Tagged with 'ulcerative-colitis'

Zinc is called an “essential trace element” because it's necessary for numerous chemical processes that take place within a cell. It is required for the activity of approximately 100 enzymes and it plays a role in immune function, protein synthesis, wound healing, DNA synthesis, and cell division. Zinc also supports normal growth and development during pregnancy, childhood, and adolescence and is required for proper sense of taste and smell. To maintain a steady state of zinc, daily intake is required because our bodies don’t have a specialized system for storing zinc.

There are six instances when people are at risk of zinc deficiency or inadequacy. Supplemental zinc may be appropriate in certain situations.

People with Gastrointestinal and Other Diseases

Digestive disorders such as ulcerative colitis, Crohn’s disease, and short bowel syndrome, can decrease zinc absorption. Other diseases associated with zinc deficiency include malabsorption syndrome, chronic liver disease, chronic renal disease, sickle cell disease, diabetes, malignancy, and other chronic illnesses. Chronic diarrhea also leads to excessive loss of zinc.

Vegetarians

The bioavailability of zinc from vegetarian diets is lower than from non-vegetarian diets because vegetarians do not eat meat, which is high in bioavailable zinc and may enhance zinc absorption. In addition, vegetarians typically eat high levels of legumes and whole grains, which contain phytates that bind zinc and inhibit absorption.

Vegetarians sometimes require as much as 50% more of the RDA for zinc than non-vegetarians.

Pregnant and Lactating Women

Pregnant women, particularly those starting their pregnancy with borderline zinc status, are at increased risk of becoming zinc insufficient due, in part, to high fetal requirements for zinc. Lactation can also deplete maternal zinc stores. For those reasons, the RDA for zinc is higher for pregnant and lactating women than for other women.

Older Infants Who Are Exclusively Breastfed

Breastmilk provides sufficient zinc (2 mg/day) for the first 4-6 months of life but does not provide recommended amounts of zinc for infants aged 7-12 months, who need 3 mg/day. In addition to breastmilk, infants aged 7-12 months should consume age-appropriate foods or formula containing zinc. Zinc supplementation has improved the growth rate in some children who demonstrate mild-to-moderate growth failure and who have a zinc deficiency.

People with Sickle Cell Disease

Results from a large cross-sectional survey suggest 44% of children with sickle cell disease have a low plasma zinc concentration, possibly due to increased nutrient requirements and/or poor nutritional status. Zinc deficiency also affects approximately 60%-70% of adults with sickle cell disease. Zinc supplementation has been shown to improve growth in children with sickle cell disease.

Alcoholics

Approximately 30%-50% of alcoholics have low zinc status because ethanol consumption decreases intestinal absorption of zinc and increases urinary zinc excretion. In addition, the variety and amount of food consumed by many alcoholics is limited, leading to inadequate zinc intake.

Foods Containing Zinc

A wide variety of foods in the American diet contain zinc. Oysters contain more zinc per serving than any other food, but red meat and poultry provide the majority of zinc. Other good food sources include chickpeas, kidney beans, almonds, cashews, certain types of seafood, such as crab and lobster, whole grains, fortified breakfast cereals, cheese, milk, and yogurt.

Aside from eating well-balanced, nutritious foods everyday, if you feel you are at risk of zinc deficiency, talk to your health care provider. 

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

Reference:

1. National Institutes of Health; Office of Dietary Supplements. Zinc: Fact Sheet for Health Professionals 

If you live in the Northern Hemisphere, you’re in the midst of winter and your body more than likely can’t make enough vitamin D from the sun because the sun is at too low an angle in the sky. Along those lines, isn’t it interesting a vitamin D deficiency is common in people with Inflammatory Bowel Disease (IBD)? Inflammatory bowel disease encompasses two independent but related entities: ulcerative colitis and Crohn's disease. In the Northeastern part of the United States, known for their lengthy, overcast winters, rates of ulcerative colitis and Crohn’s disease are highest, with rates in the Midwest and West not far behind.

The Link Between Vitamin D and Autoimmune Disease

Inflammatory bowel diseases are chronic, inflammatory, autoimmune disorders of the GI tract. It is now proven vitamin D is an important regulator of the immune system which may have implications for the development, severity and management of immune related disorders such as IBD. Particularly if someone with IBD has any malabsorption of dietary vitamin D, and/or has less exposure to the sun due to living in a climate suboptimal for vitamin D synthesis in the skin.

Ulcerative Colitis vs. Crohn’s Disease

The symptoms of these two diseases are quite similar, but the areas affected in the gastrointestinal tract (GI tract) are different.

Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, also called the large intestine, but it may affect any part of the gastrointestinal tract, from the mouth to the anus. Ulcerative colitis is limited to the large intestine.

Crohn’s disease can also affect the entire thickness of the bowel wall, while ulcerative colitis only involves the innermost lining of the colon. Another difference is in Crohn’s disease, the inflammation of the intestine can “skip”— leaving normal areas in between patches of diseased intestine. This does not occur in ulcerative colitis. For more details about Crohn’s disease, visit my blog here.

Absorption of Dietary Vitamin D

Absorption of dietary vitamin D occurs in the upper small intestine, so if a person has had an intestinal resection due to some form of inflammatory bowel disease, they should be considered at risk of malabsorption of vitamin D, thus a low vitamin D status.

Vitamin D, IBD, and Bone Health

Vitamin D deficiency has been linked to bone loss among people with IBD, and bone loss is a problem for up to 50% of people with IBD. As a result, people with IBD are at risk of developing osteoporosis. To prevent bone disease, there are clear guidelines that recommend vitamin D supplementation for people with IBD, especially when undergoing steroid treatment. However, despite these recommendations, vitamin D deficiency is still common with IBD.

How Much Vitamin D?

The Vitamin D Council recommends adults with ulcerative colitis keep their serum vitamin D levels in the high-natural range, about 70-80 ng/ml. Your primary care physician can perform a simple blood test to determine current levels. The Vitamin D Council also advises children with ulcerative colitis should be given 2,000 IU per 25 pounds of body weight per day.

For Crohn’s disease, one study gave patients 2,000 IU per day and after 3 months, they had significantly less fatigue, increased muscle strength and an overall improvement in their quality of life.

Bottom Line: Vitamin D seems to play in integral part in overall well-being for those with some form of irritable bowel disease. Consult with your gastroenterologist and have your vitamin D levels checked.

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

References:

1. Andreassen H, Rungby J, Dahlerup JF, Mosekilde L. Inflammatory bowel disease and osteoporosis. Scand J Gastroenterol 1997;32:1247–55.

2. Andreassen H, Rix M, Brot C, Eskildsen P. Regulators of calcium homeostasis and bone mineral density in patients with Crohn's disease. Scand J Gastroenterol 1998;33:1087–93.

3. Margherita T Cantorna, Yan Zhu, Monica Froicu, and Anja Wittke. Vitamin D status, 1,25-dihydroxyvitamin D₃, and the immune system. Am J Clin Nutr. December 2004; vol. 80, no. 6:1717S-1720S.

4. Crohn’s and Colitis Foundation of America.

5. Holick MF. Vitamin D. In: Shils ME, Olson JA, Shike M, Ross CA, eds. Modern nutrition in health and disease. Baltimore: Williams & Wilkins, 1999:329–99.

6. Compston J, Creamer B. Plasma levels and intestinal absorption of 25-hydroxyvitamin D in patients with small bowel resection. Gut 1977;18:171–5.

7. Vitamin D Council: Inflammatory Bowel Disease.

8. Blanck S, Aberra F. Vitamin D deficiency is associated with ulcerative colitis disease activity. Dig Dis Sci. 2013 Jun;58(6):1698-702.

9. Vitamin D Council: Does vitamin D deficiency contribute to inflammatory bowel disease?

10. Walsh N. Vitamin D boosts quality of life in Crohn’s. MedPage Today. Mar 20, 2013.

Crohn's is the pits and anyone who has it would agree with me and probably say "the pits" is an understatement! I don’t have Crohn’s, but know people with it, and I remember thinking treating it was so difficult, complicated, and sort of a crap shoot because different treatments worked for some people but not others. There was no clear cut answer. There is no magic pill. There’s no way around it and people with Crohn’s have to learn to live with it and manage it day-to-day.

What is Crohn’s Disease?

It’s a form of Inflammatory Bowel Disease (IBD) that causes chronic inflammation and irritation of the digestive tract. There isn’t a known cause, but it is known to run in families. A person’s immune system and environment appear to also play a role in developing Crohn’s. A recent study published in October 2013, claims scientists have discovered Crohn’s disease can originate from a specialized intestinal cell type called Paneth cells. This is great news and provides a possible new target for treatment.

What happens with Crohn’s Disease?

In a majority of patient’s, Crohn’s starts in early adulthood, and involves cramping pain, diarrhea, weight loss, low grade fever, and has a profound impact on quality of life. Crohn’s disease is often associated with maldigestion and malabsorption of dietary protein, fat, carbohydrates, water, and a wide variety of vitamins and minerals. As a result, much of what a person with Crohn's eats may never truly get into the body.

