Nutrient deficiencies & why they should be an important focus in the management of IBD
Prevalence of nutrient deficiencies in IBD
More than half of us with IBD have deficiencies in micronutrients (vitamins and minerals) and we get most micronutrients from the food we eat. Micronutrient deficiency is associated with a prolonged and complicated course of disease in people with IBD as micronutrients play hugely important roles in our bodies, including supporting and regulating our immune system and energy levels, so correcting any deficiencies, and supporting nutrient intake should always be an important consideration in the management of IBD.
The most common micronutrient deficiencies are iron, vitamin D, vitamin B12, zinc, and folic acid deficiency.
What causes nutrient deficiencies and is there a difference in Crohn’s and Ulcerative Colitis?
There are many reasons why people with IBD may be deficient in some micronutrients. These include restricting food intake or food avoidance, trouble absorbing nutrients (due to inflammation or fast transit time), and undesirable effects of some medication.
If you have Crohn’s disease you are more likely to have deficiencies than if you have Ulcerative Colitis. This is because Crohn’s often affects the small intestine which is where we absorb many micronutrients. It is also more common to have nutrient deficiencies during flare ups than at times of remission.
The type of IBD you have, the area of the intestines affected and the severity of inflammation are all very important when we are looking at food and nutrient status. For example, in ileocolitis, the most common type of CD, where inflammation affects your ileum (the last part of your small intestine) and your large intestine (most often on the right side), your ability to absorb some nutrients, particularly vitamin B12, can be affected as this vitamin is absorbed in the ileum.
If you have ulcerative colitis (UC), where the inflammation is in your colon or large intestine, perhaps you may be iron deficient from blood loss so we need to test this and to support you accordingly. With just those two examples we can see why it is important we deal with CD & UC and each different subtype of these conditions differently and personalise everything we do to you.
IBD symptoms may cause food avoidance, which may lead to food choices that might not provide a balanced diet. I see this quite often where clients don’t know which foods to avoid or read misinformation on the internet and exclude foods unnecessarily and end up eating a very restricted diet for fear of setting off their IBD. But restricting food intake and excluding food groups puts us at risk of nutrient deficiencies, if not done properly, which may make the course of disease worse.
What to do
Get tested – not all nutrients can be effectively tested for but iron, B12, vitamin D and folate can be. If you are worried you might have a deficiency you can have a simple blood test done by your GP to see if you have any deficiencies.
Correcting deficiencies – if you do have deficiencies it may mean to have to supplement that specific nutrient and include more foods in your diet that contain that nutrient. In some cases, you may need injections or infusions for vitamin B12 and iron. Please don’t just supplement without asking a nutrition professional first and without knowing whether you have a deficiency or not - you may not have any impact if you have a real deficiency or you may cause more harm than good. For example, if you have a vitamin D deficiency you may need to supplement at a high dose for a short period of time to rectify this before continuing at a lower maintenance dose. On the other hand, supplementing with iron may increase and exacerbate inflammation and cause symptoms like diarrhoea and nausea.
Preventing deficiencies – ensuring we are eating a diverse range of different foods and food groups can help reduce the risk of deficiency. Take a look at my balanced plate and portion guide to help you here.
Get help – if you are on a very restricted diet or you worry you might be at risk of nutrient deficiencies then get help from a nutrition professional so they can help to make sure you are getting all the nutrients you need in your diet and any supplements you may need.
I have written a free e-book to help you find a way forward for your everyday life with Inflammatory Bowel Disease. Whether you are right at the beginning of your journey with IBD or have been living with your condition for years and feel like you have tried almost everything, there are things you can do everyday, beyond the medication you are taking, to help you take back control.
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We are all wonderfully unique and what works for one person may not work for another so please seek help and advice before changing your diet to work out the right way forward for you.