From the Guidelines
Patients with ulcerative colitis are not typically at risk for vitamin B12 deficiency unless they have had a resection of more than 30 cm of the distal ileum, in which case they should receive 1000 mg of vitamin B12 prophylactically every month and indefinitely 1. However, these patients may experience deficiencies in other vitamins and minerals due to malabsorption, dietary restrictions, and increased intestinal losses. The most common deficiencies include:
- Vitamin D
- Folate (vitamin B9)
- Iron
- Zinc
- Magnesium Vitamin D deficiency is prevalent due to malabsorption of fat-soluble vitamins and reduced sun exposure in patients who may limit outdoor activities due to symptoms. To address these deficiencies, patients should take daily supplements including:
- Vitamin D (1000-2000 IU daily)
- Folate (1 mg daily) Regular blood testing every 3-6 months is recommended to monitor levels and adjust supplementation accordingly 1. A well-balanced diet rich in these nutrients is also beneficial, though supplementation is often necessary due to the impaired absorption. These deficiencies should be addressed promptly as they can worsen symptoms, delay healing, and contribute to complications such as anemia and bone density loss in ulcerative colitis patients. It is essential to monitor patients with extensive ileal disease or prior ileal surgery for vitamin B12 deficiency, as well as vitamin D and iron deficiency 1.
From the Research
Vitamin Deficiency Associated with Ulcerative Colitis
- Vitamin D deficiency is common in patients with ulcerative colitis (UC) 2, 3, 4, 5, 6
- Studies have shown that vitamin D supplementation can contribute to disease relief in UC patients 2, 3
- The exact etiological link between vitamin D deficiency and UC is not clear, and more research is needed to determine the efficacy of vitamin D supplementation in the treatment of UC 2
- Vitamin D deficiency has been associated with increased disease activity, extent, and duration of UC 4, 5, 6
- Patients with longer disease duration, more severe symptoms, and pancolitis are likely to have lower vitamin D levels 4
- Vitamin D levels have been shown to be lower in patients with extensive UC compared to those with limited UC 5
- Vitamin D deficiency is also associated with an increased need for treatment with steroids in UC patients 6
Key Findings
- A study found that 2000 IU daily dose of vitamin D can increase serum 25-OHD concentration, and quality of life, while it reduces disease activity in UC patients with vitamin D deficiency 3
- Another study found that vitamin D levels were lower in patients with UCDAI > 6, having pancolitis, and longer duration of illness > 2 years 4
- A study also found that vitamin D deficiency is common among patients with active UC, particularly those requiring corticosteroids 6
Relationship Between Vitamin D and Ulcerative Colitis
- Vitamin D plays a key role in gut immunity and maintenance of the mucosal barrier 4
- Vitamin D deficiency worsens ulcerative colitis and its supplementation ameliorates the disease in mouse models 4
- The relationship between vitamin D and UC is still being researched, and more high-quality double-blind randomized clinical studies are needed to determine the efficacy of vitamin D supplementation in the treatment of UC 2