Supplements & Gut Health – Part 1

Can supplements like vitamins and minerals improve your gut health? Does your digestive condition increase your need for vitamins and minerals? Should you take a multivitamin?

In Part 1 of this series I will begin answering these questions.

We will look at different supplements including vitamins, minerals and nutrients. We will discuss how and when they might play an important role in healing your gut. We’ll discuss who may be at risk for nutrient deficiencies and how to recognize when you may be deficient. And for those who don’t absorb nutrients at all? Don’t worry – we’ve got you covered!

How do you know which nutrients to take for gut health?

One way is to test.

This is my preferred method with the patients I work with.

But as I’ll explain, sometimes you don’t need a test for determining your need for something. In fact, sometimes the test isn’t useful and we’ll talk about that too.

Mostly, I use standard labs when it comes to testing for nutrients.

The one nutrient that affects most of my digestive patients is iron.

Iron

Iron is super important for forming hemoglobin in your red blood cells. This allows your red blood cells to transport oxygen to your body. When iron levels drop you might feel short of breath, have pale skin, and become tired. These are symptoms of iron deficiency anemia (IDA).

Although there are many causes of IDA, the most common causes are:

• Excessive blood loss (menstruation, ulcers, Crohn’s disease)
• Not getting enough iron in your diet (Vegetarian/vegan diets)
• Not absorbing iron (Celiac disease, H. pylori infection, Crohn’s & Colitis, Intestinal surgery, SIBO)

Testing for Iron

Usually when your doctor tests your iron levels they are testing something called Ferritin. Ferritin is the stored form of iron. In healthy individuals, this is pretty accurate for how much iron is actually in your body. However, there are some nuances when it comes to testing for iron using ferritin alone.

For Example:

Testing ferritin in those with inflammatory conditions can be very misleading.

Ferritin & Inflammatory Bowel Disease

One of ferritin’s other roles is to participate in the inflammatory reaction. (BTW platelets do this too). In inflammatory bowel diseases like Crohn’s disease and ulcerative colitis where inflammation may be rampant, ferritin is unreliable. It may look normal or even high in someone who actually has low iron levels. It is falsely elevated.

In these patients I always run the following tests:

• Serum Iron
• Total iron binding capacity (TIBC)
• Transferrin
• Transferrin saturation

This will provide a more accurate representation of iron status in the body. This can help determine the need for iron supplements in someone with compromised gut health. This is very important for those with inflammatory bowel disease (IBD).

Pro Tip: If you have IBD and have high platelets have your doctor check your iron levels (not just ferritin!). Iron replacement therapy may reduce high platelets if you are iron deficient. High platelets can increase your risk of life-threatening blood clots so ask for an iron assessment!

Constipation & Iron Supplements

For those with IBS-related constipation and iron deficiency, you may need to be careful with the type of iron supplements you take. Certain iron supplements (especially prescription iron) can worsen gut health complaints like constipation and abdominal pain. I have found it’s best to take a well absorbed iron supplement like heme iron. These are generally well tolerated and effective at increasing your iron levels.

Shouldn’t everyone take iron?

No.

Only those who have a need for iron deficiency. In fact, taking iron can be harmful when you don’t need it. Iron overload can cause abdominal pain, liver, kidney and heart damage and many other symptoms. So get a blood test and talk to your healthcare provider before starting iron supplements.

Foods that contain iron include red meat and fish (heme iron), blackstrap molasses, wheat bran and legumes (all non-heme).

Vitamin B12

Cobalamin, or B12 as we commonly know it as, helps your red blood cells mature. Beyond this, B12 has so many other important functions. Like ensuring your nerve cells work properly, helping our brain and mood, promoting energy production, and maintaining heart health.

Digestion/Absorption of B12

The absorption of B12 occurs in three parts. First, B12 is made available when stomach acid breaks down animal protein. Then, the B12 binds with something called intrinsic factor in the stomach. Intrinsic factor is produced by the same cells that produce stomach acid. These are called parietal cells. Therefore, stomach acid plays an important role in B12 digestion and absorption.

