8 Vitamins and Supplements for Crohn’s Disease

People with Crohn’s disease are at an increased risk of certain nutrient deficiencies. Factors such as food avoidance, inflammation of the gastrointestinal (GI) tract, and medical treatments can improve nutrient absorption.

Supplements can help you obtain the vitamins and minerals you can’t get from food alone. While some deficiencies are common in Crohn’s disease, needs can vary from person to person. Your healthcare provider can help you find supplements based on your symptoms, blood tests, and current treatment plan.

1. Folic Acid

Folic acid (B9) helps create new cells throughout the body. It is also important for women before and during pregnancy since it can promote healthy neural tube development, which prevents major birth defects of a baby’s brain or spine.

Folic acid is a water-soluble vitamin that your body obtains through food. A water-soluble vitamin dissolves in water and is absorbed by tissues for immediate use. Any excess is passed in urine, so folic acid must be replenished regularly. Foods rich in folic acid include leafy green vegetables, fruits, dried beans, peas, and nuts. It is also available in enriched grain products such as pasta, cereals, and bread.

Folic acid deficiencies in Crohn’s disease can often be attributed to the fact that some medications used to treat the disease, including Azulfidine (sulfasalazine) and Trexall (methotrexate), may interfere with the normal absorption of this nutrient. In addition, it is common for people with Crohn’s to avoid certain foods, such as fresh fruits and vegetables, which are the main sources of folic acid.

A folic acid supplement may help treat some of the following symptoms of this type of deficiency:

2. Calcium

Calcium is an essential nutrient and the most abundant mineral in the body. About 99% of calcium is stored in teeth and bones, making it a key factor in maintaining body strength and preventing osteoporosis (loss of bone mass and bone mineral density). Calcium also supports healthy circulation, hormones, nerve, and muscle health.

Since the body does not produce calcium, you have to get it through foods such as dairy products, dark green leafy vegetables, certain fish, and calcium-fortified foods and beverages. Despite their diets, research indicates that calcium levels are generally lower in people with Crohn’s disease than in those who do not have the disease.

Calcium is absorbed in the small intestine, where Crohn’s disease typically attacks. Inflammation and bowel resection (removal of a damaged portion of the bowel) can make it harder to absorb calcium in your intestines.

Corticosteroids, such as prednisone, which are often used to treat Crohn’s disease, tend to reduce calcium absorption in the intestines and increase your risk of osteoporosis. In addition, people with Crohn’s disease may avoid rich dairy foods due to lactose intolerance or because these foods may worsen Crohn’s disease symptoms.

Your healthcare provider may advise calcium supplements to treat symptoms of hypocalcemia (calcium deficiency), which can include:

3. Iron

Iron is a mineral you can only get through your diet. It is necessary for human growth and development. It is used to produce hemoglobin, a protein in red blood cells that carries oxygen from your lungs to other body parts. Iron also plays a key role in maintaining healthy bone marrow, muscles, organ function, and some hormones.

Iron is absorbed in your duodenum and proximal jejunum (the first parts of the small intestine through which digested food travels). However, when this area is affected by Crohn’s disease or surgically removed during a resection, your body may be unable to absorb adequate iron levels (malabsorption). Iron deficiency in Crohn’s disease happens due to inadequate iron intake in your diet or chronic blood loss due to bleeding ulcers in the gastrointestinal tract.

Iron deficiency in Crohn’s disease can lead to a substantial decrease in quality of life. It ranks as a leading cause of hospitalization for people with this disease. Iron supplementation may be advised to treat any of the following symptoms:

• Brittle nails or hair loss
• Chronic fatigue or lack of energy
• Dizziness
• Dyspnea (shortness of breath)
• Headaches
• Pale skin or nails
• Reduced tolerance for exercise
• Syncope (fainting)
• Tachycardia

4. Vitamin B12

Vitamin B12 (cobalamin) is a water-soluble vitamin, and you must regularly supply the vitamin through foods you eat or supplements. Vitamin B12 helps in the formation of healthy red blood cells, the maintenance of your central nervous system, and the production of DNA. It is present in foods of animal origin, which include fish, poultry, meat, eggs, and dairy products. Some cereals and yeast are fortified with vitamin B12.

Crohn’s disease commonly affects your small intestine and the top of your large intestine. Most absorption of vitamin B12 occurs in the ileum, the last and longest section of your small intestine. Vitamin B12 deficiency affects up to 38% of people with Crohn’s. It typically occurs when the ileum is affected by the disease or the disease is treated with ileal resection (removal of the diseased section of the ileum).

