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Diet and Lifestyle

Nutritional Deficiencies and Crohn’s Disease

When people eat, most of the food is broken down in the stomach and absorbed in the small intestine. However, in many people with Crohn’s disease — and in nearly all of those with small bowel Crohn’s disease — the small intestine is unable to absorb nutrients properly, resulting in what is known as malabsorption.

People with Crohn’s disease have an inflamed intestinal tract. The inflammation or irritation can occur in any part of the intestinal tract, but it most commonly affects the lower section of the small intestine, which is known as the ileum. The small intestine is where critical nutrient absorption takes place, so many people with Crohn’s disease don’t digest and absorb nutrients well. This can result in various problems, including malabsorption of important vitamins and minerals. These vitamin and mineral deficiencies may eventually lead to additional health complications, such as dehydration and malnutrition.

Fortunately, blood tests can help doctors determine whether people with Crohn’s disease are getting the vitamins and nutrients they need. If they’re not, they may be referred to a gastroenterologist for evaluation. A gastroenterologist is someone who specializes in diseases affecting the intestinal tract and liver. They can recommend a treatment plan for someone who has nutritional deficiencies due to Crohn’s disease.

Types of Nutritional Deficiencies

People with Crohn’s disease may have trouble absorbing a large number of vitamins and nutrients, including:

Calories

Calories are derived from macronutrients, such as carbohydrates, protein, and fat. When someone isn’t absorbing enough calories due to malabsorption, they often lose a significant amount of weight very quickly.

Protein

People with Crohn’s disease may need to supplement their protein intake due to:

  • the use of high-dose steroids, such as prednisone
  • prolonged blood loss or diarrhea
  • wounds or fistulas affecting the small intestine

Fat

People who have severe Crohn’s disease and who have had more than 3 feet of their ileum removed may need to incorporate more healthy fats into their diet

Iron

Anemia, or a lack of healthy red blood cells, is a common side effect of Crohn’s disease. The condition can lead to iron deficiency, so many people with Crohn’s require additional supplementation of iron.

Vitamin B-12

People who have severe inflammation and who have had their ileum removed often require regular injections of vitamin B-12.

Folic Acid

Many people with Crohn’s disease take sulfasalazine to treat their symptoms. However, this medication may affect the body’s ability to metabolize folate, taking folic acid supplements necessary. People who have extensive Crohn’s disease of the jejunum, or middle section of the small intestine, may also need to supplement their folic acid intake.

Vitamins A, D, E, and K

Deficiencies of these fat-soluble vitamins are often associated with fat malabsorption and inflammation of the small intestine. They may also be related to the removal of large sections of either the ileum or the jejunum. The risk of vitamin D deficiency is also believed to be higher in people who take cholestyramine, as this medication can interfere with the absorption of vitamin D.

Zinc

People with Crohn’s disease may need to take zinc supplements if they:

  • have extensive inflammation
  • have chronic diarrhea
  • have had their jejunum removed
  • are taking prednisone

These factors can interfere with the body’s ability to absorb zinc.

Potassium and Sodium

The colon or large intestine is responsible for processing fluids and electrolytes. People who have had this organ surgically removed will, therefore, need to increase their intake of both potassium and sodium. There is an increased risk of potassium loss in people who take prednisone and who frequently experience diarrhea or vomiting.

Calcium

Steroids interfere with the absorption of calcium, so people who take these medications to treat symptoms of Crohn’s disease will likely need to incorporate more calcium into their diet.

Magnesium

People who have chronic diarrhea or who have had their ileum or jejunum removed may not be able to properly absorb magnesium. This is a key mineral for bone growth and other body processes.

Symptoms of Malabsorption

Many people with Crohn’s disease don’t experience symptoms of malabsorption, so it’s important to undergo regular testing for nutritional deficiencies. When malabsorption symptoms do appear, they may include:

  • bloating
  • gas
  • stomach cramping
  • bulky or fatty stools
  • chronic diarrhea

In severe cases of malabsorption, fatigue or sudden weight loss may also occur.

Causes of Malabsorption.

A number of factors related to Crohn’s disease may contribute to malabsorption:

  • Inflammation: Persistent, long-term inflammation of the small intestine in people with small bowel Crohn’s disease often leads to damage to the intestinal lining. This can interfere with the organ’s ability to absorb nutrients properly.
  • Medications: Certain medications used to treat Crohn’s disease, such as corticosteroids, may also affect the body’s ability to absorb nutrients.
  • Surgery: Some people who’ve had a portion of their small intestine surgically removed may simply have less of the intestine left to absorb food. This condition, known as short bowel syndrome, is rare. It is usually only found in people who have less than 40 inches of the small intestine remaining after multiple surgeries.

