Can vitamin D help with the treatment of inflammatory bowel disease?

By Andreu Prados, PhD, BPharm, RDN, and Stephanie L. Gold, MD

Low vitamin D levels are common in children and adults with inflammatory bowel disease (IBD) and have been associated with more severe disease activity, increased risk of surgery as well as hospitalizations, and poor quality of life in patients with IBD.^1,2 Intestinal malabsorption, dietary restrictions, and lifestyle changes may contribute to vitamin D deficiency in patients with IBD. 

A recent Cochrane review was designed to evaluate the benefits and potential harms of vitamin D supplementation in patients with IBD.³ This study included 22 randomized controlled trials (RCTs) and 1874 patients with both Crohn’s disease (CD) and ulcerative colitis (UC) with 4 to 52 weeks of vitamin D supplementation. Of interest, 17 of these studies included adults with IBD supplemented with vitamin D and 3 focused on children.³

Across the various analyses in this meta-analysis, the authors overall concluded that due to a very low quality of evidence, few conclusions could be drawn.³ However, the authors stated that there may be fewer clinical relapses in those IBD patients concurrently treated with vitamin D compared to those not on vitamin D supplementation (RR 0.57, 95% CI 0.34 to 0.96; 3 studies, 310 participants).3 There was no clear improvement in quality of life in those treated with vitamin D compared to those not on vitamin D.³

The meta-analysis also compared high and low doses of vitamin D, concluding that there may not be a difference in clinical relapse rates in patients with CD in the low and high dose groups, however, once again, the certainty of the evidence was low. No clear conclusions could be drawn about adverse events associated with vitamin D supplementation unfortunately. All together, the authors concluded that while there may have been fewer clinical IBD relapses in those on vitamin D compared to placebo, the low-certainty of evidence limited any further conclusions from this study.³

Of interest, a similar retrospective study of 88 patients with IBD treated with vedolizumab (VDZ) found that higher levels of vitamin D prior to treatment with VDZ were associated with significant endoscopic improvement in those with UC.⁴

Both studies concluded that future, prospective studies are needed to assess the relationship between vitamin D supplementation and endoscopic disease activity, biomarkers as well as disease metrics.^3,4 The authors of the meta-analysis clearly delineated that future studies need to identify the purpose of the vitamin D treatment being studied (supplementation, improvement in IBD symptoms, reduction in inflammation etc.) and use appropriate dose strategies consistently. Without this, there will continue to be significant heterogeneity in future studies, limiting our ability to draw clinically meaningful conclusions from these incredibly important research studies.

To sum up, the data available on vitamin D supplementation for the treatment of IBD are inconclusive. While awaiting more research that clarifies how vitamin D supplementation might help people with CD and UC, ask your healthcare practitioner for personalized advice based on your individual health status, background vitamin D status and potential interactions with other drugs.

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References:

1. Kabbani TA, Koutroubakis IE, Schoen RE, et al. Association of vitamin D level with clinical status in inflammatory bowel disease: a 5-year longitudinal study. Am J Gastroenterol. 2016; 111(5):712-719. doi: 10.1038/ajg.2016.53.
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2. Sachan A, Thungapathra M, Kaur H, et al. Comprehensive assessment of nutritional and functional status of patients with ulcerative colitis and their impact on quality of life. Indian J Gastroenterol. 2024; 43(1):254-263. doi: 10.1007/s12664-024-01539-9.
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3. Wallace C, Gordon M, Sinopoulou V, et al. Vitamin D for the treatment of inflammatory bowel disease. Cochrane Database Syst Rev. 2023; 10(10):CD011806. doi: 10.1002/14651858.CD011806.pub2.
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4. Abraham BP, Fan C, Thurston T, et al. The role of vitamin D in patients with inflammatory bowel disease treated with vedolizumab. Nutrients. 2023; 15(22):4847. doi: 10.3390/nu15224847. ^.

^‍‍About the writers:

‍Dr. Andreu Prados is a science and medical writer specializing in making reliable evidence of non-prescription therapeutics for gastrointestinal conditions understandable, engaging and ready for use for healthcare professionals and patients. He holds bachelor’s degrees in Pharmacy and Human Nutrition and Dietetics and a PhD in nutrition communication.
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‍Stephanie L. Gold, MD is an Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai and a gastroenterologist at the Mount Sinai Hospital, with a focus on inflammatory bowel disease (IBD) and nutrition. Her research interests include improving the identification of malnutrition, micronutrient deficiencies and sarcopenia in patients with IBD as well as identification of dietary patterns associated with disease activity.

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