Your healthcare provider may advise B12 supplementation to address the following symptoms of Vitamin B12 deficiency:

• Anemia (inadequate red blood cells)
• Fatigue
• Cognitive difficulties (difficulty thinking and reasoning)
• Memory loss
• Numbness, tingling, or strange sensations in your hands, legs, or feet
• Staggering or difficulty walking or maintaining balance
• Swollen, inflamed tongue
• Weakness

5. Vitamin D

Vitamin D (calciferol) is a fat-soluble vitamin. It is absorbed by fat globules that travel through the small intestines and distribute the vitamin throughout your body. When a gastrointestinal disease such as Crohn’s disease interferes with your gut health, it can prevent your digestive tract from absorbing the vitamin D your body needs.

Vitamin D has key roles in healthy bone formation and resorption (the process in which bones are broken down and absorbed by the body). It also helps your body retain and absorb calcium and phosphorus. It can be obtained from diet when eating fatty fish, dairy, and certain vitamin D-fortified soy alternatives, orange juices, and dairy substitutes.

Your body can make vitamin D when exposed to sunlight. However, immunosuppressive therapies used to treat Crohn’s disease, such as Imuran (azathioprine) and Humira (adalimumab), can increase the risk of skin cancer. Therefore, people taking these medications are advised to use sunscreen, which prevents UVB synthesis of vitamin D.

Vitamin D is important for people with calcium deficiency, osteopenia, or osteoporosis. In addition, vitamin D supplements may be advised for anyone with Crohn’s disease who is taking corticosteroids since these drugs cause vitamin D resistance.

While a vitamin D deficiency is usually asymptomatic (having few or no symptoms), severe and prolonged deficiency can cause the following symptoms:

• Bone pain
• Bowed legs, in extreme cases
• History of broken bones
• Increased sensitivity to any pain
• Muscle pain or spasms
• Muscle tremors or twitches
• Muscle weakness in the upper arms or thighs or other body parts near the trunk of your body
• Tingling or “pins-and-needles” sensation in your hands or feet

6. Vitamins A, E, and K

Vitamin A, vitamin E, and vitamin K are fat-soluble vitamins that you need to produce cells, prevent cell damage, and produce blood. These vitamins also fight infections and maintain bone health.

You must ingest these vitamins since your body doesn’t produce them. You can find them in the following foods:

People with trouble absorbing fat may have low levels of these fat-soluble vitamins. Fat absorption problems in people with Crohn’s disease may be due to significant small bowel inflammation and/or missing or removing portions of the jejunum and ileum.

Your healthcare provider may advise supplementation to treat symptoms of these deficiencies:

Vitamin A:

• Bitot spots (foamy deposits) in the whites of your eyes
• Dry and scaly skin
• Nyctalopia (night blindness)
• Softening and deterioration of the dry cornea
• Thickening and stiffening of the lining of the lungs, intestine, and urinary tract
• Xerophthalmia (dry and thick conjunctiva (whites of your eyes) and cornea

Vitamin E:

Vitamin K:

• Hemorrhage (bleeding) into the skin, from the nose, in the stomach, or the intestines
• Life-threatening bleeding within or around the brain in newborns
• Weakened bones

7. Potassium, Magnesium, and Zinc

Potassium, magnesium, and zinc are electrolytes. These nutrients regulate muscle contractions and keep you hydrated. They also control the function of your nervous system and balance your pH levels (the measure of acidity and alkalinity of a substance).

Symptoms of Crohn’s disease, such as severe diarrhea, can cause dehydration, which can deplete your body of fluids, nutrients, and electrolytes such as potassium, magnesium, and zinc. Other factors contributing to electrolyte deficiencies in Crohn’s disease include GI malabsorption caused by intestinal inflammation and corticosteroids commonly used to treat Crohn’s disease.

Your healthcare provider may advise supplements to treat an electrolyte deficiency of potassium, magnesium, or zinc if you have any of the following symptoms of this type of deficiency:

• Brain swelling
• Confusion
• Dizziness
• Fatigue
• Headache
• Irritability
• Lethargy
• Muscle cramping or weakness
• Nausea and vomiting
• Numbness and tingling
• Overheating
• Seizures

8. Potassium

Potassium is an electrolyte that helps your nerves function and muscles contract. It also helps your heartbeat remain regular and moves nutrients into cells and waste products out of cells. Potassium can also offset some of sodium’s harmful effects on your blood pressure.

Potassium-rich foods include bananas, sweet potatoes, tomatoes, carrots, cucumbers, dairy products, fish, and leafy greens. People with Crohn’s disease have an increased risk of potassium deficiency (hypokalemia) when they experience common disease symptoms of chronic vomiting and diarrhea. The risk of potassium deficiency increases with the use of corticosteroids such as prednisone.

