Vitamins that may be helpful
Vitamin D malabsorption is common in
Crohn’s18 and can lead to a deficiency of the vitamin.19
Successful treatment with vitamin D for
osteomalacia (bone brittleness caused by vitamin D deficiency) triggered by Crohn’s
disease has been reported.20 Another study found 1,000 IU per day of vitamin D
prevented bone loss in people with Crohn’s, while an unsupplemented group experienced
significant bone loss.21 A doctor should evaluate vitamin D status and suggest the
right level of vitamin D supplements.
Inflammation within the gut occurs in people suffering from Crohn’s disease. EPA and
DHA, the omega-3 fatty acids found in fish oil, have anti-inflammatory activity. A two-year
trial compared the effects of having people with Crohn’s disease eat 3.5 to 7 ounces of
fish high in EPA and DHA per day or having them eat a diet low in fish.22 In that
trial, the fish-eating group had a 20% relapse rate compared with 58% among those not eating
fish. Salmon, herring, mackerel, albacore tuna, and sardines are all high in EPA and DHA.
In a double-blind trial, people with Crohn’s disease who took supplements providing
2.7 g of EPA/DHA per day had a recurrence rate of 26% after one year, compared to a 59%
recurrence rate among those taking placebo. 23 Participants in this study used a
special enteric-coated, “free-fatty-acid” form of EPA/DHA taken from fish oil.
Other blinded trials using other fish oil supplements that were neither enteric-coated nor in
the free-fatty-acid form have reported no clinical improvement.24 25
These disparate outcomes suggest that the enteric-coated, free-fatty-acid form may have
important advantages, including the reported elimination of gastrointestinal symptoms that
often result from taking regular fish oil supplements.26 Unfortunately,
enteric-coated “free-fatty-acid” fish oil is not commercially available at this
In a preliminary trial, six of seven people with Crohn’s disease went into remission
after taking 200 mg per day of DHEA for eight
weeks.27 This large amount of DHEA has the potential to cause adverse side effects
and should only be used under the supervision of a doctor.
In double-blind research, diarrhea caused
by Crohn’s disease has partially responded to supplementation with the beneficial
boulardii.28 Although the amount used in this trial, 250 mg taken three
times per day, was helpful, as much as 500 mg taken four times per day has been administered
in research successfully using Saccharomyces boulardii as a supplement with people
suffering from other forms of diarrhea.29
In people with Crohn's disease, vitamin K
deficiency can result from malabsorption due to intestinal inflammation or bowel surgery, from
chronic diarrhea, or from dietary changes necessitated by food intolerance. In addition,
Crohn's disease is often treated with
antibiotics that have the potential to kill beneficial vitamin K–producing bacteria
in the intestines. Vitamin K levels were significantly lower in a group of people with Crohn's
disease than in healthy people. Moreover, the rate of bone loss in the Crohn's disease
patients increased with increasing degrees of vitamin K deficiency.30 When combined
with earlier evidence that vitamin K is required to maintain healthy bones, this study
suggests that vitamin K deficiency is a contributing factor to the accelerated bone loss that
often occurs in people with Crohn's disease.
Crohn’s disease often leads to
malabsorption. As a result, deficiencies of many nutrients are common. For this reason, it
makes sense for people with Crohn’s disease to take a high potency multivitamin-mineral supplement. In particular,
deficiencies in zinc, folic acid, vitamin B12, vitamin D, and iron have been reported.31 32
33 Zinc, folic acid, and vitamin B12 are all needed to repair intestinal cells
damaged by Crohn’s disease. Some doctors recommend 25 to 50 mg of zinc (balanced with 2
to 4 mg of copper), 800 mcg of folic acid, and 800 mcg of vitamin B12. Iron status should be
evaluated by a doctor before considering supplementation.
