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Vitamin B12 and Crohns
Vitamin B12 deficiency is one of the most common nutritional deficiencies in Crohn’s disease. It is caused by damage to the end of the small intestine and may not respond to oral supplementation. There are serious implications of vitamin B12 deficiency in Crohn’s disease and studies suggest that this deficiency may affect the heart and brain. What makes vitamin B12 important to patients with Crohn’s patients? What is the link between vitamin B12 deficiency and folate deficiency? How is vitamin B12 deficiency treated in Crohn’s disease? Read on to find out.
Nutrition is important to people suffering from Crohn’s disease in many ways. First, Crohn’s disease can be caused and/or worsened by nutritional deficiency.
Although Crohn’s disease is largely believed to be caused by bacterial damage to the gastrointestinal tract following impaired immunity, certain mineral and vitamin deficiencies have been proven to contribute to the disease.
Vitamin D deficiency is a good example of a nutritional deficiency that can increase the risk of Crohn’s disease. However, the disease can also be worsened by low levels of other vitamins such as the 2 important B vitamins: vitamins B9 and B12.
In fact, both Crohn’s disease and its treatment can affect the levels of important nutrients in the body.
When Crohn’s disease causes inflammation and damage in the small intestine, the absorption of macronutrients (carbohydrates, fats etc.) and micronutrients (vitamins and minerals) are affected.
The damage to the gastrointestinal tract can also lead to internal bleeding in the digestive tract. Such bleeding can cause anemia and the loss of important nutrients such as iron, folic acid and vitamin B12.
In addition, Crohn’s disease can also cause loss of appetite, difficulty swallowing and diarrhea. All of these symptoms reduce the amount of food in the gastrointestinal tract and, therefore, the amount of nutrients absorbed into the body.
Furthermore, treating Crohn’s disease can also cause nutritional deficiency. For example, some of the drugs used in the treatment of this disease are known to affect the absorption of nutrients.
Besides drugs, the surgical removal of part of the gastrointestinal tract can also affect the absorption of nutrients. For example, the resection of the ileum (to address partial or total blockage of the ileum) directly affects the absorption of vitamin B12.
Since the end of the ileum is the site of vitamin B12 absorption, this surgery can cause vitamin B12 deficiency.
Although vitamin B12 is one of the vitamins used by the body to repair itself, the vitamin is only given to patients with Crohn’s disease to prevent vitamin B12 deficiency.
Of course, some of the vitamin B12 administered may help repair the cells of the intestine but the damage done by Crohn’s disease is often too extensive to be addressed by only vitamin B12 supplementation.
The need for vitamin B12 supplementation is important for people living with Crohn’s disease because the terminal ileum (last 2 feet of the section of the small intestine known as ileum) is commonly damaged by the inflammation and bacterial invasion that characterizes the bowel disease.
If the vitamin B12 lost in the ileum is not duly replaced, vitamin B12 deficiency can easily developed.
In fact, clinical data and multiple studies show that vitamin B12 deficiency is common among patients with Crohn’s disease.
Vitamin B12 deficiency may cause other complications and worsen the symptoms of Crohn’s disease. Signs of this deficiency include weakness, fatigue, depression, failing memory and pernicious anemia.
Prolonged or severe vitamin B12 deficiency may cause irreversible damage to the nervous system and cardiovascular system. Severe vitamin B12 deficiency can cause nerve damage experienced as tingling and numbness of the toes and fingers. Damage to the brain will result in episodes of mania and psychosis.
Most of the damage caused by vitamin B12 deficiency is due to the increased level of homocysteine.
Homocysteine is a toxic intermediate of amino acid synthesis. It is produced in the body during the syntheses of certain amino acids. The body quickly converts it into safer products but the conversion requires folic acid and vitamin B12.
The buildup of homocysteine caused by vitamin B12 deficiency affects the cells of the nervous and cardiovascular systems as well as other organ-systems in the body.
Since homocysteine raises harmful free radicals, it may also trigger the inflammation of the gastrointestinal tract and, therefore, worsen the symptoms of Crohn’s disease. In fact, a few studies have demonstrated that homocysteine is also accumulated in the gastrointestinal mucosa in Crohn’s disease.
The presence of homocysteine in the raw, exposed, inflamed mucosal surface of the gastrointestinal can only lead to further inflammation and soft tissue damage.
Vitamin B12 supplementation is absolutely important for Crohn’s disease patients because of the importance of vitamin B12 to general health and the fact that Crohn’s disease and treatment can specifically impair the absorption of vitamin B12.
Therefore, such patients are advised to regularly check their vitamin B12 levels.
However, raising blood levels of vitamin B12 with supplements and foods is often impractical. This is because both dietary and supplemental sources of vitamin B12 still need to be absorbed in the gastrointestinal tract.
Rather than using vitamin B12-rich foods and oral multivitamin supplements to avoid and treat vitamin B12 deficiency in Crohn’s disease patients, other routes of administration are recommended.
