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    Vitamin A and D Deficiency Common in Kids with Newly Diagnosed Celiac Disease


    Jefferson Adams
    • A new study shows that children with newly diagnosed celiac disease showed significantly reduced levels of vitamin D and A, among other vitamin issues. 

    Vitamin A and D Deficiency Common in Kids with Newly Diagnosed Celiac Disease
    Image Caption: Image: CC--Matthew Hurst

    Celiac.com 07/17/2018 - What can fat soluble vitamin levels in newly diagnosed children tell us about celiac disease? A team of researchers recently assessed fat soluble vitamin levels in children diagnosed with newly celiac disease to determine whether vitamin levels needed to be assessed routinely in these patients during diagnosis.

    The researchers evaluated the symptoms of celiac patients in a newly diagnosed pediatric group and evaluated their fat soluble vitamin levels and intestinal biopsies, and then compared their vitamin levels with those of a healthy control group.

    The research team included Yavuz Tokgöz, Semiha Terlemez and Aslıhan Karul. They are variously affiliated with the Department of Pediatric Gastroenterology, Hepatology and Nutrition, the Department of Pediatrics, and the Department of Biochemistry at Adnan Menderes University Medical Faculty in Aydın, Turkey.

    The team evaluated 27 female, 25 male celiac patients, and an evenly divided group of 50 healthy control subjects. Patients averaged 9 years, and weighed 16.2 kg. The most common symptom in celiac patients was growth retardation, which was seen in 61.5%, with  abdominal pain next at 51.9%, and diarrhea, seen in 11.5%. Histological examination showed nearly half of the patients at grade Marsh 3B. 

    Vitamin A and vitamin D levels for celiac patients were significantly lower than the control group. Vitamin A and vitamin D deficiencies were significantly more common compared to healthy subjects. Nearly all of the celiac patients showed vitamin D insufficiency, while nearly 62% showed vitamin D deficiency. Nearly 33% of celiac patients showed vitamin A deficiency. 

    The team saw no deficiencies in vitamin E or vitamin K1 among celiac patients. In the healthy control group, vitamin D deficiency was seen in 2 (4%) patients, vitamin D insufficiency was determined in 9 (18%) patients. The team found normal levels of all other vitamins in the healthy group.

    Children with newly diagnosed celiac disease showed significantly reduced levels of vitamin D and A. The team recommends screening of vitamin A and D levels during diagnosis of these patients.

    Source:

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    Guest Mary C. D,

    Posted

    I was diagnosed with gluten intolerance and corn intolerance in 1993, when I was 57 years old.  It first showed up as Dermatitis Herpitiformis.  I've been on a gluten-free diet and have avoided corn products since.

    Back when I was 14, (that would have been in 1950), I developed an outrageous case of psoriasis.  In those days, it was treated with X-ray and various creams and soaps.  My dermatologist was very wise, however.  He discovered I was vitamin A deficient and prescribed 25,000 I. U. of Vitamin A daily, until the psoriasis cleared.  After that, I was to take the Vitamin A, 25,000 I.U. for three months and then stop.  At the first sign psoriasis was returning, I was to resume the Vitamin A, 25,000 I.U. for three months, and continue the routine forever.  The reason for the stop and start treatment was that Vitamin A can be quite toxic if too much is taken.

     

    In the 1980's Beta Carotine became readily available, and I switched to Beta Carotine, 25,000 IU, because the body eliminates the Beta Carotine it doesn't need, and so it is not toxic.

     

    In the last couple of years, I have developed a touch of psoriasis, for which I use a small amount of prescribed ointment.  The psoriasis hasn't expanded, and I continue the Beta Carotine.

     

    In looking back over the years, I suspect I was Gluten Intolerant from early childhood, but not to an extreme degree.  I have passed on my intolerance to my two sons and my two grandchildren.  Interesting.  And my brothers have it too.

     

    I mention all this because it may be useful information to add to the body of knowledge we as fellow Gluten Intolerant people, are gathering.

     

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    I'm very curious about this information. 

      I was told at an early age that we needed to be in the sun for at least ten minutes a day to get the necessary amount of vitamin d.

      So what's going on with celiac and vitamin d? Are our bodies not making the vitamin because of the celiac? Are we not getting enough sun and seeing an increase in symptoms, or greater intensity of symptoms? 

