Saturday, June 2, 2012

Vitamin D

Winter or summer, a dose of Vitamin D can help

Vitamin D has gained recognition in the last few years as a nutrient that is key for good overall health, and bone health in particular. Known as the sunshine vitamin, Vitamin D is produced when the sun’s ultraviolet rays strike the skin. Much epidemiological research shows people who live in northern latitudes are more at risk of having inadequate levels of Vitamin D compared to their counterparts who live in southern latitudes.

A recent study published in the journal Gut shows geography also affects the incidence of inflammatory bowel disease (IBD): increasing latitude of residence was linked to an elevated incidence of Crohn’s disease and ulcerative colitis in a population of American women. Yet another study published in the journal Gastroenterology late last year demonstrated a connection between higher Vitamin D status and lower Crohn’s disease, suggesting greater Vitamin D intake is a means of decreasing the risk of Crohn’s disease.

Emerging research is pointing to Vitamin D and its role in the inflammatory process, and as a factor in the disease activity in patients with IBD, according to Dr. Gilaad Kaplan, a gastroenterologist with a research interest in IBD and Assistant Professor in the Departments of Medicine and Community Health Sciences at the University of Calgary.

“When we look at patients with Crohn’s disease and ulcerative colitis, and check their Vitamin D levels, they are usually deficient in Vitamin D,” notes Dr. Kaplan. But he says it’s not clear whether low Vitamin D levels are making the disease course worse in someone who has an established diagnosis of Crohn’s disease or ulcerative colitis, or whether IBD patients who have active IBD have a more difficult time absorbing Vitamin D.

Clinicians like Dr. Kaplan want to determine whether healthy stores of Vitamin D will reduce inflammation and quiet the disease activity in IBD patients, given the body of research suggesting Vitamin D decreases inflammation and regulates the immune system.

“The question is whether we can improve the disease course by taking Vitamin D,” he says. “In 2012, we can’t definitively say that by taking Vitamin D, you will improve the disease course. We need to do studies to show that."

But in the absence of those definitive studies, Dr. Kaplan recommends that his IBD patients take oral Vitamin D supplements to increase their Vitamin D levels, noting Vitamin D supplementation poses no harm. It can be a struggle to derive enough Vitamin D through diet and sun exposure, so a daily dose is recommended as an effective route to acquire enough Vitamin D.

And IBD patients shouldn’t assume they are getting enough Vitamin D daily in the summer months, as they still may be challenged to get enough sun exposure if they are working in an office most of the day, for example. Indeed, Vitamin D deficiency is not limited to the darker, winter months, stresses Dr. Kaplan.

“Patients with IBD should continue to take Vitamin D supplements in the summertime,” says Dr. Kaplan. “Even in the summertime, people can be Vitamin D deficient.”
A future study that would shed more light on the impact of Vitamin D in the disease activity of IBD patients would involve a large sample of IBD patients with similar history and health status, where one group of patients would be administered sufficient doses of Vitamin D and one group would not get Vitamin D supplements. Investigators would then evaluate whether the patients getting vitamin supplementation had a clinical benefit in their course of disease.
Anecdotally within CCFC’s IBD community, patients report that they experience less joint pain when they take Vitamin D supplements. Patients’ observations fit with scientific studies which tie IBD with suboptimal bone health. Furthermore, osteoporosis is a co-factor in IBD patients, and bone disease is attributed in part to a lack of Vitamin D.

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