Vitamin D Put to the Test for Crohn’s Disease

Inflammatory bowel disease (IBD), “a chronic inflammatory condition of the intestine that causes abdominal pain, diarrhea, and weight loss,” includes Crohn’s disease and ulcerative colitis. When we compare identical twins, even though they have the same genes, most of the time, if one twin has IBD, the other does not. In that case, there must be some important, non-genetic trigger factors. What might they be?

Studies like the ones I discuss in my video Vitamin D for Inflammatory Bowel Disease offer a clue. Why do those living in the southern United States have lower IBD rates than those living in the north? Maybe it’s because Southerners get more sun, which means more vitamin D and which may also mean less inflammation.

So, do people with Crohn’s and ulcerative colitis who have low vitamin D levels have worse disease? Apparently so. Not only is there an increased risk of surgery and hospitalization, but those who normalize their vitamin D levels appear to reduce their risk of relapse. However, instead of better vitamin D levels leading to better Crohn’s, maybe better control of Crohn’s led to better vitamin D. Indeed, perhaps they felt so good, they went outside more, “increasing physical activity and outdoor sun exposure.” We can’t tell if it’s cause and effect unless we put it to the test.

The first pilot study tried 1,000 units of vitamin D a day and saw no change in the Crohn’s disease activity index. At six weeks, however, there may have been a slight increase in IBD quality of life scores, but even that disappeared by year’s end, so the results were pretty disappointing overall. Perhaps the researchers didn’t use enough vitamin D? How about 1,200 IU a day? At that level, the relapse rate appeared to be cut in half, as you can see at 1:45 in my video, though there were too few people in the study to reach statistical significance. What happens with 2,000 IU of vitamin D a day? Gut leakiness (so-called intestinal permeability) continued to worsen in the placebo group, but appeared to stabilize in the vitamin D group, though only those who reached blood levels over 75 nanomoles per liter appeared to have a significant drop in inflammation. And, indeed, if Crohn’s patients are started on 1,000 IU of vitamin D per day and then the dose is ramped up until a target blood level is reached, it’s possible to get a significant boost in quality of life accompanying a significant drop in disease activity, as you can see at 2:19 in my video. Disease scores under 150 are considered remission, so “the majority of patients achieved remission” with improvements in disease activity in all but one person in the study. This suggests that Crohn’s patients may want to take 5,000 IU of vitamin D a day, but that’s nearly ten times the Recommended Daily Allowance. Why so much? Because that’s what it may take to get vitamin D levels that are normal for our species—that is, the kind of levels one might get running around half naked in Africa, as we did for millions of years.


For more on the role diet can play in preventing and treating inflammatory bowel diseases, see:

Interested in learning what else healthy vitamin D levels can do for you and your family? Check out:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Wheatgrass Juice Put to the Test

In an editorial that accompanied a landmark study showing an extract of the spice turmeric could be used to fight ulcerative colitis, the authors congratulated the researchers on performing the largest study ever on complementary or alternative medicine approaches to treat inflammatory bowel disease. But that’s not saying much.

Two of the only other high quality trials tested aloe vera gel and wheat grass juice. No significant improvements in clinical remission rates or endoscopy findings on aloe vera were observed,. (And I would recommend against internal aloe use–see my aloe vera videos here). However the wheat grass findings were impressive, as I discuss in my video Wheatgrass Juice for Ulcerative Colitis. “The use of wheat grass…juice for treatment of various gastrointestinal and other conditions had been suggested by its proponents for more than 30 years, but was never clinically assessed in a controlled trial”…until now.

Wrote the researchers: “The use of wheat grass juice in the treatment of [ulcerative colitis] UC was brought to our attention by several patients with UC who attributed improvement to regular use of the extract.” So, in a pilot study, the researchers gave 100 cc of wheatgrass juice, which is between a third and a half cup, daily to ten patients for two weeks. “Eight patients described clinical improvement, one had no change, and one got worse.” Why had I never heard of this study? Because it was never published. They thought they were really onto something, so they wanted to do it right. Therefore, the “randomized, double-blind, placebo-controlled trial was designed to examine the effects of wheat grass juice in patients with active distal U[lcerative]C[olitis].”

The study found that treatment with wheatgrass juice was associated with reductions in overall disease activity and the severity of rectal bleeding. Ninety percent of the wheatgrass patients improved, and none got worse. The researchers concluded that wheatgrass juice appeared effective and safe as a single or added treatment of active lower ulcerative colitis.

No answer is available at present as to the site of wheatgrass juice action. Does the active substance get absorbed into the body and have some kind of general anti-inflammatory effect, or does it act locally right in the colon? How would you figure that out? Well, you could juice in the opposite direction (i.e. wheatgrass enemas).