Vitamin A is needed for the growth and
repair of cells that line both the small and large intestine.34 At least two case
reports describe people with Crohn’s disease who have responded to vitamin A
supplementation.35 36 However, in one trial, vitamin A supplementation
failed to maintain remission of the disease.37 Therefore, although some doctors
recommend 50,000 IU per day for adults with Crohn’s disease, this approach remains
unproven. An amount this high should never be taken without qualified guidance, nor should it
be given to a woman who is or could become
People with Crohn’s disease may be deficient in pancreatic enzymes, including lipase.38 In theory, supplementing with
enzymes might improve the nutrient malabsorption that is often associated with Crohn’s
disease. However, people with Crohn’s disease considering supplementation with enzymes
should consult a doctor.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
1. Mayberry JF, Rhodes J. Epidemiological aspects of Crohn’s
disease: a review of the literature. Gut 1984;886–99.
2. Heaton KW, Thornton JR, Emmett PM. Treatment of Crohn’s disease
with an unrefined-carbohydrate, fibre-rich diet. BMJ 1979;2(6193):764–6.
3. Brandes JW, Lorenz-Meyer H. Sugar free diet: a new perspective in the
treatment of Crohn disease? Randomized, control study. Z Gastroneterol
4. Shoda R, Masueda K, Yamato S, Umeda N. Epidemiologic analysis of
Crohn’s disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids
and animal protein relates to the increased incidence of Crohn’s disease in Japan.
Am J Clin Nutr 1996;63:741–5.
5. Riordan AM, Hunter JO, Cowan RE, et al. Treatment of active
Crohn’s disease by exclusion diet: East Anglian Multicentre Controlled Trial.
6. Alic M. Baker’s yeast in Crohn’s disease—can it kill
you? Am J Gastroenterol 1999;94:1711 [letter/review].
7. Wantke F, Gotz M, Jarisch R. Dietary treatment of Crohn’s
disease. Lancet 1994;343:113 [letter].
8. O’Morain C, Segal AW, Levi AJ. Elemental diet as primary
treatment of acute Crohn’s disease: a controlled trial. Br Med J (Clin Res Ed)
9. Gorard DA, Hunt JB, Payne-James JJ, et al. Initial response and
subsequent course of Crohn’s disease treated with elemental diet or prednisolone.
10. Teahon K, Pearson M, Levi AJ, Bjarnason I. Practical aspects of
enteral nutrition in the management of Crohn’s disease. JPEN J Parenter Enteral
11. Raouf AH, Hildrey V, Daniel J, et al. Enteral feeding as sole
treatment for Crohn’s disease: controlled trial of whole protein v amino acid based feed
and a case study of dietary challenge. Gut 1991;32:702–7.
12. Rigaud D, Cosnes J, Le Quintrec Y, et al. Controlled trial comparing
two types of enteral nutrition in treatment of active Crohn’s disease: elemental versus
polymeric diet. Gut 1991;32:1492–7.
13. Park RH, Galloway A, Danesh BJ, et al. Double-blind controlled trial
comparing elemental and polymeric diets as primary therapy in active Crohn’s disease.
Eur J Gastroenterol Hepatol 1991;32:1492–7.
14. McDonald PJ, Fazio VW. What can Crohn’s patients eat? Eur J
Clin Nutr 1988;42:703–8.
15. Gaby AR. Commentary. Nutr Healing 1998;January:1,10–1
16. Persson PG, Ahlbom A, Hellers G. Diet and inflammatory bowel disease:
a case-control study. Epidemiology 1992;3:47–52.
17. Cottone M, Rosselli M, Orlando A, et al. Smoking habits and
recurrence in Crohn’s disease. Gastroenterol 1994;106:643–8.
18. Leichtmann GA, Bengoa JM, Bolt MJG, Sitrin MD. Intestinal absorption
of cholecalciferol and 25-hydrocycholecalciferol in patients with both Crohn’s disease
and intestinal resection. Am J Clin Nutr 1991;54:548–52.
19. Harris AD, Brown R, Heatley RV, et al. Vitamin D status in
Crohn’s disease: association with nutrition and disease activity. Gut
20. Driscoll RH, Meredith SC, Sitrin M, Rosenberg IH. Vitamin D
deficiency and bone disease in patients with Crohn’s disease. Gastroenterol
21. Vogelsang H, Ferenci P, Resch H, et al. Prevention of bone mineral
loss in patients with Crohn’s disease by long-term oral vitamin D supplementation.