Treatments for Malabsorption

Replacement of nutrients is usually an effective treatment for people who have nutritional deficiencies due to Crohn’s disease. Lost nutrients may be replaced with certain foods and dietary supplements. Supplements may be taken orally or given through a vein (intravenously).

Avoiding certain foods is also critical for treating malabsorption. Various foods may make gas or diarrhea much worse, especially during flare-ups, but responses are individual. Potential problematic foods include:

  • beans
  • seeds
  • broccoli
  • cabbage
  • citrus foods
  • butter and margarine
  • heavy cream
  • fried foods
  • spicy foods
  • foods high in fat

People with an intestinal blockage may need to completely avoid eating high-fiber foods, such as raw fruits and vegetables.

People with Crohn’s disease are encouraged to eat a healthy, well-balanced diet to promote the absorption of vitamins and minerals. It’s also recommended to eat small amounts of food throughout the day and to drink plenty of water. Dairy may need to be avoided, as some with Crohn’s disease become intolerant to dairy.

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Diet and Lifestyle

Udo’s Choice® Super 8 Microbiotic

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Diet and Lifestyle

Get Your Gut Back On Track!

An estimated 110,000 people consume antibiotics daily in Ireland, between December/March. (Source: Health Protection Surveillance Centre).

We asked Nutritional Therapist Rosanna Davison for her Top Tips to get your gut back on track after an illness.

1. Take time out

Don’t push yourself too quickly.  Remember your body needs time to rebuild its reserves and regain strength.

Take more rest than usual.  If you need to sleep longer, go to bed earlier.

Cut back on non-essential activities; they can wait until you are feeling 100%.

  1. Embrace fibre-rich foods full of protective nutrients

Fresh vegetables and fruits are rich in dietary fibre, vitamins and antioxidants.  Try eating seven to nine portions over the course of each day. Choose different colours so that you nourish your body with a variety of phytonutrients.

Eat a portion of complete protein at each meal, such as poultry, fish, eggs, beans, pulses or tofu.

Consume essential omega-3 fatty acids daily.  Avocados, seeds (flax, chia) and oily fish (mackerel, wild and organic salmon), are naturally rich in anti-inflammatory fats.

  1. Go ‘fermented’

Fermented foods are rich in ‘friendly’ bacteria.  Sauerkraut is simple to make at home or buy kefir or kimchi in your local health store.

  1. Reduce or eliminate sugary foods

Processed foods often contain refined sugars to enhance taste. Excess refined sugar and processed foods may encourage the growth of ‘unfriendly’ bacteria, so aim to buy and eat fresh food.

If you have a sweet tooth, try eating berries (strawberries, blackberries, blueberries, raspberries).  They are rich in antioxidants and naturally low in sugar.

If you need a sweetener, try Stevia which is extracted from plant leaves and doesn’t impact blood sugar levels.

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Diet and Lifestyle

Do vegans need to take supplements?

Do vegans need to take supplements

A varied, wholesome vegan diet provides almost all essential nutrients in sufficient quantities. I hear you shouting ‘Noooo! It provides absolutely everything we need!’ and you may be right, but only if you regularly eat certain fortified foods. The sad truth is that modern food production systems and lifestyles make it more difficult for everyone – vegans or not – to get all they need from diet alone. It doesn’t mean a vegan diet is unnatural or unhealthy, in fact the opposite is true. It means that how we grow, produce and consume food has changed and, with an ever-growing population, the demands on the systems that produce our food are so high that certain nutrients become harder to obtain.

Confusion, confusion

I get a lot of questions about supplements and understand why people are confused. Over the years, I’ve worked on many vegan research projects and as science and population studies reveal ever more data, the guidelines and recommendations change and evolve. Hence, what we were told 10 years ago may no longer be up-to-date and that’s why different opinions arise, depending on where and when we got our information. It’s my job to keep up-to-date, so hopefully I can bring some clarity to the supplement discussion!

So what’s needed? The trio of nutrients to keep a close eye on are vitamin B12, vitamin D and iodine. You may not need to supplement with all these, all year long, but it depends on several factors. Read on…

Vitamin B12

Vitamin B12 naturally comes from bacteria in the soil and both people and animals would traditionally have got it from eating unwashed plants. However, we not only wash vegetables before we eat them (and for good reasons), but food production is now so sanitised that most vegetables are washed in chlorine, or other sterilising solutions, so there’s not a trace of B12 left.

