Lack of vitamin B and a particular infection increases Inflammation in Crohn’s disease

People suffering from the Crohn’s disease, an inflammatory bowel disorder, often lack folic acid and vitamin B12. It is also known that this disease can be triggered by an infection with Mycobacterium avium subspecies paratuberculosis (MAP), a type of bacteria that can survives in pasteurized milk. A new study that is published in Nutrients has found why lack of folic acid and vitamin B12 disrupts the immune defense, thereby contributing to chronic inflammation that can occur in the wake of an infection with MAP.

In the new study, the scientists looked at patients with Crohn’s disease. They divided the patients into two groups. One group was infected with Mycobacterium avium subspecies paratuberculosis (MAP). This is a very resilient bacterium that can be passed on to humans through water, meat, and dairy products and cause paratuberculosis (para-TB) and various inflammatory diseases. The other group of Crohn’s patients was not infected with MAP.
The researchers looked at how lack of folic acid (vitamin B9) and vitamin B12 affects macrophages, a type of white blood cells, causing them to unleash powerful inflammatory processes at the same time as being prevented from carrying out apoptosis (programmed cell death).
Macrophages are part of our innate immune defense and are able to handle most kinds of infections by devouring bacteria. This process is known as phagocytosis. Once macrophages have devoured bacteria such as MAP, it is vital for the macrophages to be able to carry out apoptosis so the bacteria are fully destroyed.
The scientists hypothesized that macrophages infected with MAP need folic acid and vitamin B12 to carry out apoptosis. It is also the macrophages’ job to activate the immune defense by initiating inflammatory processes and to terminate the inflammation, once the infection has been defeated. Macrophages are of key importance to the emergency response of the immune system, the communication of the immune defense, and the inflammatory processes that are controlled by signaling compounds called cytokines.
The researchers measured plasma levels of folic acid and vitamin B12, both in the group of Crohn’s patients with the MAP infection and in the group without. Also, they measured the activity of pro-inflammatory cytokines such as IL-1β and TNF-α plus cellular apoptosis and the bacterial activity in MAP-infected macrophages that had been cultivated in folic acid- and vitamin B12-deficient media.
They discovered that MAP-infected Crohn’s patients had significantly lower plasma levels of folic acid and vitamin B12 compared with patients that were not infected with MAP.
Lack of folic acid and vitamin B12 following a MAP infection caused macrophages to carry out apoptosis at a slower rate. Without apoptosis, MAP can survive and replicated inside the cell.
MAP also appears to disrupt the immune defense. Crohn’s patients with a MAP infection had a significantly increased production of pro-inflammatory cytokines like IL-1β and TNF-α. The scientists observed that supplementation with folic acid and vitamin B12 lowered the production of these pro-inflammatory cytokines significantly.
Based on their observations, the scientists concluded that folic acid and vitamin B12 are key nutrients that affect the survival of cells as well as the inflammatory processes in connection with a MAP infection.

Facts about the MAP bacterium that causes para-tuberculosis

• Occurs in ruminants (cattle, sheep, goats, and deer)
• Spreads to humans by way of contaminated water, meat, and dairy products
• Able to survive pasteurization
• Survives in the white blood cells after phagocytosis
• Replicates inside white blood cells
• Disrupts the immune defense’s ability to protect the body’s tissues
• May be the cause of inflammatory and autoimmune diseases like Crohn’s disease, rheumatoid arthritis, Hashimoto’s disease, and sclerosis
• Should be able to be destroyed by a well-functioning immune defense

Why do Crohn’s patients often lack folic acid and vitamin B12?

It seems that patients with this disease often have difficulty with absorbing folic acid and vitamin B12. Also, patients may be following strict diet plans where these two nutrients are not present in sufficient quantities. It is also known that antacids and certain other types of medicine can disrupt the uptake and utilization of the vitamins.

Sources of folic acid and vitamin B12 and supplementation

We get folic acid from liver, legumes, vegetables, nuts, eggs, and dairy products. Folic acid is water-soluble so we need it on a daily basis. Vitamin B12 is only found in animal foods such as liver, meat, fish, eggs, and dairy products. B12 is the only B vitamin that we humans can store. If you don’t eat animal foods it may take months or even more than a year before you notice deficiency symptoms.
In the case of a deficiency of folic acid and vitamin B12, it may be a good idea to take a strong vitamin B complex. For those with B12 absorption issues, lozenges are a viable option. They ensure that the vitamin is absorbed directly by the oral mucosa.

References:

Joseph A. Vaccaro et al. Folate and Vitamin B12 Deficiency Exacerbates Inflammation during Mycobacterium avium paratuberculosis (MAP) Infection. Nutrients 2023

Mary Garvey. Mycobacterium avium subspecies paratuberculosis: A possible causative agent in human morbidity and risk to public health safety. Open Vet J 2018 May