Supplements for Ulcerative Colitis: What Should You Take?
If you’re living with ulcerative colitis (UC), you know all about the pain chronic inflammation and ulcers cause in your digestive tract. You also probably know the fatigue that comes from the inflammatory bowel disease (IBD) interfering with your body’s ability to absorb nutrients. That’s why many people with UC take supplements, says Eugene Yen, M.D., a gastroenterologist and co-chair of the Patient Education Committee for the Crohn’s & Colitis Foundation. But are supplements necessary? And what types should you consider taking? Here’s what the experts have to say.
Nutrition Suffers During Flares
UC causes inflammation throughout your large intestine, but fortunately this area isn’t as important in absorbing vitamins or minerals as your small intestine, says Dr. Yen. Still, because inflammation during UC flares means your body is working harder to protect itself, you may need to up your caloric and nutrient intake during this time, explains Diane Javelli, R.D. a clinical dietitian with the University of Washington Medical Center’s IBD Center.
Diet Doesn’t Always Cover Your Needs
Fantasy: You eat a well-balanced diet that gives you all the vitamins and minerals you need every day. Reality: During a UC flare, there is often nothing balanced about what’s going in—or coming out—of your body. If you’re having a lot of diarrhea, the food and nutrients you consume may not have a chance to be fully absorbed, says Javelli. Plus, many people avoid certain nutrient-dense foods such as fruit, vegetables, and whole grains because these can worsen symptoms, leaving you a day late and dollar short when it comes to nutrition.
A Multivitamin Might Help
“Because there are so many reasons why UC patients may not be getting proper nutrition, it’s often recommended for them to take a multivitamin to help with any nutritional gaps,” says Javelli. If you are low on any particular vitamin or mineral, however, a multivitamin alone likely isn’t going to be enough. Some common deficiencies in people with ulcerative colitis include iron, vitamin D, calcium, folic acid, and vitamin B12.
Blood Tests Provide the Bottom Line
Don’t guess when it comes to your nutrition. Get a complete blood count test done at least once a year, including testing your iron and ferritin levels (which show how well your body is storing iron). Your lab work will also reveal info about vitamin D, calcium, and vitamin B12 levels. If you’re low in any of these or other nutrients, your doctor may suggest taking a supplement. Whatever your course of action, follow up with additional lab work in a few months to see if your deficiency has been corrected, says Javelli.
Why You Might Want an Iron Supplement
Iron is the building block for blood cells, but if you suffer from UC, inflammation and blood loss through ulcers in your GI system make it difficult for your body to absorb enough of the mineral. “When your body is sick, it doesn’t make blood cells very efficiently,” says Dr. Yen. “Not only are you losing blood through your ulcers, but your body is probably not making it very fast, either.” That’s a problem because if you don’t have enough healthy red blood cells to carry oxygen throughout your body, you will develop anemia, causing you to feel super-tired all the time.
The Tricky Thing About Iron Supplements
Most of the time, doctors prefer you get iron through your diet, but people with UC often have a hard time eating high-iron foods like green leafy vegetables, which can worsen diarrhea. Complicating matters, taking an iron supplement can also be iffy for people with UC, Dr. Yen says, because it may irritate the bowels (definitely not what you need). The sort-of good news: “In cases where iron deficiencies are bad, we can give intravenous iron—a little easier on the bowels,” says Dr. Yen.
Supplements for Vitamin D and Calcium?
Vitamin D and calcium are key to bone health—and that’s especially important if you are one of the many people with UC who take high levels of prescription oral steroids, which can be harmful to your bones. Another benefit of vitamin D: It is believed to play a role in decreasing intestinal inflammation, says Dr. Yen. Because the vitamin may help your body better absorb calcium, you’ll often find the two packaged together in a single supplement.
When to Consider a Folic Acid Supplement
Folate (the natural form of vitamin B9 in food) and folic acid (the synthetic form used in supplements) help your body produce and maintain new cells. The nutrient plays a role in preventing anemia, so it’s important to keep your levels high. Because some UC medications, including Azulfidine (sulfasalazine) and Rasuvo and others (methotrexate), may impede your body’s ability to absorb folate, if you’re taking these meds, your doctor will likely prescribe folic acid supplements.
Should You Take a Vitamin B12 Supplement?
Vitamin B12 helps keep your body’s nerve and blood cells healthy while working to prevent certain types of anemia. Although deficiencies are more common in patients with Crohn’s disease, it can affect people with UC, too, Javelli says. “B12 is absorbed in an area of the small intestines called the distal ileum,” says Dr. Yen. “This type of deficiency is common in people who have had surgery on this area of their gut, making it hard for the body to absorb the nutrient.”
Do Your Homework
Before taking any supplements, talk with your gastroenterologist (GI doctor) to identify nutritional deficiencies and decide which supplements might help the most. Your doc can tell you about potential side effects and possible interactions with any other meds or supplements you might be taking. Also, some herbal supplements can affect the digestive system, possibly making diarrhea and other UC symptoms worse, Javelli says, so always run things by a medical expert first.
UC and Vitamin D: Journal of Crohn’s and Colitis. (2018). “The Effect of Vitamin D on Intestinal Inflammation and Faecal Microbiota in Patients with Ulcerative Colitis.” ncbi.nlm.nih.gov/pubmed/29726893
UC and Sulfasalazine: The New England Journal of Medicine. (1981). “Sulfasalazine Inhibits the Absorption of Folates in Ulcerative Colitis.” nejm.org/doi/full/10.1056/NEJM198112173052506
UC and Methotrexate: Inflammatory Bowel Diseases. (2016). “Use of Methotrexate in the Treatment of Inflammatory Bowel Diseases.” ncbi.nlm.nih.gov/pmc/articles/PMC4679484/
UC and B12: National Institutes of Health. (n.d.) What Is Vitamin B12 and What Does it Do? ods.od.nih.gov/factsheets/VitaminB12-Consumer/