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Due to frequent diarrhea, reduced absorption caused by inflammation of the intestines, increased metabolic requirements, medications, and altered diets, vitamin and mineral deficiencies in people with Crohn's Disease, Ulcerative Colitis, and other forms of Inflammatory Bowel Disease (IBD) are very common. Boron is an essential trace element for bone metabolism including efficient use of calcium and magnesium and proper function of endocrine glands. Calcium is the most abundant mineral in the human body.[12] Calcium is required for vascular contraction and vasodilation, muscle function, nerve transmission, intracellular signaling and hormonal secretion, though less than 1% of total body calcium is needed to support these critical metabolic functions.
Inadequate intakes of dietary calcium from food and supplements produce no obvious symptoms in the short term. Over the long term, inadequate calcium intake causes osteopenia which if untreated can lead to osteoporosis. Chromium is an essential trace element though its use in the human body is not well understood and is found primarily in two forms: 1) trivalent (chromium 3+), which is biologically active and found in food, and 2) hexavalent (chromium 6+), a toxic form that results from industrial pollution. Symptoms of Chromium Deficiency: Impaired glucose tolerance, loss of weight, confusion, peripheral neuropathy (nerve damage). Natural Sources of Chromium: Whole-grain products, processed meats, high-bran breakfast cereals, coffee, nuts, green beans, broccoli, pans and cans made of steel. Copper is necessary for iron uptake, and a copper deficiency can result in iron deficiency. Anatomy of Absorption: The primary location of copper absorption in humans is not definitively known but it is thought to take place in the stomach and duodenum. Natural Sources of Copper: Oysters and other shellfish, whole grains, beans, nuts, potatoes, organ meats (kidneys, liver), dark leafy greens, prunes, cocoa, black pepper, and yeast.
Symptoms of Essential Fatty Acid Deficiency: Pimply, rough skin at the back of the upper arms, hair loss, dandruff, eczema, PMS, darmatitis. Fish, shellfish, flaxseed (linseed), hemp oil, soya oil, canola (rapeseed) oil, chia seeds, pumpkin seeds, sunflower seeds, leafy vegetables, and walnuts. According to the World Health Organization, in 2007, nearly 2 billion individuals had insufficient iodine intake, a third being of school age.[17] In some areas, iodine deficiency has been greatly reduced by adding iodine to salt. Some researchers have found an epidemiologic correlation between iodine deficiency, iodine-deficient goitre and gastric cancer; a decrease of the incidence of death rate from stomach cancer after implementation of the effective iodine-prophylaxis has been reported also.
Because iodine cannot be stored for long times in the body, tiny amounts must be consumed regularly. Iron deficiency anemia is very common in people with Inflammatory Bowel Disease and should be regularly monitored.
Anatomy of Absorption: Iron absorption is primarily in the duodenum by enterocytes of the duodenal lining and the upper jejunum.
When the body has sufficient iron to meet its needs (functional iron), the remainder is stored for later use, mostly in the bone marrow, liver, and spleen.
Serum iron is a test that measures the amount of circulating iron that is bound to transferrin. Absorption of dietary iron in iron salt form (as in most supplements) varies somewhat according to the body's need for iron, and is usually between 10% and 20% of iron intake. Our bodies' rates of iron absorption appear to respond to a variety of interdependent factors, including total iron stores, the extent to which the bone marrow is producing new red blood cells, the concentration of hemoglobin in the blood, and the oxygen content of the blood. Good sources of non heme iron include: Blackstrap molasses, prunes, raisins, apricots, lima beans, soybeans, dried beans and peas, kidney beans, almonds, brazil nuts, broccoli, spinach, kale, collards, asparagus, dandelion greens, millet, oats, brown rice. The health status of the digestive system and the kidneys significantly influence magnesium status. As magnesium is required for processing of potassium, low potassium levels even after supplementation may be due to magnesium deficiency. Cardiac arrhythmias, elevated blood pressure, muscular weakness, myalgia, muscle cramps, constipation, paralytic ileus (think bowel obstruction!), decreased reflex response. Excessive potassium loss can be seen due to diarrhea, chronic vomiting, extensive inflammation of the small bowel, particularly the jejunum and ileum[28], profuse sweating, pancreatic fistulae, or if you are on prednisone.[26] Therefore, people with Inflammatory Bowel Disease are at high risk for developing potassium deficiency.
If you use diuretics, your doctor may have you supplement with potassium aspartate (20 mg per day), since diuretics flush out potassium from the body and cause a deficiency. Selenium deficiency can occur in people with severely compromised intestinal function or those on Total Parental Nutrition. Selenium deficiency can cause symptoms of hypothyroidism, including extreme fatigue, mental slowing, goiter, cretinism and recurrent miscarriage. Vegetables grown in soils high in selenium, fish, shellfish, red meat, grains, eggs, chicken, liver, brewer's yeast, wheat germ, and enriched breads are also good sources of selenium.
Sodium levels in the blood can be measured routinely as 'urea and electrolytes' or U and E for short. Sodium is passively absorbed throughout the small intestine (meaning if there are large amounts of sodium present, it will diffuse across the intestinal wall).
An intake of 1.5g of sodium is adequate for healthy adults (children need considerably less).
Most of the sodium we eat is from salt, however there may also be small amounts gained from additives (like monosodium glutamate). Most vegetables and dairy produce contain trace amounts of sodium (eg 100mg of sodium in 1 cup of milk). Since vitamin A is fat-soluble, disposing of any excesses taken in through diet is much harder than with water-soluble B vitamins and vitamin C, vitamin A toxicity is possible and it is suggested that people with IBD don't supplement vitamin A.
Vitamin A is commonly known as the anti-infective vitamin, because it is required for normal functioning of the immune system.
Vitamin A deficiency has an adverse effect on hemoglobin synthesis, even a slight increase in vitamin A intake can lead to a significant rise in hemoglobin levels. You are at increased risk of vitamin A deficiency if you have trouble absorbing fats or have inflammation in or surgical removal of the duodenum or upper jejunum.[26] In addition, iron deficiency can lead to reduced uptake of vitamin A, alcohol consumption can lead to depletion, and fighting infection utilizes significant amounts of vitamin A. Vitamin B6 (also known as Pyridoxine) deficiency impairs aspects of both humoral and cell-mediated immunity due to its requirement in the biosynthesis and metabolism of amino acids (the building blocks of proteins like cytokines and antibodies) [55].


If Vitamin B6 deficiency reduces metabolism of the amino acid methionine, S-adenosylmethionine can increase, Blocking the Synthesis of Nerve Myelin. Vitamin B6 is important for the Synthesis of Neurotransmitters (ie Dopamine, Serotonin, Epinephrine, Norepinephrine, GABA). Certain diseases and conditions have a greater likelihood of Vitamin B7 - Biotin Deficiency. Folate is a water soluble vitamin whereas folic acid is the synthetic form of folate that is found in supplements and added to fortified foods.[10].
Drugs shown to interfere with Folic Acid Utilization include methotrexate and sulfasalazine.
B12 deficiency also causes folate to be trapped in the body in an unusable form leading to symptoms of folate deficiency [53] and on the other side of the coin, folate deficiency can cause increases in B12 analogues (inactive B12) and decreases in cobalamin (active B12).
Vitamin B12 is absorbed in the terminal ileum (the last part of the small intestine) which happens to be one of the more commonly inflamed areas in Crohn's patients. Inadequate B12 Absorption or Deficiencies can be caused by multiple medications, including: Proton Pump Inhibitors (PPI), H2 Blockers, anti seizure medications, Colchicine, Metformin, Oral Contraceptives[54], Seromycin (cycloserine) [66]. Elderly are at even higher risk due to lower decreased stomach acid which readies dietary B12 to be bound by intrinsic factor.
