Crohn's sufferers should be careful taking vitamin D supplements.

[Tired]

Usually the blood tests done for vitamin D is for it's 25-hydroxy form. When I did the test, it was very low. I have read that it was common for Crohn's disease.

But there is not much documentations as the reason for that, absorption might explain in part, but not for those who have adquate Sun exposure. I have read that vitamin D supplements are good for Crohn's disease.

Things got more complicated when I did a blood test for the active form of vitamin d, 1,25-hydroxyvitamin D. Results were high, off the chart. With a bit of reading I have learned why that is so.

Crohn's is a Granulomatous disease, and overproduction of the active metabolite of vitamin D has been described in granulomatous diseases because macrophages / histiocytes inside the granulomas convert vitamin D from its inactive form 25-hydroxyvitamin D to its active form 1,25-hydroxyvitamin D, resulting in elevated levels of the hormone 1,25-dihydroxyvitamin D.

This might also explain why those with Crohn's disease can have low 25-hydroxyvitamin D levels, because too much is being converted to the active form.

What might appear as a deficiency might actually reveal to be an overdose. So it might not be a good idea to take vitamin D supplements with calcium, this might either lead to hypercalcemia or physiological compensatory responses (e.g., suppression of the parathyroid hormone levels).

This abnormal vitamin D conversion might by itself be in part responsable in the regulation of the immune system much like it is suspected in sarcoidosis, which is another granulomatous disease.

With this info, I have stopped taking vitamin D, believing it's not a really good idea to take them.

1. http://www.uptodate.com/contents/hypercalcemia-in-granulomatous-diseases
2. http://www.ncbi.nlm.nih.gov/pubmed/15696436
3. http://www.ncbi.nlm.nih.gov/pubmed/9558297
4. http://www.ncbi.nlm.nih.gov/pubmed/22802372
5. http://www.ncbi.nlm.nih.gov/pubmed/18238746

 

[afidz]

Thank you for the info, it sounds like a great study

 

[rollinstone]

wow, thanks for posting this, very interesting

 

[Beach]

Interesting, thanks for sharing. I had not heard this before. Overall, it is good to test for high blood calcium (hypercalcemia) when taking vitamin D, whether with an inflammatory disease or if health.

I've read a couple of Dr. Michael Holick's books. He is the discover of activated vitamin D.

In some of his writings he talks about treating Crohn's patients with vitamin D, the different methods his team used to raise vitamin D levels successfully in patients, with sunlight and with pills, along with testing done.

From his web sight, an interview of his mentioning avoiding high calcium in patients, Crohns, & thyroid issues.

"Dr. Holick’s Responses to Participant Questions During the December 5, 2008 Live Webinar Presentation “Vitamin D & Chronic Disease Risk”"

http://vitamindhealth.org/2009/03/dr...disease-risk”/

snippets from his interview:

...Is there a role in checking both 25 vitamin D an 1,25 vitamin D in inflammatory and/or autoimmune disease as 1,25 vit D is elevated in inflammatory states?
Response: For patients with inflammatory diseases, I measure a blood level of 25-hydroxyvitamin D. I only measure a 1,25-dihydroxyvitamin D if the patient has a high blood calcium (hypercalcemia). It is true that patients with sarcoidosis, tuberculosis and other granulomatous disorders can have an elevated blood calcium along with an elevated blood level of 1,25-dihydroxyvitamin D....

...With no parathyroid and taking calcitriol 0.125mg a day will a patient have any problems taking vitamin D? If not, what level do you recommend?
Response: Patients who have no parathyroid hormone and take calcitriol should also take vitamin D. These patients need to maintain a blood level of 25(OH)D of between 30 and 100 ng/ml. This can be accomplished as I have noted in my responses to previous questions for treating vitamin D deficiency and maintaining vitamin D sufficiency. I treat my patients with hypoparathyroidism with 50,000 IU of vitamin D once a week for eight weeks to correct their vitamin D deficiency, and then maintain their blood level of 25(OH)D of between 30 and 100 ng/ml by keeping them on 50,000 IU of vitamin D2 once every two weeks thereafter...
CROHN’S

