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Vitamin and Mineral Deficiencies

The information below is a work in progress.

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. Adding in the variable that the nutrient value of many foods has decreased over the years[1], anyone with IBD should become aware of the importance of proper diet and supplementation and the signs of vitamin and mineral deficiencies. We strongly suggest opening a dialogue with your medical provider regarding the monitoring of your vitamin and mineral levels. If your health care provider is not willing to discuss vitamin and mineral deficiencies with you, we suggest finding one who will.

Contents


Boron

Boron is an essential trace element for bone metabolism including efficient use of calcium and magnesium and proper function of endocrine glands. One study found that within eight days of supplementing boron, women lost 40 percent less calcium, 33 percent less magnesium and less phosphorus through their urine. Information on boron from reputable sources can be hard to come by. This site has additional information but the quality of the information has not yet been established by crohnsforum.com

Symptoms of Boron Deficiency: Arthritis, osteoporosis [8]

Anatomy of Absorption: Unknown

Recommended Daily Intake: Not well established

Natural Sources of Boron: Non-citrus fruits, leafy vegetables, nuts, and legumes. Some have put forth the idea that boron uptake by plants has been severely reduced due to the way soils are cultivated on factory farms. The validity of this claim is not known.

Calcium

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. Serum calcium is very tightly regulated and does not fluctuate with changes in dietary intakes; the body uses bone tissue as a reservoir for, and source of calcium, to maintain constant concentrations of calcium in blood, muscle, and intercellular fluids[13] thus osteoporosis (loss of bone density) becomes a problem if prolonged calcium deficiency is experienced.

Symptoms of Calcium Deficiency:
Inadequate intakes of dietary calcium from food and supplements produce no obvious symptoms in the short term. Circulating blood levels of calcium are tightly regulated. Hypocalcemia results primarily from medical problems or treatments, including renal failure, surgical removal of the stomach, and use of certain medications. Symptoms of hypocalcemia include numbness and tingling in the fingers, muscle cramps, convulsions, lethargy, poor appetite, and abnormal heart rhythms. If left untreated, calcium deficiency leads to death.

Over the long term, inadequate calcium intake causes osteopenia which if untreated can lead to osteoporosis. The risk of bone fractures also increases, especially in older individuals. Calcium deficiency can also cause rickets, though it is more commonly associated with vitamin D deficiency

Anatomy of Absorption:
Duodenum[74]
Jejunum[74]

You are at increased risk of calcium deficiency if you have trouble absorbing fats, are taking prednisone, have extensive inflammation throughout your small intestines, or have had extensive removal of the small intestines.[26]

The two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is both inexpensive and convenient. 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. Calcium citrate is also useful for people with achlorhydria, inflammatory bowel disease, or absorption disorders.[13]

Other factors also affect calcium absorption including the following:

* Amount consumed: the efficiency of absorption decreases as calcium intake increases.

* Age and life stage: net calcium absorption is as high as 60% in infants and young children, who need substantial amounts of the mineral to build bone. 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.

* Vitamin D intake: this nutrient, obtained from food and produced by skin when exposed to sunlight of sufficient intensity, improves calcium absorption.

* Other components in food: phytic acid and oxalic acid, found naturally in some plants, bind to calcium and can inhibit its absorption. Foods with high levels of oxalic acid include spinach, collard greens, sweet potatoes, rhubarb, and beans. Among the foods high in phytic acid are fiber-containing whole-grain products and wheat bran, beans, seeds, nuts, and soy isolates. The extent to which these compounds affect calcium absorption varies. Research shows, for example, that eating spinach and milk at the same time reduces absorption of the calcium in milk [10]. In contrast, wheat products (with the exception of wheat bran) do not appear to lower calcium absorption. 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.

Some absorbed calcium is eliminated from the body in urine, feces, and sweat. This amount is affected by such factors as the following:

* Sodium and protein intakes: high sodium intake increases urinary calcium excretion. High protein intake also increases calcium excretion and was therefore thought to negatively affect calcium status. 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.

* Caffeine intake: this stimulant in coffee and tea can modestly increase calcium excretion and reduce absorption. One cup of regular brewed coffee, for example, causes a loss of only 2–3 mg of calcium. Moderate caffeine consumption (1 cup of coffee or 2 cups of tea per day) in young women has no negative effects on bone.

* Alcohol intake: alcohol intake can affect calcium status by reducing its absorption and by inhibiting enzymes in the liver that help convert vitamin D to its active form. However, the amount of alcohol required to affect calcium status and whether moderate alcohol consumption is helpful or harmful to bone is unknown.

* Phosphorus intake: the effect of this mineral on calcium excretion is minimal. 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. However, the effect is probably due to replacing milk with soda rather than the phosphorus itself.

* Fruit and vegetable intakes: metabolic acids produced by diets high in protein and cereal grains increase calcium excretion. Fruits and vegetables, when metabolized, shift the acid/base balance of the body towards the alkaline by producing bicarbonate, which reduces calcium excretion. However, it is unclear if consuming more fruits and vegetables affects bone mineral density. 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.

Recommended Daily Intake:
Please see the chart below for recommended daily intake for calcium:



Natural Sources of Calcium:
Milk, Blackstrap molasses, yogurt, cheese, kale, broccoli, Chinese cabbage

For More Information on Calcium please check out the Wiki Page HERE

Chromium

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. [9] Chromium deficiency is thought to be very rare but HAS been observed in people who are on liquid diets (total parenteral nutrition) for long periods of time.

Symptoms of Chromium Deficiency: Impaired glucose tolerance, loss of weight, confusion, peripheral neuropathy (nerve damage).

Anatomy of Absorption:

Recommended Daily Intake: 30–35 µg (adult male) and 20–25 µg (adult female)

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

Copper is necessary for iron uptake, and a copper deficiency can result in iron deficiency. Copper deficiency can sometimes be caused by excessive zinc or iron supplementation and will occasionally manifest at the same time as B12 deficiency[2]. However, a 1993 study found Crohn's Disease patients to have higher serum levels than the control group, bringing into question the likelihood of IBD patients developing copper deficiency.[11]

Symptoms of Copper Deficiency: Tiredness, fatigue, light headedness, anemias including leukopenia and neutropenia [3], low hemoglobin due to enlarged red blood cells, myelopathy [4], peripheral neuropathy, optic neuropathy, difficulty walking, torso-based tremors, numbness, tingling, reduced reflexes, vision loss, impaired sense of smell and taste.[72]

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. Copper is stored in the liver. Ceruloplasmin (which plays a major part in iron metabolism) carries about 70% of the total copper in human plasma while albumin carries about 15%. Phytlates, fructose, and sucrose can inhibit absorption.

Recommended Daily Intake: In North America, the recommended intake of copper for healthy adult men and women is 900 micrograms/day (0.9 mg/day) with a maximum tolerable intake of 10 mg/day. Safe and acceptable daily intakes have been estimated from adult data and are as follows: 340 micrograms/day (0.34 mg/day) for children of 1–3 years; 440 micrograms/day (0.44 mg/day) for 4–8 years; 700 micrograms/day (0.7 mg/day) for 9–13 years; and 890 micrograms/day (0.89 mg/day) for 14–18 years. [5]

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.

Poll:
Have you been tested for copper deficiency?

