In Crohn's disease, damage to the digestive tract, and sometimes the surgery and medication used to treat it, can make it hard for the body to absorb nutrients.
The good news is that many people with Crohn's disease can get what they need from their diet and a daily multivitamin, says Arthur DeCross MD, associate professor of medicine at the University of Rochester Medical Center in Rochester, New York.
Still, people with Crohn's should be on the look-out for shortages in vitamins and minerals, which can vary depending on the amount and location of damage in the body.
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Crohn's disease can cause bleeding in the intestines, which can result in loss of hemoglobin, the iron-laden protein in red blood cells, and anemia, a red-blood-cell deficiency.
The classic symptom of anemia is fatigue, but it can also result in headaches and pale skin.
A blood test can turn up any problems. If any, iron in pills or a liquid form may help. The Crohn's & Colitis Foundation of America (CCFA) recommends taking between 8 to 27 milligrams one to three times a day.
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Crohn's disease can damage the ileum, the lower part of the intestine necessary for vitamin B12 absorption. Sometimes portions of the ileum have to be surgically removed.
B12 deficiencies can manifest as weakness, fatigue, light-headedness, and megaloblastic anemia (larger-than-normal red blood cells). In extreme cases, it can damage the nerves, resulting in tingling or numbness in fingers and toes and difficulty walking.
If you have a true B12 deficiency, supplements won't be enough. Instead, you may need a once-a-month shot, says Dr. DeCross.
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Folic acid is another B vitamin and it's essential for forming new cells.
Folic acid is especially critical in pregnant women to prevent birth defects. But the drugs sulfasalazine (Azulfidine) and methotrexate can cause deficiencies.
The CCFA recommends that people taking sulfasalazine, in particular, fortify themselves with 1 milligram of folate a day as a supplement.
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Sometimes people with Crohn's have calcium deficiencies because the body can't absorb the nutrient. Lactose intolerance, an inability to digest calcium-rich dairy foods, is common in Crohn's and doesn't help either.
Calcium deficiencies can also result from taking corticosteroids or having persistent active inflammation, says Dr. DeCross. This can heighten the risk of early osteoporosis. Many people with Crohn's "benefit from being on calcium and vitamin D to keep their bones strong," says Dr. DeCross.
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Diarrhea is a common symptom of Crohn's disease and people with excessive, watery diarrhea can find their bodies deprived of magnesium and potassium, says Nirmal Kaur, MD, medical director of the Inflammatory Bowel Disease Center at Henry Ford Health System in Detroit.
The mineral is critical for a variety of body processes, including keeping the heart, muscles, and kidneys in good working order. Symptoms of a deficiency can include anxiety, difficulty sleeping, nausea and vomiting and restless legs syndrome.
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Prolonged diarrhea can also deplete zinc reserves. And a zinc deficiency can lead to more diarrhea, creating a "vicious cycle," says Dr. DeCross.
This type of deficiency is rare, though children may be at greater risk. A 2011 study in the journal Clinical Pediatrics found that children recently diagnosed with Crohn's disease had lower zinc levels than their healthy counterparts.
Zinc deficiency can result in slowed growth, loss of appetite, and can also compromise the immune system.
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People whose lower intestines have been damaged or removed due to Crohn's disease may have difficulty absorbing vitamin A. More commonly, though, deficiencies may occur if Crohn's has resulted in any obstruction of the intestine. The ileum usually has a small population of bacteria. When the intestine is blocked, however, fluid can stagnate, causing a "festival" of bacteria, says Dr. DeCross. "The bacteria will compete for and consume vitamin A," he says.
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As many as 68% of people with Crohn's may have vitamin D deficiencies, according to the CCFA, which can result in bone pain and weak muscles. Vitamin D is not that easy to get from food, but is produced by sun exposure and can be obtained in a supplement. "Vitamin D is frequently deficient in patients with Crohn's disease," says Dr. Kaur. "Every patient who has inflammatory bowel disease should have a vitamin D level checked at least annually and supplemented as needed."
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Another casualty of damage to the ileum is vitamin E, known for its anti-oxidant properties. Symptoms can include tingling and numbness in the fingers and toes (known as peripheral neuropathy) and muscle weakness.
Vitamin E can be found in nuts, seeds, vegetable oils, green leafy vegetables, and fortified cereals. But people with Crohn's may need water-soluble forms of vitamin E, such as tocopheryl polyethylene glycol-1000 succinate.
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Like vitamins A, D, and E, vitamin K is a fat-soluble vitamin meaning it is less easily absorbed than water-soluble vitamins such as B and C. That makes people with Crohn's disease especially vulnerable to vitamin K (along with A, D, and E) deficiencies.
Vitamin K is essential for blood clotting and possibly also to maintain strong bones. You can find it in green leafy vegetables (think spinach, kale, and collards) as well as in fish, liver, meat, and eggs.
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