Problems with how your body absorbs nutrients, as well as blood loss, diarrhea, and even some of the drugs used to treat this inflammatory bowel disease (IBD) can all increase the risk of nutritional deficiency. Maintaining healthy levels of essential nutrients is possible with proper nutrition and supplementation. Here are six of the most common nutritional deficiencies associated with ulcerative colitis, and what you can do about them.
Calcium and Vitamin D Keep Bones Strong
Kristi L. King, MPH, RD, a dietitian at Texas Children’s Hospital and a clinical instructor at the Baylor College of Medicine in Houston, says that low stores of calcium and vitamin D are the main vitamin and mineral deficiencies in patients with ulcerative colitis. When you have this condition, “the intestines and colon don’t absorb nutrients in the same way they do for someone without the disease,” she notes, adding that many drugs commonly prescribed to treat colitis, such as prednisone, can also interfere with the absorption of calcium and vitamin D when used for prolonged periods of time. And, losing calcium and vitamin D will deplete your bone density and put you at risk of osteoporosis. Up to 60 percent of people with inflammatory bowel disease have lower-than-average bone density, according to the Crohn’s and Colitis Foundation. You may not have any noticeable symptoms, but your gastroenterologist should regularly check for these deficiencies as part of ulcerative colitis treatment, King says. Over-the-counter supplements can help restore healthy levels. Making some changes to your diet will help, too. Dairy products are rich sources for both calcium and vitamin D, but according to a study published in March 2021 in the journal Nutrients , many people with UC restrict dairy from their diets after their diagnosis thinking that dairy will trigger symptoms. If you’re sensitive to dairy, grab a glass of soy or rice milk that’s fortified with calcium and vitamin D instead. You can also increase your leafy green vegetables (cooked to minimize bowel irritation), which are rich in calcium.
Iron Helps Fight Fatigue
Iron deficiency is extremely prevalent in people with inflammatory bowel disease. Roughly 20 percent of patients suffer from anemia. Another 37 percent experience iron deficiency that falls short of anemia, according to a study published in February 2021 in the journal Nutrients. This deficiency may be due to blood loss from bloody diarrhea or internal ulcerations of the colon, or it could be caused by some drugs used to treat ulcerative colitis, such as cholestyramine. All patients with IBD should be screened for anemia — every 6 to 12 months for patients in remission and at least every 3 months for patients with active inflammation, according to guidelines established by the European Crohn’s and Colitis Organization in January 2015. “Symptoms of iron deficiency include fatigue, pale skin, and a profound craving for ice or mud” (odd as that may sound), says David T. Rubin, MD, the Joseph B. Kirsner Professor of Medicine and the codirector of the digestive diseases center at the University of Chicago Medical Center in Illinois. Although it was a panacea for Popeye, Dr. Rubin says that spinach alone isn’t enough to treat iron deficiency. Iron supplements are an option, but they may make ulcerative colitis symptoms worse in some people, and their efficacy is not proven in patients with non-anemic iron deficiency. Another option is intravenous iron infusions, which are more effective at replenishing iron stores, and work faster and more efficiently than oral supplements with fewer side effects, according to guidance published in 2018 in Therapeutic Advances in Gastroenterology. Only very rarely are blood transfusions used, Rubin says. Once your iron stores are back to normal, eating an iron-rich diet with foods like lean meats and cooked leafy greens can help keep your iron at a healthy level.
B Vitamins Can Boost Energy and Memory
People with ulcerative colitis may have problems absorbing folate — also known as folic acid or vitamin B9 — and other B vitamins, especially vitamin B12, which plays a crucial role in healthy cell growth and osteoporosis prevention, notes a study published in February 2021 in Nutrients. Earlier research published in Nutrients, in April 2017, found that patients with IBD tended to have lower folate levels than healthy patients. Vitamin B12 is absorbed in only one part of the small intestine, known as the ileum, right before it joins the colon, says King. Some medications, such as cholestyramine and sulfasalazine, can prevent B12 from being absorbed in this area and interfere with folate absorption, too. Signs of a vitamin B deficiency are a lack of energy, weakness, mood changes, and tingling in the fingers and toes, according to MedlinePlus. And a deficiency of vitamin B12 may cause memory problems. Once diagnosed by a blood test, folate and vitamin B12 deficiencies may be treated with supplements. But if you’re on a medication that interferes with vitamin B12 absorption, a B12 prescribed supplement or injections of the vitamin may be needed to maintain a healthy level. In conjunction with treatment, eat a diet rich in sources of B vitamins and folate, like meat, poultry, and eggs, to maintain healthy levels. RELATED: 8 Surprising Health Benefits of B Vitamins
Potassium Helps Relieve Muscle Cramps
Potassium may play a role in reducing inflammation in UC patients. A study published in Scientific Reports in 2017 found that UC patients with active disease had lower urinary potassium levels than healthy controls. Additionally, in a follow-up laboratory study looking at inflammatory cells common in UC patients, researchers found that increased potassium levels reduced inflammatory cell activity. More research is ongoing to determine potassium’s clinical use, but it’s well known that the chronic vomiting and diarrhea that can result from UC, as well as the use of corticosteroids (prednisone), can lead to potassium deficiency. King says potassium deficiency comes into play with UC because the colon is the final place where potassium is absorbed in the body. “The colon actually reabsorbs potassium, and it goes through the bloodstream that way,” she says. Symptoms of this deficiency may include muscle cramps, irregular heartbeat, or feeling dizzy and fainting. Eating a diet high in potassium-rich foods, such as bananas, cooked leafy green vegetables, and potatoes, is usually enough to correct a potassium deficiency, says King. Getting too much potassium through an over-the-counter supplement may increase the risk of heart problems. Too much of the nutrient in your blood (hyperkalemia) can also cause symptoms such as muscle weakness or difficulty breathing.
Magnesium Can Affect Your Muscles and Mood
Magnesium is involved in preventing bone loss — more than half the body’s magnesium stores are in our bones, per the Harvard School of Public Health. And yet, deficiency is a common issue for people with UC because most of the mineral is absorbed in the ileum (the largest segment of the small intestine), which is often affected by the disease. Magnesium loss is also associated with the chronic diarrhea in digestive disorders, notes the National Institutes of Health. Symptoms of magnesium deficiency include muscle twitching, numbness, or tingling, as well as mood changes. To treat this deficiency, you may need to take oral supplements or eat more magnesium-rich foods that you can tolerate, such as creamy peanut butter, spinach, and fish such as salmon or halibut. Dig into some Greek yogurt, since dairy products are a key source of dietary magnesium. Some common magnesium-rich foods, like nuts and dried fruits, may not be as easily digested. “You want to make sure to talk to your registered dietitian or doctor, because too much magnesium can cause diarrhea,” says King. Additional reporting by Amy Kraft.