People are not generally aware that most farmed animals are given B12 supplements and this is how the vitamin eventually ends up in their flesh. So, the argument that meat is a natural source of B12 doesn’t really stack up as meat-eaters essentially consume B12 supplements recycled by the animals that were given them!

It is absolutely necessary that we have a reliable source of vitamin B12 for our bodies. We need it to make red blood cells, for a healthy heart and circulation, and it’s essential for the nervous system. It takes years to develop a B12 deficiency, so on one hand, you don’t need to worry about not having taken B12 for a while. On the other hand, you do need to pay attention, as when symptoms develop, it’s usually serious.

Do vegans need to take supplements

To ensure adequate intake, you should have at least 5µg (micrograms) daily from supplements or fortified foods. The B12 used in both foods and supplements is produced commercially by growing bacterial cultures in large vats – and it’s always suitable for vegans.

There are two forms of B12 in supplements – cyanocobalamin (cheap) and methylcobalamin (expensive). Cyanocobalamin is the stable ‘inactive,’ form of B12 and is used in supplements and to fortify foods and drinks. Once ingested, it’s activated by your body so it can be used. Methylcobalamin is the ‘active’ form of vitamin B12 as it does not require any metabolic reactions to be activated. It costs more and is not so stable.

So which one to choose? Unless you’re a heavy smoker, have kidney failure or any other serious condition affecting your metabolism, cyanocobalamin – the cheap form of B12 – is perfectly fine. Intakes up to 2,000µg a day are safe and you can take either a lower dose daily or a higher dose a couple of times a week.

Vitamin D

We need vitamin D for healthy bones, teeth and muscles and it also performs other essential functions in our metabolism. It is produced in the skin when exposed to sunlight and this is the main source of vitamin D for most people. However, if you always use sun-block, cover most of your skin or live in a country, like the UK, where we don’t get enough sunlight over the winter, you need a supplement, whether you’re vegan or not.

The UK Government now recommends that we all take a supplement from October to April and, if you protect your skin ferociously over the sunnier spring and summer months, you should take a supplement all year long. Otherwise, just 20 minutes of sunlight on the face and arms is all that is required by the body to manufacture sufficient vitamin D.

Do vegans need to take supplements

Fortified breakfast cereals, bread, plant milks and vegan margarines can be useful sources if exposure to sunlight is not practicable, but may not be enough. When it comes to supplements, there are two types and your body can use both, but it’s advisable to check the source – vitamin D2 is always vegan, but vitamin D3 can be of animal origin. Many vegan foods are fortified with vitamin D2 and labelled so, but if not specified, especially on cereal products, vitamin D tends to be of animal origin. If you choose to supplement your diet, there’s a range of quality and affordable vegan supplements with vitamin D2. There are also those made from algae or mushrooms that contain D3 and these are recommended if you need a higher dose. When deciding on your dosage, 10µg per day is enough and you shouldn’t go above 25µg.

Iodine

Iodine has been a hot topic lately, especially with plenty of tabloid ‘experts’ warning that vegans are missing out. This mineral is necessary for thyroid function and helps to regulate how energy is produced and used in the body.

The amount of iodine in plants depends upon the iodine content of the soil in/on which they are grown. The closer to the sea, the more iodine and therefore vegans can get enough from plant foods, but there’s no guarantee. Seaweed, which of course grows in seawater, is always a good source and includes nori, laver, dulse and the kelp family (kombu, arame, wakame). But be warned – kelp absorbs far more than other seaweeds and you can get too much iodine from it. So, while seaweed consumption is encouraged, kelp should be used only sparingly.

Do vegans need to take supplements

It’s best to use a kelp supplement so you know exactly how much iodine you’re taking – it’s cheap, reliable and you don’t have to worry about taking too much. The recommended daily intake is 140µg and intakes up to 500µg are considered safe. In many countries, iodised salt is commonly used to ensure iodine intake, but it’s not the norm in the UK.

The dairy industry has been boasting about the iodine content of cow’s milk. What they don’t tell you is that it’s not a natural component of milk, but comes from iodinated cattle feed, supplements, iodophor medication, iodine-containing sterilisers of milking equipment, teat dips and udder washes. Cow’s milk is neither a natural nor the best source of iodine, so we can happily leave all that dairy out of our diet.

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