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  • Betty Wedman-St Louis, PhD, RD
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    Vitamin B12 and Celiac Disease

      Journal of Gluten Sensitivity Winter 2016 Issue - Originally published January 5, 2016

    Caption: Photo: CC--francois schnell

    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.

    Vitamin B12 is important in DNA synthesis, red blood cell formation, homocysteine metabolism and the production of S-adenosylmethionine (SAMe). Adequate B12 is essential for proper neurological and immune function.

    The importance of Vitamin B12 in health and anemia management began during the Depression era when animal protein foods were limited in the American diet. Three physicians who reversed pernicious anemia in dogs were awarded the 1934 Nobel Prize for medicine. Dr. George Hoyt Whipple and two other physicians fed the dogs and humans 1/2 pound of fresh liver per day as a means to control anemia.

    Animal proteins—meat, poultry, fish, eggs—are the sources of Vitamin B12 for humans. Plants do not need or produce B12. How B12 gets into your blood is a complex dance of stomach acids and intrinsic factors that starts with pepsin in the stomach splitting off the B12 from the protein compound. The intrinsic factor made by the parietal cells of the stomach attaches to the B12 to be shuttled to the ileum where receptors pull it into the blood.

    Once in the blood, B12 is picked up by transcobalamin to be carried to cells throughout the body. Any excess is stored in the liver or excreted in the urine.

    If inadequate intrinsic factor is available—loss from aging or proton pump inhibitor use—B12 deficiency symptoms such as macrocytic anemia, neurological disorders and psychiatric symptoms (memory loss, depression, confusion, paranoia) may occur. Severe B12 deficiency can result in intestinal damage, hyper-pigmentation of the skin, hypotension, and immune dysfunction.

    The Institute of Medicine indicates that only 2 to 4 mcg Vitamin B12 is needed daily. The average American diet contains 5-15 mcg per day according to NHANES studies. Vegetarians and infants breastfed by vegan mothers are at greatest risk of developing B12 deficiency.

    Other factors increase the risk of developing Vitamin B12 insufficiency. Achlorydria secondary to gastritic, gastric bypass surgery, and ileal resection for Crohn’s disease need assessment due to malabsorption. Apathy abounds throughout the medical community despite the 2009 Centers for Disease Control and Prevention statistics indicating 1 out of every 31 people over 50 being B12 deficient. With increasing numbers of gastric bypass patients and Crohn’s resections, this deficiency could be significantly higher.

    Adverse symptoms can first be noted with the CBC test indicating large RBC or macrocytosis—a folate and B12 deficiency. Other symptoms may include balance problems, numb hands and feet, leg pains, early onset dementia, pre-Parkinson’s-like disease, infertility and depression.

    Many physicians are poorly educated on Vitamin B12 importance since it is a vitamin and easy to treat. Treatment with methylcobalamin injections with few definitive ways to test efficacy seems to be a primary factor. A complete medical history assessing for gut inflammation, celiac disease, GERD, recent nitric oxide use in surgery, and genetic factors like MTHFR should trigger a closer look at B12 adequacy even with a normal homocysteine (HCY) plasma test. High levels of B12 on standard blood analysis usually indicates poor absorption and not intoxification of Vitamin B12. Elevated B12 results >800pg/ml frequently indicate PPI use or low stomach acid malabsorption. Lab results <350pg/ml may still be inadequate for a patient with celiac disease, gluten enteropathy or gastric bypass surgery, so supplementation should be considered.

    Medications matter when considering Vitamin B12 status. Below are common drugs that impair absorption:

    • Antacids- maalox, MOM, Mylanta, Tums
    • Histamine blockers- Zantac, Tagamet, Axid, Pepcid
    • Proton Pump Inhibitors- Prevacid, Prilosec, Nexium,. Omeprazole, Acidhex
    • Colchicine
    • Questran
    • Metformin, Glucophage
    • Celexa, Effexor, Elavil, Nardil, Paxil, Prozac, Zoloft, Wellbutrin
    • Ativan, Librium, Valium, Xanax
    • Viagra, Cialis, Levitra
    • Compazine, Haldol, Risperdal, Tegretal

    Vitamin B12 supplementation is probably the safest medical treatment available. Many people need B12 injections to show improvement in their symptoms. Effectiveness of injections depends more on frequency of administration than on amount given with each injection. Those who improve with injections rarely improve with oral or sublingual products no matter how large the dose because the routes of administration are not capable of achieving high enough absorption levels.

    Treatment with Vitamin B12 needs to be continued for life. Until more research on efficacy and safety of oral B12 is available, intramuscular daily or weekly injections should be considered a standard of care, especially in celiac disease and those with gastric bypass surgery.

    A 20 page handout on Digestive Wellness is available for $15 from Dr. Betty Wedman-St Louis, 17920 Gulf Blvd, Ste 606, St. Petersburg, FL 33708. It includes information on how GMO foods destroy health which will be covered in a future article.


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    The dogs in the experiment didn't have Pernicious Anemia. After World War I, doctors were interested in finding a way to more quickly reverse anemia (mainly the type caused by battle wounds), so they bled dogs and fed them different foods to see what worked the best. It turned out that liver worked the best. Liver happens to be high in iron, which the dogs were deficient in. Liver also happens to be high in B12, which Pernicious Anemia patients are deficient in and which is a vitamin that wouldn't be discovered for several more years. Pernicious Anemia was not well understood at the time. It was basically just lucky that liver helped correct both types of anemia.

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    The article stated that many physicians are poorly educated about B12. I found this to be sadly true. My terminal ileum had to be resected a year before I was diagnosed with celiac disease. That is where B12 is absorbed. I was advised that I would need regular injections. Ever since then 26 years ago, I've gotten injections. I have had to beg my family physician to test my blood levels regularly. At one point, when my level was in the normal range (about 200-1200) my physician told me I didn't need the injections anymore and wouldn't prescribe it. About 8 months later I was called on the carpet at school for a huge mistake I made teaching math. I had other symptoms that were neurological. When I saw my neurologist he asked what my B12 levels were. They were 200. "Normal" Long story short on his advice I keep my levels close to 1000 by getting an injection every 3 weeks. Every six months I have a blood test. If you have to fight for it, ask the doctor to put pernicious anemia down as the reason, or the test most likely will not get covered.

     

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    I have celiac disease and am not taking any of the medicines that would impair absorption. My B12 was just tested at >1500. I did not take my sublingual B12 supplement the day of the blood draw. I found this article very interesting but leaving me wondering what my test results mean.

    The article says, "High levels of B12 on standard blood analysis usually indicates poor absorption and not intoxification of Vitamin B12". Does this mean I need injections of B12? Further testing?

    Further clarification would be most welcome. Thank you for a well written and timely article.

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    I know that I suffer from B12 deficiency from time to time, and can often be alerted by mood changes. I take 8 1,000 mg sublingual methylcobalamin tabs and usually feel a positive effect within half an hour. I find I do not necessarily need it every day. I take medications and have 2-3 medical conditions which would lead to B12 loss, so am encouraged that I do not seem to have to stick a needle in myself. I did learn about the use of B12 from a severe Crohn's survivor.

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    I give this a 4 star, because I need more information. My B12 numbers are ridiculously high, am I understanding that the B12 is not absorbing? What should I do then? The doc was concerned I was getting too much. This may not be so according to this article. Why does the doc think I am getting too much? Shouldn't she know if I am getting too much or not absorbing? She told me to stop taking it. I am so confused. How do I talk to a doctor and have this investigated further?

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    I was diagnosed with B12 deficiency 15 years ago, I went from getting shots once a month to having to do them once a week. I was diagnosed with Celiac 3 years ago and always wondered if they were related somehow. Thanks for the arrival.

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  • About Me

    Betty Wedman-St Louis, PhD, RD is Assistant Professor, NY Chiropractic College, MS Clinical Nutrition Program Nutrition Assessment Course & Food Science Course.  She is author of the following books:

    • Fast and Simple Diabetes Menus, McGraw Hill Companies
    • Diabetes Meals on the Run, Contemporary Books
    • Living With Food Allergies, Contemporary Books
    • Diabetic Desserts, Contemporary Books
    • Quick & Easy Diabetes Menus Cookbook, Contemporary Books
    • American Diabetes Association Holiday Cookbook and Parties & Special Celebrations Cookbook, Prentice Hall Books

     

  • Related Articles

    Betty Wedman-St Louis, PhD, RD
    Celiac.com 07/18/2016 - Dietary phosphorus occurs naturally in dairy foods, animal meats, and legumes but according to the Institute of Medicine, high levels of phosphorus can be a contributor to cardiovascular, kidney and osteoporosis disorders.
    While phosphorus is considered an essential nutrient, the increased amounts found in processed foods via additives like anti-caking agents, stabilizers and leavening agents or acidifiers does not have to be stated on the nutrition label. Individuals following a gluten-free diet need to consider the health implications of phosphates found in processed foods eaten regularly in their diet. Reducing carbonated beverages is the best way to reduce phosphorus levels in the diet. Extra attention needs to be paid to the ingredient statement on foods.
    Ingredient statements may include these declarations: tri-calcium phosphate, tri-magnesium phosphate, disodium phosphate, di-potassium phosphate. Just because the label states "natural" or "organic" does not mean it is a healthy food for daily consumption. Fresh is best!
    Here is a guide to where phosphates can be found in gluten-free processed foods:
    Baked goods- cake mixes, donuts, refrigerated dough (pyrophosphates are used for leavening and as a dough "improver") Beverages- phosphoric acid in colas (acidulant), pyrophosphate in chocolate milk to suspend cocoa, pyrophosphate in buttermilk for protein dispersion, tri-calcium phosphate in orange juice for fortification, tetra-sodium phosphate in strawberry flavored milk to bind iron to pink color Cereals- phosphate in dry cereals to aid flow through extruder, fortification of vitamins Cheese- phosphoric acid in cottage cheese to set acidification, phosphate in dips, sauces, cheese slices and baked chips for emulsifying action and surface agent Imitation Dairy Products (non-dairy products)- phosphate as buffer for smooth mixing into coffee and as anti-caking agent for dry powders Egg Products- phosphate for stability and color + foam improvement Ice Cream- pyrophosphate to prevent gritty texture Meat Products- tri-phosphate for injections into ham, corned beef, sausage, franks, bologna, roast beef for moisture Nutrition Bars & Meal Replacement Drinks- phosphates for fortification and microbiological stability Potatoes- phosphate in baked potato chips to create bubbles on the surface, pyrophosphate in French fries, hash browns, potato flakes to inhibit iron induced blackening Poultry- tri-phosphate for moisture and removal of salmonella and campylobacter pathogens Pudding & Cheesecakes- phosphate to develop thickened texture Seafood- tri-phosphate in shrimp for mechanical peeling, pyrophosphate in canned tuna and crab to stabilize color and crystals, surimi (crab/sea sticks) tri-phosphate and pyrophosphate as cryoprotectant to protein {surimi contains gluten and is not recommended for gluten-free diets] Hyperphosphate levels can contribute to muscle aches, calcification of coronary arteries and skeletal issues. Many food companies do not provide phosphorus analysis information because it is not required on the label but here is a representative sample of phosphorus levels in some commonly consumed on a gluten-free diet.
    Peanuts (1 ounce) 150 mg
    Yogurt (1 cup) 300 mg
    M&M Peanuts (1.74 oz pkg) 93 mg
    Rice Krispies Cereal (1 cup) 200 mg
    Dietary recommendations for an adult for Phosphorus is 800 to 1000 mg.