A study like this raises so many questions. How would wheatgrass juice perform head-to-head against other treatments? Does it have any role in preventing attacks, or does it only work when you already have one? Should we be giving it to people with Crohn’s disease, too? What’s the best dose? It’s been over ten years since the publication of this study, yet nothing has been published since. How sad. Yes, no one’s going to make a million dollars selling wheat berries, but what about the wheatgrass juicer companies? I wish they’d pony up some research dollars.

Until then,  the researchers “believe that wheat grass juice offers a genuine therapeutic advantage in the disabling disease of UC.” That is, if you can stand the taste.


The turmeric video I mentioned is Striking with the Root: Turmeric Curcumin and Ulcerative Colitis.

I think the only other video  I’ve mentioned wheatgrass is How Much Broccoli Is Too Much? and that was really just for comic relief. This is one of the topics I get lots of questions about, but there just wasn’t any good science…until now! Please never hesitate to contact me with topics you’d like us to cover.

For more on ulcerative colitis and inflammatory bowel disease, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Turmeric Curcumin Put to the Test for Inflammatory Bowel Disease

My video Striking with the Root: Turmeric Curcumin and Ulcerative Colitis tells the story how this amazing discovery was made, and how curcumin stacks up against pharmacological interventions.

Despite evidence going back 40 years that the turmeric spice component curcumin possesses significant anti-inflammatory activity, it wasn’t until 2005 that it was first tested on inflammatory bowel disease. Why did it take so long? Well, who’s going to fund such a study? Big Curry? Even without corporate backing, individual physicians from New York decided to ask the next five patients with ulcerative colitis who walked through their office doors to start curcumin supplements.

“Ulcerative colitis (UC) is a debilitating, chronic, relapsing-remitting [i.e., it comes and goes] IBD [inflammatory bowel disease] that afflicts millions of individuals throughout the world and produces symptoms that impair quality of life and ability to function.” As with most diseases, we have a bunch of drugs to treat people, but sometimes these medications can add to disease complications, most commonly nausea, vomiting, headaches, rash, fever, and inflammation of the liver, pancreas, and kidneys, as well as potentially wiping out our immune system and causing infertility. Most ulcerative colitis patients need to be on drugs every day for the rest of their lives, so we need something safe to keep the disease under control.

So how did those five patients do on the spice extract? Overall, all five subjects improved by the end of the study, and four of the five were able to decrease or eliminate their medications. They had “more formed stools, less frequent bowel movements, and less abdominal pain and cramping. One subject reported decreased muscle soreness, commonly felt after his exercise routine.” This, however, was what’s called an open-label study, meaning the patients knew they were taking something so some of the improvement may have just been the placebo effect. In 2013, another small open-label pilot study found encouraging results in a pediatric population, but what was needed was a larger scale, double-blind, placebo-controlled trial.

And, researchers obliged. They took a bunch of people with quiescent ulcerative colitis and gave them either turmeric curcumin along with their typical anti-inflammatory drugs, or a placebo and their drugs. In the placebo group, 8 out of 39 patients relapsed, meaning their disease flared back up. In the curcumin group, however, only 2 out of 43 relapsed, significantly fewer. And, relapse or not, clinically, the placebo group got worse, while the curcumin group got better. Endoscopically, which is objectively visualizing the inside of their colons, doctors saw the same thing: trends towards worse or better.

The results were stunning: a 5 percent relapse rate in the curcumin group compared with a 20 percent relapse rate in the conventional care group. It was such a dramatic difference that the researchers wondered if it was some kind of fluke. Even though patients were randomized to each group, perhaps the curcumin group just ended up being much healthier through some chance coincidence, so maybe it was some freak occurrence rather than curcumin that accounted for the results? So, the researchers extended the study for another six months but put everyone on the placebo to ensure the initial findings were not some aberration. The curcumin was stopped to see if that group would then start relapsing, too—and that’s exactly what happened. Suddenly, they became just as bad as the original placebo group.

The researchers concluded: “Curcumin seems to be a promising and safe medication for maintaining remission in patients with quiescent ulcerative colitis.” Indeed, no side effects were reported at all. So, “Curry for the cure?” asked an accompanying editorial in the journal of the Crohn’s and Colitis Foundation of America. “Can curcumin be added to our list of options with respect to maintaining remission in ulcerative colitis? What is noteworthy about this trial is the fact that not only did the authors demonstrate a statistically significant decrease in relapse at 6 months, but a statistically significant improvement in the endoscopic index as well. Equally telling is the fact that upon withdrawal of curcumin the relapse rate quickly paralleled that of patients treated initially with placebo, implying that curcumin was, in fact, exerting some important biologic effect.”

Similarly, a Cochrane review concluded in 2013 that curcumin may be a safe and effective adjunct therapy. Cochrane reviews take all the best studies meeting strict quality criteria and compile all the best science together, which is normally a gargantuan undertaking. Not so in this case, however, as there is really just that one good study.


Turmeric is one of the most popular trending topics, and I encourage you to check out the most popular turmeric videos, including:

For more on ulcerative colitis and inflammatory bowel disease, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: