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Vitamin D Put to the Test for Crohn’s Disease

Inflammatory bowel disease (IBD), “a chronic inflammatory condition of the intestine that causes abdominal pain, diarrhea, and weight loss,” includes Crohn’s disease and ulcerative colitis. When we compare identical twins, even though they have the same genes, most of the time, if one twin has IBD, the other does not. In that case, there must be some important, non-genetic trigger factors. What might they be?

Studies like the ones I discuss in my video Vitamin D for Inflammatory Bowel Disease offer a clue. Why do those living in the southern United States have lower IBD rates than those living in the north? Maybe it’s because Southerners get more sun, which means more vitamin D and which may also mean less inflammation.

So, do people with Crohn’s and ulcerative colitis who have low vitamin D levels have worse disease? Apparently so. Not only is there an increased risk of surgery and hospitalization, but those who normalize their vitamin D levels appear to reduce their risk of relapse. However, instead of better vitamin D levels leading to better Crohn’s, maybe better control of Crohn’s led to better vitamin D. Indeed, perhaps they felt so good, they went outside more, “increasing physical activity and outdoor sun exposure.” We can’t tell if it’s cause and effect unless we put it to the test.

The first pilot study tried 1,000 units of vitamin D a day and saw no change in the Crohn’s disease activity index. At six weeks, however, there may have been a slight increase in IBD quality of life scores, but even that disappeared by year’s end, so the results were pretty disappointing overall. Perhaps the researchers didn’t use enough vitamin D? How about 1,200 IU a day? At that level, the relapse rate appeared to be cut in half, as you can see at 1:45 in my video, though there were too few people in the study to reach statistical significance. What happens with 2,000 IU of vitamin D a day? Gut leakiness (so-called intestinal permeability) continued to worsen in the placebo group, but appeared to stabilize in the vitamin D group, though only those who reached blood levels over 75 nanomoles per liter appeared to have a significant drop in inflammation. And, indeed, if Crohn’s patients are started on 1,000 IU of vitamin D per day and then the dose is ramped up until a target blood level is reached, it’s possible to get a significant boost in quality of life accompanying a significant drop in disease activity, as you can see at 2:19 in my video. Disease scores under 150 are considered remission, so “the majority of patients achieved remission” with improvements in disease activity in all but one person in the study. This suggests that Crohn’s patients may want to take 5,000 IU of vitamin D a day, but that’s nearly ten times the Recommended Daily Allowance. Why so much? Because that’s what it may take to get vitamin D levels that are normal for our species—that is, the kind of levels one might get running around half naked in Africa, as we did for millions of years.


For more on the role diet can play in preventing and treating inflammatory bowel diseases, see:

Interested in learning what else healthy vitamin D levels can do for you and your family? Check out:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


79 responses to “Vitamin D Put to the Test for Crohn’s Disease

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  1. From the bottom of my heart, I want to thank Dr. Greger and the NutritionFacts.org team for my improved health.
    Yesterday, I received my pathology results from my most recent colonoscopy – NO evidence of Crohn’s!!!!
    I have an 18 year diagnosis of CD with 1 surgery in 2014 for terminal ileum stricture. I have been on and failed biologic therapy, so for the last several years, have subscribed to a WFPB SOS free lifestyle. For approximately the last year, I have eliminated yeast from my diet as well.
    Thank you, thank you, thank you! I am a very happy person!

  2. I love it so much when you give the results at different doses.

    It shows me why different study conclusions can be so opposite.

    I feel like I don’t have a “big picture” for what Vitamin D supplementation can do because of the debate in the wider communities.

    The fact that it helped with leaky gut is something that so many people might benefit from, since so many autoimmune conditions seem to start with leaky gut.

  3. I have Crohn’s and have been taking extra Vit D. My blood tests say I am too high. I was told it can cause kidney stones. Also someone told me that if I take magnesium that it wouldn’t cause kidney stones.

    Can you comment about that please?

    1. Rhonda,

      It can cause them if you are predisposed to kidney stones.

      The bigger risk is if you are taking such high levels that you end up with high calcium levels which can lead to bone and kidney problems and things like hypertension.

