Crohn’s may be well-known for its impacts on the digestive system; however, thirty percent of patients also report some degree of hair thinning or hair loss.
Crohn’s disease is an autoimmune disease that’s characterized by chronic inflammation of the digestive tract which causes bloating, belly pain, diarrhea, and constipation. But Crohn’s effects aren’t isolated to your digestive system. It can wreak havoc throughout your body. Symptoms that show up outside of your digestive tract are called extra-intestinal manifestations (EIMs). Hair loss is one such EIM.
Crohn’s may lead to hair loss through several mechanisms, listed below.
Crohn’s disease prevents your body from absorbing enough nutrients from the food you eat, which leads to malnutrition. Hair grown from malnourished hair follicles tends to be brittle, thin and susceptible to breakage. To make matters worse, when your follicles are malnourished, they can stop producing new strands, causing significant, overall thinning.
2. Alopecia Areata.
If you have an autoimmune disease like Crohn’s, you’re more likely to develop another autoimmune condition. In fact, about 25% of sufferers have multiple immune disorders. Evidence shows a link between Crohn’s and the autoimmune disorder known as Alopecia Areata, which causes sudden hair loss when your immune system attacks your hair follicles leading to coin-sized patches of hair falling out. The hairs on the border of these patches are usually short and resemble exclamation marks, a tell-tale sign of the condition. In rare cases, Alopecia Areata may progress into Alopecia Totalis or total hair loss.
There is some evidence that some Crohn’s medications may cause hair loss; however, the claims remain controversial. Hair can take weeks or even months to react to stress or illness, so it’s often difficult to determine whether your hair loss is from the medication or from the disease itself. If you suspect your treatments are causing your hair loss, do not discontinue taking them! Consult your doctor before making any changes to your treatment plan.
Take control of your Crohn’s disease first. Then, when you’re ready to take control of your hair loss, talk to us. Crohn’s-related hair loss is rarely permanent, but regrowing your hair can be a slow and discouraging process. With more than 40 years of expertise in the area of hair restoration and regrowth, Hair Club can help. Schedule a complimentary, no-obligation consultation today. You’ll receive a free hair and scalp analysis that will help you better understand your hair loss, as well as options that can help you regrow your hair more quickly or achieve the look you miss while your hair recovers.
Things to know about inflammatory bowel disease (IBD)
Most people with IBD are diagnosed between the ages of 15 and 40, with some even being diagnosed in childhood.
Inflammatory Bowel Disease (IBD) is a term that refers to both Crohn’s disease and ulcerative colitis – life-long conditions for which there is currently no cure. These are long-term conditions with periods of wellness (remission) and relapses (flares).
Whether you are one of the 40,000 Irish people who has IBD, know someone who has it, or just want to learn more, below are 10 things you should know about this debilitating disease.
1 IBD affects both young and old
Most people with IBD are diagnosed between the ages of 15 and 40, with some even being diagnosed in childhood. IBD is a life-long condition; however, modern treatments mean people can live relatively normal and productive lives.
Most people with IBD are diagnosed between the ages of 15 and 40, with some even being diagnosed in childhood.
2 What’s the difference between Crohn’s disease and ulcerative colitis?
People can get confused when they hear about IBD because it’s a term that encompasses different illnesses, with different symptoms.
Ulcerative colitis affects the lining of the large bowel (colon) with Crohn’s affecting any part of the gastrointestinal tract from the mouth to the anus, causing inflammation that may affect the full thickness of the intestine wall.
Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the anus. Symptoms of Crohn’s disease include:
• Persistent diarrhoea, sometimes with blood
• Cramping abdominal pain
• Joint pain, mouth ulcers, skin and eye problems.
Unlike Crohn’s disease, ulcerative colitis is confined to the large bowel and only affects the lining of the large bowel usually starting in the rectum. Symptoms of ulcerative colitis include:
• Cramping abdominal pain
• Loose stools
• Bloody stool
• An urgent need to use the toilet
• Loss of appetite
3 So what is irritable bowel syndrome (IBS) – is that different?
Irritable bowel syndrome (IBS) is a much less serious condition than either Crohn’s disease or ulcerative colitis, though the symptoms may be similar. Unlike IBD, IBS does not cause inflammation, ulcers or other damage to the bowel.
