January 11, 2018

Possible Colitis Nutrient Deficiencies

The large intestine is primarily responsible for absorbing water from the remaining indigestible food and transporting them to be excreted. When the large intestine is inflamed and not functioning optimally there can be deficiencies along with side effects of medication. Here are some common nutrient deficiencies for someone with ulcerative colitis: Calcium, Magnesium, Potassium, Iron, Vitamin D, K, B12 

Calcium – This deficiency can be a side effect of prednisone or if not enough calcium is absorbed from diet due to restrictions such as removing dairy from the diet and not replacing it with other calcium sources such as bone broth, green veggies, etc.

Functions:
· The most abundant mineral in the human body and among the most important. Represents 1.5-2% of our body weight (where 98% of that is in our bones, 1% in our teeth and the remainder in other tissues and circulation).
· Maintaining a proper blood calcium level is especially important to cardiac function.
· Many nutrients, Vitamin D and hormones are essential for calcium absorption, function and metabolism.
· Becomes less efficient as we age. 50%-70% may be absorbed during infancy and childhood whereas only 30%-50% during adulthood.
· Duodenum is the main location of absorption – further down the small intestine is too alkaline.
· Fast moving intestinal tract reduces absorption as well as lack of exercise and stress.
· It improves absorption of B12, but too much will interfere with absorption of magnesium, zinc, iron and manganese.
· Foods high in oxalic acid will reduce absorption (ex: spinach, rhubarb, chard and chocolate) as well as phytates (whole grain foods/foods rich in fiber).
· Important in the nervous system – calming to the nerves with higher concentrations; decreasing nerve irritability.
· Many factors will affect absorption – 30-80% may be excreted. Overall, need good sources of calcium and good nutrition habits.

Companion Nutrients:
· Vitamin D (most important) and magnesium for absorption.
· Vitamins A and C can also help transport calcium.
· Phosphorus for normal bones (also magnesium, silicon, strontium, possibly boron and the protein matrix)
· Magnesium for its functions in the blood as well as nerves, muscles, tissues – especially regulating heart and muscle contraction and nerve conduction.
· Protein and fat can help absorption but too much may reduce it.

Deficiency Signs:
· If not enough in the diet to maintain calcium in the blood, the parathyroid glands will release more parathyroid hormone (PTH) drawing calcium out of the bones and increase intestinal absorption. Even though most of the calcium is in the bones, the blood/cellular concentrations are maintained first
· Osteoporosis: brittle and fragile bones from loss of tissue. Elderly people (who usually have less calcium in their diets) and particularly postmenopausal women. Calcium is often drained from the bones during pregnancy and nursing and becomes hard to replace in later years.
· Bone health affecting mouth, jawbone and teeth: loose teeth, gingivitis, periodontal disease.
· Phosphorus-to-Calcium ratio should be 1:1 but often 2:1 or more leading to calcium being removed from bone àbone loss and tissue calcification.
· Other symptoms: toxemia of pregnancy, anxiety, hyperkinesis, MS (theory with correlation to Vit D during puberty), nerve sensitivity, insomnia, confusion, chronic depression.

Toxicity:
· Hypercalcemia: having too high of calcium levels in the blood. Possible to experience by consuming too many calcium supplements or certain diseases can also lead to high calcium levels in the blood. Mostly it is a result of thyroid dysfunction: hyperparathyroidism. The parathyroid gland produces the hormones that regulate calcium in the body. If those hormone levels are out of whack, calcium can be released from the bones into the blood weakening bone structure. Symptoms of hypercalcemia: lethargy, mental imbalance, weakness, dehydration, constipation, nausea, diarrhea, and heart arrhythmia. When chronic constipation is associated with thyroid disorders, it is often attributable to hypercalcemia.
· Overabundant amount in conjunction with magnesium deficiency can lead to calcification of soft tissues or kidney stones.

