxidants such as vitamins A, C, and E plus minerals like selenium and zinc.
There are numerous cook books out on the market with good advice and useful recipes for anti-inflammatory diets.

Referencer:

Aristea Gioxari et al. Serum vitamins D, B9 and B12 in Greek Patients with Inflammatory Bowel Diseases. Nutrients 2020

Koji Hosomi and Jun Kunisawa. The specific Roles of Vitamins in the Regulation of Immunosurveillance and Maintenance of Immunologic Homeostasis in the gut. Immune Network 2017

Cheryl Tay. Abdominal pain in IBS: A lack of omega-3 could be the culprit, says Taiwan Study. NUTRA-ingredients-asia.com. 2018