Symptoms of IBS can include cramping pain, bloating, mucus in the stool, diarrhoea and constipation.
There are tests to distinguish between IBS and IBD, some of which can be carried out by your GP, though you may need to see a specialist for others. Long-term specialist follow-up is usually necessary for people living with IBD but not IBS.
4 Can a bad diet cause IBD?
Diet is not the cause of IBD, but certain foods may trigger a flare-up or make symptoms worse in those who already have it. These triggers can vary widely from person to person and no one type of food or beverage aggravates symptoms for all people with ulcerative colitis or Crohn’s disease.
5 What food should I avoid if I have IBD?
Although there is no ‘magic’ diet that works for everyone with IBD, a healthy diet generally will help manage IBD and reduce the effects of flare-ups. A healthy diet is more about what you keep in your diet, rather than what you cut out. If you exclude foods but find no real difference in your symptoms, then you can try to reintroduce them back into your diet.
To determine which foods tend to provoke symptoms and flare-ups, it can be useful to keep a food diary. This can help you to see how your diet relates to your symptoms.
6 People with IBD can feel embarrassed – but they shouldn’t
Because of the nature of the symptoms of IBD – diarrhoea, passing blood, pain, rushing to the toilet and sometimes incontinence – it can be embarrassing to talk about. But remember that up to 40,000 people in Ireland are living with this condition you are not alone.
The Irish Society for Colitis and Crohn’s Disease (ISCC) has great support to help you tell other people about your condition, including advice about talking about it in work and school/college.
7 Can IBD be prevented?
Ulcerative colitis and Crohn’s disease can’t be prevented – but by taking your medications as prescribed, attending medical appointments as scheduled and learning to recognise flares and knowing how to manage them, you can minimise the impact the disease has on your life.
8 How would I know if my child has IBD?
IBD can develop slowly and children can adapt to symptoms he or she might be experiencing. So it can be you, the parent, who discovers that something is wrong. You may notice bowel symptoms (stomach pain, diarrhoea), loss of appetite, or that your child is not growing as fast as their friends, or maybe puberty seems to be delayed.
You may also notice your child needs to go to the toilet very urgently or that they take a long time in the bathroom. If you are worried that your child might have IBD, visit your GP for a check-up.
9 What causes IBD?
The cause of Crohn’s disease and ulcerative colitis is still unknown, which means IBD can’t be prevented; it is thought that it is caused by a trigger in the environment which leads to IBD in those who have a genetic predisposition.
Supplements That Can Help IBS
With the number of people diagnosed with a Vitamin B12 and Iron deficiency increasing every day, it’s important we address an underlying cause that not many sufferers are aware of: the gut. Too many of those deficient in Iron and/or B12, are simply given supplements, sometimes indefinitely, to try and raise their levels.
What they’re not doing is addressing the reason the deficiency came about in the first place. And for a lot of people, the issue is with their ability to absorb Vitamin B12 in the gastrointestinal tract – a problem that is also often accompanied by IBS-type symptoms. With Vitamin B12 and Iron both essential for almost all functions of the body, a deficiency can contribute to serious long-term ill health.
Here is a summary of what we are going to cover:
> How low levels of Vitamin B12 can cause Iron deficiency anemia
> Symptoms of Vitamin B12 deficiency
> What causes Vitamin B12 deficiency
> The functional lab testing you need to do to uncover the root cause of Vitamin B12 deficiency
> How to correct a Vitamin B12 and Iron deficiency
How Vitamin B12 can Cause Iron Deficiency Anemia
Let’s get this sorted first. Why are we talking about both Vitamin B12 and Iron? Well, it’s because blood loss is one of the primary causes of Iron deficiency. And given B12 is required for the production of red blood cells, a deficiency in Vitamin B12 can lead to a deficiency in Iron. This is why the onset of anemia is often the result of a B12 deficiency rather than an Iron deficiency on its own.
So, if you’ve been diagnosed with low Iron levels, the problem might actually be with your Vitamin B12 levels – our focus for this specific post.
