Crohn’s Disease: Supplements

This is a review of supplements and Crohn’s Disease[CD]. Some of the findings may apply to IBS and CFS.

  • “A diet high in protein, particular animal protein, may be associated with increased risk of inflammatory bowel disease and relapses” [2012]
  • ” Micronutrient intakes were suboptimal most notably for folate, vitamins C, E, and calcium.” [2007]
  • Trace Elements
    • The recommendation of the supplementation of these trace elements [Zinc, Selenium, Copper] in IBD is further supported by the findings of this study'[2002]
    • Copper[Cu]
      • No studies on supplementation on humans with CD found
    • Selenium [Se]
      • “Selenium deficiency is common in patients with severe gastrointestinal disorders. The deficiency is mainly related to malabsorption, and a low selenium level was almost invariably present in patients” [1998]
      • “This data, particularly from animal experiments, hold promise that adequate dietary Se supply may counteract chronic intestinal inflammation in humans.” [2014]
      • “New Zealand has one of the highest incidence rates of Crohn’s Disease (CD), whilst the serum selenium status of New Zealanders is amongst the lowest in the world.”[2012]
      • “Selenoprotein-P is a selenium-rich serum protein that carries more than 50% of serum selenium.. the serum selenoprotein-P level is decreased in patients with CD “[2005]
      • ” Supplementation of selenium (100 microg/day) and zinc (10 mg/day) for 2 months significantly improved the trace element status in CD patients.” [2007]
    • Zinc [Zn]
      • “[At onset]  serum zinc levels are significantly lower compared with children without IBD” [2011]
      • [AI found low Zinc level dominantly produced] 94% correct classification of CD and healthy subjects. [2014]
      • Zinc supplementation tightens leaky gut in Crohn’s disease.[2012]
        • “oral zinc sulfate supplements (110 mg three times a day) for 8 weeks”  [2001]
      • ” adolescents with CD have significantly reduced zinc absorption” [2004]
      • “Serum zinc levels correlated with plasma vitamin A in acute colitis”[1990]
  • Vitamin A Supplement – should supplement, but no impact on symptoms expected
  • Vitamin C [ascorbic acid] – do not supplement (contradictory results)
    • “Caution should be exerted regarding surplus ascorbic acid intake for patients with chronic inflammatory diseases.” [2003]
    • “The results indicate that ascorbic acid absorption is normal in patients with both fistulizing and nonfistulizing Crohn’s disease.”[1989]
  • Vitamin D supplement — big plus
    • “We found statistically significant inverse associations between vitamin D status and development of any autoimmune disease and thyrotoxicosis in particular.” [2015]
      • translation: low vitamin D level means higher risk of ALL autoimmune diseases
    • “Short-term treatment with 2000 IU/day vitD significantly increased 25(OH)D levels in CD patients in remission and it was associated with increased LL-37 concentrations and maintenance of IP. Achieving 25(OH)D ≥ 75 nmol/l was accompanied by higher circulating LL-37, higher QoL scores and reduced CRP.” [2015]
    • vitamin D doses between 1800–10,000 international units/day are probably necessary.” [2015]
    • “an association between vitamin D deficiency/insufficiency and disease activity in IBD patients” [2015]
    • “Replication of phagocytosed E. coli was substantially decreased by [hydroxychloroquine] HCQ and vitamin D” [2015]
    • “Increased UV exposure is associated with a reduced risk of inpatient surgery among patients with CD. Further studies of vitamin D‘s role in CD are necessary.”[2015]
    • “Greater inflammation was associated with lower PTH and 1,25(OH)2D concentrations.” [2014]
  • Whey

Probiotics – recent articles

  • “The highly concentrated probiotic mixture VSL#3 has been shown to be effective in prevention of pouchitis onset and in maintaining antibiotic-induced remission.” [2015]
  • Detail analysis in The role of probiotic lactic acid bacteria and bifidobacteria in the prevention and treatment of inflammatory bowel disease and other related diseases: a systematic review of randomized human clinical trials. 2015 is worth reading. Note that many of the trials were done taking 5-ASA with it.
    • “The current scientific evidences are more significant in UC than in CD. However, more detailed mechanistic studies on the effectiveness of probiotics in IBD are necessary to determine their potential beneficial effects.”
  • Bifidobacterium longum subsp. infantis BB-02 attenuates acute murine experimental model of inflammatory bowel disease.[2015]
  • “Escherichia coli Nissle 1917 has comparable effects to low doses of mesalamine in maintaining remission in UC. VSL#3, a combination of 8 microbes, has been shown to have an effect in inducing remission in UC and preventing pouchitis. Prebiotics have yet to be shown to have an effect in any form of IBD, but to date controlled trials have been small” [2014]
  • “E. coli Nissle 1917 seems promising in maintaining remission and it could be considered an alternative in patients intolerant or resistant to 5-ASA preparations. in pouchitis, small controlled trials suggest a benefit from VSL no. 3 in the primary and secondary prevention of pouchitis;” [2013]
  • “support the promising results for E. coli Nissle in inactive UC and the multispecies product VSL#3 in active UC and inactive pouch patients.”[2012]
  • “Patients with CD in remission present alterations in the integrity of the intestinal mucosal barrier according to lactulose/mannitol ratio. S. boulardii added to baseline therapy improved intestinal permeability in these patients, even though complete normalization was not achieved.”[2008]

#autoimmune, #crohns