Essential Fatty Acids

Symptoms of Essential Fatty Acid Deficiency: Pimply, rough skin at the back of the upper arms, hair loss, dandruff, eczema, PMS, darmatitis.

Anatomy of Absorption:

Recommended Daily Intake:

Natural Sources of Essential Fatty Acids:
Fish, shellfish, flaxseed (linseed), hemp oil, soya oil, canola (rapeseed) oil, chia seeds, pumpkin seeds, sunflower seeds, leafy vegetables, and walnuts.

Also check out Omega 3 Fatty Acids for specific information on DHA and EPA.

Folate

See Vitamin B9 / Folic Acid

Iodine

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. However, most processed foods do not utilized iodized salt giving rise to new levels of deficiency. In a study of the United Kingdom published in 2011, almost 70% of test subjects were found to be iodine deficient.[18]

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. The proposed mechanism of action is that iodide ion can function in gastric mucosa as an antioxidant reducing species that can detoxify poisonous reactive oxygen species, such as hydrogen peroxide.

Symptoms of Iodine Deficiency: Thyroid swelling, fatigue, goiter, mental slowing, depression, weight gain, and low basal body temperatures, modest weight gain, cold intolerance, excessive sleepiness, dry/coarse hair, constipation, dry skin, muscle cramps, increased cholesterol levels, vague aches and pains, swelling of the legs.[19]

Anatomy of Absorption:
Iodine accounts for 65% of the molecular weight of T4 and 59% of the T3. 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.

Recommended Daily Intake:
The following are the recommended daily allowances for iodine:

Infants 40 - 50 micrograms
Children
o one to three years 70 micrograms
o four to six years 90 micrograms
o seven to 10 years 120 micrograms
o 11+ years 150 micrograms
Pregnant women 175 micrograms
Lactating women 200 micrograms
Adult men & women 100 - 200 micrograms

Because iodine cannot be stored for long times in the body, tiny amounts must be consumed regularly.

Natural Sources of Iodine:
Seafood, cod, sea bass, haddock, perch, kelp, dairy products, plants grown in soil rich in iodine.[19]

Iron

Iron deficiency anemia is very common in people with Inflammatory Bowel Disease and should be regularly monitored. Anemia is often first shown by routine blood tests, which generally include a complete blood count (CBC). A sufficiently low hemoglobin (HGB) by definition makes the diagnosis of anemia.

Symptoms of Iron Deficiency: Pale/fissured tongue, hair loss, anxiety often resulting in OCD type compulsions and obsessions, irritability, angina, constipation, sleepiness, tinnitus [14], mouth ulcers, heart palpitations, hair loss, fainting or feeling faint, depression, breathlessness on exertion, twitching muscles, tingling, numbness, burning sensations, missed menstrual cycle, heavy menstrual period, dark circles under the eyes, glossitis (inflammation or infection of the tongue), angular cheilitis (inflammatory lesions at the mouth's corners), koilonychia (spoon-shaped nails), brittle nails, poor appetitie, pruritus )itchiness), dysphagia.

Anatomy of Absorption: Iron absorption is primarily in the duodenum by enterocytes of the duodenal lining and the upper jejunum. The physical state of iron entering the duodenum greatly influences its absorption. At physiological pH, ferrous iron (Fe2+) is rapidly oxidized to the insoluble ferric (Fe3+) form. Gastric acid lowers the pH in the proximal duodenum, enhancing the solubility and uptake of ferric iron. When gastric acid production is impaired (for instance by acid pump inhibitors such as the drug, prilosec), iron absorption is substantially reduced. Therefore, people with IBD should be careful about utilizing PPI's and realize that they can impair not only iron but also the absorption of many other essential vitamins and minerals when they already have absorption problems due to inflammation.

A number of dietary factors influence iron absorption. Ascorbate, citrate, and amino acids increase iron uptake whereas iron absorption is inhibited by plant phytates and tannins. Phytates are found in wheat [find other sources of phytates], while tannins are prevalent in (non-herbal) teas and should be avoided like the plague by people with IBD.

Celiac disease can cause malabsorption of iron.

Vitamin C deficiency has been shown to affect iron levels. Supplementation of vitamin C alongside normal iron supplementation has shown to greatly improve iron status versus iron supplementation alone.[40]

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. 65% of the iron in the body is bound up in hemoglobin molecules in red blood cells. About 4% is bound up in myoglobin molecules. Around 30% of the iron in the body is stored as ferritin or hemosiderin in the spleen, the bone marrow and the liver. Small amounts of iron can be found in other molecules in cells throughout the body. None of this iron is directly accessible by testing the serum.

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. 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.

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. We also absorb less iron during times of inflammation.

Ferritin is a protein that stores iron and releases it in a controlled fashion. The amount of Ferritin stored reflects the amount of iron stored. In humans, it acts as a buffer against iron deficiency and iron overload. The serum ferritin level correlates with total body iron stores; thus, the serum ferritin is the most convenient laboratory test to estimate iron stores. However, ferritin levels may be artificially high in cases of anemia of chronic disease where ferritin is elevated in its capacity as an acute phase protein and not as a marker for iron overload. In the setting of anemia, serum ferritin is the most specific lab test for iron deficiency anemia. However it is less sensitive, since its levels are increased in the blood by infection, or any type of chronic inflammation.

Low ferritin may also indicate hypothyroidism, Vitamin C deficiency or Celiac disease.

Ferritin Range: 30–400 ng/mL for males, and 13–150 ng/mL for females

Recommended Daily Intake: Please reference the chart [6] below:



Natural Sources of Iron:

There are two forms of dietary iron, heme and non heme. Heme iron is much easier for the body to absorb and is where a Crohnie should first look for dietary supplementation. Sources of heme iron:



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. [7]

Poll:
Have you been tested for iron deficiency?

Magnesium

Magnesium is the fourth most abundant mineral in the body and is essential to good health. Approximately 50% of total body magnesium is found in bone. The other half is found predominantly inside cells of body tissues and organs. Only 1% of magnesium is found in blood, but the body works very hard to keep blood levels of magnesium constant.[20]

Magnesium is needed for more than 300 biochemical reactions in the body. It helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis. There is an increased interest in the role of magnesium in preventing and managing disorders such as hypertension, cardiovascular disease, and diabetes.[21]

Symptoms of Magnesium Deficiency: Cold hands, soft/brittle nails, tender calf muscles, muscle cramps, shaking hands, hypertension, loss of appetite, nausea, vomiting, fatigue, weakness, numbness, tingling, muscle contractions and cramps (Tetnus), seizures, personality changes, abnormal heart rhythms (Arrhythmias), light sensitivity, agitation, anxiety, restless leg syndrome (RLS), sleep disorders, irritability, nausea, vomiting, low blood pressure, confusion, hyperventilation, insomnia, poor nail growth, ADHD, chronic fatigue syndrome, depression, epilepsy, diabetes mellitus, tremor, Parkinsonism, arrhythmias, circulatory disturbances (stroke, cardiac infarction, arteriosclerosis), hypertension, migraine, cluster headache, cramps, neuro-vegetative disorders, abdominal pain, osteoporosis, asthma, stress dependent disorders, tinnitus, ataxia, confusion, preeclampsia, weakness.[36],[41],[63],[73]


Anatomy of Absorption:
Magnesium is absorbed primarily in the distal small intestine (terminal ileum), and healthy people absorb approximately 30% to 40% of ingested magnesium.[23]

The health status of the digestive system and the kidneys significantly influence magnesium status. Magnesium is absorbed in the intestines and then transported through the blood to cells and tissues. Gastrointestinal disorders that impair absorption such as Crohn's disease can limit the body's ability to absorb magnesium. These disorders can deplete the body's stores of magnesium and in extreme cases may result in magnesium deficiency. Chronic or excessive vomiting and diarrhea may also result in magnesium depletion.[20][26]

In a study that compared four forms of magnesium preparations, results suggested lower bioavailability of magnesium oxide, with significantly higher and equal absorption and bioavailability of magnesium chloride and magnesium lactate.[22]

As magnesium is required for processing of potassium, low potassium levels even after supplementation may be due to magnesium deficiency.

