Vitamin D associates with improved quality of life in participants with irritable bowel syndrome: outcomes from a pilot trial

Abstract

BackgroundVitamin D deficiency has been associated or implicated with the pathophysiology of the gastrointestinal conditions inflammatory bowel disease and colorectal cancer, as well as with depression. No trials or epidemiology studies to date have investigated a link with irritable bowel syndrome (IBS). A single case report has suggested a benefit in IBS of vitamin D supplementation. We hypothesised that IBS participants with vitamin D insufficiency would benefit from repletion in terms of their IBS symptoms. We undertook a pilot trial to provide data to support a power calculation and to justify a full trial.MethodsThis was a randomised, double blinded, three-arm parallel design trial of vitamin D, placebo or a combination of vitamin D and probiotics. Participants were further stratified according to whether they were vitamin D replete or insufficient. Vitamin D status was determined by blood test at baseline and exit; IBS symptoms were assessed by validated questionnaire; dietary intakes were assessed by food frequency questionnaire.ResultsA significant proportion of the IBS population were vitamin D deficient, such that the replete stratum could not be adequately recruited. There was a significant association in the baseline data between circulating vitamin D level and quality of life (“How much has IBS affected your life?”). Supplementation significantly improved vitamin D level versus placebo. IBS symptoms were not significantly improved in this pilot, although a power calculation was enabled from the intervention data.ConclusionsThe IBS population exhibits significant levels of vitamin D insufficiency and would benefit from screening and possible supplementation. The impact of IBS on quality of life may be reduced by vitamin D level. Future trials should have a sample size of over 97.Trial registration number:ICTRN 6116003917.

Gene Expression Profiling and Assessment of Vitamin D and Serotonin Pathway Variations in Patients With Irritable Bowel Syndrome

“…Interestingly, the IBS-C patients in this population were the most responsive to vitamin D supplementation in terms of a striking improvement across nearly all IBS symptoms. 47 Because IBS-C patients are thought to possess lower gut serotonin levels, 48 the responsiveness of these patients to vitamin D supplementation is consistent with the actions of vitamin D to raise gut TPH1/serotonin levels 25 and with our current hypothesis that vitamin D, via induction of the intestinal TPH1 gene, may play a role in IBS pathophysiology. While this study was limited by its small sample size, our IBS cohort displayed a trend toward diminished serum vitamin D levels relative to our non-IBS control group.…”

“…Thus, the IBS pathological state may be correlated with dysregulated serotonin production, possibly secondary to (or in combination with) vitamin D deficiency. Moreover, during the administration of the current study, another clinical trial was published 47 that reported an IBS cohort with appreciably depressed serum 25(OH)D levels and a significant positive association between quality of life and circulating 25(OH)D concentrations after vitamin D supplementation. Interestingly, the IBS-C patients in this population were the most responsive to vitamin D supplementation in terms of a striking improvement across nearly all IBS symptoms.…”

Vitamin D/VDR, Probiotics, and Gastrointestinal Diseases

“…Patients with vitamin D deficiency displayed increased UC clinical disease severity and a lower quality of life (QOL) in a cohort of patients with IBD [14, 15] . After supplementation with recommended doses of vitamin D and reserving saturation of 1,25(OH) D 3 , the serum concentration of vitamin D and health related quality of life can be improved [16, 17] . However, more recently, a study showed that daily supplementation with 1000 IU of vitamin D3, 1200 mg of calcium, or both did not significantly reduce the risk of recurrence of colorectal adenomas after its removal over a period of 3 to 5 years [18] .…”

Vitamin D status in irritable bowel syndrome and the impact of supplementation on symptoms: what do we know and what do we need to know?

“…Tazzyman et al (2015) conducted a 12 week randomised double-blind three-arm parallel pilot 12 study in people with IBS which compared placebo to either vitamin D supplementation13 (75µg/d) or combination of vitamin D (75µg/d) plus probiotic (two strains of Lactobacillus 14 acidophilus per capsule). The trial was conducted in the UK in January-April 2015.…”