      You can probably check for that, too.

      When you say that you are taking extra and that your blood tests say that you are high in Vitamin D, I wonder what that means in numbers.

      I have a friend whose naturopath has her on 50,000 or something like that and that dose could eventually harm her kidney function, but she trusts her naturopath and has told me to shut up more than once and I have to shut up now.

      Maybe lower the dose a little?

          1. Judy, Thanks for the link. Note that the NIH states the following:

            ” Some are potentially at risk for inadequacy at levels ranging from 30–50 nmol/L (12–20 ng/mL). Practically all people are sufficient at levels ≥50 nmol/L (≥20 ng/mL); the committee stated that 50 nmol/L is the serum 25(OH)D level that covers the needs of 97.5% of the population. Serum concentrations >125 nmol/L (>50 ng/mL) are associated with potential adverse effects.”

            It seems to me that whether or not below 20 ng/ml is “normal” (does that term as you used it mean not atypical in the population or causing no harm?), it is better to be above 20 ng/ml and less than 50 ng/ml. My doctor (and her lab) recommends above 30 ng/ml, but I realize the best cutoff point is controversial.

            I’ve been thinking about cutting back on vitamin D supplementation (my ;evel is about 45 ng/ml) and reviewing the material in the link has been helpful to me.

    2. I’m glad you are turning here for health information rather than acting on what “someone” told you’
      You have already received some good information about how too much Vitamin D might cause kidney stones and taking supplements esp if your levels are high is something you need to review with your doctor.
      About magnesium-that information about Vit D may have been referring to Vit B6: According to this source: https://medlineplus.gov/druginfo/natural/934.html “People with a hereditary disorder called type I primary hyperoxaluria have an increased risk of forming kidney stones. There is some evidence that taking vitamin B6 by mouth, alone or along with magnesium, or getting vitamin B6 injected into the vein, can decrease the risk of kidney stones in people with this condition. However, it does not appear to help people with other kinds of kidney stones”
      Since you mentioned Chron’s disease and magnesium, the following might be helpful: https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ “The chronic diarrhea and fat malabsorption resulting from Crohn’s disease, gluten-sensitive enteropathy (celiac disease), and regional enteritis can lead to magnesium depletion over time [2]. Resection or bypass of the small intestine, especially the ileum, typically leads to malabsorption and magnesium loss [2)”
      Hope these help answer your questions.

  4. I’m sorry I’m going to miss you on this year’s Holiday at Sea Cruise- till 2021.
    I have an 11 year old Chronie- should he also take 5000 IU or less?

    1. Miriam,

      The dosing of any nutrient, but especially Vit D, is a very much a “your mileage may vary” situation based on unique genetics, BMI, lifestage, outdoor time, skin tone. The science seems pretty clear about that. So you cannot really make a blanket statement about what dosage to take for anyone.
      The only way to know for sure is to actually measure 25 hydroxy Vit D level in the winter and compare your level to what you get from supplementation and diet. IF you are found low you must increase your dose judiciously (some formulas out there based on body weight) and after a month of diligent supplementation recheck your levels and again, adjust your dose as needed. I know some people seem to be in optimal range taking 2,000 IU per day, whereas a friend of mine who is obese takes 10,000 IU/day to get into borderline optimal range. I take 5,000/day all year long, as I have skin cancer issues and dont get much sun exposure and my levels are very good (And I feel so much better!).

      The Linus Pauling Institute based at Oregon State University has a very good overview all things VItamin D here: https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

      But thanks to Dr. Greger for bringing that optimal Vit D study to our attention…that is what got me to spend the money to get my levels checked years ago…and found I was borderline deficient. I had to pay out of pocket (my insurance would not pay for it…which I think is criminal) but it has been SO worth it!

  5. High level of ‘synthetic’ Vitamin D can cause excessive thinning of the blood. I have ITP and I have had some terrible reaction to high dose Vitamin D. Fortunately, I live in south FL so getting good does of vitamin D sun are possible. So, high dose Vitamin D may well be contraindicated in certain people.

    1. Stephen,

      Thanks for the heads up.

      Regarding the thinning of the blood, that answer is probably why Vitamin D levels are so important in mortality of people who have Ischemic strokes. It has been a mild Winter where I live, but this morning was very icy here. Winter is when they are more likely to happen. Good time for those who don’t have thin blood to be taking them.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525921/

  6. Here is the link for a research article named: “The Big Vitamin D Mistake” about vit D situation in Finland and the daily recommendations which are at 8.000 IU daily…

    https://www.ncbi.nlm.nih.gov/pubmed/28768407

    Also a great lecture from Bruce W. Hollis, PhD, Medical University of South Carolina free over at YouTube: – Results of a Prostate Cancer/Vitamin D Trial: Effectiveness Safety Recommendations

    https://youtu.be/QrU1yrmNIqc

    I am also aware of some people using ten times that amount or more plus vit K and magnesium and getting rid of MS or at least getting it under control plus all sorts of ailments disappearing. You can google that…

    1. Thanks for posting that plantbrother.

      The ten times more one is something I pause at inwardly because of the kidney function problems.

      Maybe temporarily though. I am not sure how to follow the logic between the fact that it really would be good for autoimmune, but it has similar risks to spinach on the kidneys.

      It didn’t shut down the kidneys anywhere as fast as multiple cups of spinach, but kidney function and blood becoming too thin are topics that give me a sense of upper limit.

      I will be listening to the prostate cancer and Vitamin D lecture later. Really excited about that one because that is part of the debate in the wider community.

      1. plantbrother,

        When I got to the biopsies improving after a year of supplementing Vitamin D with men who started with high PSA and enlarged prostates, I felt angry.

        I am a woman in the Northeast who noticed the study where women in the Northeast were so much more likely to get Breast Cancer and where low levels of Vitamin D were associated with much higher levels of Breast Cancer and greater mortality.

        That man’s study, just adding in Vitamin D, the men had improvement in biopsies. Matched to themselves.

        That means that the Vitamin D improved their own Cancer????

        That makes me angry.

        Sorry, the inner rebel within me gets mad that there is a campaign against the supplements.

        Honestly, those results mean more to me than a randomized trial because the men started off with Cancer and their biopsy results got better.

    1. Thanks for the math.

      Yesterday, I helped with the “Help make Alexa smarter” questions and I gave the right answer which was similar to 2.496 and they responded, “Alexa would not say an answer like that.”

  7. This confirms my suspicion that our great grand parents knew the important things: get some exercise, go outside, eat your vegetables, be nice to people, do a good job at work. Many of these issues seem to get better by doing all of them well, not just by separating them into a disease/non disease.

  8. I was under the impression that the RDA of D3 in USA had been raised to 2 000 IU a day, this following recommendations from a number leading American and Canadian experts on the subject, with corresponding recommended blood levels of between 75 and 120 nanomoles per lt (depending on age and region of residence). Right now I can’t find where I read this, but one of the experts mentioned was Dr. Holick.
    Dangers from D3 was said to occur only with high dosis of more than 10 000 IU a day sustained over a long periode of time (longer than 6 months).
    Can anyone shed some light on this?

      1. I will say that the toxicity chart tells me that some of the WFPB leaders are a little reactionary in their fear of the supplement.

        Don’t get me wrong, I love all of the doctors, but “fear of supplements” leading to a “fear of Vitamin D” supplementation is part of the wider culture.

        Mentally, I have mentally gone back and forth on this issue and I have argued with people like Jeff Nelson, about whether there are benefits that outweigh the risks for people who are at risk of being deficient, but the risks of toxicity aren’t happening at lower levels.

        It would be more like being afraid of spinach, which people are.

        1. I already regret posting that because I know that people are looking for the “safe margins” but people think that it is okay to be deficient, but if they just let themselves be deficient, they are more likely to die from a stroke or get an autoimmune disease or a respiratory infection and even Type 2 diabetes and if they are part of the Black community, they are at greater risk of getting cancer and dying from cancer.

          That is an important enough list to mention and that doesn’t even include pain and arthritis and asthma and overall immunity and helping MS.

