Vitamin D and Crohn’s Disease

Cheapest Prescription for Crohn’s Disease: More Sunshine

More and more people are complaining about gastrointestinal (GI) discomforts such as flatulence, bloating and abdominal pain. At David Allen Nutrition, we are strong proponents of maintaining optimal levels of vitamin D. It turns out that there is a wealth of research out there that supports our conviction. Here, we report a review of studies that show GI diseases, such as Inflammatory Bowel Disease (IBD), particularly Crohn’s Disease (CD), are directly linked to the individual’s serum vitamin D levels. When it comes to proper digestion and absorption in the GI tract, the sunshine vitamin comes into the spotlight once again.

A simplified depiction of the pathology of Crohn’s Disease starts with body’s development of an immune response to the innate microbes that usually co-exist with us in the gut. These triggers can be genetic or environmental. Signals that detect the existence of gut microbes cause the naïve immune cells CD4⁺ to differentiate into Th1, with is a T-cell phenotype that promotes the secretion of proinflammatory cytokines IL-2, IFN-y and TNF-a that further go on to damage the epithelial mucosa to cause CD symptoms and GI distress.

The vitamin D receptor (VDR) binds the active form of vitamin D (1,25)-dihydroxyvitamin D and is present on immune cells. With the binding of vitamin D, downstream genomic changes occur that result in altered DNA expression.

What defines as adequate serum vitamin D levels? There has not been a consensus on adequate levels yet, but a serum level below 20 ng/mL is considered as deficient. However, studies show serum levels of above 32 ng/mL habe to be reached before intestinal calcium transport can be maximized. This is due to the synergistic effects of vitamin D and calcium in the intestines. Serum levels of above 60 ng/mL mark the upper limit, above which toxicity was found.

The actual development of the disease is dependent on genetic factors and environmental triggers. Many genes are involved. Vitamin D Binding Protein (DBP) is the most importantly linked with circulating vitamin D levels. Other related genes include genes related to epithelial barrier function and genes that initiate primary and secondary immune responses.There could be individual variances that are uncontrollable by dietary interventions. Individuals with these variants will benefit from genetic testing and subsequent vitamin D supplementation. However, when studying monozygotic twins, the concordance rate for Crohn’s Disease is only 20-50%. The rest 50-80% variation is related to the environment.

In the environment,serum vitamin D level is a major determinant. Several experiments prove this. First, when the vitamin D Receptor was inhibited in vivo, resulting in an inhibition of vitamin D uptake, the harmful pro-inflammatory T-Cell Th1 was up-regulated and Th2 was down-regulated. In addition, in participants already diagnosed with IBD, vitamin D supplementation helped to suppress the pathology of the disease. The most influential finding is that there is also a negative correlation between CD patients and serum vitamin D levels. For patients with Crohn’s Disease, it has been found that they should achieve a serum vitamin D level of at least 40 ng/mL.

Crohn’s Disease is an exacerbated condition that results from an over-production of inflammatory responses in the intestines. However, there could be many individuals who suffer from a mild version of this inflammatory response, but not the extent to which GI diseases can be diagnosed. Even for these individuals, weight gain, abdominal symptoms and even skin rashes can be telling symptoms. Vitamin D supplementation, the sunshine prescription may be able to help.

Source:

• Basson. A. Vitamin D and Crohn’s Disease in Adult Patient: A Review. J Parenteral Enter Nutr. 2013. doi: 10.1177/0148607113506013