The National Health and Nutrition Examination Survey (NHANES) 1999-2000, a U.S. national survey, found American adults who consumed less than the RDA of magnesium were 1.48 to 1.75 times more likely to have elevated CRP levels compared to those who consumed at least the RDA. This survey found that 68% of the sample consumed less than the RDA of magnesium.[38]

Recommended Daily Intake:
The following chart provides daily recommended intake of Magnesium.[21]



Natural Sources of Magnesium:
Spinach, Blackstrap molasses, beans, peas, whole/unrefined grains, halibut, almonds, cashews, soybeans, potatoes, peanut butter, brown rice, avocado, bananas, milk chocolate, raisins

Poll:
Have you been tested for Magnesium deficiency?

Potassium

Potassium deficiency is known as hypokalaemia, hypopotassemia or hypopotassaemia. The risk of potassium deficiency is increased in people with IBD who suffer from chronic vomiting or diarrhea or are taking prednisone.[26]

Symptoms of Potassium Deficiency:
Cardiac arrhythmias, elevated blood pressure, muscular weakness, myalgia, muscle cramps, constipation, paralytic ileus (think bowel obstruction!), decreased reflex response. In severe cases low potassium levels can be fatal[64]

Anatomy of Absorption:
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. Normal potassium levels are 3.5 to 5.0 mEq/L and 95% of potassium is found in cells with the rest being found in the blood.

As magnesium is required for processing of potassium, low potassium levels even after supplementation may be due to magnesium deficiency.

Recommended Daily Intake:
* 1 - 3 years: 3 g/day
* 4 - 8 years: 3.8 g/day
* 9 - 13 years: 4.5 g/day
* 14 - 18 years: 4.7 g/day
* 19 and older: 4.7 g/day[27]

Natural Sources of Potassium:
Excellent sources of potassium include (look at the reference document for a fantastic list): Blackstrap molasses, Cantaloupe, dates, raisins, avocado, apricots, bananas, peaches, prune juice, orange juice, tomato juice, grapefruit juice, baked potato, acorn squash, tomatoes, spinach, mushrooms, lentils, yogurt, milk, flounder, sardines, liver, pistachios [25]

Warnings:
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. Do not take extra potassium without informing your doctor. Some diuretics do the opposite and cause potassium to accumulate in the body.[24] Too much potassium in the blood is known as hyperkalemia.

Selenium

Selenium deficiency can occur in people with severely compromised intestinal function or those on Total Parental Nutrition. It also occurs in areas with low amounts of selenium in the soil as dietary selenium occurs when plants uptake selenium and are then consumed. One study showcased that 26% of people with Crohn's Disease were selenium deficient whereas those with Ulcerative Colitis were rarely found to be deficient.[31]

Symptoms of Selenium Deficiency:
Selenium deficiency can cause symptoms of hypothyroidism, including extreme fatigue, mental slowing, goiter, cretinism and recurrent miscarriage. It may also lead to a depressed immune system and rheumatoid arthritis.[30],[33],[34]

Anatomy of Absorption:
A study found that anyone with greater than 200cm of small bowel removed were at high risk for severe selenium deficiency and should be regularly monitored and likely supplemented.[32]

Several forms of selenium enter the body as part of amino acids within proteins. 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. The primary sites of absorption are from throughout the duodenum. Virtually no absorption occurs in the stomach and very little takes places in the remaining two segments of the small intestine. Selenomethionine is absorbed from the duodenum at a rate close to 100%. Other forms of the element have been shown to also be generally well absorbed. However, absorption of inorganic forms of the element varies widely due to luminal factors. This variation in absorption reduces total absorption of all forms to somewhere between 50 and 100%. Selenium absorption is not affected by body selenium status. Absorption of selenium is closely related to multiple nutritional factors that inhibit or promote absorption. Vitamins A, C, and E along with reduced glutathione enhance absorption of the element.[35]

Recommended Daily Intake:
In the USA, the Dietary Reference Intake for adults is 55 µg/day. In the UK it is 75 µg/day for adult males and 60 µg/day for adult females.

Natural Sources of Selenium:
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.

Warning:
Too much selenium (greater than 100 mcg/dL) can lead to selenosis. Supplementation of selenium should be discussed with a medical provider.

Sodium

Sodium is a electrolyte, meaning it can carry electrical charges in the body. All cells need sodium in order to be able to function correctly. Sodium is readily available in the diet as salt, therefore deficiency is not normally due to dietary factors. However, in IBD, there are various factors that increase the risk of deficiency, also called Hyponatremia. These include inflammation, scarring or removal of the terminal ileum and loss of sodium through diarrhoea. In addition, people in hospital are more at risk of deficiency, as are people taking selective serotonin reuptake inhibitors (SSRIs, a class of antidepressant). Finally, Addison's disease also causes loss of sodium, which may be a concern for patients weaning off steroids.

Sodium levels in the blood can be measured routinely as 'urea and electrolytes' or U and E for short.

Symptoms of sodium deficiency
Headache, nausea and vomiting, tiredness, fatigue, muscle cramps. In severe cases, neurological problems or even coma can result.

Anatomy of absorption
Sodium is passively absorbed throughout the small intestine (meaning if there are large amounts of sodium present, it will diffuse across the intestinal wall). However, it is actively absorbed in the terminal ileum, meaning the body expends energy to be able to absorb small amounts of sodium.

Recommended daily intake
An intake of 1.5g of sodium is adequate for healthy adults (children need considerably less). This equates to 4g of salt. Current guidelines state that healthy adults should eat no more than 6g of salt per day. However, patients who have had their terminal ileum removed may be advised to eat more.

Sources of sodium
Most of the sodium we eat is from salt, however there may also be small amounts gained from additives (like monosodium glutamate). Salt and additives are present in high quantities in processed foods, and possibly those served in restaurants etc. Salt may also be added directly to food during cooking, or before eating.

Most vegetables and dairy produce contain trace amounts of sodium (eg 100mg of sodium in 1 cup of milk).

