Vitamin D Therapy in Inflammatory Bowel Diseases: Who, in What Form, and How Much?

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DustyKat

DustyKat

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Abstract:

Background:
The north–south geographical gradient of inflammatory bowel disease (IBD) prevalence, its epidemiology, the genetic association of vitamin D receptor polymorphisms, and results in animal models suggest that vitamin D plays an important role in the pathogenesis of IBD.

Aims:
The purpose of this review was to critically appraise the effectiveness and safety of vitamin D therapy in patients with IBD.

Methods:
MEDLINE, Scopus and Google Scholar were searched from inception to May 20, 2014 using the terms ‘Crohn’s disease’, ‘ulcerative colitis’ and ‘vitamin D’.

Results:
Vitamin D deficiency is common in patients with IBD. Limited clinical data suggest an association between low vitamin D concentration and increased disease activity in both ulcerative colitis (UC) and Crohn’s disease (CD). To date, only two small open label trials and one randomized controlled trial have shown a positive effect of vitamin D supplementation on disease activity in patients with CD; no effect has been shown for UC. An optimal vitamin D supplementation protocol for patients with IBD remains undetermined, but targeting serum 25-hydroxy vitamin D [25(OH)D] levels between 30 and 50ng/mL appears safe and may have benefits for IBD disease activity. Depending on baseline vitamin D serum concentration, ileal involvement in CD, body mass index, and perhaps smoking status, daily vitamin D doses between 1800–10000 international units/day are probably necessary.

Conclusion:
Increasing preclinical and clinical evidence suggests a role for vitamin D deficiency in the development and severity of IBD. The possible therapeutic role of vitamin D in patients with IBD merits continued investigation.
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Full Article:

http://ecco-jcc.oxfordjournals.org/content/9/2/198
 
DustyKat said:
Increasing preclinical and clinical evidence suggests a role for vitamin D deficiency in the development and severity of IBD. The possible therapeutic role of vitamin D in patients with IBD merits continued investigation.
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I take a vitamin D tablet every morning. It is part of my routine in addition to my prescribed medicines. I believe it has been beneficial to me.
 
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JMC said:
I take a vitamin D tablet every morning. It is part of my routine in addition to my prescribed medicines. I believe it has been beneficial to me.
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Agreed, I do that too, 2000 IU per day and have been doing so for 2 years. I wonder, however, whether I should double that to 4000 IU. I have found out that other supplements require high dosages for me to work.
 
Role of vitamin-d pathway in innate immune system's ability to clear intra-cellular mycobacterial infections.

"These data support a link between TLRs and vitamin D–mediated innate immunity and suggest that differences in ability of human populations to produce vitamin D may contribute to susceptibility to microbial infection."

http://www.sciencemag.org/content/311/5768/1770.full
 
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In our experience it is trial and error Lam123.

Both of my kids have had ileal resections and Vit D deficiency and they have blood levels done every 3-6 months. Having that information at your fingertips allows you track trends and adjust dosages accordingly. That said we haven’t had to adjust down just up and then found a dose that maintains the level we want.

After much reading here on the forum and elsewhere I was content that those with Crohn’s should maintain a Vit D level toward the upper end of normal, again this is just my opinion. So in Aus that is 120 which I think translates to 70 in US values. Not sure what value you use in Canada.

Over time what works for us and keeps the kids levels at around the 120 mark is 4,000 iu a day.

Also be aware that blood levels may change naturally according to the season. Depending on where you live the end of Winter will give you your lowest reading so this is usually not the recommended time to get tested. If you get testing at this time just put into its seasonal context.

Dusty. xxx
 
As Dusty said, PLEASE get your blood levels tested. There has been way too much anecdotal evidence on this forum pointing towards vitamin D playing a role. At this point I conclude that it does. If you're just guessing how much you should be taking, you're doing it wrong. PLEASE get your blood tested and work to optimize your dosage/sun exposure over time.
 
David said:
As Dusty said, PLEASE get your blood levels tested. There has been way too much anecdotal evidence on this forum pointing towards vitamin D playing a role. At this point I conclude that it does. If you're just guessing how much you should be taking, you're doing it wrong. PLEASE get your blood tested and work to optimize your dosage/sun exposure over time.
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If you are guessing that people are taking the wrong dose then it is probably you who is wrong. If you can get your vitamin D levels tested, then great, do it and adjust your dose accordingly. If not, there is no harm in taking 1000-10000iu daily, that is made quite clear in the published research, it is not "anecdotal". Please empower people to help themselves, not discourage them from actively using scientific evidence that may not have filtered down to all gastroenterologists.
 
here's some info I wanted to know for a while : the incidence of IBD in Southern vs Northern United States... :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418414/

also a clinical trial about to start evaluating >50ng/ml :

https://clinicaltrials.gov/ct2/show/NCT02208310?term=crohns&rank=11

From my last check up , I was at 86 nmol/L (normal level)which would be around 35ng/ml in american value, if im getting this conversion right.
I was below normal level few years ago when we discovered I had debuting osteopenia, prior to taking Vit D supplements. Im going to try to target that 50 ng/ml from now on by increasing my dosage.
 
