I’m back (finally) with an overdue post on vitamin and mineral deficiencies that are possible with IBD; I meant to get this written up sooner, but the Big, Bad Wolf visited us here in Texas last week and tried to blow our house down. Well, more like he tried to pummel it into the ground. April can be a bizarre month here, and this year was no exception. Last weekend, my husband and I were sitting out on the back patio one night, reading and enjoying a fire. All of the sudden, the TV in the living room sounded it’s Emergency Warning siren (which I have long ago learned is NEVER a test here) and the bulletin said that there was a Severe Thunderstorm Warning, with a storm moving through a town about 10 miles southwest of us. I looked toward the sky, noticing a very faint flicker of lightening in the distance, and told my husband that we should probably head inside. I headed in, taking both of our dogs with me, and was inside for all of about two minutes, closing windows, etc, when I heard the thunder, so I went outside again to tell George to get his ass inside. The words were barely out of my mouth when the sky opened up, sending golf ball sized hail into the house from every direction. We could barely hear each other speak inside the house it was so loud; it sounded like we were being bombed with mortar shells. We grabbed both dogs and headed into the guest bathroom, which is one of the only rooms in our house without a window. We waited in there about 15 minutes, until the hail lightened up and the winds died down. George was typing away quickly on his phone, and I wondered who on earth was so important that it couldn’t wait. He was emailing the insurance agent already, quite sure that we would have some broken windows to deal with.
By the time the next morning rolled around and we could fully assess the damage in the daylight, we had lost nine windows, three outdoor lanterns and the gutters. We had serious questions about the roof, which were affirmed when the insurance adjustor stopped by and told us that the entire roof would need to be replaced, too. It was some storm. So of course this last week has been a mix of cleanup and various meetings with repair people to get the damage fixed.
Anyway, as I mentioned above, I wanted to do a post about vitamin and mineral deficiencies that can occur in those with IBD; these can be caused by a variety of factors such as malabsorption, chronic inflammation, surgical removal of small or large bowel tissue and occasionally the medications used to treat the disease. It’s good to be aware of them in advance so you can request that your doctor run some tests if he or she hasn’t already to see where you stand. Better to get ahead of it than run the risk of a long term deficiency that can, in some cases, be life threatening. Your levels of the vitamins and minerals below can be easily obtained by a thorough blood test, just make sure that you specifically ask for each to be screened. Here we go…
Protein – can be deficient due to use of Prednisone, extended periods of blood loss, chronic diarrhea and the presence of wounds or fistulas in the small bowel.
Fat – can have malabsorption due to severe Crohn’s ileitis, or in cases where more than three feet of the lower small intestine have been removed.
Iron – anemia due to chronic blood loss can occur, in addition to absorption issues in those with portions of the bowel surgically removed. If you’re going to get a test for your iron levels, request a full iron study that, in addition to your basic hemoglobin levels, will include your B12 and ferretin counts, which is a measure of how much iron your body is actually capable of storing for future use.
B12 – extensive inflammation or removal of the ileum can cause deficiencies. While B12 supplements are sold in pill form, for a true deficiency, injections will be needed to properly absorb this vitamin.
Folic Acid – both sulfasalazine (Asacol) and methotrexate can affect the metabolism of folic acid, so supplementation is often needed if you take either of these medications. Also can be deficient if you have Crohn’s in the middle section of the small bowel, or if this area has been surgically removed.
Potassium and Sodium – anyone who has had their entire colon removed will likely run into challenges with this, as the large intestine is (or was, as in my case) where fluids and electrolytes are processed. Low levels of either of these can cause severe problems, even death, as they are responsible for a proper heartbeat and the regulation of blood pressure. For potassium specifically, anyone on prednisone or who has chronic vomiting or diarrhea is also at risk. Drink supplements can help with this, I use the Nuun brand, to which there is a link on the Resources page.
Calcium – anyone on prednisone can be at risk, not to mention anyone with a lactose intolerance, as many with IBD do.
Vitamins A, D, E & K – basically, all the fat soluble vitamins, due to the possible issues with fat malabsorption mentioned above. The medication Questran can also interfere with vitamin D absorption. Vitamin E is also available in a water soluble form, which may be better for anyone with IBD.
Magnesium – anyone with extensive inflammation or who has had the ileum removed can be at risk. Magnesium is important for bone growth; a deficiency here can also lead to problems with potassium and sodium levels.
Zinc – anyone on prednisone, with chronic diarrhea or with extensive inflammation. A deficiency in zinc is a little more rare than the rest, but levels too low can further compromise the immune system.
I know, it’s a lot. Plus, many of us don’t digest pills very well, so there’s that, too. However, many of these come in liquid form, which will prevent you from dropping money into the toilet on a regular basis. A great site that I’ve used for a while with pretty good success is Vitacost; I’ll put a link to them on the Resources page. It’s important to note that you should talk with your doctor about any supplements prior to taking them, as levels too high in some areas can also cause major issues as well (referring to potassium and sodium here). Not something to mess with, and I’ve been hospitalized due to my low potassium before, so I speak from experience. Keep in mind to that with the electrolytes, as we enter into the warmer months (or if you live in a place where it is just hot as balls most of the year, as I do), you are more at risk for low levels due to perspiring more. Dehydration is one thing, but keeping the electrolyte levels in balance to one another can be tricky, so please talk with your GI about your optimum levels and how to achieve them.
I feel it’s also important to note that even for those who may not have had surgical removal of parts of their bowel or extensive inflammation, the dietary restrictions forced on us from IBD (i.e. lactose intolerance, avoiding nuts and seeds, raw leafy veggies, etc) can also contribute to decreased levels in some of these. I mean, just take a look at the foods with the highest levels of vitamin K or E – it basically reads like a list of “Things I Should Eat When I’m Dying to Visit My Nurse Friends in the ER”. Kale? Swiss Chard? Nuts? Yes, Mr. Trebek, I’ll take “Bowel Obstructions” for $500, please. Why can’t all this shit be obtained by eating ice cream and tacos??? That’s what I want to know.
Hope you’ve found this helpful! Here’s to a great week, as well as new windows and a roof.