Sulfur

Symptoms of Sulfur Deficiency:

Anatomy of Absorption:

Recommended Daily Intake:

Natural Sources of Sulfur:

Vitamin A

Warning
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. It is strongly suggested to have your vitamin D levels checked (and likely supplement vitamin D) before supplementing Vitamin A. Too much vitamin A while deficiency in vitamin D can lead vitamin D impairment.[46]

Vitamin A is commonly known as the anti-infective vitamin, because it is required for normal functioning of the immune system. 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. Retinol and its metabolites are required to maintain the integrity and function of these cells. Vitamin A and retinoic acid (RA) play a central role in the development and differentiation of white blood cells, such as lymphocytes, which play critical roles in the immune response.[39]

Symptoms of Vitamin A Deficiency: rough skin (especially on the heels), dry eyes, night blindness, diminished immune response, xerophthalmia (reduced tear production), eye infection [37], decreased sense of smell[72]

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.

Supplementation of vitamin A in individuals with iron deficiency anemia alongside normal iron supplementation is shown to have significantly improved iron status than iron supplementation alone.[40]

Anatomy of Absorption:
Distal Ileum[74]

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.

Recommended Daily Intake:


Natural Sources of Vitamin A:
* liver (beef, pork, chicken, turkey, fish) (6500 μg 722%)
* dandelion greens (5588 IU 112%)
* carrot (835 μg 93%)
* broccoli leaf (800 μg 89%)
* sweet potato (709 μg 79%)
* butter (684 μg 76%)
* kale (681 μg 76%)
* spinach (469 μg 52%)
* pumpkin (400 μg 41%)
* collard greens (333 μg 37%)
* Cheddar cheese (265 μg 29%)
* cantaloupe melon (169 μg 19%)
* egg (140 μg 16%)
* apricot (96 μg 11%)
* papaya (55 μg 6%)
* mango (38 μg 4%)
* pea (38 μg 4%)
* broccoli (31 μg 3%)
* milk (28 μg 3%)

Vitamin B1

Symptoms of Vitamin B1 Deficiency: Deficiency causes beriberi. Symptoms of this disease include weight loss, emotional disturbances, Wernicke's encephalopathy (impaired sensory perception), weakness and pain in the limbs, peripheral neuropathy, burning feet, periods of irregular / rapid heartbeat, and edema (swelling of bodily tissues), difficulty rising from a squatting position, abnormal eye movements, stance and gait abnormalities.

Anatomy of Absorption:

Recommended Daily Intake:

Natural Sources of Vitamin B1:

Vitamin B2

Vitamin B2 (Riboflavin) is a water soluble vitamin. Riboflavin deficiency alters iron metabolism. Riboflavin deficiency may impair iron absorption, increase intestinal loss of iron, and/or reduce iron utilization for the creation of hemoglobin. Improving riboflavin levels has been found to increase circulating hemoglobin levels. Correction of riboflavin deficiency in individuals who are both riboflavin and iron deficient improves the response of iron-deficiency anemia to iron therapy.[50]. Riboflavin deficiency is known as Ariboflavinosis and is endemic is certain areas of the world and in specific populations such as vegans.[62]

Symptoms of Vitamin B2 Deficiency: Greasy/red scaly skin on face and sides of nose, sore/burning/red/inflamed tongue, peeling lips, split / cracked lips with sores (cheliosis), sores at the corners of the mouth (angular stomatitis), sensitivity to sunlight, inflammation of the tongue, seborrheic dermatitis or pseudo-syphilis (particularly affecting the scrotum or labia majora and the mouth), pharyngitis (sore throat), vascularization of the cornea (red eyes), decreased red blood cell count (normochromic normocytic anemia), hyperemia (increase blood flow to areas of the body), preeclampsia in pregnant women, and edema of the pharyngeal and oral mucosa.

Anatomy of Absorption:
It appears that vitamin B2 is absorbed in both the small and large intestine[49] though other sources state the proximal small intestine and is catalyzed by enterocytes.[62] There is evidence that the current RDA is too low or thresholds for deficiency are incorrect.[62]

Recommended Daily Intake:



Natural Sources of Vitamin B2:



Toxicity
No toxic or adverse effects of high riboflavin intake in humans are known.[50]

Vitamin B3

Niacin, also known as Vitamin B3, is a water soluble vitamin.

Symptoms of B3 Deficiency: Deficiency of niacin causes Pellagra. Symptoms include aggression, dermatitis, insomnia, weakness, mental confusion, and diarrhea. A thick, scaly, darkly pigmented rash develops symmetrically in areas exposed to sunlight. In advanced cases, Pellagra may lead to dementia and death (the 3(+1) Ds: dermatitis, diarrhea, dementia, and death). [65]

Decreased sense of smell and taste[72]

Causes of B3 Deficiency: [65]
- Inadequate Dietary Intake / Reduced Bioavailability in Diet
- Medication (Isoniazid)
- Hartnup's Disease
- Carcinoid Syndrome
- Seromycin (cycloserine) [66]

For More Information on Vitamin B3 / Niacin Please Click This Link.

Vitamin B5

Vitamin B5 deficiency in humans is extremely rare except in extreme cases of malnutrition.

Symptoms of Vitamin B5 Deficiency:

Anatomy of Absorption:

Recommended Daily Intake:

Natural Sources of Vitamin B5:

Vitamin B6

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. [67]

Vitamin B6 deficiency can cause deficiency in Vitamin B3 / Niacin, which can cause symptoms similar to Pellagra. [67]

Vitamin B6 is important for the Synthesis of Neurotransmitters (ie Dopamine, Serotonin, Epinephrine, Norepinephrine, GABA). [67]

Symptoms of Vitamin B6 Deficiency: Irritability, depression, and confusion, inflammation of the tongue, sores or ulcers of the mouth, ulcers of the skin at the corners of the mouth.[51], and peripheral neuropathy [67].

Decreased sense of smell[72]

For More Information on Vitamin B6 / Pyridoxine Please Click This Link

Vitamin B7 - Biotin


Other Names for Vitamin B7
- Biotin
- Coenzyme R
- Vitamin H

About Vitamin B7 - Biotin

- Biotin is a water soluble vitamin.

What does Vitamin B7 - Biotin Do?
Biotin is an important factor in the body's biochemical pathways, including:
- Gluconeogenesis - The process by which the body makes its own glucose.
- Making Fatty Acids
- Making Amino Acids - Isoleucine
- Making Amino Acids - Valine

Vitamin B7 - Biotin Deficiency

- Biotin is a water soluble vitamin and deficiency is rare except in people on Total Parenteral Nutrition (TPN) or in persons that consume large quantities of raw egg whites (without the yolk) for prolonged periods.

Causes of Vitamin B7 - Deficiency
Certain diseases and conditions have a greater likelihood of Vitamin B7 - Biotin Deficiency.
- Alcoholism / Alcoholics

- Achlorhydria / Hypochlorhydria - No stomach acid or Low Levels of stomach acid.

- Gastrectomies

Symptoms of Vitamin B7 Deficiency: Hair loss, scaly red rash around the eyes, nose, mouth, and genital area, depression, lethargy, hallucination, and numbness and tingling of the extremities.[52]

Anatomy of Absorption:

Recommended Daily Intake:

Natural Sources of Vitamin B7:

Vitamin B9 / Folate / Folic Acid

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]. If you are found to be deficient in folate, recent studies have found that supplementation with folate, vitamin B6, and vitamin B12 rather than just folate has superior results.[47]

Symptoms of Vitamin B9 / Folate Deficiency: Deficiency results in a macrocytic anemia, megaloblastic anemia, and elevated levels of homocysteine.