      1. I was just about to share the same information about Vitamin D, but I would like to second what you wrote. I already have osteoporosis and have been taking between 2,000 and 5,000 on any given day, but I am going to decrease my supplemental intake until after I have a vitamin D test. My husband, on the other hand, has never had his Vitamin D tested, and he has consistently been taking 5,000 IU per day. A recent x-ray showed a compression fracture in his vertebrae. I am hoping his doctor will order a DEXA scan.
        I found the NIH report after reading this blog by a RD. https://www.food4osteoporosis.com/blog.html?article=Dont-take-a-Vitamin-D-supplement-if-you-dont-need-one

        1. Judy,

          There has been a back and forth in the studies for osteoporosis and for fractures.

          For instance, for fractures, one study with D3 showed a 33% improvement in fractures and one with D2 showed people having more fractures. The Cochrane Review, there was a benefit, but only when it was given with calcium.

          1. Tom’s publication post agreed with what I was reading on PubMed and the concept that there is a dose J curve is still one concept that I don’t fully understand, but it will likely explain the opposite results.

            Hoping Dr. Greger will post a “J Curve” picture eventually.

            Among postmenopausal women and older men, supplements of both vitamin D and calcium result in small increases in bone mineral density throughout the skeleton. They also help to reduce fractures in institutionalized older populations, although the benefit is inconsistent in community-dwelling individuals [1,2,48]. Vitamin D supplementation alone appears to have no effect on risk reduction for fractures nor does it appear to reduce falls among the elderly [1,2,48]; one widely-cited meta-analysis suggesting a protective benefit of supplemental vitamin D against falls [49] has been severely critiqued [1]. However, a large study of women aged ≥69 years followed for an average of 4.5 years found both lower (<50 nmol/L [<20 ng/mL]) and higher(≥75 nmol/L [≥30 ng/mL]) 25(OH)D levels at baseline to be associated with a greater risk of frailty [50]. Women should consult their healthcare providers about their needs for vitamin D (and calcium) as part of an overall plan to prevent or treat osteoporosis.

      2. Tom,

        Thank you for sharing the official answers.

        I highly respect you.

        It is hard to process these topics.

        A few studies, that amount wasn’t enough to get results.

        I realize that Vitamin D as a research topic is harder.

        People go out in the sun.

        People drink milk.

        It is the institutionalized that showed the best results.

        I honestly know that this is going to be like skipping breakfast having opposite results as intermittent fasting and the doctors are doing a tug of war.

        Dr Greger,

        Is there a chronobiology answer?

        They said to take D in the morning or it might mess up my sleep.

        Taking it in the morning might help my sleep and I already nodded off a little tonight.

        I ask about the chronobiology because time and light already push me to want to understand how D fits into chronobiology.

  9. On Vitamin D but taken orally with a spray instead of tablets, does anyone know if this is safe, it also has ethanol in it. Bioceuticals Liposomal D3 1000IU.

    1. Lesley,

      They have studied the use of ethanol in herbal supplements on children and said that the doses of ethanol were low enough that it wasn’t a problem. Plus, they said it doesn’t accumulate in their system.

      They did a study where they gave 142 mg ethanol to children between 6 and 12 years up to 12 times per day and said that each dose of ethanol was eliminated within 3 min and didn’t accumulate in their system.

      Some sites say not to overdo it with supplements with ethanol for the sake of the liver and they also say that chronic ethanol exposure lowers the level of Vitamin D in your system.

      But I am thinking that would be much higher doses than what is in your Liposomal D3.

    1. Gillian,

      I wish he had included the data with the mechanism, because, for instance, the last blog was about how people who supplemented had fewer infections and a stronger immune system.

      I will be interested in seeing whether it was a different dose of D or a different type of D to get the opposite results.

  10. Here is a research paper where they tried to map incidences of cancer relative to latitude

    “Breast and colorectal cancer incidence rates are highest in countries distant from the equator and lowest in near-equatorial countries. It is known that adequate levels of vitamin D, which require sunlight for synthesis in the skin, tend to be associated with lower age-adjusted incidence rates of these cancers.”

    LINK:
    https://www.researchgate.net/publication/241901214_MAPPING_VITAMIN_D_DEFICIENCY_BREAST_CANCER_AND_COLORECTAL_CANCER

    There are similar curves (or almost identical) in case of other diseases/conditions so it seems obvious that vitamin D deficiency plays a major role in body’s defense mechanisms.

    1. plantbrother,

      That is true.

      Unfortunately, there is a stupid “J” curve with Vitamin D and the studies go back and forth depending on which type of D was used and on what dose of D was used and whether people were deficient or not.

      I just wandered through the research and the doses are so ridiculously different that it is hard to make real conclusions.

      Today, to see if I can reverse my insomnia, I did one high dose. I have no desire to do lots of high doses, but the study I was reading, the one high dose was enough if people were deficient and people didn’t need hypnotics.

      I took it this morning and I actually feel sleepy already.

      I guess I will find out this week if it actually works.

      1. I still feel tired 2 hours later.

        As if I took a Benadryl.

        I haven’t had the sensation of feeling tired for maybe a decade.

        Even when I slept using the ICES PeMF, I didn’t feel tired. That was more like being put under at the dentist.

            1. Day 2 after the one high dose Vitamin D and I slept 8 hours.

              I just did that original 25,000 IU from the sleep study and didn’t take any more after that.

              The study did 50,000 followed by 1,090 per day for a month.

              I have 5,000 IU pills and felt like I wanted to stay out of the toxic range.

              Two nights of sleep so far.

              1. What occurs to me was that I have bought different kinds of pillows and sheets and mattresses and under the back pillows and blankets and fans and white noise machines and blue blocker glasses and room darkening shades and earplugs and noise machines and a new cell phone with room for sleep apps and light therapy lamps and melatonin and Tylenol pm and Advil pm and chamomile tea and Sweet Dreams and Sleepy Time tea and a brain Sound machine that brings you into gamma and delta and a PEMF which worked for a few weeks And essential oils and diffusers…

                And it is going to be that I am low in vitamins.

    1. YR,

      Sylvia Tara was just talking about a virus that causes people to store fat.

      I don’t know whether it is a bird virus or bovine virus or what. She didn’t say.

      She did say though that for people who have diabetes if they are slightly overweight they have better mortality than Diabetics who are seriously thin.

      It is interesting.

  11. Vitamin D is immuno suppressive, maybe that is why it helps. Often when 25 D levels are low 1, 25 D levels are super high and the 25 D has been over converted to the active metabolite 1, 25 D, which means you are not really low in vitamin D. This is seen in many chronic diseases.

    1. Rebecca,

      One of the articles I read said that there are opposing theories about it.

      Mentally, I go to Finland preventing Type 1 Diabetes by adding supplemental Vitamin D.

      Is it the immunosuppressive function of Vitamin D that successfully prevents an autoimmune disease?

      1. Anyway, Day 3 and I am tired at night again. I am going to bed now. Four or five hours earlier than before I tried the Vitamin D supplement study. Sleep is good. I am so tired and I am wondering if this is what Melatonin production feels like.

      2. And usually with things like steroids they get more infections and Vitamin B supplementation they get fewer infections, fewer cases of flu, fewer cases of sepsis, etc.

  12. Hello Dr Greger, I’d love it if you found time to investigate the research on the relationship between Vits D and K2. There’s talk ‘out there’ that K2 helps make D more bio-available. Considering that the body works best when all nutrients are present, it makes sense that deficiency of the one would interfere with absorption of the other. I have an anecdote to share – my 86 y.o. mom, who doesn’t take any prescription meds, could not seem to get her D levels up into a normal zone even after 3 months on 5,000 IUs/day – the numbers didn’t budge. She doesn’t eat enough greens and she resisted the recommendation to eat fresh greens. So I gave her a high quality K2 capsule supplement to take along with her vit D supplement. That did the trick for her. Perhaps, people with Crohn’s or IBS or any other seemingly D deficient ailments don’t eat enough greens to get adequate amounts of K2. If there is indeed a bio-availability relationship between K2 and D, then it ‘might’ help a person to get better results with lower dosages of D if they made sure they were getting enough K2 either through greens or good quality supplements.

  13. Though I eat tons of greens and take a brand that includes K and I am post menopausal and overweight and I just recently did a larger does and that changed my sleep remarkably (after a decade of severe insomnia)

  14. Greens are a good source of k1, which does not always convert to K2 in some. K2 is higher and more available in liver, some dairy products, and natto, not the best tasting. Take a look at Dr Kate Rheaume-Bleue, online or her book, Vitamin K2 and the Calcium Paradox. It may be necessary to supplement with K2, but not all forms are created equal.

  15. I have a (potentially) weird observation. If I take Vit D supplements, after a period of time I get small red bumps on my scalp. Stop taking them, the bumps go away. It has happened with different supplements, including one with Vit K as well.

    I’m wondering if anyone knows what might be happening. My Doc is at a loss and recommends I stop taking when the bumps show up.

    I supplement because my Vit D levels test low, and I have an auto-immune issue which is supposed to get worse with low Vit D

    1. Do you take it with or without food? I’m wondering if you took a different form of D or K, whether or not it would make a difference. So, if you are taking D3, try D2 and vice versa. You could even try a liquid form. K2 comes in different formulations. There is MK7 AND mk4 forms of K2, and some supplements that combine all forms of K into one.

      1. Normally, with food. I’ve tried tablets, drops, capsules. With with and without K2. Lower and higher doses. The response seems to be the same (higher dosages make it happen faster than lower, but all do over time).

    2. Hi, VJacques! It may be that the bumps on your scalp are a signs of toxicity when you have taken more vitamin D than you need. If a lower dose does not fix the problem, then taking a break from the supplements when the bumps show up may be the best advice. Vitamin D is a fat-soluble vitamin, so it is stored in the body. Maybe taking the supplement less often would alleviate the symptoms you are experiencing. You can find everything on this site related to vitamin D supplements here: https://nutritionfacts.org/topics/vitamin-d-supplements/ I hope that helps!

  16. That may be – but I wonder why the test results show I’m low in Vit D. It’s a catch-22. Test show low –> try to supplement –> reaction, so stop supplement –> test shows low levels. Maybe the issue is the test?

    1. VJacques – There are dozens of nutrients that act as support for each other, hence the advice that it’s best to obtain your nutrition from food because Nature has already combined many of the enzymes, co-enzymes, co-factors, etc. However, for various reasons, many of us don’t always do the right thing in regards to our diets, and supplements can be so much easier sometimes to use as a fill in for those times. But care must be taken when taking supplements. Taking isolated nutrients in supplement form can lead to problems. Learning about relationships between nutrients is pretty important if you want results and don’t want to end up with a toxicity situation. One thing to consider during your attempts to figure out why you are having this Vit D off/on issue is this particular relationship : Besides the Vit K I mentioned earlier, Magnesium is another nutrient that helps to activate Vitamin D. Turns out that Vitamin D, in turn, is necessary for the proper utilization of Magnesium. Because they work together, it would follow that too much, or not enough of one could cause metabolizing problems for both. In this case, Vit D can easily accumulate to a toxic level because it’s a fat soluble vitamin which is stored in the body. Magnesium, on the other hand is water soluble, which means it isn’t stored (excess gets excreted through urine) , so the chance that you may have a magnesium deficiency that’s keeping your vit D levels from stabilizing could be a thing to consider, (and look into), as a contributing factor in your situation. Magnesium deficiencies can be common due to the fact that it’s refined out of many foods, it’s sensitive to cooking, and it’s somewhat subject to being made less bio-available by oxalic acids in foods like spinach. Age, too, can be a factor in Magnesium deficiency because of decreased absorption potential as we age, especially if we haven’t consistently eaten a healthy diet.

      1. Thank you for your follow-on message Cheryl. I continue to focus on whole food vs supplements and will spend some more time looking at all of my vitamins/minerals and see if I can identify anything. I do have a spinach based smoothie almost every morning (a healthy one, with beans, broccoli, tumeric, cabbage, citrus fruit, various herbs & spices), so that might be something to look at as well.

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