Vitamin D can help ease irritable bowel pain?
‘I didn’t know whether to make a dash to the bathroom or just sit it out and hope it would pass,’ recalls Vicky, 43, a medical librarian, who is divorced and lives in Sheffield. ‘I was coping with up to seven bouts of diarrhoea a day and it was really taking its toll on me.
‘I decided to risk it and stay put, but I was concentrating so hard on staying in control that everything being said in the meeting passed over my head.
‘I felt bloated, tired and fatigued. My weight was below 7st (I’m 5ft 3in). I’d lost so much weight and looked terrible – I’m sure people thought I had anorexia. It was also making me depressed.
‘I’d tried every drug, complementary therapy and diet under the sun, some things helped a little but nothing made my symptoms manageable. I was just so fed up with being ill all the time.’
Vicky, then in her early 30s, had been struggling to cope with irritable bowel syndrome (IBS) since the age of 13. IBS is the medical name for a collection of symptoms including abdominal pain and spasms, diarrhoea, constipation or an erratic bowel, bloating, and wind.
Up to a third of the population is thought to have IBS at some point, with one in ten experiencing symptoms so severe they seek medical help – IBS accounts for a tenth of all visits to GPs.
But the condition is notoriously tricky to diagnose and treat: IBS doesn’t show up on X-rays, blood tests or scans. Doctors still don’t know what causes it, and unlike other bowel diseases it does not physically damage the gut, yet patients suffer very real symptoms.
Treatment is often a case of trial and error – options include drugs for diarrhoea or constipation, antidepressants, relaxation and psychological therapies, and dietary changes.
But could vitamin D offer another option? After years of debilitating symptoms and failed treatments, this is what helped Vicky, and her experience has now led to a major new study looking at the nutrient’s benefits.
Vicky first ‘plucked up the courage’ to see her GP in her early 20s. ‘He told me I did have IBS and that in my case it was due to stress and advised me to tackle the stress,’ she says.
‘I didn’t think I was any more stressed than any of my friends and thought the stress I was under was at least partly due to coping with my IBS. I tried meditation, but it made no difference.
‘Over the years my IBS left me feeling totally drained.’
Then, in her early 30s Vicky was finally referred to a gastroenterologist after she broke down in tears at her GP’s because she felt so depressed. ‘I felt I just couldn’t cope with my symptoms any more.’
The consultant she saw suggested antidepressants for her depression and anxiety and explained these can have a calming effect on the gut, too. ‘I carried on trying alternative remedies – aloe vera juice, herbal supplements, counselling, hypnotherapy and probiotics to name but a few – but nothing fixed it,’ she says. Vicky’s experience is far from unusual, according to Dr Nick Read, chairman of the IBS Network’s medical advisory group. ‘Trying successive treatments is fairly typical as there isn’t any one definitive treatment and it’s a matter of deciding what makes most sense and works best for you.’
IBS is most common in women between the ages of 19 and 32.
‘It tends to occur in the more sensitive individuals, who can find themselves overwhelmed with their busy lives,’ says Dr Read.
‘They tend to blame their diet, but symptoms of IBS often start or get worse after a significant change, such as a new job, a holiday, a breakdown of a relationship or the start of a new one, marriage, childbirth, or later, empty nesting, care for elderly parents, bereavement – the stuff of life,’ he says, adding: ‘Sometimes it follows an attack of food poisoning.’
Such changes and stresses can make the bowel more sensitive to different foods, particularly fats and coffee as these cause the bowel to contract, and milk, wheat, and fruits and vegetables that cause gas. ‘To understand IBS, think food and mood,’ says Dr Read.
Three years ago, Vicky took to the internet hoping to find a new treatment. She teaches medical students how to appraise medical journals and had read many papers in such publications about treatments for IBS, but says she ‘also wanted to find out what patients were saying about what worked for them’.
‘One thing that kept cropping up online was how high-dose vitamin D supplements could help,’ recalls Vicky. ‘I read one blog then reports from patients on forums talking about this – it was generating a lot of interest.’
Vitamin D is a fat-soluble vitamin important for bone health, a healthy immune system, muscle growth and blood clotting. It is made by the body under the surface of the skin through exposure to sunlight. Small amounts are contained in dairy products, egg yolks, oily fish and fortified margarine.
It’s well known that people in the UK and other Northern countries have low levels of vitamin D in the winter months. Increasingly, research is linking a lack of vitamin D to a host of illnesses including inflammatory bowel disease, multiple sclerosis, colorectal cancer and depression.
Based on what she’d read, Vicky started a low daily dose of the nutrient (1,000 international units) – she took vitamin D2, a form which comes mainly from plants. But it had no effect.
‘Then a work colleague who has multiple sclerosis mentioned that vitamin D3 from fish oils is closer to the type the body makes naturally and was more effective and should be taken at a higher dose,’ says Vicky. ‘So I switched to 4,000 international units a day of D3, which is a safe dose. Within days, my symptoms eased and progressively improved over the months.
‘After years of symptoms, my diarrhoea, cramps, pain and bloating disappeared. I started to feel well, put on weight and my depression lifted.
‘It was amazing. My symptoms would flare up again though, if I forgot to take it.’
With the help of medical researchers she knew from her work at Sheffield University medical school, Vicky wrote up her experience as a case report for the British Medical Journal – she included anecdotal reports on vitamin D from blogs, which suggested it worked in 70 per cent of cases.
The article generated a lot of interest. ‘Lots of patients wanted to know more but I knew doctors wouldn’t – quite rightly – recommend vitamin D unless it was backed up by clinical trial evidence,’ says Vicky, who is now studying for a doctorate based on patient experiences of IBS.
Now the university’s oncology department is to run a randomised controlled trial of the treatment involving 100 IBS patients – half will take a high daily dose (3,000 international units) of vitamin D3, the other half a placebo, for three months.
‘Hopefully this will produce some hard evidence one way or the other,’ says Vicky, who is a researcher on the trial (which will soon be recruiting patients).
There’s been an ‘explosion’ of research into the role of vitamin D in illnesses including cancer multiple sclerosis and inflammatory bowel disease, says Dr Bernard Corfe, head of Sheffield University’s molecular gastroenterology research group. ‘So it is not unreasonable to investigate whether it plays a role in IBS,’ he adds.
There are several ways vitamin D might work, including boosting the immune system and improving the gut’s barrier. Dr Read says there is evidence some types of IBS involve a low level of inflammation in nerve endings in the gut.
‘Inflammation around the gut’s nerve cells may make the intestine more sensitive to food and stress,’ he explains. ‘We can’t say vitamin D works as a treatment for IBS yet. Only a properly designed trial will establish whether it works or not.’
Julian Walters, professor of gastroenterology at Imperial College, London, agrees the idea that vitamin D may play a role in IBS is ‘plausible’.
‘We shouldn’t assume it will work,’ he cautions. ‘It could just be the power of placebo.’
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