Anatomy of Absorption:
As folate is primarily absorbed in the jejunum extensive inflammation in the jejunum (middle portion of the small intestine) or removal of the jejunum increases the likelihood of fotate deficiency.[26]

Drugs shown to interfere with Folic Acid Utilization include methotrexate and sulfasalazine. If sulfasalazine is prescribed, folic acid supplements are normally given. The purpose of methotrexate is to inhibit dihydrofolate reductase and thereby reduce the rate de novo purine and pyrimidine synthesis and cell division. It may therefore be counter-productive to take a folic acid supplement with methotrexate. Although the folic acid inhibition of sulfasalazine is normally seen as a side effect, it is possible that it is a part of the therapeutic effect of the drug, given that methotrexate, a frank folic acid inhibitor, is often given if sulfasalazine fails. It would therefore be wise to consult with a physician before taking a folic acid supplement along with sulfasalazine or methotrexate. [Citation needed]

- Supplementation of Zinc and Folate (Folic Acid) together can reduce absorption of both Zinc and Folate. [68][69] *Care should be taken when supplementing.

- Multiple Anti-Epileptic, Anti-Seziure, Bipolar Disorder medications decrease Folate absorption (i.e. Valproic Acid / Valproate / Carbamazepine). Often, Folic Acid Supplementation is suggested especially for females of reproductive age. [70] Consult your physician before beginning a supplementation regieme.


Recommended Daily Intake:

Natural Sources of Vitamin B9:

Vitamin B12

Vitamin B12 deficiency is very common in people with Crohn's Disease. Some doctors do not test vitamin b12 levels directly but mistakenly only look for signs of megaloblastic anemia which can be masked by high folic acid intake and is NOT present in upwards of 25% of cases[53] or if there is not elevated MCV (it can be normal with B12 deficiency).[57] Make sure they, at the very least test serum B12 levels. Vitamin B12 deficiency leads to a serum build-up of methylmalonic acid and homocysteine. Because of this, Homocysteine and Methylmalonic acid levels are considered more reliable indicators of B12 deficiency than the concentration of B12 in blood. Approximately 10% of patients with vitamin B12 levels between 200–400pg/l will have a vitamin B12 deficiency on the basis of elevated levels of homocysteine and methylmalonic acid. Part of the problem is there are vitamin B12 analogues which are inactive B12 in the body and cobalamin which is the active B12. Serum B12 tests do not differentiate.

Symptoms of Vitamin B12 Deficiency: Premature grey hair, tinnitus [16], subacute combined degeneration (SCD) of the spinal cord, weakness, tiredness, light-headedness, rapid heartbeat and breathing, pale skin, sore tongue, easy bruising or bleeding, including bleeding gums, stomach upset, weight loss, diarrhea, constipation, tingling or numbness in fingers and toes (peripheral neuropathy), megaloblastic anemia, difficulty walking, mood changes or depression, memory loss, disorientation, dementia, decreased sense of smell and taste72

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).

Anatomy of Absorption:
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. H.pylori infection has been incriminated to cause B12 malabsorption among adults. About 1% of large oral doses of vitamin B12 passively diffuses into the bloodstream from the small intestine.

Recommended Daily Intake:
Intake is based upon what the person with Crohn's Disease needs. It is best to get your levels tested so that it can be determined if supplementation is needed and at what dosage and interval.

Natural Sources of Vitamin B12:
The chart below provides sources of vitamin B12:



While vitamin B12 supplementation is generally safe, there are some safety measures to be aware of first. Potassium levels should be monitored closely while taking high doses of B12, eating a banana or peanut butter may help increase dietary potassium intake.

Supplementation of Vitamin B12 may reduce levels of other B Vitamins and can lead to imbalance [54]. Consult your physician about adding a B Complex Vitamin to your Vitamin B12 therapy.

More Information on Vitamin B12
For More Information on Vitamin B12 Please Check the Vitamin B12 Wiki Page Here

Poll:
Have you been tested for Vitamin B12 deficiency?

Vitamin C

[pos]vitca[/pos]Vitamin C

Vitamin C is also known as ascorbic acid. As humans cannot make vitamin C, it needs to come entirely from diet and symptoms can begin to emerge after a mere 30 days without consumption. Vitamin C is necessary for iron absorption (and should be taken alongside supplemental iron), collagen formation, hair growth, and stability.

Symptoms of Vitamin C Deficiency: Bleeding gums, frequent colds, perifollicular hemorrhages, petechiae, splinter hemorrhages (vertical lines under nails), follicular keratosis, poor wound healing, fatigue, weight loss, diarrhea, depression, shin nodules, peripheral edema.[29]

Anatomy of Absorption:

Recommended Daily Intake:
Smokers and those on prednisone have greater daily needs for vitamin C.[pos]29a[/pos]

Natural Sources of Vitamin C:

Vitamin D

[pos]vitda[/pos]Vitamin D

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. 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. The active form of vitamin D, 1,25-dihydroxyvitamin D, inhibits proliferation and stimulates the differentiation of cells.[42]. 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. In addition, the active form of vitamin D stimulates the expression of antimicrobial peptides, which are synthesized by various immune cells and function as critical components of the innate immune system.[55]

It has been shown that wearing just SPF 8 sunscreen reduces Vitamin D synthesis via sunlight by 95%.[43] Obese people are also at higher risk for vitamin D deficiency due to the low bioavailability of vitamin D in their system because it is stored in body fat.[45]

Symptoms of Vitamin D Deficiency:
Bone pain, soft bones (osteomalacia), rickets, hyperparathyroidism, muscle weakness, muscle pain, joint pain, poor immune function, and depression [59].

Anatomy of Absorption:
Distal Ileum[74]

You are at increased risk of vitamin D deficiency if you have trouble absorbing fats or have inflammation of large portions of the jejunum and/or ileum or you have had portions of the jejunum or ileum surgically removed.[26]. Vitamin D is one of the most important vitamins for people with IBD to supplement as it can make a world of difference. This thread is full of people with IBD who have benefited from supplementing with it.

Recommended Daily Intake:
The US RDA for vitamin D is completely outdated and not pertinent to people with Crohn's Disease or other forms of IBD. A serum level of 60-80 ng/ml ("normal" range can be much lower, pay no attention to that) of 25-hydroxy vitamin D should be your target [48] which will likely require as much as 6,000iu per day to achieve. However, everyone is different and you may require more or less. Get your levels tested and begin supplementing under care of a doctor. Get your levels tested regularly so you can find the daily supplementation amount that works best for you.

100 IU (2.5 mcg) per day increases vitamin D blood levels 1 ng/ml (2.5 nmol/L).
200 IU (5 mcg) per day increases vitamin D blood levels 2 ng/ml (5 nmol/L).
400 IU (10 mcg) per day increases vitamin D blood levels 4 ng/ml (10 nmol/L).
500 IU (12.5 mcg) per day increases vitamin D blood levels 5 ng/ml (12.5 nmol/L).
800 IU (20 mcg) per day increases vitamin D blood levels 8 ng/ml (20 nmol/L).
1000 IU (25 mcg) per day increases vitamin D blood levels 10 ng/ml (25 nmol/L).
2000 IU (50 mcg) per day increases vitamin D blood levels 20 ng/ml (50 nmol/L).[60]

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]. According to a letter from Doctor John J Cannell MD of the Vitamin D Council written in November 2011 to Crohnsforum.com, "25(OH)D levels need to be 70-80 ng/ml, which requires 5,000 – 10,000 IU/day of vitamin D3, to treat Crohn’s disease.