Common Signs and Symptoms of Vitamin B12 Deficiency
Symptoms of a Vitamin B12 deficiency can include:
> Tiredness, fatigue or low energy
> Muscle weakness and aches
> Shortness of breath
> Dizziness or feeling light-headed
> Heart palpitations
> Loss of appetite
> Digestive issues including diarrhoea, cramping and nausea
> Mood changes including depression and anxiety
> Numbness and tingling sensation in hands or feet (peripheral neuropathy)
> Poor concentration, brain fog, memory loss, confusion
> Low Iron levels (explained above).
What Causes Vitamin B12 Deficiency
The causes of Vitamin B12 deficiency generally fall within one of the three following categories:
1. LOW DIETARY INTAKE OF VITAMIN B12
As our bodies do not make Vitamin B12, we must rely on dietary sources or supplementation. The average adult’s daily requirement is estimated to be 2.4 micrograms a day, with the best dietary sources of B12 coming from animal products.
While plant-based sources of B12 exist, studies have shown they are poorly absorbed and have little to no effect on our B12 blood levels. This presents a challenge for those who follow a vegan and vegetarian way of eating, placing them at risk of Vitamin B12 deficiency.
2. IMPAIRED ABSORPTION OF VITAMIN B12 IN THE STOMACH OR SMALL INTESTINE
Even with adequate intake of B12, if our body can’t absorb the vitamin then we may still develop a deficiency. The absorption, assimilation, and methylation of B12 is a complex process that involves many steps, as summarised in the diagram below.
Here are the most common reasons for poor absorption of Vitamin B12:
> Low stomach acid – without sufficient HCl and pepsin, the animal proteins that are bound to Vitamin B12 are unable to be digested. This means the B12 is not ‘free’ to bind with other glycoproteins and move through the GI tract for absorption. Anyone with Atrophic Gastritis or Hypochlorhydria as a result of conditions like H. pylori bacterium infection are at particular risk. As is anyone who has been prescribed proton pump inhibitors (PPIs) or acid suppressing medications.
> Exocrine pancreatic insufficiency – without the production of sufficient pancreatic (digestive) enzymes, the body is unable to breakdown the Cobalamin-R complexes in the Duodenum. As a result, the B12 cannot bind with Intrinsic Factor (IF) and make its journey through the small intestine to be absorbed.
> Surgical resection or disease of the distal ileum – because B12 is absorbed at the lower end of the small intestine, any surgical removal (e.g. weight loss surgery) or an inflammatory condition (e.g. Crohn’s and Celiac disease) that impairs the distal ileum will also impair absorption of Vitamin B12.
3. MTHFR GENE MUTATION
Individuals with gene mutations such as MTHFR or MTRR have trouble with the process of methylating B12 into its usable form. So, while the body might absorb sufficient amounts into the blood, it is unable to absorb it into the tissues where it’s ultimately needed. Your Vitamin B12 levels might still be normal or high, however your body just struggles to use it properly.
This has become a relatively hot topic recently and one that many people may be too quick to jump to. Only once you’re eating enough high quality sources of Vitamin B12 and have tested and healed your gut, whether that’s H.pylori, SIBO, parasites or other sources of inflammation, should you be looking to MTHFR gene testing. And if you do decide to complete gene testing early on, make sure you’re onto the gut testing as well.
THE FUNCTIONAL LAB TESTING YOU NEED TO DO TO UNCOVER THE ROOT CAUSE OF VITAMIN B12 DEFICIENCY
While you might have already done the standard blood test to identify low levels of Vitamin B12 and Iron, the important testing you need now is to find out the underlying root cause. These are a comprehensive Stool Test, Organic Acids Test and/or SIBO Breath Test.
If none of these tests reveal underlying gut dysfunction and/or you have already healed your gut, that’s when it’s important to look to MTHFR gene testing.
