The last part of the small intestine — the ileum — is a common site of inflammation in Crohn’s disease. This is where the body absorbs and recycles bile acids, which are important for the absorption of fat.
People with Crohn’s disease experience fat malabsorption, and as fat drains out of their body, it takes the fat-soluble vitamins A, D, E, and K and vitamin B12 with it.
This, along with a reduced ability to eat during flare-ups and the nutrient-depleting side-effects of Crohn’s medications can quickly lead to multiple vitamin and mineral deficiencies in Crohn’s patients.
Many experts recommend trying to make up for this loss by eating natural foods. But with Crohn’s disease, this is often not possible.
Many nutrient-rich foods like spinach can actually trigger your Crohn’s symptoms. Crohn’s patients often suffer from lactose-intolerance, which is another reason foods aren’t the best way to make up for these deficiencies.
So if you’ve Crohn’s disease, here are 8 vitamins (and minerals) you need to supplement your diet with.
1. Vitamin B12
Vitamin B12 is absorbed by the ileum, which is the most common site inflammation in Crohn’s. While your liver stores large amounts of vitamin B12, the long-term nature of Crohn’s disease means a deficiency can develop.
People with vitamin B12 deficiency can experience:
- Anemia — impaired production of red blood cells, leading to fatigue
- Impaired vibratory, position, and touch sensations
- Tingling in the arms and the legs
- Large, beefy tongue
You can try oral vitamin B12 supplements, but because of the damage to the small intestine, they probably won’t work. A monthly injection of vitamin B12 is the workaround to this, so talk to your doctor about this.
Folate is also absorbed from the small intestine. And unlike vitamin B12, your body has minimal stores of folate, which means a deficiency can develop quickly.
Plus, Crohn’s medications like sulfasalazine and methotrexate can impair the body’s ability to absorb and utilize folate, respectively. If you’re deficient in folate, you can experience:
- Red, swollen tongue
- If you are pregnant, your baby can develop neural tube defects
And while green, leafy vegetables are a great source of folate, if they seem to trigger your symptoms, a daily oral pill may help.
3. Vitamin D
Around 70% of Crohn’s patients are thought to be deficient in vitamin D. That’s because it’s a fat-soluble vitamin and when you can’t absorb fats (due to inflammation), you can’t absorb vitamin D.
The goal of vitamin D is to give you strong bones. It helps the body absorb calcium and phosphate to mineralize your bones, and when you’re deficient in it, you can develop:
- Osteomalacia — your bones may become soft and fracture easily
- Hyperparathyroidism — which can further weaken your bones
Plus, most Crohn’s flare ups are treated with drugs called glucocorticoids, which further impair the body’s ability to absorb calcium and thus weaken your bones.
So talk to your doctor about vitamin D supplements, especially those in liquid form because your body may have a hard time absorbing a pill.
There are four reasons why Crohn’s patients can develop a calcium deficiency.
- Low vitamin D levels, which normally helps you absorb calcium
- Lactose-intolerance, which makes you avoid dairy products
- Surgery of the small intestine
- Glucocorticoids, which hinder calcium absorption
Severely decreased levels of calcium can cause stiff, spasmodic muscles due to a condition called tetany. At other times, you may feel a tingling sensation around your mouth. So try to obtain 1.5 grams of calcium daily. You may want to divide your total intake into two or three smaller doses for better absorption.
Although not a vitamin, zinc is important for growth and development, immune functioning, wound healing, and good appetite. A deficiency will compromise all these functions and can alter your smell and taste sensations.
Crohn’s patients experience prolonged diarrhea, which can cause a zinc deficiency. In turn, zinc deficiency promotes diarrhea, setting up a vicious circle. Although a zinc deficiency is rare in adult Crohn’s patients, it’s relatively common in children with the condition.
So if your child has Crohn’s, talk to your doctor about possible zinc supplementation.
Crohn’s leads to ulcer formation in your gut. If these ulcers bleed significantly, you can develop iron-deficiency anemia. You may experience fatigue, palpitations, and a craving for dirt (or ice).
Many natural foods are amazing sources of iron. They include fish, broccoli, cashews, spinach, poultry items, and dairy foods like cheese and milk.
If you feel your iron levels are low despite an iron-rich diet, you can ask your doctor for a supplement. Depending on the severity of your deficiency, your doctor may prescribe you a pill, liquid supplement, or an iron infusion.
7. Vitamin A
If you have trouble seeing at night, you may have vitamin A deficiency.
Crohn’s patients often suffer from intestinal obstruction. Bacteria proliferate as a result of this obstruction and suck up all your vitamin A.
Plus, vitamin A is a fat-soluble vitamin, which makes it difficult for the body to absorb it due to fat malabsorption.
It’s important to note that an overdose of vitamin A can lead to dangerous symptoms like liver enlargement, joint pain, and increased pressure in the brain. Therefore, before you start vitamin A supplementation, make sure to talk to your doctor. Vitamin A supplementation shouldn’t be taken by pregnant women because it can harm the baby.
8. Vitamins E and K
Both vitamins E and K are fat-soluble, making it difficult for Crohn’s patients to absorb them.
If you’re deficient in vitamin E, you can experience tingling in your arms and legs, and muscle weakness. While seeds, nuts, and green, leafy veggies are good sources of vitamin E, if you’ve got Crohn’s, you may need a water-soluble form of the vitamin. An example is tocopheryl polyethylene glycol-1000 succinate.
Vitamin K is necessary for blood clotting. People with vitamin K deficiency can bleed and bruise easily. And while your doctor probably won’t recommend you a vitamin K supplement, if you feel you could use some of its goodness, consider a diet rich in spinach, broccoli, Brussel sprouts, beef liver, and soybean oil!
Medically Reviewed by Onikepe Adegbola, MD PhD