Contraindications:
· Calcium supplements can interact with many different prescription medications, including blood pressure medications, synthetic thyroid hormones, bisphosphonates, antibiotics and calcium channel blockers. Depending on the medications, may need to take the supplement with or between meals.

Whole Food Sources:
· Found in many foods but only high amounts in some: Milk (has a good balance of protein, fat, magnesium and phosphorus) – many people are lactose intolerant and it’s the lactose that helps with absorption, yogurt, cheese (swiss, jack, cheddar)
· Leafy green vegetables: broccoli, cauliflower, peas and greens. Spinach and chard less so because they contain oxalic acid.
· Nuts (almonds, brazil, hazelnuts) and seeds (sunflower and sesame), molasses and some fruits (citrus, figs, raisins and dried apricots).

Drinking soft water, which is high in sodium and low in calcium can lead to increases in cardiovascular disease. Hard water supplies extra calcium and magnesium which protect the heart.

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Magnesium – This mineral is absorbed in the colon and eating foods rich in magnesium such as avocado and banana is important.

Important essential macro-mineral, even though there are only several ounces in the body (0.05% of body weight). 65% in Bone and teeth. 35% in blood, fluids, and other tissues. Higher concentration in Brain (higher than blood).

Best absorption of Mg requires an acidic stomach environment: Best taken between meals or at bedtime. Maintain and regulates our electrolyte balance.

Companion mineral:

• Mg works with Ca in its functions in the blood, nerves, muscles, and tissues, particularly in regulating heart and muscle contraction and nerve conduction.
• Process of digestion and absorption of Mg is similar to Ca. Ratio of intake: 2:1 (Ca:Mg).
• To function optimally, Mg must be balanced in the body with calcium, phosphorus, potassium and sodium chloride.

Sources:

• Dark green vegetables: raw spinach, swiss chard, kale, collar greens
• Nuts, Seeds: pumpkin seeds, sesame seeds, Brazil nuts, almonds, cashews, pecans
• Seafood/ Fish: Mackerel, Pollock, Sardine
• Legumes, Beans and Lentils: soy beans, tofu, white beans, french beans, black-eyes peas
• Whole grains: wheat (bran and germ), brown rice, millet
• Fruit: avocado, bananas, dried figs, dried prunes, dried apricot
• Low-fat dairy: Plain non fat yogourt
• Dark Chocolate
• Hard water

Factors affecting Mg availability from foods:

• Amount of Mg in the soil in which the food is grown.
• Processing and refining of foods, and in the making of oils from the Mg-rich nuts and seeds.
• Soaking and boiling foods can leach Mg into the water.
• Oxalic acid (ex: spinach, chard, rhubarb, chocolate) and Phytic acid (ex: whole grains) may form insoluble salts with Mg, causing it to be eliminated rather than absorbed. -> Reducing absorption.

Functions:

• Anti-Stress. Relax skeletal muscles and smooth muscles of blood vessels and the gastrointestinal tract. Relax nerves.
• Influence on good function of heart: Preventing angina, preventing coronary artery spasm, a significant cause of heart attacks, myocardial infarctions.
• Helps with nervousness, anxiety, insomnia, depression, and muscle cramps.
• Alleviate PMS, menstrual cramps, irritability, fatigue, depression and water retention (with Mg, Ca, B6)
• Needed in DNA and RNA production and function, the body’s internal instructions for building proteins and new cells
• Modulate the electrical potential across cell membranes.
• Helps with fatigue and energy. Help release of energy by transferring the key phosphate molecule to adenosine triphosphate (ATP), an energy source generated by the cytochrome system.
• Mg combine with malic acid, as magnesium malate is helpful with chronic fatigue syndrome and fibromyalgia pains.
• Mg sulfate - Epson salts: Effective laxative, relaxing and help drain toxins

Deficiency & Toxicity Signs:

