Calcium & Vitamin D

Why are calcium and vitamin D important?

Calcium and vitamin D are well known for their roles in achieving and maintaining bone health and strength. New research suggests that vitamin D also plays an important role in the development and progression of autoimmune diseases, such as Inflammatory Bowel Disease (IBD). In IBD, it is believed that the body’s own immune system attacks the gastrointestinal tract causing inflammation. Adequate levels of vitamin D may help to decrease this response and therefore may decrease the severity of IBD symptoms.

Am I at risk for osteoporosis?

The connection between IBD, calcium, and vitamin D is complex. Ask your dietitian if you have any questions or would like more information. Inflammation of the intestine can lead to poor absorption of calcium and vitamin D.

Incorporating calcium and vitamin D rich foods into your diet is a safe and effective way to decrease the risk of osteoporosis and reduce the severity of IBD symptoms.

Which foods contain calcium?

Calcium is present in a number of foods. The best sources of calcium are dairy products. If you limit your dairy intake because of poor tolerance, you can try consuming lactose-free dairy products or taking Lactase tablets (eg. Lactaid®) prior to consuming dairy products. Lactose-free products contain the same amount of calcium as the lactose-containing versions. You may also consume plant-based foods that contain calcium.

Food	Serving	Calcium⁷,¹¹
Cow’s Milk (skim, 1%, 2%, whole, chocolate, lactose- free)	250 mL, 1 cup	300 mg
Fortified Soy Milk	250 mL, 1 cup	300 mg
Yogurt (plain or flavored)	175 mL, ¾ cup	280 mg
Sardines (with bones)	75 g, 2 ½ oz.	180 mg
Pink or Sockeye Salmon (with bones)	75 g, 2 ½ oz.	170 mg
Spinach	125 mL, ½ cup	130 mg
Cheese	50 g, 1 ½ oz.	300 mg
Ice Cream or Ice Milk	125 mL, ½ cup	90 mg
Almonds	60 mL, ¼ cup	90 mg

Which foods contain vitamin D?

Few foods are naturally rich in vitamin D. Fish liver oils and the flesh of fatty fish are natural sources of vitamin D. Cow’s milk and soy milk are fortified with vitamin D. Check the labels of products such as orange juice, almond beverage, and rice beverage as only some of these products are fortified with vitamin D.

Food	Serving	Vitamin D⁷,¹¹
Sardines (canned in oil)	75 g, 2 ½ oz.	360 IU
Salmon	75 g, 2 ½ oz.	250 IU
Cow’s Milk (skim, 1%, 2%, whole, chocolate, lactose-free)	250 mL, 1 cup	100 IU
Fortified Soy Milk	250 mL, 1 cup	100 IU
Fortified Orange Juice	250 mL, 1 cup	100 IU
Tuna (canned in oil)	75 g, 2 ½ oz.	60 IU
Egg	1 egg	20 IU

Can I get vitamin D from the sun?

Vitamin D can also be made naturally by the skin following direct sun exposure. In northern areas (all of Canada) the sun’s intensity is not strong enough to stimulate vitamin D synthesis in the skin from October to May. During the summer months 10 to 15 minutes of sunlight (face, arms, and hands exposed) twice a week can produce enough vitamin D for the body.

What about calcium and vitamin D supplements?

Healthy adults need 1000-1200 mg of calcium per day and 200-600 IU of vitamin D per day.

Many people with IBD require more calcium and vitamin D than the average healthy adult. For this reason, people with IBD may benefit from daily supplementation of 1000-1500 mg of calcium and 2000-4000 IU of vitamin D. Supplementation is especially important if you are taking corticosteroids. Check with your dietitian to find the specific amount recommended for you.

When looking for a calcium supplement look for a label that says “calcium carbonate”. For best absorption, calcium supplements should be taken with meals and spread throughout the day (eg. half taken at breakfast and half taken at supper).

When looking for a vitamin D supplement look for a label that says “vitamin D3”. Supplementing vitamin D is particularly important in the winter months (October-May) when vitamin D cannot be synthesized in the skin. The need for vitamin D supplementation also increases after age 50.

References

Abitbol, V., Mary, J., Roux, C., Soules, J., Belaiche, J. & Dupas, J. (2002). Osteoporosis in inflammatory bowel disease : Effect of calcium and vitamin D with or without flouride. Aliment Pharmacology Therapy, 16: 919-927.
Bartram, S., Peaston, R., Rawlings, D., Francis, R. & Thompson, N. (2003). A randomized controlled trial of calcium with vitamin D, alone or in combination with intravenous pamidronate, for the treatment of low bone mineral density associated with Crohn’s disease. Aliment Pharmacology Therapy, 18:1121-1127.
Cantorna, M., Zhu, Y., Froicu, M. & Wittke, A. (2004). Vitamin D status, 1,12-dihydroxyvitamin D₃, and the immune system. American Journal of Clinical Nutrition, 80: 1717S-1720S.
Froicu, M., Weaver, V., Wynn, T., McDowell, M., Welsh, J. & Cantorna, C. (2003). A crucial role for the vita- min D receptor in experimental inflammatory bowel disease. Journal of Molecular Endocrinology, 17(12): 2386-2392.
Gilman, J., Shanahan, F. & Cashman, K. (2006) Determinants of vitamin D status in adult Crohn’s disease patients, with particular emphasis on supplemental vitamin D use. European Journal of Clinical Nutrition, 60: 889-896.
Health Canada (2009). Canadian Nutrient File. Retrieved February 6, 2010, from http://webprod.hc-sc. gc.ca/cnf-fce/start-debuter.do?lang=eng
Institute of Medicine (2006). Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies Press, 122-139.
Jeejeebhoy, K. (2002). Clinical nutrition: 6. Management of nutritional problems of patients with Crohn’s disease. Canadian Medical Association, 166(7), 913-917.
Lee, C. & Majka, D. (2006). Is calcium and vitamin D supplementation overrated? Journal of the American Dietetic Association, 106: 1032-1034.
Nelms, M., Sucher, K., & Long, S. (2007). Nutrition Therapy and Pathophysiology. Belmont, CA: Thomson Higher Education, 488-496.
Steinhart, H. A., & Cepo, J. (2008). Crohn’s & Colitis Diet Guide. Toronto, ON: Robert Rose Inc, 82-85.
Zhu, Y., Mahon, B., Froicu, M. & Cantorna, M. (2005). Calcium and 1α,25-dihyroxyvitamin D₃ target the TNF-α pathway to suppress experimental inflammatory bowel disease. European Journal of Immunology, 35: 217-224.

Handout designed by Amanda Lachowitzer, Brooke Guedo and Leah Edmonds, College of Pharmacy & Nutrition, University of Saskatchewan.

Funding for this project provided by the Interprofessional Health Collaborative of Saskatchewan and the Saskatoon Health Region.