Sunday, March 23, 2014

Research Update - Late Winter

Research Update 


Sleep and IBD


There have been a number of articles in the past 12 months related to sleep and IBD.  The theme is consistent – IBD is associated with higher levels of fatigue and poor sleep quality.  The first study looked at two years of IBD patients and determined that active disease is strongly correlated with fatigue.  

Additionally, IBD-related fatigue is correlated with increased psychological stress and decreased quality of sleep.(1)  For those with impaired sleep, there was a two-fold increase in risk for disease relapse in Crohn’s disease (but not ulcerative colitis) (adjusted odds ratio, 2.00; 95% confidence interval, 1.45–2.76).  Interestingly, females were more likely to have sleep disturbances and related issues in both studies.(2)  Doctors may want to include basic sleep questions as part of their diagnostic regime, such as the Pittsburgh Sleep Quality Index (http://www.opapc.com/images/pdfs/PSQI.pdf).

Vitamin D and IBD


Often-discusses is the relationship of Vitamin D and Inflammatory Bowel Disease.  A recent survey looked at Vitamin D studies and found the following:

·         Between 16 and 95% of IBD patients are vitamin D deficient. To appropriately bound this, however, some studies have estimated the global vitamin D deficiency percentage to be 42% in the general population, with much higher numbers I higher latitudes.(3)
·         Low vitamin D was associated with an increased risk in surgery for Crohn’s disease (OR 1.8, 95% CI 1.2–2.5) but not Ulcerative Colitis.
·         Low vitamin D was associated with increased hospitalizations for both Crohn’s (OR 2.1, 95% CI 1.6–2.7) and UC (OR 2.3, 95% CI 1.7–3.1).(4)

While the studies showed correlations between vitamin D deficiency and IBD, they have not shown causation.  Those who are the least healthy may venture out less (less sun exposure) or have worse absorption.  Alternatively, vitamin D deficiency may cause a worsening of symptoms.  Although the causality isn’t know, there are other risks of low vitamin D that warrant supplementation when extremely low (such as cardiac disease and rickets).

Diet, Revisited


We have looked at the role in diet on this blog before, but another review study came to essentially the same conclusions.  The study looked at all of the papers mentioning diet and IBD between 1975 and the present and came to the conclusion that:

                There is little evidence from interventional studies to support specific dietary recommendations.

The study did confirm that enteral nutrition can be helpful in inducing remission, but that as soon as enteral nutrition is stopped the diet factors become irrelevant.  The key takeaway in this study, which is one of the few to stress this with IBD, is that “dietary intake should not be inappropriately restrictive.”(5)

Bottom Line


·         For physicians, asking about sleep issues can assist IBD patients that may be aggravating their symptoms (and general quality of life) identify issues.
·         Low vitamin D may be correlated with IBD.  Extremely low levels should be supplemented as with any deficiency, especially in the winter and in climates at high latitudes.
·         Individual diets and IBD relapse are not well correlated.  While more work is warranted in this area, patients should not unnecessarily restrict diets based on outdated advice.
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1.       Graff, Lesley A., Ian Clara, John R. Walker, Lisa Lix, Rachel Carr, Norine Miller, Linda Rogala, and Charles N. Bernstein. "Changes in fatigue over 2 years are associated with activity of inflammatory bowel disease and psychological factors." Clinical Gastroenterology and Hepatology 11, no. 9 (2013): 1140-1146.
2.       Ananthakrishnan, Ashwin N., Millie D. Long, Christopher F. Martin, Robert S. Sandler, and Michael D. Kappelman. "Sleep Disturbance and Risk of Active Disease in Patients With Crohn's Disease and Ulcerative Colitis." Clinical Gastroenterology and Hepatology 11, no. 8 (2013): 965-971.
3.       Prentice, Ann. "Vitamin D deficiency: a global perspective." Nutrition reviews66, no. s2 (2008): S153-S164.
4.       Ardizzone, Sandro, Andrea Cassinotti, Maurizio Bevilacqua, Mario Clerici, and Gabriele Bianchi Porro. "Vitamin D and inflammatory bowel disease." Vitamins and hormones 86 (2010): 367-377.

5.       E. Richman, J. M. Rhodes.  Evidence-Based Dietary Advice for Patients With Inflammatory Bowel Disease.  Aliment Pharmacol Ther. 2013;38(10):1156-1171.

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