      My symptoms did not get really bad until i was dx'd with lupus and had a sun allergy. I was staying out of the sun completely. 

      I wonder how many others have quit sun bathing, or use intense sun screens. How many of us take supplements to counteract the lack of sun exposure?

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

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    Melissa Reed
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    Betty Wedman-St Louis, PhD, RD
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    Celiac.com 04/12/2016 - Vitamin B12 is a group of cobalt containing compounds described by Alan R. Gaby, M.D. in Nutritional Medicine called cobalamins. Methylcobalamin is the coenzyme form of B12 that is critical for human health. Hydroxocobalamin is a more stable form of B12 but it first needs to be converted to an active form before use in metabolism.
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    Yvonne Vissing Ph.D.
    Celiac.com 07/25/2016 - Celiac disease is a tricky rascal. Just when you think you've got it under control, it sneaks up and manifests into new and often unexpected problems. At least, this is what we have found over the last decade. From contacts with others who have celiac disease, we know we're not alone. I'm in my early thirties and find that sometimes my body acts more like that of an old man's. For instance, I've had gout even though my diet contains almost none of the food culprits traditionally associated with that disorder. Then I learned that what gout and celiac disease have in common is that they are both auto-immune diseases. My skin is quirky and has been since I've been little; I can't wear certain types of fabric and have to use soaps and detergents for people with "sensitive skin". Celiac disease, I gather, is associated with a variety of skin problems, including psoriasis. I had to have my gall bladder removed a couple of years ago. I have elevated liver rates. Why me? I'm too young for this! Then I found that it is common for people with celiac disease to have liver and gall bladder problems.
    This spring, I started becoming so tired that I couldn't wait to go to bed, even though the sun was still shining. I finally went in to see my MD who took my blood for testing. The results? I had no vitamin D. None. I have a good diet (see my book Going Gluten Free for proof of this!), and I know that vitamins are important. I know that sunshine is associated with vitamin D, and while I'm not outside all the time, I'm not like a vampire that only goes out at night. I do get sunshine. I also have a sun lamp over my desk. So why did my blood levels indicate I have no vitamin D? Evidently I'm in good company again – lots of people with celiac disease have vitamin D problems.
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    So what are people like us to do? First thing is to see a doctor and have a blood test so you can get an accurate indication of if you actually have a vitamin D deficiency, and if you do how much of a deficiency you have. Don't try to self-diagnose your condition. It's tempting to do this. But go see your doc or an expert in the field. It seems that serum concentration of 25(OH)D is the best indicator of vitamin D status, so that's probably what test they will run.
    Don't go to the store and buy vitamin D and start taking it without knowing what you are doing. How much a person needs varies by the individual. There are vitamin D supplements available, but it is not wise to start self-medicating and guessing at how much you should take. Get a professional opinion and follow it. Get your serum blood levels tested regularly, monitoring it to make certain you're on the right amount. Evidently the amount of stress one is under, the time of the year, what one is eating and other factors may influence absorption levels. There is such a thing as vitamin D toxicity where people can take too much of a good thing. So find out from the doctor exactly what amounts you should be taking.
    It's important to figure out exactly why you have the vitamin D deficiency. Perhaps it is associated with your diet or lifestyle. It is possible to alter our diets and eat more foods that are in our best interests. Actually, very few foods naturally contain high amounts of vitamin D. The flesh of fatty fish like salmon, tuna, and mackerel and cod liver oils are among the best sources of vitamin D. Smaller amounts of vitamin D can be found in beef liver, cheese, mushrooms and egg yolks. Foods, like milk and milk products that are fortified with vitamin D, provide most of the vitamin D for people in the USA. If you take vitamin D supplements, addressing them could do the trick for you.
    Most of us could get out into the sun more, but if we've got a malabsorption issue the amount of vitamin D we get from the sun may actually not matter that much. It never hurts to get into the sun (with moderation, of course). Doctors may tell you to get out into the sunshine, since ultraviolet rays from the sun interface with the body to activate it through vitamin D receptors. These receptors are located throughout the body, including the brain, heart, skin, and a variety of other organs. But it's not as simple as just getting out and talking a walk. Season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation exposure and vitamin D synthesis. Sales of ultraviolet ray lamps have increased dramatically with people who have to stay inside doing work under them just so they can capture some Vitamin D. But for some of us with celiac disease, we can't get enough of it by being out in the sun, sitting under the lamp or eating the right diet. We have vitamin D problems mostly because our bodies can't absorb it properly.
    It's important to pay attention to what your body is telling you. When something doesn't seem quite right, it's important to then do something about it – like going to a professional who can diagnose, treat and prescribe. It could be that you, like me, keep realizing new ways that Celiac impairs our lives. Celiac is not for sissies. If you've got it, you've got to work with your body, listen to it, and take actions to honor it. By working with health professionals who know about celiac disease, keeping up with the research, being diligent and having a positive attitude, we can still live good and healthy lives.


    Based on its review of data of vitamin D needs, a committee of the Institute of Medicine concluded that persons are at risk of vitamin D deficiency at serum 25(OH)D concentrations 125 nmol/L (>50 ng/mL) are associated with potential adverse effects [1] (Table 1).
    Table 1: Serum 25-Hydroxyvitamin D [25(OH)D] Concentrations and Health* [1]
    nmol/L**
    ng/mL*
    Health status
    <30
    <12
    Associated with vitamin D deficiency, leading to rickets
    in infants and children and osteomalacia in adults
    30 to <50
    12 to <20
    Generally considered inadequate for bone and overall health
    in healthy individuals
    ≥50
    ≥20
    Generally considered adequate for bone and overall health
    in healthy individuals
    >125
    >50
    Emerging evidence links potential adverse effects to such
    high levels, particularly >150 nmol/L (>60 ng/mL)
    * Serum concentrations of 25(OH)D are reported in both nanomoles
    per liter (nmol/L) and nanograms per milliliter (ng/mL).
    ** 1 nmol/L = 0.4 ng/mL
    Reference Intakes
    Intake reference values for vitamin D and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of The National Academies (formerly National Academy of Sciences) [1]. DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These values, which vary by age and gender, include:
    30. Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy people.
    31. Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.
    32. Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects.
    The FNB established an RDA for vitamin D representing a daily intake that is sufficient to maintain bone health and normal calcium metabolism in healthy people. RDAs for vitamin D are listed in both International Units (IUs) and micrograms (mcg); the biological activity of 40 IU is equal to 1 mcg (Table 2). Even though sunlight may be a major source of vitamin D for some, the vitamin D RDAs are set on the basis of minimal sun exposure.
    Table 2: Recommended Dietary Allowances (RDAs) for Vitamin D
    Age
    Male
    Female
    Pregnancy
    Lactation
    0–12 months
    400 IU
    (10 mcg)
    400 IU
    (10 mcg)
        1–13 years
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
        14–18 years
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    19–50 years
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
    51–70 years
    600 IU
    (15 mcg)
    600 IU
    (15 mcg)
        >70 years
    800 IU
    (20 mcg)
    800 IU
    (20 mcg)
       
     
    References:
    Gluten Free Society. Celiac disease linked to gall bladder and liver problems. https://www.glutenfreesociety.org/celiac-disease-linked-to-gall-bladder-and-liver-problems/ Holick MF. Vitamin D and Health: Evolution, Biologic Functions, and Recommended Dietary Intakes of Vitamin D. In Vitamin D: Physiology, Molecular Biology and Clinical Applications by Holick MF. Humana Press 2010. Middleton, Bert. Gout and Celiac Disease: What is the connection? http://www.selfgrowth.com/articles/gout-and-celiac-disease-what-is-the-connection National Institutes of Health. Office of Dietary Supplements. Vitamin D. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Reasoner, Jordan. Why everyone with celiac disease desperately needs vitamin D. http://scdlifestyle.com/2012/07/why-everyone-with-celiac-disease-needs-vitamin-d/ Rottman, Leon. Vitamin D revisited. http://www.csaceliacs.org/vitamin_d.jsp Tavakkoli, A. Analysis of Vitamin D Levels in Patients with Celiac Disease and Co-Existing Autoimmune Disorders. http://www.biomath.info/Protocols/PGY2/docs/AnnaTavakkoli.pdf Tavakkoli A, Digiacomo D, Green PH, Lebwohl B. Vitamin D Status and Concomitant Autoimmunity in Celiac Disease. J Clin Gastroenterol. 2013; Jan 16. Vitamin D Council. Am I deficient in Vitamin D? https://www.vitamindcouncil.org/about-vitamin-d/am-i-deficient-in-vitamin-d/ Watson, Lisa. Nutrient Deficiencies in Celiac Disease. http://drlisawatson.com/nutrient-deficiencies-celiac