• More likely in people eating processed-food diet, cooking or boiling all foods, especially vegetable, drinking soft water, alcoholics, eating food grown in mg-deficient soil. Meals high in protein or fat, a diet high in phosphorus or calcium (Ca and Mg can compete).
• When Mg absorption is decreased: burns, serious injuries, surgery, patients with diabetes, liver disease, malabsorption problem.
• When Mg elimination is increased: alcohol, caffeine, excess sugar, diuretics drugs or birth control pills. Stress increase Mg excretion.
• Early symptoms: fatigue, anorexia, irritability, insomnia, muscle tremors or twitching.
• Psychological changes: apathy, apprehension, decreased learning ability, confusion, poor memory.
• Moderate deficiency: Tachycardia and other cardiovascular changes.
• Severe deficiency: numbness, tingling, and tetany (sustained contraction) of the muscles, delirium and hallucinations. Arterial spasm, specifically of the coronary arteries, can lead to angina symptoms or even a heart attack. Blood pressure rise, tissue calcification and kidney stones.
• Toxicity due to Mg overload is almost unknown in a nutritional context, as excesses are usually eliminated in the urine and faeces. Often seen in people with kidney failure. But can occur if Calcium intake is low.
• Depression of the central nervous system, causing muscle weakness, fatigue, sleepiness, or even hyper-excitability, muscle weakness, irregular heartbeat, low blood pressure, respiratory distress, cardiac arrest. In extreme states can lead to death.
• Bowel laxative. (350mg for tolerable supplements. Ok till about 1,000 mg.)

Contraindication or to be monitored strictly:

• Blood pressure medications / calcium channel blockers (ex: Nifedipine)
• Kidney disorders: kidney failure -> strictly monitored
• Diabetes & Insulin injection: may reduce the amount on insulin injections
• Antibiotics where the absorption is hindered by the intake of Mg: Quinolone antibiotics, Tetracycline, Nitrofurantoin. (schedule 2 hrs gap away)
• Pharmaceutical interactions (binding effect in the gut creating non-absorbable complexes): Levothyroxine (under-active thyroid), Tiludronate & Alendronate (osteoporosis), Warfarin/ Coumadin

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Vit D – Deficiency found in the majority of IBD patients.

It’s also known as “sunshine” vitamin. Vitamin D is generated when human skin is in contact with the ultra violet rate (UVB) from the sun. 

Sources: 
Vitamin D2: Plant Derived- Mushrooms, or dark leafy greens. Low content of Vitamin D. 
Vitamin D3: Animal Derived – Cod oil, salmon, sardines, mackerel, egg yolk, butter, liver. 

Functions: 
· helps regulate calcium metabolism. Vitamin D3 increases the absorption of Calcium from the gut 
· regulates bone formation. 
· Maintain normal blood levels of calcium and phosphorus. 
· Maintain nerves system, heart function and normal blood clotting with calcium
· Acts more like hormone than a vitamin- helps to treat anxiety, menopause, hot flash and depression. · Helps with muscles spasms, especially when related to anxiety, visual problems, skin issue, arthritis. 
Note: Vitamin D can be combined with Vitamin A to reduce season colds. 

Deficiency: 
· Osteomalacia (Loss of bone mineral)
· Chronic pain, chronic kidney disease, rickets, osteopenia. 
· In children- soft skull bones, fragile in bones, increase sizes of joints, loss of hearing, poor structure of teeth, nearsightedness due to vitamin D effect on eye muscles and loss of calcium in ear bones. 

Toxicity: 
· Milder symptoms: Excessive thirst, diarrhea, nausea, weakness and headaches. (usually goes away when decrease intake of Vitamin D). 
· Increase the level of calcium and phosphors in the blood and urine, abnormal calcification of soft tissues may occur. 
· Excessive vitamins D can speed the process of atherosclerosis. Big concern with fortified Vitamin D added in milk. This synthetic D2 is added to decrease rickets (weaken bones) but may increase amount of calcium in calcification of the arteries from infancy through old age. 