Vitamin D needs cofactors to work properly. 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. These are the cofactors vitamin D needs to work. For example, the vitamin D receptor is like a glove. At the base of the fingers of the glove is a zinc molecule. Most Americans are zinc deficient. The same is true for boron, magnesium and probably K2.

I recommend the new D-Plus from Bio-Tech Pharmacal. Make sure it is the new formula, not the old one. 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. Take with largest meal of day."

Vitamin D Should Not Be Used:
[58]
- In patients with hypercalcemia (high calcium levels)
- In dialysis patients may a drop in serum alkaline phosphatase may occur before hypercalcemia.
- In patients previously having an allergic reaction to any of the pill's ingredients
- In patients with symptoms of Vitamin D Toxicity

Vitamin D Should Be Used With Caution:[58]
- In Dialysis Patients
- In Children
- In patients with high Calcium and Phosphate Intake

Symptoms of Vitamin D Toxicity/Overdosage:[58]
- Hypercalcemia (High Serum Calcium)
- Hypercalcuria (High Calcium in Urine)
- Hyperphosphatemia (High Serum Phosphate)

Early Vitamin D Toxicity Signs:[58]
- weakness, headache, tiredness, nausea/vomiting, dry mouth, constipation, pain in muscle or bone, metallic taste.

Late Vitamin D Toxicity Signs:[58]
- frequent urination, weight loss, loss of appetite, photophobia (sensitivity of eyes to light), hyperthermia (high body temperature), excessive thirst, runny nose, high blood pressure, high cholesterol, inflammation of the pancreas, heart rhythm abnormalities, itchy skin, increased serum SGOT (serum glutamic oxaloacetic transaminase) and SGPT (serum glutamic pyruvic transaminase), calcium deposits in tissues, increased serum BUN (blood urea nitrogen), and albuminuria (albumin in the urine).

Vitamin D Supplement by Injection
For those who are unable to get sufficient Vitamin D through food, sunlight or oral supplementation, Vitamin D can be administered by injection. One example of an injectable Vitamin D supplement is Zemplar (Paricalcitol), supplied by Abbott Laboratories.[61]

More Information on Vitamin D
For More Information on Vitamin D Please Check the Vitamin D Wiki Page Here

Vitamin E

[pos]vitea[/pos]Vitamin E

Symptoms of Vitamin E Deficiency:

Anatomy of Absorption:
Distal Ileum[74]

You are at increased risk of vitamin E deficiency if you have trouble absorbing fats or have inflammation of large portions of the jejunum and/or ileum or you have had portions of the jejunum or ileum surgically removed.[26]

Recommended Daily Intake:

Natural Sources of Vitamin E:

Vitamin K

[pos]vitka[/pos]Vitamin K

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. While vitamin K deficiency is rare in healthy individuals, having Crohn's Disease significantly increases your risk of deficiency.[56]

Symptoms of Vitamin K Deficiency:
Bleeding gums, bloody nose, decreased bone density

Anatomy of Absorption:
Distal Ileum[74]
You are at increased risk of vitamin K deficiency if you have trouble absorbing fats or have inflammation of large portions of the jejunum and/or ileum or you have had portions of the jejunum or ileum surgically removed.[26]

Recommended Daily Intake:
Children 4 - 8 years: 55 mcg
Children 9 - 13 years: 60 mcg
Adolescents 14 - 18 years: 75 mcg
Men 19 years and older: 120 mcg
Women 19 years and older: 90 mcg

Available Forms
There are 3 forms of vitamin K:
  • Vitamin K1 or phylloquinone, the natural version of K1 and phytonadione, the synthetic type of K1
  • Vitamin K2 or menaquinone
  • Vitamin K3 or menaphthone or menadione

Natural Sources of Vitamin K:
Green leafy vegetables, asparagus, green tea, beef liver, gut bacteria

Zinc

[pos]zinca[/pos]Zinc
- Excessive Zinc supplementation can result in zinc toxicity and blocking of copper absorption. Care should be taken when supplementing.

- Supplementation of Zinc and Folate (Folic Acid) together can reduce absorption of both Zinc and Folate. [68][69] Care should be taken when supplementing.

Symptoms of Zinc Deficiency: White spots on nails, ridges on nails, stretch marks, frequent colds, miscarriage, infertility, premature labor, poor sense of smell/taste[72], tinnitus (ringing in the ears) [15]

Anatomy of Absorption:
You are at increased risk for zinc deficiency if you have extensive inflammation located in the jejunum or have had it surgically removed, have chronic diarrhea, are losing fluids through fistula, or are taking prednisone.[26]

Natural Sources of Zinc:

Warning:
Excessive supplementation of Zinc can lead to zinc toxicity. Pay special attention to recommended daily intake and supplementation levels.

Drug Specific Vitamin And Mineral Information

Various drugs have varying affects on the body's use of and absorption of vitamins and minerals.

Prednisone

Prednisone causes decreased absorption of calcium and phosphorus from the small intestine. It also causes increased losses of calcium, zinc, potassium and vitamin C. With continual use of high doses of prednisone, the result may be bone loss, osteoperosis and development of bone disease. People on long term prednisone are often encouraged to take Vitamin D and Calcium supplements. [71] Protein needs also are increased for people taking prednisone because it increases protein breakdown in the body.[26]

Sulfasalazine

Sulfasalazine interferes with folate absorption. People taking this drug also should take a 1 milligram folate supplement each day.[26]

Welchol, Questran (Cholestyramine), Psyllium Husk

Welchol and Questran (Cholestyramine) and Psyllium husk are often taken as a means to reduce frequency of bowel movements. However, they are shown to inhibit absorption of the fat soluble vitamins A, D, E, and K as well as folate, vitamin B-12, calcium and iron. Vitamin levels should be monitored closely (most Crohnies are deficient in vitamin D in many of these) and supplements should be taken at least four hours prior to taking Welchol, Questran, or psyllium husk.[26]

Methotrexate

Methotrexate is shown to inhibit absorption of vitamin B12[54], something many Crohnies are already deficient in. Get your B12 levels checked regularly.

Notes About Supplementation:

1. One should not self-supplement just because symptoms above are present. We strongly recommend proper testing and evaluation by a medical professional as too much of some vitamins and minerals can be detrimental to your health.

