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People who are already suffering from Inflammatory Bowel Disease(IBD) are at risk of developing nutritional deficiency. One clinical option is to supplement them. But as their gut is already compromised such conventional supplements are contraindicated.

According to WebMd these are some of the contraindications of multimineral supplements

  • an ulcer from too much stomach acid

  • a type of stomach irritation called gastritis

  • ulcerative colitis

  • an inflammatory condition of the intestines

Do guidelines exist for how people with Inflammatory Bowel Disorder should supplement with multiminerals and not risk a flare?

Are there other ways of supplementing? Are there supplements that are not contraindicated?

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  • What is IBD? (more letters here because SE does not allow short comments)
    – Thomas
    Oct 25 '20 at 22:53
  • @Thomas I have updated Oct 26 '20 at 4:20
  • How is this offtopic?? Care to explain?? Jan 25 at 8:10
  • Someone has marked this question as off topic, stating it as personal. I dont see how this question is personal. Jan 25 at 8:11
  • @MrGreenGold Asking how to manage a disease and asking for specific supplement recommendations is medical advice.
    – Carey Gregory
    Jan 25 at 15:21
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+50

Supplementation of vitamins and minerals in the context of Inflammatory Bowel Disease (IBD) should be specific to existing deficiencies in each patient (1).

There is little evidence in this context for blind ingestion of over the counter supplements without a diagnostic correlate for, or at least reasonable clinical suspicion of a particular deficiency.

Do guidelines exist for how people with Inflammatory Bowel Disorder should supplement with multiminerals and not risk a flare?

Guidelines exist for management of IBD including treatment of deficiency (for example: 2, 3). The intended audience is physicians. Informational resources for patients are also available (for instance: 4, 5). Patients should consult with their physicians to determine the necessity of taking supplements.

...as their gut is already compromised such conventional supplements are contraindicated.

IBDs are variable in their severity: the function of the gut is not necessarily continuously compromised and different sections of the gut can be affected. As such the choice of supplement and method of administration must be tailored to the individual situation: disease activity, patient tolerance, degree of deficiency and success or failure of a given supplement are relevant factors.

Are there other ways of supplementing?

Application methods depend on the substance. The most common deficiencies in the context of IBD are Iron, Vitamin D, Vitamin B12, Zinc and Calcium (6). All of these can be administered per os or intravenously (1, 6). As pointed out elsewhere, Vitamin B12 and Vitamin D can be administered under the skin or in the muscle (7).

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Are there other ways of supplementing? Are there supplements that are not contraindicated?

Yes. There are ways to deliver vitamins directly to the cell without needing to be passed by the intestinal system.

E.g. Vitamin B12, one of the most commonly deficient vitamins observed in IBD and crohn's patients as uptake is mainly oral and the main site of oral absorption being in the ileum, can be delivered intramuscularly via injection. [1]

Oral Vitamin D supplements also tend to be less effective in IBD patients with active inflammation in the small bowel as that is where most absorption takes place. And can be supplemented through natural biosynthesis by the keratinocytes in the epidermis when in the presence of UV light.

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