Contraindications: 
· Aluminum, calcipotriene (Dovonex), Digoxin, Diltiazem, Verapamil, water pills. Kidney stone/diseases. 
· High calcium levels, sarcoidosis, tuberculosis, parathyroid disease (calcium imbalance), having an organ transplant 

Fun Facts: 
· The ultraviolet sunlight can’t penetrate glass. Therefore you won’t generate Vitamin D when sitting in the car or home. Wearing SPF will prevent you from generating vitamin D as well. 
· A person will have to drink 10 tall glasses of vitamin D fortified milk each day to reach the minimum levels of vitamin D. 
· People who have darker skin pigmentation may need more exposure to sunlight than fair skinned people to generate the same amount of vitamin D. 
· You will need more exposure to the sun to generated vitamin D when you live further from the equator. For example: Canada, UK and most states in the US.

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Iron – Inflammation and bleeding will result in iron deficiency. Iron is the key component of blood.

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B12 and other B vitamins–Colitis medications can get in the way of absorption.

B12, also known as Cobalamin, are one of eight B vitamins that are essential in converting the food we consume into usable energy. Playing a huge role in the formation of red blood cells in our bodies,

Functions:
- Essential for metabolism of nerve tissue
- Stimulates growth and increases appetite in children
- Utilizes proteins, fats and carbs in the body
- Referred to as being the “longevity” vitamin because it helps increase energy and activity levels of the nervous system in the elderly

Deficiency Signs:
- Usually results from people who follow a strict vegetarian or vegan diet
- Poor digestion and assimilation of food
- Body forms large, immature red blood cells which can affect the blood itself, one’s energy level, state of mind and nervous system

Toxicity Signs:
- In rare cases, if amount exceeds daily recommended dose of 2.4 mcg (in adults) potential trembling of hands, arms and/or face may occur
· Though this is unlikely as Vitamin B12 is a water-soluble vitamin meaning most of it gets excreted through the urine.

Whole Food Sources:
- Found in large amounts only in animal protein foods such as chicken, beef, oysters, egg yolk, crab, trout and live culture yogurt
- Organ meats such as liver, heart, and kidney
- Vegetarian options: tempeh, miso, soy and almond milks (fortified beverages)
· If one is vegetarian, they must supplement with a B12 Vitamin to ensure they are getting enough

Contradictions:
- Most medications are generally safe to take with B12, however, it is always good to consult a doctor before use.

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Potassium – Deficiency can be a side effect of prednisone and it is also absorbed in the colon. Having plenty of foods high in potassium is important such as avocado, sweet potato, banana.

Functions:
- Conducts electrical impulses around the body which helps to: Manage blood pressure, Manage muscle contractions and nerve impulses, and Maintain normal heart beat
** Does this by instigating a brief sodium-potassium exchange across cell membranes upon entering the cells (which it does more easily than Sodium). Once Potassium leaves the cell, it changes the membrane potential, which then allows for the nerve impulse to progress and additionally helps to generate muscle contractions including one’s heartbeat.
- assists in digestion
- Manages a healthy pH balance (acidity – alkalinity)
- Healthy Kidneys maintain a normal potassium level because they remove excess amounts through urine

Best Sources:
Baked Potato with skin, Winter Squash, Sweet Potato with skin, Yogurt, Halibut, Broccoli, Cantaloupe, Banana, Salmon, Dry Roasted Pistachios, Raisins, Chicken Breast

Deficiency Signs: aka Hypokalemia
- When this occurs, excessive sweating, diarrhea, vomiting may happen
- Extreme fatigue
- Muscle spasms
- Irregular heartbeat
- Lead to kidney disease
· That is why it is so important to replenish your body with the right electrolytes after a workout or any kind of sweat session such as being in a sauna or even a hot tub

Toxicity Signs: aka Hyperkalemia
- When this occurs, it can lead to kidney disease, diabetes, and most commonly, irregular heart beat (severe cases can lead to death)

Companion Nutrients:
- Sodium, Potassium and Magnesium
· Together, these 4 nutrients comprise electrolytes which are essential for good health

Contraindications:
- Antibiotics such as Penicillin as it kills off any and all bacteria in the body and blood stream
- Overuse of diuretics (such as coffee or alcohol that makes you go to the bathroom too often for your body to have the chance to absorb the potassium it is being given)

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Vitamin K – These vitamins are made in small intestine but can be absorbed in colon.