While vitamin B12 supplementation is generally safe, there are some safety measures to be aware of first.
Supplementation of Vitamin B12 may reduce levels of other B Vitamins and can lead to imbalance [54]. Vitamin D is a fat soluble vitamin that is essential for efficient utilization of calcium and phosphorus and can be obtained via sunlight (the skin synthesizes it) or dietary means. Bone pain, soft bones (osteomalacia), rickets, hyperparathyroidism, muscle weakness, muscle pain, joint pain, poor immune function, and depression [59]. The US RDA for vitamin D is completely outdated and not pertinent to people with Crohn's Disease or other forms of IBD. Only oil based forms (such as capsules) of vitamin D3 should be taken, NOT dry tablets as they are poorly absorbed (unless taken with a teaspoon of olive oil) [48].
For those who are unable to get sufficient Vitamin D through food, sunlight or oral supplementation, Vitamin D can be administered by injection.
Vitamin K is a fat soluble vitamin that plays an important part in the coagulation of blood (clotting) and proper utilization of calcium to build bone. Various drugs have varying affects on the body's use of and absorption of vitamins and minerals.
Finally, a homemade cereal recipe that is free of sweeteners without sacrificing any crunchy clusters. Granola is a healthful, delicious way to start the day -- a balance of sustaining protein (10 grams per serving here!), complex carbohydrates and fiber, plus essential good fats, vitamins and minerals from a variety of nuts and seeds. In a food processor, puree prunes, applesauce, coconut oil, almond butter, flaxseed, and salt. As the weather warms up, I very often make salads based around cooked grains, which can be healthy, delicious and very filling.
I’ve been going through my Pinterest boards this week and trying to finally get around to making some of the temptations that I saved there. In the midst of the Whole30 challenge I was in search of a healthy alternative to the classic football appetizer. Absorption decreases to 15%?20% in adulthood (though it is increased during pregnancy) and continues to decrease as people age; compared with younger adults, recommended calcium intakes are higher for females older than 50 years and for both males and females older than 70 years. Foods with high levels of oxalic acid include spinach, collard greens, sweet potatoes, rhubarb, and beans.
High protein intake also increases calcium excretion and was therefore thought to negatively affect calcium status. However, the amount of alcohol required to affect calcium status and whether moderate alcohol consumption is helpful or harmful to bone is unknown. Several observational studies suggest that consumption of carbonated soft drinks with high levels of phosphate is associated with reduced bone mass and increased fracture risk.
Copper deficiency can sometimes be caused by excessive zinc or iron supplementation and will occasionally manifest at the same time as B12 deficiency[2]. 15?20 mg of iodine is concentrated in thyroid tissue and hormones, but 70% of the body's iodine is distributed in other tissues, including mammary glands, eyes, gastric mucosa, the cervix, and salivary glands.
Absorption of iron from animal products, and some plant products, is in the form of heme iron, and is more efficient, allowing absorption of from 15% to 35% of intake. It helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong.
Magnesium is absorbed in the intestines and then transported through the blood to cells and tissues. The two most common forms of the element that enter the body are selenomethionine and selenocysteine which are found mainly in plants and animals respectively. However, it is actively absorbed in the terminal ileum, meaning the body expends energy to be able to absorb small amounts of sodium.
Salt and additives are present in high quantities in processed foods, and possibly those served in restaurants etc. The skin and mucosal cells (cells that line the airways, digestive tract, and urinary tract) function as a barrier and form the body's first line of defense against infection. Symptoms include aggression, dermatitis, insomnia, weakness, mental confusion, and diarrhea. Vitamin D deficiency is common in people with Crohn's Disease and we implore everyone with IBD to get their vitamin D levels checked.[44] Uncontrolled proliferation of cells with certain mutations may lead to diseases like cancer.
Vitamin D is one of the most important vitamins for people with IBD to supplement as it can make a world of difference.


