Vitamin B12 Deficiency

Vitamin B12 deficiency and IBS and IBD

Two major diseases of the bowel are associated with vitamin B12 deficiency, albeit for different reasons, Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD.

Vitamin B12 deficiency and Irritable Bowel Syndrome (IBS) 

IBS is a common disorder that affects the large intestine and can result in cramping, abdominal pain, gas, diarrhoea, or constipation of both. The disease occurs in 10-20% of the Western population. As many as 60% of IBS patients have fatigue with 14% having chronic fatigue syndrome. In addition, many IBS sufferers are diagnosed with depression and anxiety. Considerable evidence exists for an involvement in the over-production of serotonin, of disorders for the serotonin transporter, and correlations with Tryptophan hydroxylase I variants. Studies have shown lower levels of Selenium intake in IBS sufferers. It has also been shown that individuals with IBS have lower night time melatonin levels. Further, some success in treatment of IBS has been obtained using oral melatonin, suggesting that potentially it is over-production of serotonin, with underproduction of melatonin that is causative for the condition. Taken together, there is a strong possibility that the condition occurs as a result of vitamin B12 deficiency. Such deficiency would lead to decreased production of melatonin, with increased over-production of serotonin, with subsequent sequelae. In addition, deficiency of methyl B12 also would result in lower activity of the histamine-neutralizing enzyme, Histamine-N-methyl transferase, thus leading to greater sensitivity to histamine in foods.

Crohn’s Disease and Ulcerative Colitis 

Crohn's disease and Ulcerative colitis are two closely related chronic inflammatory condition that involving the lining of the small and large intestine (Crohn’s Disease) or the large intestine alone (Ulcerative colitis). Together, Crohn's disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohn's disease have no medical cure. Persons with IBD often experience stomach cramps, diarrhoea and weight loss. 

Vitamin B₁₂ and Inflammatory Bowel Disease 

During the course of IBD, the wall of the intestine becomes inflamed and is no longer able to absorb vitamin B12 via the VB12-intrinsic factor mediated uptake system. As a result patients with chronic IBD, such as those with Crohn's Disease and Ulcerative Colitis soon become deficient in vitamin B₁₂ This vitamin B₁₂ deficiency in turn can lead to even less control of the inflammation, thus exacerbating the disease. Dietary supplements containing vitamin B₁₂ can no longer be absorbed and so vitamin B₁₂ must be given either by injection or some other route, such as transdermal application. 

Treatment of Vitamin B₁₂ deficiency in IBD 

The very condition that causes vitamin B12 deficiency in IBD also means that vitamin B12 supplementation by traditional means is largely ineffective. Furthermore, once deficiency has manifested itself high dose supplementation is required to reverse the progression of the deficiency and associated conditions. Recently a topical form of vitamin B12 has been developed which is a specially formulated preparation that is an easy to apply, needle-free delivery system to the skin of the IBD patient. This pain-free form of delivery greatly increases the patient comfort experienced during the administration of the medication and allows for self-medication without the need for medical staff or any special training. In addition, the topical formulation is particularly suited to patients who may have gastro-intestinal problems, such as Crohn’s Disease and Ulcerative Colitis which often lead to vitamin B12 deficiency. 

Treatment of IBS with Vitamin B₁₂ 

It is known that in vitamin B12 deficiency there is an over-production of serotonin, which is the precursor for the production of melatonin. The possibility exists, therefore, that the cause of IBS is actually vitamin B12 deficiency. This would result in the observed alterations in serotonin production and processing, plus the reduced production of melatonin and the accompanying irregular gastro-intestinal mobility, poor control of local anti-inflammatory responses and subsequent abdominal pain. Whilst treatment with melatonin may partially over-come the melatonin deficiency it would be less effective in controlling the increased serotonin production. Further, the alterations in the gut wall would potentially reduce the effectiveness of oral treatment with vitamin B12, and hence injection of B12 or transdermal application (B12 oils) would be more effective. The very condition that causes vitamin B12 deficiency in IBD also means that vitamin B12 supplementation by traditional means is largely ineffective.

Further Information on Inflammatory Bowel Disease

Further Information on Crohn’s Disease and Ulcerative Colitis can be found at the following web-sites:

http://www.angelfire.com/ga/crohns/faq.html

http://www.ccfa.org/

http://www.crohnsandcolitis.com.au/

References

Heitkemper etal. Serum tryptophan metabolite levels during sleep in patients with and without Irritable Bowel Syndrome. Biol Res Nurs. 2015 18, 193-8.

Siah etal. Melatonin for the treatment of Irritable Bowel Syndrome. World J. Gastroenterol. 2014 20: 2492-8

Chojnacki et al. Influence of melatonin on symptoms of Irritable Bowel Syndrome in postmenopausal women. Endorynol Pol. 2013 64: 114-20

Mozaffari et al. Implications of melatonin therapy in Irritable Bowel Syndrome: a systematic review. Curr Pharm Des. 2010 16:3646-55

Pozo etal. Melatonin, a potential therapeutic agent for smooth muscle-related pathological conditions and aging. Curr. Med Chem. 2010 17: 4150-65

Radwan etal. Is melatonin involved in the Irritable Bowel Syndrome? J Physiol Pharmacol 2009 60: 67-70