How to correct a Vitamin B12 and Iron Deficiency
1. DIETARY SOURCES HIGH IN VITAMIN B12
As discussed above, the average adult’s daily requirement is 2.4 micrograms a day, with the best dietary sources of Vitamin B12 coming from animal products. And although the exact rate of absorbability depends on a person’s digestive health, here are the top food sources of B12:
> Beef and chicken liver
> Organic greek yoghurt
2. HEAL THE GUT TO IMPROVE VITAMIN B12 ABSORPTION
Given the importance of a healthy and well-functioning GI tract for the absorption of Vitamin B12, healing your gut could be the key to healing a B12 deficiency. The most common gut related conditions I see that impair B12 absorption, are:
> H. pylori – lowers stomach acidity and the animal proteins that are bound to Vitamin B12 are unable to be digested.
> SIBO – bacterial overgrowths in the small intestine can consume the Vitamin B12 before it is absorbed by the body.
> Parasites – infections like Giardia can also compete with the body for the absorption of Vitamin B12.
If you have a Vitamin B12 deficiency and also suffer from GI related symptoms then it is advisable to have a practitioner order some functional lab tests to identify potential gut infections or other imbalances.
Only once you have identified the underlying cause of the Vitamin B12 malabsorption (and deficiency) can you work to eradicate the infection and heal the lining of the gut. While healing the gut, I often recommend supplementing with HCl and digestive enzymes to help B12 absorption from food sources.
3. SUPPLEMENT VITAMIN B12
For those with permanent B12 malabsorption, such as individuals with MTHFR gene mutations, vegans/vegetarians, IBD or ileum resection, Vitamin B12 supplementation is generally recommended.
For anyone healing their gut to correct a B12 deficiency, short-term supplementation might still be advisable depending on your current B12 levels and the amount of gut healing that is required.
When looking for B12 supplements, be sure to look for it in the form of methylcobalamin, rather than cyanocobalamin. This Methyl-B12 form is typically the easiest for the body to absorb and utilise, giving the biggest impact on your B12 levels. There are three main ways you can get your B12 supplementation:
> Orally in capsule form – easiest to find at the store or available on Amazon here (USA) or iHerb here (Australia).
> Sublingual drops – recommended for those with SIBO or other gut infections or imbalances that are affecting absorption. Normally available via practitioners or available on Amazon here (USA).
> Injections – recommended for more serious cases of deficiency including pernicious anemia and severe depletion causing neurological disorders.
If you suspect you have a Vitamin B12 and/or Iron deficiency, the first step is to get tested. If you are deficient in B12, step two is to identify the underlying mechanism or cause of your deficiency. Once the root cause is identified, the appropriate form of supplementation (oral, sublingual or injection), dosages and length of treatment can be determined, as well as any gut healing and rebalancing that needs to occur to heal the root cause. I hope you found this post useful and continue to work towards vibrant health, minus the B12 deficiency.
Healing the gut is a journey. If you are ready to begin yours, please head to the Work With Me page to learn more about how I work online with clients in many countries to test for and treat the many root causes of IBS symptoms and other GI condition
Coronavirus (COVID-19) information for patients with inflammatory bowel disease
University of Chicago Medicine section chief of Gastroenterology, Hepatology and Nutrition, David T. Rubin, MD, answers common questions about coronavirus (COVID-19) and inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis.
What are the symptoms of COVID-19 and are they different for inflammatory bowel disease patients?
Patients who are infected with the novel coronavirus called SARS-CoV-2 may develop a disease called COVID-19. The symptoms of COVID-19 are most frequently fever, cough and other respiratory symptoms, which might progress to shortness of breath. Other common symptoms include fatigue or muscle aches. Some digestive symptoms have been associated with COVID-19 as well, including a loss of appetite, a loss of smell or taste, abdominal discomfort, more frequent bowel movements or loose stools.
We haven’t seen enough IBD patients who’ve developed COVID-19 to know whether these patients have different types of symptoms but for patients with IBD, having digestive symptoms could be confused for activation of IBD. The unique concern here is to distinguish between someone who is having a relapse of their IBD, compared to someone who might be having symptoms of an infection. We’re working hard with our patients and performing additional research to figure this out.
Are inflammatory bowel disease patients considered immunosuppressed? Do they have a higher risk of contracting COVID-19?
