Down to the Bone
Getting enough calcium and protecting against bone loss is a challenge for all of us, especially as we get older. But the odds are seriously stacked against you if you have Crohn’s Disease.
Any digestive disorder carries the threat of nutritional deficiency, and Crohn’s is particularly tricky. First, the chronic diarrhea and other symptoms of the disease can make it tough to get adequate nutrition from even the healthiest diet. Then, Crohn’s patients are often on corticosteroids for long periods of time to relieve the intestinal inflammation. These medications further deplete the system of calcium. These factors explain why, next to the intestinal aspects of the disease, degenerative bone disorders top the list of Crohn’s disease complications.
One recent study took a look at a drug called etidronate to see if it would help protect the bones of people with Crohn’s disease. The bad news: It didn’t. The good news: The vitamin D and calcium supplements that were taken in the control group were highly effective all on their own.
The big challenge for doctors and Crohn’s patients alike is ensuring they consume — and absorb — enough of this natural cocktail for preserving bone health. People who have digestive disorders often avoid fiber, since it can exacerbate symptoms. But avoiding fiber also means avoiding many of the fruits and vegetables that either contain or help you to absorb calcium. Don’t give up completely on fruits and vegetables. Instead, experiment. For some fruits, the fiber content is mostly in the skin. Peel the fruit and you might find it more tolerable. Fruit smoothies might also work better than whole fruit.
When it comes to greens, it pays to try them separately, and look up their nutritional content before checking for tolerance. For example, the calcium in beet greens and swiss chard is not readily absorbed and the fiber content is high — not worth trying. But arugula and watercress each have a fiber content of less than 1 gram per half cup, and a calcium content of 48 grams and 61 grams per half cup respectively.
If you just can’t stomach the fiber, try adding in extra sardines, salmon, and other cold water fish that are high in calcium and vitamin D, but low in fiber.
Working with a nutritionally oriented physician to monitor that you are getting enough calcium and vitamin D through supplementing is also important, especially if you have active Crohn’s Disease and are taking corticosteroids.
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Cramp in your style
Q: For the past year, I have been having really painful leg and toe cramps at night. I’ve tried a number of things, including potassium and magnesium, but nothing seems to help. What can you suggest to stop this and help me get a good night’s sleep again?
JVW: It might not be that the potassium and magnesium aren’t working, but rather, your stomach. Sometimes low stomach acid, called hypochlorhydria, can cause vitamins and minerals, whether from food or supplements, to pass through the system without being properly absorbed. You might want to consider having your stomach function tested. If your levels of stomach acid are low, work with a physician skilled in natural medicine to correct the problem with hydrochloric acid supplements. Once you’ve taken these steps, you might find that the supplements you tried before do work.
If stomach function isn’t the problem, there may be another interesting phenomenon at work, preventing you from getting the anti-spasmotic benefits of magnesium. It’s called “magnesium-induced magnesium deficiency.”
Magnesium can cause something the British call “gastrointestinal hurry.” This means that the magnesium is causing your body to rush your food through your system, making it harder to absorb vitamins and minerals — including the magnesium that’s causing the “hurry” in the first place.
Most people can take between 200 and 600 mg of magnesium each day without risking gastrointestinal hurry or magnesium-induced nutrient deficiency. But keep in mind that it can happen even at lower doses.
You can measure your own transit time (the length of time food takes to go from the entrance to the exit of the gastrointestinal tract) easily by eating beets or corn or swallowing charcoal tablets and observing how long it takes to emerge. Although estimates vary, a reasonable range for normal intestinal transit time varies from 12-14 hours to 20-24 hours. If yours is quicker, you might not be getting as much benefit from the magnesium and potassium you’re taking as you could be.
My best advice to you is to find a doctor who can help you with this. If you don’t know one in your area, you can contact the American College for Advancement in Medicine (ACAM) at 800-532-3688 or go to www.acam.org.
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What is…Crohn’s disease?
Crohn’s disease is an inflammatory bowel disease. It usually causes abdominal pain, diarrhea, and most often occurs in the lower part of the small intestine, although it can affect any part of the digestive tract.
Theories about what causes Crohn’s disease abound, but none have been proven. The most popular theory is that the body’s immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestine. About 20 percent of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease.
Yours in good health,
Amanda Ross
Managing Editor
Nutrition & Healing
Sources: Siffledeen JS, et al. “Randomized trial of etidronate plus calcium and vitamin D for treatment of low bone mineral density in Crohn’s disease.” Clin Gastroenterol Hepatol. 2005; 3(2): 122-132