References

[pos]1a[/pos][1] http://hortsci.ashspublications.org/...stract/44/1/15
[pos]2a][/pos][2] http://cat.inist.fr/?aModele=afficheN&cpsidt=20334693
[pos]3a[/pos][3] http://www.mayoclinicproceedings.com...7/943.full.pdf
[pos]4a[/pos][4] http://www.ncbi.nlm.nih.gov/pubmed/20232210
[pos]5a[/pos][5] http://www.nlm.nih.gov/medlineplus/e...cle/002419.htm
[pos]6a[/pos][6] http://ods.od.nih.gov/factsheets/iron#h4
[pos]7a[/pos][7] http://www.nlm.nih.gov/medlineplus/e...cle/002422.htm
[pos]8a[/pos][8] http://www.ncbi.nlm.nih.gov/pmc/arti...00403-0084.pdf
[pos]9a[/pos][9] http://ods.od.nih.gov/factsheets/chromium
[pos]10a[/pos][10] http://ods.od.nih.gov/factsheets/Fol...thProfessional
[pos]11a[/pos][11] http://informahealthcare.com/doi/abs...65529309096096
[pos]12a[/pos][12] http://ods.od.nih.gov/factsheets/calcium
[pos]13a[/pos][13] http://www.iom.edu/~/media/Files/Rep...rt%20Brief.pdf
[pos]14a[/pos][14] http://www.bmj.com/content/314/7077/360.extract
[pos]15a[/pos][15] http://journals.lww.com/otology-neur...nnitus.18.aspx
[pos]16a[/pos][16] http://www.sciencedirect.com/science...9607099390046A
[pos]17a[/pos][17] http://www.thelancet.com/journals/la...009-0/fulltext
[pos]18a[/pos][18] http://www.thelancet.com/journals/la...693-4/abstract
[pos]19a[/pos][19] http://www.med.umich.edu/1libr/aha/umioddef.htm
[pos]20a[/pos][20] http://onlinelibrary.wiley.com/doi/1...8.13.4.749/pdf
[pos]21a[/pos][21] http://ods.od.nih.gov/factsheets/magnesium
[pos]22a[/pos][22] http://www.ncbi.nlm.nih.gov/pubmed/11794633
[pos]23a[/pos][23] http://www.cmellc.com/geriatrictimes/g020208.html
[pos]24a[/pos][24] http://www.umm.edu/altmed/articles/edema-000055.htm
[pos]25a[/pos][25] http://www.umassmed.edu/uploadedFile...yPotassium.pdf
[pos]26a[/pos][26] http://www.ucsfhealth.org/education/...bowel_disease/
[pos]27a[/pos][27] http://www.umm.edu/ency/article/002413rec.htm
[pos]28a[/pos][28] http://www.siumed.edu/mrc/research/nutrient/gi42sg.html
[pos]29a[/pos][29] http://www.amazon.com/Diagnosis-Agin...8190093&sr=8-1 also available through Google book search
[pos]30a[/pos][30] http://ods.od.nih.gov/factsheets/selenium
[pos]31a[/pos][31] http://www.ncbi.nlm.nih.gov/pubmed/9...?dopt=Abstract
[pos]32a[/pos][32] http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract
[pos]33a[/pos][33] http://www.ncbi.nlm.nih.gov/pubmed/8...?dopt=Abstract
[pos]34a[/pos][34] http://www.ncbi.nlm.nih.gov/pubmed/9...?dopt=Abstract
[pos]35a[/pos][35] http://www.exrx.net/Nutrition/Antiox.../Selenium.html
[pos]36a[/pos][36] http://www.umm.edu/altmed/articles/magnesium-000313.htm
[pos]37a[/pos][37] http://jn.nutrition.org/content/134/1/231S.full.pdf
[pos]38a[/pos][38] http://www.ncbi.nlm.nih.gov/pubmed/15930481
[pos]39a[/pos][39] http://lpi.oregonstate.edu/infocente...mins/vitaminA/
[pos]40a[/pos][40] http://www.sciencedirect.com/science...4067369392246P
[pos]41a[/pos][41] http://www.springerlink.com/content/n7x08g2444795hn0/
[pos]42a[/pos][42] http://lpi.oregonstate.edu/infocente...mins/vitaminD/
[pos]43a[/pos][43] http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract
[pos]44a[/pos][44] http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract
[pos]45a[/pos][45] http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract
[pos]46a[/pos][46] http://www.vitamindcouncil.org/news-...tamin-a-ratio/
[pos]47a[/pos][47] http://www.reference-global.com/doi/.../CCLM.2001.128
[pos]48a[/pos][48] http://www.trackyourplaque.com/blog/...n-d-right.html
[pos]49a[/pos][49] http://ajpcell.physiology.org/content/278/2/C268.full
[pos]50a[/pos][50] http://lpi.oregonstate.edu/infocente...ns/riboflavin/
[pos]51a[/pos][51] http://lpi.oregonstate.edu/infocente...tml#deficiency
[pos]52a[/pos][52] http://lpi.oregonstate.edu/infocenter/vitamins/biotin/
[pos]53a[/pos][53] http://lpi.oregonstate.edu/infocente...ns/vitaminB12/
[pos]54a[/pos][54] http://www.umm.edu/altmed/articles/v...b12-000332.htm
[pos]55a[/pos][55] http://lpi.oregonstate.edu/ss10/nutrition.html
[pos]56a[/pos][56] http://www.umm.edu/altmed/articles/vitamin-k-000343.htm
[pos]57a[/pos][57] http://www.ncbi.nlm.nih.gov/pubmed/10757449
[pos]58a[/pos][58] http://www.drugbank.ca/system/fda_la...pdf?1265922794
[pos]59a[/pos][59]http://jcem.endojournals.org/content....full.pdf+html
[pos]60a[/pos][60] http://www.medscape.com/viewarticle/589256_8
[pos]61a[/pos][61] http://www.rxabbott.com/pdf/zemplarivpi.pdf
[pos]62a[/pos][62] http://www.ajcn.org/content/77/6/1352.full
[pos]63a[/pos][63] http://www.fda.gov/Safety/MedWatch/S.../ucm245275.htm
[pos]64a[/pos][64] http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001510
[pos]65a[/pos][65] http://lpi.oregonstate.edu/infocenter/vitamins/niacin
[pos]66a[/pos][66] http://dailymed.nlm.nih.gov/dailymed...fo.cfm?id=4488
[pos]67a[/pos][67] http://books.google.com/books?id=L6_...epage&q&f=true
[pos]68a[/pos][68] http://www.ajcn.org/content/43/2/258.full.pdf+html
[pos]69a[/pos][69] www.ajcn.org/content/39/4/535.full.pdf
[pos]70a[/pos][70] http://www.ncbi.nlm.nih.gov/pmc/arti...00077-0025.pdf
71. http://www.unc.edu/~antheald/PDF%20F...costeroids.pdf
[pos]72a[/pos][72] http://www.aafp.org/afp/2000/0115/p427.html
[pos]73a[/pos][73] http://www.jacn.org/content/23/6/730S.full
[pos]74a[/pos][74] http://gsm.utmck.edu/surgery/documen...lIntestine.pdf

http://www.food.gov.uk/multimedia/pd...ewofchrome.pdf
http://www.wikipedia.org
http://www.drmyhill.co.uk/wiki/Nutri...al_features_of
http://sickle.bwh.harvard.edu/iron_absorption.html
http://www.faqs.org/nutrition/Smi-Z/...r-Soluble.html
http://www.nal.usda.gov/fnic/DRI//DR...96-305_150.pdf
http://lpi.oregonstate.edu/infocente...ns/vitaminB12/
http://www.sciencedirect.com/science...95435603003834
http://www.nejm.org/doi/full/10.1056/NEJMoa022639
http://www.aafp.org/afp/2003/0301/p979.html
http://www.ncbi.nlm.nih.gov/pubmed/8154512
http://www.aafp.org/afp/2003/0301/p979.html