Patients who have Crohn’s disease and ulcerative colitis have a chronic condition in which the immune system of the intestines is overactive. The goal of IBD treatment is not to immune suppress the patient, but rather to modify their overactive immune system so it’s under better control. We don’t think of our IBD patients at baseline as being immune suppressed. In fact, it’s the opposite. When we treat them effectively, we turn down the overactive immune system just enough so their body takes over, and we minimize their risk for infections.
Being on immune therapies for inflammatory bowel disease may increase the risk for some viral infections, but based on the information we have so far, we have not seen an increased risk of contracting COVID-19 in patients who are on the standard IBD therapies. Of the Crohn’s and ulcerative colitis patients we have seen who developed COVID-19, their course and recovery is exactly like what we’re seeing in the general population. Our general message to patients right now is to stay on your existing therapies and stay in remission. If you have any concerns, please make an appointment with your doctor and have a conversation about whether there might be any adjustments to be made.
What should I do if I have Crohn’s disease or ulcerative colitis and develop COVID-19 symptoms?
Patients with inflammatory bowel disease who develop COVID-19 will have the same symptoms as the general population of patients who don’t have IBD: fever, cough, respiratory symptoms (shortness of breath) or new onset diarrhea. Let your doctor know right away if you develop some of these symptoms or if you’re worried that you might have developed COVID-19.
If you have been diagnosed with COVID-19, based on the treatments you’re on, you may need to stop your therapy for a couple weeks. I don’t recommend that you stop your medicines without talking to your doctor first. Based on an international registry of IBD patients who developed COVID-19, there does not appear to be an increased risk overall in patients with IBD developing COVID-19 or having a different set of outcomes. Most IBD patients who develop COVID-19 won’t require hospitalization, but if they get sicker or develop more shortness of breath, it is important to know that we’re here to help.
Managing Crohn’s disease and Ulcerative Colitis During COVID-19 Pandemic
Should I keep my IBD appointments at this time?
Yes, you should keep your appointments, but do so virtually, if possible. Most of our IBD patients are having their appointments by telephone, MyChart, or video visits. We can handle many of your concerns and questions as well as your routine healthy follow up visits this way. If your IBD symptoms worsen and you are feeling sick, it is safe to come to an appointment at the clinic. We will work with you to find the best way to make an appointment happen. We have deferred most elective colonoscopies or other endoscopic procedures at this time. If you need a procedure because of something that’s time sensitive or essential in other ways for your management, we certainly are able to do that. The best thing to do is to call your doctor to find out what options are available for you.
If I am currently receiving infusion treatment for IBD, is it safe to go to an infusion center?
If you know that your infusion center is following proper safety protocols, then you should keep your appointments and get treatment. The University of Chicago Medicine is following safety protocols including screening patients for any known contacts with COVID-19 and any COVID-19 symptoms, spacing patients at least six feet apart and having a single provider working with each patient to limit exposure. All providers are wearing masks and gloves and offering those to the patient if they don’t already have them. After a patient has received their infusion, the chair and the surrounding area is appropriately cleaned.
Delaying infusible therapies or other treatments can lead to relapse and loss of response to the drugs.
Which IBD medications suppress the immune system? Is it safe to take these medications?
The medications we used to treat inflammatory bowel disease include a variety of therapies that work by different mechanisms or target different parts of our immune system. Sometimes we recommend immune modulator therapies called thiopurines or azathioprine and 6MP, or another medicine called methotrexate.
More recently, we have a variety of biological therapies which target different components of the immune system. A class of therapies called anti-TNF treatments focus on an inflammatory protein called TNF or tumor necrosis factor, which is elevated whenever somebody has an infection or overactive immune response. Anti-TNF drugs such as Remicade, Humira, Cimzia or Simponi are recommended to be continued at the current time.
Another drug called Entyvio targets the white blood cells that might be on their way to the bowel, blocking them from getting out of the blood vessels into the intestines. This is a more selective therapy in that it only works on the intestinal immune system, and therefore, the risk for infection might be lower than with anti-TNF and other treatments.
Lastly, we use a treatment known as Stelara, which targets two other inflammatory proteins that tend to be elevated only where there is inflammation in your body. This is a more selective treatment, but it still works on the entire body.