    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.
    Vitamin D is unique. Evidently Vitamin D isn't really a vitamin at all – it is a secosteroid, a hormonal precursor that is similar to other steroids that the body makes, such as cholesterol, testosterone or cortisol. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol. Vitamin D promotes calcium absorption and is necessary for variety of health processes, including the creation of strong bones, modulation of cell growth, neuromuscular and immune functions, and the reduction of inflammation. Vitamin D is located in the nuclei through a receptor. It impacts the creation of proteins that then transport calcium or phosphorous, which bones and other body functions require for healthy development. Vitamin D stimulates how the intestine absorbs calcium and mobilizes phosphate levels. Without vitamin D, our bodies and our lives are in trouble.
    I'm not a nutritionist – I'm a film maker. But from what I have learned, low vitamin D levels in one's body is associated with how well the body can absorb calcium. I had no idea that I was deficient in vitamin. Some people may not experience any symptoms of it at all. Symptoms of vitamin D deficiency are sometimes vague. They can include tiredness and general weakness, aches and pains, which may result in people feeling like they can't move around as well as they wish. Some folks experience frequent infections. There is no way to know if you have a vitamin D deficiency or not unless you get a blood test. Doctors measure if you're deficient in vitamin D by testing your 25(OH)D level. Getting a blood test is the only accurate way to know if you're deficient or not.
    Vitamin D deficiency is thought to be related to having a "leaky gut." Research indicates that vitamin D can be helpful to maintaining tight junctions in the small intestine that regulate what gets in and what stays out. Dr. Tom O'Bryan describes this to be similar to a rubber band wrapped around the junctions; if it gets too stretched out it may lose its elasticity and ability to snap back in place. People who are deficient in vitamin D tend to have rubber bands that aren't operating normally and allow foreign material to leak into the body, which can promote inflammation. Vitamin D seems to modulate the immune system and regulate the inflammation to keep it in check. In particular, it has been found to inhibit the development of a variety of other autoimmune diseases.
    If you've got a vitamin D deficiency, you better do something about it, otherwise you exacerbate the possibility of future health problems. Dr. Lisa Watson has found that low vitamin D levels decrease the amount of calcium that a body can absorb, and for those of us with very low vitamin D it is possible that only 10-15% of dietary calcium is absorbed (compared to 30-40% in healthy individuals). Other experts report that because people with Celiac disease have villous atrophy, we have malabsorption issues that may ultimately modify that way our immune systems react, which can lead to further autoimmune diseases. Lower absorption of calcium is also related to bone diseases, brittle bones, and osteoporosis - which makes me reconsider about why my ankle was so weak that I ended up having surgery on it a few years ago.
    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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    Got the result today, and it is indeed the IgG only, and it is "negative" with a result of: <10.0 Units I have sent a message to my doctor requesting that she at least also order the TTG IGA test. However, I'm assuming that this result does at least significantly lower the likelihood that I have celiac? This is all just a shot in the dark anyhow... but after 8 years of unsatisfactorily diagnosed mystery joint pain, I don't want to only half-explore an option and then abandon it without a reasonably definitive result.
    It sounds like you were not given the full celiac panel. The full celiac panel includes: TTG IGA
    TTG IGG
    DGP IGA
    DGP IGG
    EMA
    IGA You have to be eating gluten daily for 12 weeks before the blood test. A positive on any one blood test should lead to a gastroenterologist doing an endoscopy /biopsies to confirm a celiac diagnosis.    
    Yep, dang just realized I had a $10 off code in my email for the coffee you could have used. Yeah I love the coffees, some are odd. Most dessert ones require you to sweeten to bring it out, some you only taste cold. They are fun to play with and I love how they give me enjoyment when it comes to food.
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