How Vitamin D Can Fight Crohns

Crohn’s Disease as an Immune Deficiency Disorder

Crohn’s disease is a kind of inflammatory bowel disease. It can affect different sections of the gastrointestinal tract from the mouth to the anus. It is, therefore, characterized by vomiting, diarrhea and stomach pain.

Other symptoms of Crohn’s disease include fever, weight loss, arthritis, lethargy, lack of mental focus, skin rashes, ulcerative wounds and inflammation of the eye.

Although Crohn’s disease was once described as an autoimmune disease, recent evidence indicates that it is really caused by immune deficiency. In addition, Crohn’s disease has a strong genetic component and it commonly runs in certain families (siblings of patients with Crohn’s disease are 30 times more likely to develop the disease than others).

Besides genes, certain bacteria and environmental factors are known to increase the risk of Crohn’s disease.

Nutritional deficiency, like vitamin D deficiency, have also been demonstrated to contribute to the appearance and severity of Crohn’s disease.

Crohn’s Disease: Genes, Immunity, and Microbes

The genetic aspects of Crohn’s disease are very well studied. In fact, it is the first genetic disease to be exhaustively unraveled. Studies investigating how genes affect the risk of Crohn’s disease showed that over 30 genes are involved.

Of these, the NOD2 (or CARD15) gene was the first to be identified.

The identified genes have multiple functions. However, studies show that they are mostly involved in protein synthesis related to the immune system and invading bacteria.

For example, scientists have shown that the genetic mutations common among Crohn’s patients impair innate immunity. One of the impairments caused by these mutations affects the release of cytokines from immune system macrophages.

Therefore, when microbes invade the gastrointestinal tract, the innate immune system reacts by secreting inflammatory cytokines.

Unfortunately, in Crohn’s patients, the mechanism for turning off this cytokine invasion is faulty.

Therefore, there is sustained inflammation in different parts of the gastrointestinal tract especially in the colon.

Other Crohn’s disease gene mutations prevent the immune system from mounting an effective attack against invading bacteria. This leads to an abnormally high population of bacteria in the intestines and the weakening of the mucosal layer of the intestinal wall.

Therefore, there are different bacteria causing the symptoms of Crohn’s disease. The most common ones are Mycobacterium avium subspecies paratuberculosis and Escherichia coli.

In truth, Crohn’s disease is not a disease but a disease complex with different ailments caused by the bacteria invading the mucosal wall of the gastrointestinal tract and the inflammatory reaction mounted by the immune system against this invasion.

This is also most likely the reason there is no cure for Crohn’s disease and why its treatment involves directly addressing each of its symptoms.

Vitamin D and Crohn’s Disease

Vitamin D Status and the Risk of Crohn’s Disease

Multiple studies have confirmed that people suffering from Crohn’s disease usually have vitamin D deficiency.

It is unclear whether Crohn’s disease causes vitamin D deficiency or vitamin D deficiency is a risk factor for Crohn’s disease. But there is solid evidence linking both conditions.

Given the important roles of vitamin D especially in the immune system, experts believe that the vitamin D status of patients with Crohn’s disease should be closely monitored. In addition, vitamin D has antibacterial and anti-inflammatory properties that are helpful in the treatment of Crohn’s disease.

In a recent study published in the journal, Gut, the researchers showed that the incidences of Crohn’s disease and other types of inflammatory bowel disease are affected by geography.

More specifically, the study found that the incidence of Crohn’s disease and ulcerative colitis increased with increasing latitudes. This means that inflammatory bowel diseases are more common in populations living farther from the equator than those living close it.

This finding is confirmed by the higher incidence of Crohn’s disease among Europeans and African-Americans than Africans.

The Gut study highlights the importance of vitamin D in the treatment of Crohn’s disease. Since people living in high altitudes experience shorter sun exposure than those living near the equator, they also produce less vitamin D (vitamin D is produced in the skin following exposure to ultraviolet B radiation from sunlight).

Another study published in the journal, Gastroenterology, also showed that the risk of Crohn’s disease is lower in people with higher vitamin D status than those with low vitamin D levels.

With such results, experts advise that people living with inflammatory bowel disease such as Crohn’s disease should check their vitamin D levels every year. Keeping up their vitamin D level with supplements is important in order to prevent flare-up and keep the disease in remission.

The Genetic Link between Vitamin D and Crohn’s Disease

A 2010 study published in the Journal of Biological Chemistry found that vitamin D supplementation can relieve the symptoms of Crohn’s disease.

The researchers found that the beneficial effects of vitamin D involved the NOD2 gene and the antimicrobial protein it produces.

Besides NOD2, the researchers also discovered that vitamin D triggers the beta-defensin 2 genes to produce another antimicrobial peptide.

Therefore, these genes are not properly activated in patients with Crohn’s disease who also suffer from vitamin D deficiency.

When the antimicrobial proteins encoded by such genes are not produced in sufficient quantities, the immune system cannot mount a successful attack against the bacteria invading the gastrointestinal tract. This leads to or worsens Crohn’s disease.

With these findings, the researchers suggested that people living with Crohn’s disease should use vitamin D supplements to relieve their symptoms.

Another important implication of the results is that siblings of patients with Crohn’s disease can reduce the risks of eventually developing the disease by regularly checking their vitamin D status and taking vitamin D supplements.

Other Benefits of Vitamin D in the Treatment of Crohn’s Disease

Clinical data shows that vitamin D supplementation relieves joint pain and the symptoms of osteoporosis when taken by those with Crohn’s disease. This is important because one of the complications of Crohn’s disease is osteoporosis.