Eur J Gastroenterol Hepatol 1995;7:609–14.
22. Mate J, Castanos R, Garcia-Samaniego J, Pajares JM. Does dietary fish
oil maintain the remission of Crohn’s disease: a case control study.
Gastroenterology 1991;100:A228 [abstract].
23. Belluzzi A, Brignola C, Campieri M, et al. Effect of an
enteric-coated fish-oil preparation on relapses in Crohn’s disease. N Engl J
24. Lorenz R, Weber PC, Szimnau P, et al. Supplementation with n-3 fatty
acids from fish oil in chronic inflammatory bowel disease—a randomized,
placebo-controlled, double-blind cross-over trial. J Intern Med Suppl
25. Lorenz-Meyer H, Bauer P Nicolay C, et al. Omega-3 fatty acids and low
carbohydrate diet for maintenance of remission in Crohn’s disease. A randomized
controlled multicenter trial. Study Group Members (German Crohn’s Disease Study Group).
Scand J Gastroenterol 1996;31:778–85.
26. Belluzzi A, Brignola C, Campieri M, et al. Effects of new fish oil
derivative on fatty acid phospholipid-membrane pattern in a group of Crohn’s disease
patients. Dig Dis Sci 1994;39:2589–94.
27. Andus T, Klebl F, Rogler G, et al. Patients with refractory Crohn's
disease or ulcerative colitis respond to dehydroepiandrosterone: a pilot study. Aliment
Pharmacol Ther 2003;17:409–14.
28. Plein K, Hotz J. Therapeutic effects of Saccharomyces boulardii on
mild residual symptoms in a stable phase of Crohn’s disease with special respect to
chronic diarrhea—a pilot study. Z Gastroenterol 1993;31:129–34.
29. Bleichner G, Blehaut H, Mentec H, Moyse D. Saccharomyces boulardii
prevents diarrhea in critically ill tube-fed patients. A muticenter, randomized, double-blind
placebo-controlled trial. Intensive Care Med 1997;23:517–23.
30. Duggan P, O'Brien M, Kiely M, et al. Vitamin K status in patients
with Crohn's disease and relationship to bone turnover. Am J Gastroenterol
31. Imes S, Plinchbeck BR, Dinwoodie A, et al. Iron, folate, vitamin
B-12, zinc, and copper status in out-patients with Crohn’s disease: effect of diet
counseling. J Am Dietet Assoc 1987;87:928–30.
32. Sandstead HH. Zinc deficiency in Crohn’s disease. Nutr
33. Driscoll RH Jr, Meredith SC, Sitrin M, et al. Vitamin D deficiency
and bone disease in patients with Crohn’s disease. Gastroenterology
34. Dvorak AM. Vitamin A in Crohn’s disease. Lancet
35. Skogh M, Sundquist T, Tagesson C. Vitamin A in Crohn’s disease.
Lancet 1980; i:766 [letter].
36. Dvorak AM. Vitamin A in Crohn’s Disease. Lancet
37. Wright JP, Mee AS, Parfitt A, et al. Vitamin A therapy inpatients
with Crohn’s disease. Gastroenterology 1985;88:512–4.
38. Hegnhoj J, Hansen CP, Rannem T, et al. Pancreatic function in
Crohn’s disease. Gut 1990;31:1076–9.
39. Pizzorno JE, Murray MT. Textbook of Natural Medicine.
London: Churchill Livingstone, 1999, 1335–49.
40. Holt PR, Katz S, Kirshoff R. Curcumin therapy in inflammatory bowel
disease: a pilot study. Dig Dis Sci 2005;50:2191–3.
41. Plein K, Burkard G, Hotz J. Treatment of chronic diarrhea in Crohn
disease. A pilot study of the clinical effect of tannin albuminate and ethacridine lactate.
Fortschr Med 1993;111:114–8 [in German].