When did you last have a blood test for nutrient deficiencies?
Are nutrient deficiencies common in IBD?
People with IBD are at increased risk of malnutrition, with more than half of us with IBD have deficiencies in micronutrients (vitamins and minerals). Micronutrient deficiency is associated with a prolonged and complicated course of disease in people with IBD, as well as a reduced quality of life. Micronutrients come from the food we eat and 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 folate deficiency (1).
Why are nutrient deficiencies common in IBD?
There are many reasons why people with IBD may be deficient in some micronutrients. These include restricting food intake or food avoidance perhaps due to loss of appetite or certain foods inducing symptoms, trouble absorbing nutrients (due to inflammation or fast transit time), blood loss, and as a side effect of some medications (1).
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. People with Crohn’s Disease remain at risk of nutrient deficiencies even when in remission, whereas people with UC generally develop problems only when the disease is active (2).
The infographic below gives an illustration of where certain nutrients are absorbed in our intestines and gives an idea of why knowledge around the location of inflammation is hugely important when we look at nutrient deficiencies in IBD.
How do I find out if I have a nutrient deficiency?
It has been suggested that all IBD patients who are not under immediate or ongoing care, including those in remission, should have an annual review and basic information recorded. This may be carried out in a hospital or community clinic, or by telephone follow-up, and should be undertaken by a healthcare professional with recognised competence in IBD (3). However, in practice I see that this does not often happen.
If you are experiencing ongoing symptoms including fatigue even when in remission, or if you are in a flare and haven’t had your nutrient levels checked, I would encourage you to get in touch with your GP or IBD team and ask for a review and blood test. This is something I can also arrange for you to have done privately if you are struggling to get it. The nutrient markers I always suggest for my clients are:
Crohn’s Disease, Ileostomy, J-Pouch – vitamin B12, Folate, Iron (serum iron, ferritin, TIBC, haemoglobin), Vitamin D, calcium.
Ulcerative Colitis – Iron (serum iron, ferritin, TIBC, haemoglobin), Vitamin D, calcium.
NB: calcium blood and urine tests cannot tell us how much calcium is in the bones – if concerns over bone health and calcium status are apparent then a DEXA scan should be carried out.
How do I correct a nutrient deficiency?
Work with your GP, IBD team or nutritionist/dietician to help correct nutrient deficiencies. Do not self-medicate with supplements without seeking help from a nutrition professional to make sure you are taking the appropriate supplement at the right dose for the correct period of time.
How do I prevent nutrient deficiencies?
Eating a healthy balanced diet that contains a wide variety of foods which provide a range of different nutrients can help to prevent nutrient deficiency. I know sometimes this is difficult for people with IBD due to symptoms around some foods so if you are worried then seek help from a nutritionist or dietician who can help to make sure you are getting all the nutrients you need.
If you need help with your IBD or J-pouch I work with people in the UK and internationally to live a better quality of life with IBD and I’d love to help you.
You can book a (free) 20 minute no obligation phone call with me to find out how I can help you. During this call I love to hear about you; your journey, your struggles, your life, and we can chat about the best route forward for you.
If that sounds interesting click here so you can find a time that works for you for us to chat.
References
Balestrieri P, Ribolsi M, Guarino MPL, Emerenziani S, Altomare A, Cicala M. Nutritional Aspects in Inflammatory Bowel Diseases. Nutrients. 2020 Jan 31;12(2):372. doi: 10.3390/nu12020372. PMID: 32023881; PMCID: PMC7071234.
Han PD, Burke A, Baldassano RN, Rombeau JL, Lichtenstein GR. Nutrition and inflammatory bowel disease. Gastroenterol Clin North Am. 1999 Jun;28(2):423-43, ix. doi: 10.1016/s0889-8553(05)70063-7. PMID: 10372275.
Mowat C, Cole A, Windsor A, et al Guidelines for the management of inflammatory bowel disease in adults. Gut 2011;60:571-607.