Popular Threads Discussing Vitamin and Mineral Deficiencies



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11-28-2011, 02:07 PM   #21
fatjoe216
 
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Good stuff! I have not taken my micro nutrient test yet but this will come in handy for later. Thanks!
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11-28-2011, 04:51 PM   #22
xX_LittleMissValentine_Xx
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Oooh, this looks like fun! Let me know if u get particularly stuck on anything. I have a lot of nutrition books (coz of my degree). I don't want to get too involved right now though... will end up procrastinating on it! I do know that vit D stuff that is blank.
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12-05-2011, 11:20 AM   #23
crohnicaly stinky
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http://www.wellprovitamins.com/Spect...amin_Test.html

Anyone care to comment on this test in terms of getting good data? I have not found the cost yet

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12-28-2011, 08:07 AM   #24
QueenGothel
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Wow this is a lot of information. Anyone know if an easy to swallow adult vitamin that is for men or women I can give my DD which they take two and I can give her one daily. I found a synthetic one but unfortunately looks just like her iron pill and am worried I will get them confused. And it is lacking a lot of vital supplements.
12-28-2011, 09:27 AM   #25
David
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What makes you want to do it that way rather than a regular children's multivitamin?
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12-28-2011, 09:55 AM   #26
QueenGothel
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The children's are all liquids or chewables and they make her throw up. She is accustomed to pills now. Doctor said since she has a blood transfusion and has bad absorption to give her an adult multiple vitamin. But of course they don't have a specific one to recommend I have spent a lot of money on vitamins to open them up and they are huge. I will take them so no waste, but I have enough for me. So they recommended finding an adult 2x a day and using it as a one a day.
01-01-2012, 07:38 PM   #27
David
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I've been adding info over the last week or so without bumping, but this one requires a bump:

From the University of Maryland Medical Center:
Taking any one of the B vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, you may want to take a B complex vitamin, which includes all the B vitamins.
http://www.umm.edu/altmed/articles/v...b12-000332.htm

A LOT of people here are on B12 supplementation. And many of the extraintestinal manifestations we see are due to deficiencies in other B vitamins. So save yourself the trouble and take a quality B complex along with your B12.
01-01-2012, 11:16 PM   #28
Tesscorm
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Hi Myreinhard,

My daughter, 18 (no crohns) takes adult One-a-day Fruiti-ssentials and they are 'gummies' (like the gummy bears candy). The adult dosage is 2 per day. I haven't tried them but both my kids always liked them (when they were younger, ie. 14 years old, I had to stress that they could ONLY have 2 per day!).

Last edited by Tesscorm; 01-03-2012 at 08:50 AM.
01-02-2012, 07:42 PM   #29
Cross-stitch gal
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Thanks David! I found in an earlier post about Vitamin D which I did a little more research on. I printed off the info for a pharmacist coworker who's interested in anymore info there is. I too am interested and will be asking my doctors for more info. If I find out anything helpful I'll let you know
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Diagnosed:
Ulcerative Colitis/IBD 1996, Iritis 2001, Ulcerative Proctitis 2013, Indeterminate Colitis 2016, Remission 2017, Hand Eczema

Current Meds:
Pentasa 1000mg 2xday or Mesalamine DR 1.2gm 2xday, Canasa Suppositories (when needed) 1000mg 1xday, Tylenol 3 with codeine 300-30mg (when needed)

Non-Meds:
600+D Calcium 2xday, Multivitamin, 65mg Iron 1xday, Fish Oil 1000mg, Vitamin D3 5,000 I.U., Eye Drops 2xday


UP Support Group http://www.crohnsforum.com/showthread.php?t=68350
01-02-2012, 07:55 PM   #30
QueenGothel
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I found a children's vitamin. Natures plus children's vita-gel. They are orange flavored but you do not chew them and are easy to swallow for a 4 year old. It took me 2 months but finally found it. Rowan is a champ at swallowing her meds now. Two at a time today.
02-12-2012, 03:40 AM   #31
Rebecca85
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Just wondering if sodium ought to be included on the above list? I posted an article on it already, it would seem sodium is absorbed in the TI, lost through diarrhoea, and combined with current trends for low salt diets, people with IBD may actually become deficient! Was it Cat-a-tonic who uses soy sauce to perk herself up when she's tired?
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Crohn's in the terminal ileum, dxed Jun '10

125mg azathioprine
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02-12-2012, 03:47 AM   #32
DustyKat
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Good point Rebecca.

Following Sarah's surgery we were advised that salt depletion could be a problem for her.
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03-31-2012, 10:56 PM   #33
David
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Added some information about vitamin K.
05-16-2012, 02:35 PM   #34
CLynn
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Added information on Selenium. I didn't think it would be very important but one study stated they found 26% of Crohn's Disease patients to be deficient. Read up on Selenium as well folks

DustyKat, are you out there? I can't find where Selenium is absorbed

David, I am guessing that around 15 years ago, one of my coworker's mother printed out page of "Eating Right For A Bad Gut" for me, many of the pages dealing with vitamins and minerals that we should supplement. Selenium was one of them. I should go back to taking it.
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Cheryl
Diagnosed:1988
Previous meds: Sulfadiazine, Flagyl, Prednisone, Imuran, Pentasa, Asacol
Surgeries: re-section 2004
Currently taking: B-12 injections every 2 weeks, multi vitamin/mineral, fish oil (1000 mg), D3 (5000 mg)

Also lucky enough to have psoriasis as well.
09-22-2012, 01:22 PM   #35
AngelHeart
 
Join Date: Sep 2012
Location: Montreal, Quebec
Thank you for the forum and posted info.

David asked where the absorbtion of nutrients takes place, and if most is in the small intestine's duodenum, jejunum and ileum.

My gasto doc checked only large intestine and found colitis. symtoms have gone but im still weak and i suspect it is lack of nutrients. no loss of weight though which i suspect is due to weak metabolism due to hormone imbalance which is due to lack of nutrients. hope ur not lost.

Blood came back recently, only it is not on paper it is deep inside stool. Yet, he's prescribing enemas.

I am more suspecting the blood to be coming from much earlier stages of digestion than the colon to explain the blood clocked in stool.

Could it be that the area where the duodenum, jejunum and/or ileum are affected and bleeding hence lack of nutrients and blood?

And if so, would that mean blood should also be seen in urine? coz my urine color lacks any blood color taint. Its quite yellow.

Thanks for any help.
06-23-2014, 02:58 AM   #36
gotumtum
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Folic acid / Folate

I just wanted to make a note here that low folic acid levels in pregnancy are becoming increasingly recognised as a cause for spina bifida and related conditions ('neural tube defects').

This is the reason that folic acid supplementation is recommended to all females trying to get pregnant as the baby will develop past this critical stage before people find out if they are pregnant.

It is also worth noting that women with a family history of eg spina bifida / arnold chiari malformation / ehlers-danlos syndrome (neural tube defects) take a higher level of folic acid.

I would also encourage women with crohns considering getting pregnant, to ensure that your folic acid level is correct - and keep checking it as the Crohns often affects the area in the gut where folic acid is absorbed.

I am not sure how to add this info / or similar to the Wiki. But feel strongly about it as it has affected my family - and want to raise awareness of it - such a simple measure to take, that can prevent so much anguish.
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