When the damage to the ileum is extensive or after the surgical removal of the terminal ileum, only vitamin B12 injections, transdermal patches and nasal spray can effectively raise the level of the vitamin.
Vitamin B12 injections are usually administered as once-a-month shots while the nasal spray and patches should be used as recommended by the doctor.
These vitamin B12 formulations bypass the oral route and, therefore, avoid the gastrointestinal tract. Therefore, they produce an unimpaired absorption of vitamin B12.
A 2008 study published in the journal, Inflammatory Bowel Diseases, investigated the prevalence of vitamin B12 deficiency in patients with Crohn’s disease.
The researchers analyzed the medical records of 201 Crohn’s disease patients at a terminal care center and compared their vitamin B12 status against 40 patients with ulcerative colitis who served as control.
The results of the study showed that the prevalence of vitamin B12 deficiency among patients with Crohn’s disease was more than 3 times the prevalence of the deficiency among those with ulcerative colitis.
In addition, the study also showed out that the highest rate of vitamin B12 deficiency was found among those Crohn’s disease patients who have had part of the ileum removed.
The researchers concluded that routine screening for vitamin B12 deficiency is recommended for people living with Crohn’s disease.
In a 2006 study published in the journal, Nutrition, a group of researchers investigated whether the risk of vitamin B12 deficiency in Crohn’s disease patients was determined by the length of ileum removed during surgical treatment of the disease.
The researchers reviewed the pathology reports of 56 patients who had part of their ileums removed. They compared these results with the results of Schilling tests undertaken by those patients within 3 months of their surgeries.
The Schilling test is medical test used to determine whether a patient has pernicious anemia caused by vitamin B12 deficiency.
The results of this study showed that patients who had less than 20 cm of their ileums removed scored within the normal range of Schilling test.
However, more than half of those who had longer lengths of their ileum removed had abnormal Schilling results.
While this study showed that the risk of vitamin B12 deficiency can be determined by the length of ileum removed, the result did not find a direct relationship between the length of ileum removed and the severity of pernicious anemia or vitamin B12 deficiency.
The researchers concluded that Crohn’s disease patients who have had less than 20 cm of their terminal ileum removed are not at risk of developing vitamin B12 deficiency.
Beyond 20 cm of ileum, the researchers recommended Crohn’s disease patients to take the Schilling test to determine their vitamin B12 status or presume they do have vitamin B12 deficiency.
In a 2004 letter published in the Archives of Disease in Childhood, a couple of consultant pediatric gastroenterologists confirmed that the surgical removal of sections of the ileum led to vitamin B12 malabsorption and clear signs of vitamin B12 deficiency in children with Crohn’s disease.
In their practice, they also noted that the removal of more than 45 cm of the ileum caused vitamin B12 deficiency in 7 out of 10 children treated for Crohn’s disease.
In addition, the authors of the letter also confirmed that the absorption of vitamin B12 was not affected in children who had less than 15 cm of their ileums removed.
These clinicians detailed the link between vitamin B12 deficiency and ileum resection in children. Their observations were similar to the results obtained in adults except for one important detail. The clinicians noted that in some children treated for Crohn’s disease, the remaining section of ileum after surgery may adapt to regain the full capacity of vitamin B12 absorption later in life.
They concluded the letter by calling for more studies into the risk of vitamin B12 deficiency in pediatric patients suffering from Crohn’s disease.
In a 2000 journal published in The American Journal of Gastroenterology, a group of researchers investigated the possibility of increased risk of blood clot formation in Crohn’s disease patients.
This study was conducted because vitamin B12 deficiency (and folate deficiency) raises homocysteine levels and homocysteine has been linked with increased risk of thrombosis.
For this study, the researchers measured the levels of homocysteine, folate and vitamin B12 in 105 Crohn’s disease patients and 106 controls.
The results showed that patients with Crohn’s disease had higher homocysteine levels than the participants in the control group. In addition, the patients had lower folate and vitamin B12 levels. Furthermore, folate deficiency was found to be a greater determinant of homocysteine levels than vitamin B12.
However, damage to the terminal ileum was strongly linked to vitamin B12 deficiency.
The researchers concluded that vitamin B12 deficiency (and folate deficiency) caused by Crohn’s disease raises homocysteine levels and can increase the risk of blood clotting and cardiovascular events.
Therefore, they recommended vitamin B12 and folate supplementation for Crohn’s disease patients.
A 1996 study published in the journal, Digestive Diseases and Sciences, identified that Crohn’s disease not only affects vitamin B12 absorption but also the metabolism and the activity of the vitamin.
The researchers found out that Crohn’s disease can lead to high homocysteine levels even when folate levels are within normal ranges. This result means that the vitamin B12 deficiency caused by Crohn’s disease impaired the enzyme needed by folate to prevent homocysteine from building up.
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