The goal of these therapies is not to suppress the immune system so patients are more susceptible to infections, but rather, to control the overactive inflammation of the bowel and let the body heal itself.
The general message regarding all of these therapies is that if you are in remission and the treatment you’re on is working for your Crohn’s disease and ulcerative colitis, you should stay on that therapy during the COVID-19 pandemic. We recommend that you continue to communicate with your health care team about any additional changes that might be necessary. For most patients, we are not recommending that they stop treatments. It is important to remember that these treatments are keeping your IBD under control. If the IBD becomes active, we may recommend corticosteroids like prednisone, however they can increase your risk of infections. This is why we want our patients to do their best to stay in remission. We recommend patients stay home as much as possible, wash hands frequently and follow any guidelines from our public health officials, such as the Centers for Disease Control and Prevention (CDC).
Should I be concerned about a supply shortage of IBD medications?
No. We have assurances from the pharmaceutical companies that there is a sufficient supply of medicine available. We recommend that patients with Crohn’s disease or ulcerative colitis stay on their medication schedule and refill their prescriptions appropriately.
Should I take supplements like vitamin c or zinc to help prevent coronavirus?
At this time, I would advise against taking additional supplements, such as extra vitamins or zinc to prevent a viral infection. There is no data to support their effectiveness and starting a new supplement might cause other side effects.
How do I know the difference between an IBD flare-up vs. COVID-19?
It may be hard to tell the difference between a flare up and COVID-19 infection because their symptoms can be similar. Loss of appetite, abdominal discomfort, more frequent bowel movements or loose stools are symptoms of both conditions.
We have testing options that do not require an in-person visit. These simple tests can help identify the cause of your symptoms.
What should I do if I think I’m having an IBD flare-up?
We have treatments available that are safe to start even while this pandemic is going on. There’s guidance that we’ve developed and published that will give people more information about which treatments to use and when to use them. If a patient has more severe inflammatory bowel disease, the usual treatments we use for IBD are safe and appropriate to be used in this setting. Patients shouldn’t ignore their IBD symptoms or any other digestive symptoms. Keep in touch with your physician to get it back under control quickly. The last thing we want is for patients to be living with these symptoms and afraid to notify their doctor or come to the clinic.
Any advice for essential workers with IBD who are unable to work from home?
We know that there are a lot of IBD patients who are essential workers right now and can’t work from home. It is important for these patients to recognize their likelihood of exposure and increased chance of contact with COVID-19-positive patients. For example, paramedics, doctors, nurses, technicians, respiratory therapists and pharmacists who are interacting with patients with COVID-19 have a high risk of exposure and should make sure they protect themselves as much as possible.
The advice we’ve been giving the general public should be followed the same by IBD patients. This includes social distancing, washing hands, cleaning surfaces and staying at home when possible. We also recommend keeping in touch with your doctor to know you are in remission and making sure your medications are being managed properly.
Are there extra precautions that pregnant women with IBD should be taking during the COVID-19 pandemic?
We’ve learned some information about COVID-19 in pregnant women, which applies to pregnant patients with Crohn’s disease or ulcerative colitis as well. We have seen that women who are pregnant and develop COVID-19 recover similarly to the general population. Although their babies might be born a bit early or a little underweight, for the most part, the babies seem to do well.
At this time, we have not seen cases of pregnant women becoming infected with COVID-19 in the first trimester. The data we have from prior coronavirus epidemics and other types of infections suggest patients may be fine. Because this is a novel coronavirus, we still need to monitor those patients carefully.
We recommend that our pregnant patients with inflammatory bowel disease make sure they’re staying in remission from their IBD. Stopping their IBD therapies could cause a relapse and would require hospitalization which may increase their risk of exposure to COVID-19. We also know that when IBD is in remission, the baby and mother both stay healthy. It is important that our IBD patients who are pregnant take extra precautions and follow strict social isolation. That means in addition to staying home, they should also restrict visitors from entering the home. If pregnant patients with IBD need to go out to the grocery store, they should wear a mask and gloves, and carefully wash their hands, as we’re recommending to everybody. We don’t have data yet to say that pregnant patients with IDB have more to worry about, but we want them to be extra careful.
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