Finally, the B12-intrinsic factor complex is absorbed further down in the small intestine. Thus, a breakdown in any of these steps can result in a B12 deficiency.

Symptoms of B12 deficiency include:

• Peripheral neuropathy (loss of sensation, painful, or tingling nerves beginning in fingers and/or toes)
• Depression
• Swollen tongue
• Weakness
• Balance issues
• Dementia
• Brain Fog
• Fatigue
• Poor gut motility

Some causes for B12 deficiency include:

• Atrophic gastritis or Autoimmune gastritis
• Low stomach acid
• H. pylori infection
• Small intestinal bacterial overgrowth
• Dietary insufficiency (Vegetarian/Vegan Diet)
• Intrinsic factor deficiency
• Antacid medications (proton-pump inhibitors)
• Malabsorptive conditions (Celiac disease, Gastrectomy, Crohn’s)

Testing for B12

A blood test is best for testing for B12 status. Although many of my patients are told their levels are “normal”, B12 levels that simply fall within the standard reference range are often insufficient for optimal health. Also, patients will often exhibit symptoms of deficiency even when their levels are within range.

B12 Supplements

There are three main forms of B12 – cyanocobalamin, hydroxocobalamin and methylcobalamin. The most common routes of B12 supplements are sublingual lozenges, capsules or intramuscular injections.

People with ongoing gut health issues will likely need to supplement with either the sublingual or injectable forms of B12.

Dietary sources of B12 can be found in meat, fish, poultry and eggs. For vegetarians and vegans, nutritional yeast can provide a good dietary source of B12.

Vitamin D

Vitamin D is actually a hormone. It is responsible for maintaining our bone and muscle health and so much more!

When it comes to gut health, it has specific gut health benefits that include:

• Strengthening the intestinal barrier
• Increasing peptides that fight off other harmful bacteria in the gut
• Increasing the diversity of good bacteria in the gut

Some studies suggest Vitamin D supplements might be beneficial in those with gut health issues like IBS and IBD, especially Crohn’s disease.

This is one nutrient I always test for in my digestive patients.

The test I use is a 25-Hydroxyvitamin D from any standard lab. How much vitamin D each person needs depends on several factors. Some of these include:

• Skin tone – darker skin needs more vitamin D
• Obesity – larger individuals have an increased need for vitamin D
• Time of year – Summer months may reduce need for vitamin D supplementation*
• Age – Elderly individuals may require more, infants require less

*Many people overestimate the effects of sun exposure on Vitamin D levels. Especially if you live in the northern hemisphere like I do, sun exposure alone – even in the summer – may not be enough.

Optimal Vitamin D Levels

I counsel my patients on the importance of reaching and maintaining Vitamin D levels between 100-150 nmol/L (40-60 ng/ml) year round.

Vitamin D is absorbed in the last part of the small intestine. Those with disease affecting this portion of the small intestine (i.e., Crohn’s disease) will likely struggle to increase levels using oral supplements alone. Vitamin D injections may be a more effective option for increasing levels. More on this below.

Cholecalciferol or Vitamin D3 is the preferred form for supplementation. Although ergocalciferol (Vitamin D2) can get the job done as well.

Getting adequate amounts of vitamin D solely from your diet is next to impossible. However, consuming generous amounts of both sockeye salmon and mushrooms might help!

Zinc

Zinc is an important mineral for the immune system. It helps maintain the integrity of the gut wall. It is important for wound healing and for the function of your white blood cells.

Zinc Supplements

There are different forms of zinc supplements available. I will highlight two supplement forms that I use for their gut health properties.

Zinc L-Carnosine – This form of zinc is particularly useful for healing of gastrointestinal ulceration or inflammation. It’s also helpful in the management of mouth sores, esophagitis and diarrhea due to the effects of radiation treatments. It improves the eradication of H. pylori infection from the stomach and reduces the side effects from antibiotics.