JMC said:
If you are guessing that people are taking the wrong dose then it is probably you who is wrong. If you can get your vitamin D levels tested, then great, do it and adjust your dose accordingly. If not, there is no harm in taking 1000-10000iu daily, that is made quite clear in the published research, it is not "anecdotal". Please empower people to help themselves, not discourage them from actively using scientific evidence that may not have filtered down to all gastroenterologists.
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For most people on this forum, there is tremendous harm in taking 1000iu per day.

Why? Because for the vast majority of people on this forum with vitamin D deficiency, that will be nowhere near enough to get them an adequate vitamin D level. You wouldn't tell someone to drink just one glass of water a day, right? That would be harmful as we all know that's nowhere near enough for the body to properly function. It's the same with vitamin D; most people on this forum need way more than "one glass" of vitamin D per day.

I'm empowering people to PROPERLY help themselves by utilizing the cheap, accurate scientific tests at their disposal to ensure that they are taking the dosage that their body so desperately needs.
 
I got my test result today, 25-Hydroxy Vitamin D3 Serum was 94nmol/L which is at the low end of normal.
 
My GI just told me to take a 1000 supplement without testing. His reasoning was most Canadians are deficient due to lack of sunlight in the winter combine with people staying inside in the winter. Interesting to see what others think.
 
In the context of IBD I personally believe that 1000iu just won’t cut it for the reasons stated above by David.

In a more general sense I still don’t think advice should be given based on assumptions. Testing should be done and if treatment is needed it should be individualised.

Dusty. :)
 
When I had my son (My husband was dx'ed with Crohn's when I was 17 weeks pregnant), our ped told us to add Vit D to my breastmilk, as the Vit D didn't get transfered (or something along those lines) from my milk to baby. I have been adding extra to his formula as well, since we had to supplement. I've continued to do this all along and will continue to do so.
 
This is useful if you want to know recommended dosage to achieve a given level of vitamin D in your blood stream:
https://www.vitamindcouncil.org/further-topics/i-tested-my-vitamin-d-level-what-do-my-results-mean/

To achieve this level… Take this much supplement per day…
20 ng/ml 1000 IU
30 ng/ml 2200 IU
40 ng/ml 3600 IU
50 ng/ml 5300 IU
60 ng/ml 7400 IU
70 ng/ml 10100 IU

to convert from ng/ml (used in US) to nmol/L (used in UK/Europe) you need to multiply by 2.5 e.g. 40 ng/ml is 100 nmol/L requires 3600 IU
 
Thanks for posting that JMC. :)

One thing everyone should take into account is with that chart, that's the dosage most people have to take, but not all. Some might get a lot of sunlight and absorb fat soluble vitamins really well and may have to take less. Others may be on azathioprine and can't go in the sun, had a resection reducing available absorptive surface area, and active diarrhea resulting in a need for a much higher dosage. I think that chart is a pretty decent starting point but feel regular testing is still imperative.
 
I don't. I'm way too scared of sun damage. Although, a lady I work with has crohns or colitis and she had really low vit d levels, started going to a tanning bed and her levels went up pretty quickly.
 
I have been able to increase my nmol/l from 86 to 108 and 105 in the last 6 months, by taking 3000 UI/day, instead of the 1000 UI I was taking before. which make me about 40 ng/ml. I see most clinical trial target in between 40 and 70 ng/ml. I'd like to be at least at 50.

I wonder if I should increase my dosage to 4000 UI/day to reach higher level. I think last time I discussed this issue with my dr he talked about being careful with taking too much, but i cant clearly remember. he was not very supportive of me taking 3000 UI...

are we sure we cant overdose with vit D or take too much so it becomes detrimental on the body or some organs? :shifty:

from one of the current trials: ''Vitamin D acts on cells of the immune system and causes many effects, including the production of a "natural antibiotic" called cathelicidin. The investigators know that when people are supplemented with vitamin D, levels of cathelicidin produced by these immune cells increase. By supplementing children with Crohn's disease with vitamin D, the investigators may be able to alter their immune system "naturally," making their disease better. A consensus of vitamin D experts believes that vitamin D levels need to reach a level of 40-70 ng/mL in the blood in order to have effects on the immune system. Raising vitamin D levels to this range is one of the goals in the current study.''
 
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I Currently take 7000iu of Vit D3 daily and I've only been able to get my level to 46 from 25 but I've had my terminal ileum removed years ago due to a bowel resection! I often wonder if I could take 10,000iu and that may just bring me further into the normal range??? I do have my Vit D tested 2-3x/year
 
I walk in the sunshine daily and find anything over 1000iu in supplements will just make me piss alot so its probably too much. Someone who doesn't intentionaly expose themselves to sunlight could probably take 2000iu in the summer, but up to 2-3000iu in the winter, just my experiance though, and not necessarily based on blood tests, but my blood tests have come back fine with this regimen. Crohns patients with lots of diarhea may need alot more supplements though its a fat soluble vitamin. I have one normal bm a day with no diarhea.
 

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