    Betty Wedman-St Louis, PhD, RD
    Vitamin K2 for Healthy Bones and Arteries
    Celiac.com 10/18/2016 - Vitamin K was discovered in 1929 and named for the German word koagulation with Herrick Dam and Edward A. Doisy receiving the Nobel Prize for their research in 1943. But Vitamin K is a multi-functional nutrient.
    Vitamin K1 or phyloquinone is found in green leafy vegetables like spinach and used by the liver for blood coagulation within 10 hours.
    Vitamin K2 or menaquinone (referred to as MK-4 through MK-10) comes from natto (fermented soybeans), organ meats, egg yolks, and raw milk cheeses. It circulates throughout the body over a 24 hour period and is synthesized in the human gut by microbiota according to the Annual Review of Nutrition 2009. Aging and antibiotic use weakens the body's ability to produce K2 so supplementation needs to be considered.
    The Rotterdam Study in the Journal of Nutrition 2004 brought into focus the role of K2 as an inhibitor of calcification in the arteries and the major contributor to bone rebuilding osteocalcin- NOT calcium supplementation that many health professionals had recommend. The study reports K2 resulted in 50 percent reduction in arterial calcification, 50 percent reduction in cardiovascular deaths, and 25 percent reduction in all cause mortality. K1 had no effect on cardiovascular health.
    Dennis Goodman, M.D. in Vitamin K2- The Missing Nutrient for Heart and Bone Disease describes why most western diets are deficient in K2. Dietary awareness of Vitamin K has focused on anti-clotting since warfarin was approved as a medicine (in 1948 it was launched by the Germans as rat poisoning) and President Eisenhower was administered warfarin following his heart attack. Little attention was paid to any other nutritional importance this essential fat-soluble vitamin could provide.
    Menaquinones (K2 or MK) are rapidly depleted without dietary intake of natto or animal sources needed for repletion which results in bone health issues, especially in menopause. Without it, the body does not use calcium and Vitamin D3 to activate osteoblasts to rebuild bone. Menaquinones cause cells to produce a protein called osteocalcin which incorporates the calcium into the bone. Without it, calcium moves into the artery wall and soft tissues of the body leading to hardening of the arteries and osteoporosis.
    The benefit of K2 is not new research. In 1997 Shearer presented the roles of vitamins D and K in bone health and osteoporosis prevention in the Proceedings of Nutrition Society. The Osteoporosis International meeting in New Zealand 2013 re-emphasized this nutrient's importance proclaiming the best treatment for osteoporosis is achieving a strong peak bone mass before 30 years old and increasing Vitamin K2 food sources in the diet throughout life.
    The richest food source of K2 is the Japanese fermented soybean natto, which is produced with Bacillus natto, a bacterium that converts K1 to MK-7. Fermented cheeses like Swiss and Jarlsberg contain Mk-8 and Mk-9 which can be converted to K2 at a 20 to 40 percent lower rate than from natto, but more appealing to the western taste buds. Grass-fed beef and egg yolks are the most common source of K2 in the American diet.
    For those who have not acquired a taste for fermented soybeans or natto, my nutrition mentor, Adelle Davis, had it right when she recommended eating liver once a week. Celiacs need to be sure that their diets include ample red meats, eggs and fermented cheeses or yogurt or else dietary supplementation with Vitamin K2 (MK-4) is recommended. Without it, bones can become soft tissues and arteries "turn to stone" or calcified.
    A Chart of Vitamin K levels in Foods can provide insight into food choices for menaquinone compared to Vitamin K1. It was adapted from Schurgers et al. Nutritional intake of vitamins K1 (phylloquinone) and K2 (menaquinone) in the Netherlands. J Nutr. Environ. Med. 1999.
     
    Food K1 MK-4 MK-7,8,9 Meats 0.5-5 1-30 0.1-2 Fish 0.1-1 0.1-2   Green Vegetables 100-750     Natto 20-40   900-1200 Cheese 0.5-10 0.5-10 40-80 Eggs (yolk) 0.5-2.5 10-25    
    The American Heart Association and many medical professionals who advocated no organ meats or red meat and egg yolks, deprived Americans of primary sources of Vitamin K2 which is essential for bone and cardiovascular health.

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