Zinc Bisglycinate – A very-well absorbed form of zinc for maximal absorption. This form is great for those with malabsorption issues. This is the form of zinc I recommend when trying to increase whole body zinc levels.

Side Effects

A common side effect of zinc supplementation is nausea. You can often prevent this by taking your zinc supplement with a meal. Also, using zinc at high doses or for extended periods can cause a copper deficiency. Therefore, you should always consult your healthcare practitioner before starting a zinc supplement.

Two great dietary sources of zinc include pumpkin seeds and oysters.

This is one nutrient I don’t often test for. You could measure either a serum or red blood cell zinc. However, I often recommend zinc based off of signs and symptoms suggesting a deficiency.

Stomach Surgery, Bowel Disease & Malabsorption

If you’ve had bariatric surgery, nutrient deficiencies are the rule not the exception. Deficiencies in iron, Vitamin D, B12, calcium, magnesium and zinc are very common following surgery.

After all, it’s going to be difficult correcting your nutrients if you’ve had half your stomach removed! Likewise, If you have inflammatory bowel diseases or celiac disease your nutrient needs may also be increased.

If taking supplements isn’t improving your levels or your gut health consider the following:

• Your supplements aren’t great quality – consider a more reputable brand or better form
• You’re not great at taking them – make them more visible, set reminders
• You haven’t been taking them for long enough – be patient
• You are not absorbing them – See below options

IV & Injectable Nutrients

For those with compromised gut health and absorption or those with active disease, taking supplements by mouth often won’t cut it!

In these individuals I usually recommend a course of nutrient IVs or nutrient injections.

For example, intramuscular injections of Vitamin D can be very helpful for those not responding to oral vitamin D supplements and those with gut health issues that prevent their absorption.

Nutrient cocktail IVs can rapidly replenish nutrient deficiencies in these people. More importantly, these treatments can often provide quick noticeable changes in energy and quality of life.

Wondering if IV Therapy is right for you?

In summary, having a digestive disorder or disease may increase your risk for nutrient deficiencies. Supplementing appropriately can help replace these nutrients and may even help improve your gut health.

In Part 2, We’ll explore other key nutrients including Magnesium, Vitamin A, L-Glutamine and more. See you soon!

References:

Gümürdülü, Yüksel, et al. “The impact of B12 treatment on gastric emptying time in patients with Helicobacter pylori infection.” Journal of clinical gastroenterology 37.3 (2003): 230-233.

Kulnigg-Dabsch, Stefanie, et al. “Effect of iron therapy on platelet counts in patients with inflammatory bowel disease-associated anemia.” PLoS One 7.4 (2012): e34520.

Doi, Hiroshi, Kozo Kuribayashi, and Takashi Kijima. “Utility of polaprezinc in reducing toxicities during radiotherapy: a literature review.” Future Oncology 14.19 (2018): 1977-1988.

Sikaroudi, Masoumeh Khalighi, et al. “Vitamin D3 Supplementation in Diarrhea-Predominant Irritable Bowel Syndrome Patients: The Effects on Symptoms Improvement, Serum Corticotropin-Releasing Hormone, and Interleukin-6–A Randomized Clinical Trial.” Complementary Medicine Research (2020): 1-8.

Abbasnezhad, A., et al. “Effect of vitamin D on gastrointestinal symptoms and health‐related quality of life in irritable bowel syndrome patients: a randomized double‐blind clinical trial.” Neurogastroenterology & Motility 28.10 (2016): 1533-1544.

Bafutto, Mauro, Enio Chaves Oliveira, and Joffre Rezende Filho. “Use of Vitamin D With Anti-Tumor Necrosis Factor Therapy for Crohn’s Disease.” Gastroenterology Research 13.3 (2020): 101.