Crohn’s disease causes the thinning of the bones. Therefore, people suffering from the disease have a high risk of bone fractures.

Since vitamin D is important for the mineralization of the bones, it can help prevent bone demineralization and maintain optimal bone health.

Besides osteoporosis, vitamin D can also provide relief for another known presentation of Crohn’s disease: depression.

Like Crohn’s disease, the incidence of depression is also linked to latitude and vitamin D levels.

In addition, depression is more commonly diagnosed during the winter months when there are fewer hours of sunlight. This form of depression is a component of a medical condition known as SAD (seasonal affective disorder).

Studies show that vitamin D affects mood in similar ways in people suffering from depression and Crohn’s disease. Therefore, vitamin D can improve mood and bone health as well as reduce the risk and severity of Crohn’s disease.

Studies on Vitamin D and Crohn’s Disease

Vitamin D Status and Crohn’s Disease

In a 2004 study published in the Journal of Gastroenterology, a group of Japanese researchers studied the prevalence of vitamin D deficiency among patients with Crohn’s disease.

The researchers found that vitamin D levels were not significantly lower among patients with Crohn’s disease compared to healthy volunteers.

However, more patients with Crohn’s disease had vitamin D deficiency than healthy volunteers.

In addition, the researchers confirmed that among patients with Crohn’s disease, vitamin D deficiency can be confidently predicted by the duration of the disease and CDAI (Crohn’s Disease Activity Index) score.

The study results showed that the vitamin D status of patients with Crohn’s disease should be regularly measured especially if they had suffered the disease for longer than 15 years and when they are experiencing prolonged flare-ups of the disease.

A 2003 study published in the Canadian Journal of Gastroenterology investigated the frequency of vitamin D deficiency in adults suffering from Crohn’s disease. In addition, the researchers determined the correlation between low vitamin D levels and bone density.

The results showed that vitamin D insufficiency is more common than vitamin D deficiency. In addition, the former led to the latter if left untreated.

The researchers were able to predict vitamin D deficiency from 3 factors: the amount of sunlight exposure received, nutrition and whether a participant smoked or not.

Lastly, the study found out that although bone mineral density seemed normal, patients with Crohn’s disease showed signs of metabolic bone disease.

Who Is Most at Risk of Vitamin D Deficiency?

In a 2002 study published in The American Journal of Clinical Nutrition, the researchers determined the risk factors for vitamin D deficiency in a broad group of patients suffering from Crohn’s disease. The study involved 112 volunteers aged 5 – 22 years.

The results of the study showed that vitamin D deficiency was most common

• among African-Americans
• during winter months
• among volunteers with Crohn’s disease limited to the upper gastrointestinal tract
• among volunteers who received long-term glucocorticoid therapy

This study confirmed the link between vitamin D deficiency and Crohn’s disease. More importantly, it indicated that vitamin D deficiency is worst when Crohn’s disease is confined to the upper gastrointestinal tract.

Vitamin D Receptor Mutation and Crohn’s Disease

In a 2000 study published in the journal, Gut, researchers highlighted the genetic component of Crohn’s disease by demonstrating the link between the disease and mutations of vitamin D receptor.

The researchers determined that the gene responsible for encoding the vitamin D receptor was situated on one of the chromosomes linked to inflammatory bowel disease. To demonstrate this link the researchers recruited patients suffering from Crohn’s disease and ulcerative colitis.

The study provided preliminary evidence to suggest that mutations in the genes responsible for vitamin D receptor can raise the risk of Crohn’s disease.

This result shows that people with mutated vitamin D receptors respond to vitamin D differently and this may impair the biological functions of vitamin D enough to cause Crohn’s disease.

Treating Crohn’s Disease with Vitamin D

There is solid evidence to prove that raising vitamin D levels can significantly relieve the symptoms of Crohn’s disease and even keep the inflammatory bowel disorder in remission.

Therefore, vitamin D supplementation is highly recommended for people living with Crohn’s disease.

However, it is important to determine a patient’s vitamin D status and level before recommending vitamin D supplements.

There are 2 types of vitamin D tests. One measures 1, 25(OH)D or 1, 25-dihydroxy vitamin D while the other measures 25(OH)D or 25-hydroxyvitamin D. The latter is the better measure of vitamin D status.

While the official recommendation is to keep vitamin D levels within the range 20 – 56 ng/ml, this is a rather wide range and the lower limit actually qualifies as vitamin D insufficiency. Rather, a lower limit of 32 ng/ml is recommended and the optimal range is between 50 ng/ml and 65 ng/ml.

Tanning for Crohn’s Disease

While vitamin D levels can be raised with vitamin D supplements and dietary sources of the vitamin, some patients simply do not respond to these treatments.

In one case detailed in a 2001 paper published in the journal, Gastroenterology, the researchers reported the treatment of a 57-year old woman who suffered from Crohn’s disease. Even though she received 400 IU vitamin D3 supplement and a parenteral diet enriched with vitamin D and calcium for 36 months, she still experienced muscle weakness, bone pain, and low vitamin D levels.

The patient’s treatment was then changed. She was exposed to ultraviolet B by spending time on a tanning bed.

By spending 10 minutes on the tanning bed, 3 times per week for 6 months, the patient’s condition was significantly improved. Her vitamin D levels rose by more than 350%. In addition, both calcium and parathyroid hormone levels were increased.