Vitamin K is a fat soluble vitamin that is found in both natural food sources and produced in the body. It was discovered in Denmark, and was named vitamin K after the Danish word koagulation for its ability to assist in blot clotting. Recent evidence has shown that the benefits of Vitamin K (especially K2) extend to bone, cardiovascular, skin, brain and even prostate health.

The 3 types of Vitamin K are K1, K2 and K3.
Vitamin K1 (aka Phylloquinone)
Sources: kale, spinach, mustard greens, collard greens, beet greens, swiss chard, turnip
greens, parsley, broccoli, most leafy greens, cauliflower and kelp
Function: absorbed in small intestine then carried to liver for the synthesis of prothrombin, an
essential blood clotting factor. It also helps convert prothrombin to thrombin, with the aid of
potassium and calcium

Vitamin K2 (aka Menaquinone)
Sources: found in natto, sauerkraut, grass fed butter and cheese, egg yolk, chicken liver, and
ground beef, produced in small amounts by gut bacteria (K1 is converted to K2)
Function: absorbed in small intestine and then used by various tissues to deposit calcium in
appropriate locations, such as bone and teeth, and prevent it from depositing in locations where
it does not belong, such as soft tissues. Other potential benefits include improved
cardiovascular disease outcomes, neuroprotective against alzheimer’s disease, improved bone
mineral density, reduced risk of fractures, osteoporosis and osteoarthritis and reduced risk of
prostate cancer

Vitamin K3 (aka Menadione)
Sources: synthetic compound used therapeutically in people who don’t absorb vitamin K well,
often due to decreased bile acid production

Deficiency signs:
excessive bleeding that may start from the nose or gums, easy bruising,
blood in urine or stool

Contraindications:
excessive amounts of vitamin E or calcium can reduce vitamin K absorption
Toxicity: toxicity is exceptionally rare with K1 and K2, hemolytic anemia (reduction in blood
cells) can be a possible issue, K3 can build up and become toxic

Fun Facts:
Vitamin K1 and K2 are so different in their functions that many researchers insistthat K1 and K2 are best seen as two separate vitamins
Although we can convert K1 to K2 in our gut, the process is believed to be fairly inefficient soit is recommended to consume a preformed source of K2
Natto, a fermented soy dish popular in Japan contains the highest K2 concentration of any
food measured
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References:

Haas, Elson M. Staying Healthy with Nutrition. Berkley: Celestial Arts, 2006. Print.
The Mayo Clinic. “Calcium and Calcium Supplements. Achieving the Right Balance”. Mayo Foundation for Medical Education and Research. 1998-2016. <http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calcium-supplements/art-20047097?pg=2>
Group, Dr. Edward. “What is Calcium Toxicity and Hypercalcemia?”. Global Healing Centre. Web 11 November 2014. <http://www.globalhealingcenter.com/natural-health/what-is-calcium-toxicity-and-hypercalcemia/>
Adams, Mike. "Vitamin D Myths, Facts and Statistics." Naturalnews.com. 05 Jan. 2005. Web. 22 Mar. 2016. <http://www.naturalnews.com/003069.html>.
"Vitamin D Interactions." WebMD. 2005. Web. 22 Mar. 2016. <http://www.webmd.com/vitamins-supplements/ingredientmono-929-vitamin d.aspx?activeingredientid=929>.

Knox, Kerri. "There Are Amazingly Few Vitamin D Contraindications." Easy Immune Health.com. 2008. Web. 22 Mar. 2016. <http://www.easy-immune-health.com/vitamin-d-contraindications.html>.
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