If I had Crohn?s, I would definitely pay the extra cost and buy a vitamin D with the expensive K2, and magnesium, zinc and boron. The applesauce helps bind it all together and adds a natural sweetness, and the prunes and blueberries are rich sources of antioxidants.
If making gluten-free, ensure both the rolled oats and oat bran are certified as 100% gluten-free. I’m the type of person that makes something new, loves it, and then has it every day until I get completely sick of it. Hypocalcemia results primarily from medical problems or treatments, including renal failure, surgical removal of the stomach, and use of certain medications.
Due to its dependence on stomach acid for absorption, calcium carbonate is absorbed most efficiently when taken with food, whereas calcium citrate is absorbed equally well when taken with or without food. Among the foods high in phytic acid are fiber-containing whole-grain products and wheat bran, beans, seeds, nuts, and soy isolates. However, more recent research suggests that high protein intake also increases intestinal calcium absorption, effectively offsetting its effect on calcium excretion, so whole body calcium retention remains unchanged. Moderate caffeine consumption (1 cup of coffee or 2 cups of tea per day) in young women has no negative effects on bone. However, the effect is probably due to replacing milk with soda rather than the phosphorus itself. However, it is unclear if consuming more fruits and vegetables affects bone mineral density. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis. Gastrointestinal disorders that impair absorption such as Crohn's disease can limit the body's ability to absorb magnesium. Some diuretics do the opposite and cause potassium to accumulate in the body.[24] Too much potassium in the blood is known as hyperkalemia. Sodium is readily available in the diet as salt, therefore deficiency is not normally due to dietary factors.
Retinol and its metabolites are required to maintain the integrity and function of these cells. The active form of vitamin D, 1,25-dihydroxyvitamin D, inhibits proliferation and stimulates the differentiation of cells.[42]. The dose is three pills per day for 5,000 IU, this is important as most people take only one or two and so are still vitamin D deficient. With continual use of high doses of prednisone, the result may be bone loss, osteoperosis and development of bone disease.
Even when I used to eat the occasional piece of cake or splurge on a cupcake, I would take 90% of the frosting off and throw it away.
Symptoms of hypocalcemia include numbness and tingling in the fingers, muscle cramps, convulsions, lethargy, poor appetite, and abnormal heart rhythms. These foods, in addition to reducing calcium excretion, could possibly reduce calcium absorption from the gut and therefore have no net effect on calcium balance. These disorders can deplete the body's stores of magnesium and in extreme cases may result in magnesium deficiency. Virtually no absorption occurs in the stomach and very little takes places in the remaining two segments of the small intestine. However, in IBD, there are various factors that increase the risk of deficiency, also called Hyponatremia.
Vitamin D has many beneficial effects on immune system function as it can affect aspects of both innate and adaptive immunity, including phagocytosis, cytokine production, lymphocyte differentiation, and antibody production. People on long term prednisone are often encouraged to take Vitamin D and Calcium supplements. Research shows, for example, that eating spinach and milk at the same time reduces absorption of the calcium in milk [10]. These include inflammation, scarring or removal of the terminal ileum and loss of sodium through diarrhoea. Get your levels tested regularly so you can find the daily supplementation amount that works best for you. In contrast, wheat products (with the exception of wheat bran) do not appear to lower calcium absorption. In addition, people in hospital are more at risk of deficiency, as are people taking selective serotonin reuptake inhibitors (SSRIs, a class of antidepressant). For people who eat a variety of foods, these interactions probably have little or no nutritional consequence and, furthermore, are accounted for in the overall calcium DRIs, which factor in differences in absorption of calcium in mixed diets. However, absorption of inorganic forms of the element varies widely due to luminal factors.
Finally, Addison's disease also causes loss of sodium, which may be a concern for patients weaning off steroids. This variation in absorption reduces total absorption of all forms to somewhere between 50 and 100%.
Absorption of selenium is closely related to multiple nutritional factors that inhibit or promote absorption.



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