What is Nutrition’s Role?

Nutrient deficiency is a common concern since inflammation from this condition interferes with nutrient absorption. As a result, people with Crohn’s disease need a nutrient-rich diet with adequate calories, protein and healthy fats. Current science also advocates nutrition to enhance the body's immune system, provide antioxidants to reduce inflammatory stress, and improve a patient's feeling of strength, stamina, and well-being.

Eat to Reduce Inflammation

• Let fruits and vegetables make up at least half your plate at meals. Make a point to regularly fit in fresh, frozen or dried berries and cherries. Be sure to eat a variety of vegetables, including leafy greens like kale, chard, spinach, and Brussels sprouts.

• Select more plant-based sources of protein like beans, nuts and seeds.

• Choose whole grains instead of refined ones. Avoid the ingredient, “Enriched.” Swap brown, black or wild rice for white rice; whole oats or barley for instant oatmeal and cream of wheat; and 100% whole-wheat bread instead of white. For some individuals, eliminating wheat may reduce inflammation. Talk to your doctor before going gluten-free and a registered dietitian can help you accomplish this.

• Swap heart-healthy fats for not so healthy ones. Olive oil, avocados, nuts and seeds are a few delicious choices.

• Choose fatty fish like salmon, sardines and anchovies to get a heart-healthy dose of omega-3 fatty acids.

• Season your meals with fresh herbs and spices. They pack a flavorful and antioxidant-rich punch.

• Free your diet of processed foods, artificial sweeteners, added sugars, and unhealthy fats are always very important.

Eat to Improve Strength and Stamina

• Vitamin D supplements may help overcome fatigue and decreased muscle strength associated with Crohn’s. Besides boosting bone growth and remodeling, vitamin D is thought to improve neuromuscular and immune function, reduce inflammation and help with other bodily tasks. Discuss your vitamin D status with your primary gastroenterologist to determine whether or not vitamin D supplementation is indicated in your particular situation. It’s an easy blood test to measure your levels.

• Eat small meals or snack every 3 to 4 hours.

Other Tips and Guidelines for Crohn’s disease 

• Stay hydrated. Drink small amounts of water throughout the day. Remember to avoid plastic bottles and choose stainless steel or glass instead.

• During times when you don’t have symptoms, include whole grains and a variety of fruits and vegetables in your eating plan. Start new foods one at a time, in small amounts.

• When you have symptoms, such as diarrhea or abdominal pain, foods to avoid may include high fiber foods, raw and gas-producing vegetables, most raw fruits and beverages with caffeine.

• Some common symptom-provoking foods are dairy, high fiber grains, alcohol and hot spices.

• Discuss with your doctor about the possibility of experimenting with a gluten free diet. It may improve your symptoms slightly.

• Consider taking a probiotic. Seventy percent of your immune system is based in your intestines so you want a very strong immune system to keep your body functioning efficiently. I highly recommend ProBiota 12. Because of the potency, start by taking 1/4 tsp., about 5-10 minutes after dinner for one week. After that, increase to 1/2 tsp. until the bottle is gone. Once the bottle is gone, continue taking the probiotics, but consider changing to the capsule form and take 1 capsule/day after dinner. 

Your gastroenterologist may recommend dietary supplements such as iron, calcium, vitamin D, folate, zinc and vitamin B12 to prevent or treat deficiencies. 

Crohn’s Patients at Higher Risk for Stroke, Heart Attack

In an analysis of over 150,000 patients with IBD in nine studies, researchers estimated the risk of stroke and heart disease in patients with IBD, as compared to the general population. The results of the comparison pointed to a 10-25 percent increased risk of stroke and heart attacks in patients with IBD. The increased risk was especially more prominent in women.

Nutrition seems to be the cornerstone of Crohn's disease and the effort put into following the correct diet is well worth it. Have meaningful conversations with your gastroenterologist and seek help from a registered dietitian nutritionist.

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

References:

Adolph, TE et al. Paneth cells as a site of origin for intestinal inflammation. Nature. Oct. 2013.

Academy of Nutrition and Dietetics. Inflammation and Diet. Aug. 2013.

Academy of Nutrition and Dietetics. Crohn’s Disease and Diet. July 2013.

Mayo Clinic. Patients with inflammatory bowel disease at higher risk for stroke, heart attack. Science Daily, 14 Oct. 2013. Web. 6 Jan. 2014.