...How does vit D supplementation help with Crohn’s and should supplements be oral or by injection?
Response: Patients with Crohn’s disease especially of the proximal small intestine often have difficulty in absorbing vitamin D. I take three approaches in treating and preventing vitamin D deficiency in Crohn’s patients. The first approach is to give 50,000 IU of vitamin D2 once a week or twice a week for at least 8 weeks to see if the vitamin D deficiency can be corrected. I also use the trick of having the patient cut the capsule in half and place it in milk or some other drink and to drink the content but not the capsule. The second approach is to give much higher doses of vitamin D as much as 50,000 IU of vitamin D once a day as long as the serum 25-hydroxyvitamin D reaches a level between 30-60 ng/ml and then tailor their dose to maintain this blood level. The third alternative is to have the patient go either to a tanning salon or to purchase a vitamin D producing lamp such as the Sperti lamp that you can purchase off of the web site Sperti.com. We showed in a patient with only two feet of small intestine left that she responded very well by being exposed to our tanning bed for 50% of the time recommended for tanning and wearing sun protection on her face three times a week. All of the aches and pains in her bones and muscles associated with vitamin D deficiency (osteomalacia) resolved, and her quality of life markedly improved after three months. We were able to maintain her in a normal vitamin D status by having her be exposed to the tanning bed once or twice a week thereafter....

 

[Mattie]

I'm confused by this! I had my vit D tested recently and it was low (29) so was advised to supplement with 6000iu per day, then re-test which I am doing.

Is this report saying that we shouldn't take vit D at all or just that we shouldn't take it with calcium?

 

[Beach]

Mattie:

This vit D discussion was posted in two areas on the sight. I suppose more of a consensus can be seen here:

http://www.crohnsforum.com/showthread.php?t=54297

What I took away from it is that hypercalcemia is reportedly rare in Crohn's patients, but is certainly something to monitor for.

More information can be seen on taking vitamin D from this interview David conducted for the Crohn's Forum sight of Dr. Cannell of the Vitamin D Council.

http://www.crohnsforum.com/showthread.php?t=48140

 

[Mattie]

Many thanks for clarifying that Beach. Much appreciated.

From what I have read it seems that it would make sense to get my 1.25 vit d level, serum calcium and 25 vit D level tested? Have I read that correctly?

 

[Beach]

Well, I personally believe testing for 25-hydroxyvitamin D and also testing for high blood calcium is whats important. Avoiding hypercalcemia is the main concern.

Finding out your active vitamin D, 1,25-dihydroxyvitamin D status wouldn't hurt though and can be reassuring.

 

[Mattie]

Many thanks! Your advice is much appreciated.

 

[Beach]

Thanks Mattie! Hope the testing goes well.

It reminds me I should test my D3 levels once again soon too.

 

[David]

I'm sorry I'm late to the party on the whole 1,25 / calcium thing. When this community first came across the article about 1,25 D and calcium, I contacted the doctor who did the study to ask him about magnesium levels in those patients with high calcium. I was ignored. Anytime I hear about those high calcium levels, the first thing I wonder about is the patients' magnesium status as magnesium is not only an important vitamin D cofactor, it also regulates calcium levels.

Every organ in the body -- especially the heart, muscles, and kidneys -- needs the mineral magnesium. It also contributes to the makeup of teeth and bones. Most important, it activates enzymes, contributes to energy production, and helps regulate calcium levels, as well as copper, zinc, potassium, vitamin D, and other important nutrients in the body.

You can get magnesium from many foods. However, most people in the United States probably do not get as much magnesium as they should from their diet.

[snip]

Source

Magnesium is the one mineral I'm ok with people with Crohn's blindly supplementing (after an ok by their doctor) since the serum level test is pretty bad and I suspect most with Crohn's are deficient in it and it leads to a whole host of problems. Such as Crohn's disease according to my theory.

Point being, if someone's body isn't properly regulating vitamin D and calcium, maybe doctors should start making sure that the mineral that is known to regulate vitamin D and calcium is present in sufficient levels instead of just telling people to stop taking absolutely essential minerals and vitamins that other studies have shown are of benefit to people with Crohn's disease.

 

[Mattie]

I posed this question to my naturopath. Her view is that calcium balance is dependent on calcitonin, parathyroid hormone and levels of Vit D. Vit D doesn't cause calcium absorption. Vit D is activated in the liver and kidneys to enable a physiological response which stimulates calcium absorption in the small intestine.
Both forms of D - erogocalciferol and cholecalciferol - enable calcium absorption. Her understanding is that once the body has the level of calcium it needs it doesn't make any more, and extra Vit D can't force this.

This might also help:

http://www.ncbi.nlm.nih.gov/pubmed/18689398

 

[David]

If your naturopath isn't bringing magnesium into that equation, she's missing a very large variable.

 

[Mattie]

On the contrary. She totally agrees with everything that has been said about the need for magnesium. I paraphrased her response to exclude that aspect as it has already been raised here.

 

[David]

Ah, my apologies.