You may benefit from potassium supplements if you have any of the following symptoms of a potassium deficiency:

• Abnormal heart rhythms or light-headedness, when a large drop in blood potassium occursConstipation
• Fatigue
• Heart palpitations
• Muscle damage
• Muscle weakness or spasms
• Tingling or numbness

Other Supplements That May Help

Other dietary supplements may also be effective in improving disease activity and preventing malnutrition. While these interventions have potential value in treating Crohn’s disease symptoms, further research on their potential applications and outcomes:

Why Crohn’s Can Make You Feel Sick and Tired

It’s not uncommon to feel sick and tired if you have Crohn’s disease, especially during periods of flare-ups (active disease). Research indicates that about 70% of people with active Crohn’s disease have fatigue during a flare-up. These feelings also affect about 40% of people in remission (minor or inactive symptoms).

When you have sufficient levels of vitamins and nutrients, their biochemical properties support normal physical and emotional function. However, nutritional deficiencies can interfere with these processes and deprive your body of the energy it needs to sustain itself.

This can impact bodily functions ranging from energy production to immune function. As a result, taking the right nutritional supplements can often become a key aspect of Crohn’s disease self-care.

Nutritional deficiencies can lead to the following symptoms that can make you feel chronically “sick and tired,” at any time in your Crohn’s disease course:

• Arrhythmia (irregular heartbeat)
• Cognitive deficit, delayed milestones, and learning disabilities in children
• Difficulty concentrating
• Frequent illness
• Headaches
• Impaired growth and stunted development in children
• Joint pain
• Low mood
• Muscle soreness
• Persistent fatigue
• Weight management issues

Nutritional deficiencies can also affect how prescribed medications for Crohn’s disease and other conditions work. Vitamin and mineral deficiencies can cause changes in your gastrointestinal tract, affecting the way your body absorbs and metabolizes a drug.

Some common reasons that you may develop a nutritional deficiency with Crohn’s disease are:

• Inadequate food/fluid intake due to factors such as nausea, loss of appetite, abdominal pain, or changes in your sensation of taste
• Intestinal inflammation during flares that causes increased loss of protein, loss of fistula fluids, diarrhea, and bleeding
• Malabsorption caused by severe intestinal inflammation, resection of sections of the small intestine, and certain medications used to treat Crohn’s disease
• The need for higher-than-normal levels of nutrients due to the effects of inflammation or infection

Foods or Supplements: Which Is Better?

Generally, consuming a diet of healthy foods is the best way to meet your nutritional needs. When compared to supplements, the complexity of foods means they often provide trace elements that are not present in a supplement.

As a result, you’re likely to get better nutrition from foods, including essential fiber to manage constipation and prevent other diseases. Foods can also contain additional protective substances such as phytochemicals and antioxidants, which provide benefits in preventing heart disease, cancer, diabetes, and other diseases.

However, having Crohn’s disease may interfere with your ability to consistently consume a healthy diet. Even when you’re able to eat the right foods, the effects of Crohn’s disease may prevent your body from properly absorbing the amounts of nutrients your body needs. In these cases, your healthcare provider may advise taking supplements to help offset the effects of specific vitamin or mineral deficiencies to maintain proper nutrition.

Work With Your Healthcare Provider

Since Crohn’s disease affects everyone differently, there is not one vitamin or combination of vitamins in particular that is advised for everyone. Before starting on a new vitamin or supplement, it’s important to work with your healthcare provider to determine the best course of action. Factors such as your diet, disease severity, prescribed medications, and the impact of other health conditions can affect which vitamins and supplements are right for you.

While vitamins and supplements may seem harmless, some can worsen Crohn’s symptoms, like nausea or diarrhea. They can also interact with medications you may be taking for Crohn’s disease or other conditions.

Your healthcare provider can help you identify nutritional deficiencies and ways to correct them without interfering with your treatment plan. They can also advise a Crohn’s disease diet that may help meet your needs. If vitamins or supplements are necessary, your healthcare provider can advise the proper dosage to help you achieve the intended benefits.

Summary

While most people can get the vitamins and minerals they need from eating a healthy diet, doing so can be hard for someone with Crohn’s disease. Getting nutrients from food alone can be a challenge when you’re dealing with flares, severe symptoms, and the results of GI surgery, which are common in Crohn’s disease.

While supplements can help correct nutritional deficiencies, everyone’s needs are unique. Consult your healthcare provider before starting any new supplement. While they may seem like healthy choices, supplements may present new symptoms or change the way certain drugs work. With the proper guidance, you can maintain healthy nutrition safely without having new problems.