Vitamin Information Center

By Maureen Williams, ND

Healthnotes Newswire (September 11, 2008)—People with digestive diseases, such as ulcerative colitis and Crohn’s disease, are especially susceptible to osteoporosis and bone fractures, due in part to nutrient deficiencies caused by malabsorption and medication side effects. A new study found that people with good vitamin D status early in the course of their disease had higher bone density and a greater likelihood of increasing bone density over time.

Healthy vitamin D levels predict healthy bones

The study, published in the American Journal of Gastroenterology, included 101 people who had recently been diagnosed with inflammatory bowel disease (IBD). Vitamin D levels in the blood and bone mineral density were measured at the beginning of the study, and bone density measurements were repeated approximately two years later.

Only 22% of the people had optimal vitamin D levels at the beginning of the study. Higher vitamin D levels were associated with higher bone density in the spine, hip, and total body. People with better vitamin D status were more likely than others to have an increase in bone mineral density over the course of the study.

The link between IBD and bone density

IBD is a group of inflammatory conditions affecting the large and small intestines. Ulcerative colitis and Crohn’s disease are the most common types, both of which are believed to be autoimmune (when the immune system attacks the body’s cells) in nature. People with IBD usually experience chronic abdominal pain and diarrhea, often with bleeding and mucus.

In people with IBD, inflammation in the bowel wall and diarrhea compromise absorption and result in nutrient deficiencies. In addition, corticosteroid medicines that are used to treat IBD can interfere with calcium absorption and metabolism. Maintaining healthy bone density requires the integrated work of a number of nutrients, including calcium and vitamin D, so it is not surprising that people with IBD have high rates of low bone density (osteopenia and osteoporosis).

Improving vitamin D status

Vitamin D is made in the body through a series of chemical reactions that begins in sun-exposed skin. Modern lifestyles with limited outdoor time and widespread use of sunscreens have led to increasing rates of vitamin D deficiency in the general population, and these rates are even higher in the elderly and people with chronic disease.

“Poorer vitamin D correlates with lower baseline bone mineral density and better vitamin D status is correlated with a gain in total bone mineral density. Early optimization of vitamin D may play an important role in preventing IBD-related bone disease,” said the researchers from the University of Manitoba in Winnipeg. Small amounts of vitamin D are found in eggs and fish, as well as fortified dairy foods and some dairy substitutes, but the authors noted that their findings suggest that adding vitamin D supplements is warranted for most people with IBD.

Healthnotes Newswire (August 28, 2008)—Building and maintaining bone is complex work involving many nutrients, such as calcium, vitamin D, magnesium, boron, vitamin K, and essential fatty acids. A new study found that low levels of vitamins B6 and B12 and high levels of homocysteine were associated with increased risk of hip fracture.

B vitamins, homocysteine, and changes in bone

The study, published in the Journal of Clinical Endocrinology and Metabolism, included 714 senior men and women who were participating in the longstanding Framingham Study. Tests to measure bone density and blood levels of homocysteine, folic acid, and vitamins B6 and B12 were done at the beginning of the study and bone density was measured again after four years.

People with low vitamin B6 levels experienced more bone density loss than people with normal B6 levels, and people with B6 deficiency lost the most bone. Low and deficient levels of vitamins B6 and B12, as well as high levels of homocysteine (a potentially toxic amino acid byproduct), were each independently associated with more hip fractures.

How B vitamins and homocysteine are connected

Folic acid and vitamins B6 and B12 are all involved in the metabolism of homocysteine, and when any of these vitamin levels drops, homocysteine can accumulate, potentially leading to negative health effects. Getting more of these vitamins through diet or supplements can bring down high homocysteine levels. A high homocysteine level is a risk factor for heart disease, and some evidence suggests it might also be a risk factor for a number of other conditions including stroke, clotting problems, inflammatory bowel disease, Alzheimer’s disease, hypothyroidism, death from diabetes, pregnancy complications, and osteoporosis.

Despite their connection, B vitamins and homocysteine appear to have distinct effects on bone loss and fracture risk. “This study suggests that low vitamin B6 status, but not elevated homocysteine, is an important determinant of bone loss in community dwelling elders,” the study’s authors concluded.

Getting more B vitamins

The best way to get more vitamin B6 and folic acid is to eat plenty of fruits, vegetables, whole grains, and legumes. Vitamin B12 is found in animal foods and fish, and possibly sea vegetables and tempeh, a cultured soy food. Eating more of all three of these vitamins, especially folic acid, from food and supplements is a good strategy for reducing high homocysteine levels.

Although vitamin B6 and folic acid are usually readily absorbed, some health conditions can interfere with vitamin B12 absorption, such as gastritis, inflammatory bowel disease, infections of the digestive tract, and any condition that causes malabsorption. People with these conditions might need to take high-potency supplements and should consult their doctor first.

(J Clin Endocrinol Metab 2008;93:2206–12)

Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice in Quechee, VT, and does extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.

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