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    • knitty kitty
      Remember that damage to the small intestine can be microscopic and patchy. Deficiency in Thiamine can result in Gastrointestinal Beriberi.  The symptoms are the same as a glutening!    Clinical profile of patients presenting with thiamine-responsive upper-gastrointestinal upset: A pointer toward gastric beriberi https://pubmed.ncbi.nlm.nih.gov/35810577/ Thiamine, gastrointestinal beriberi and acetylcholine signaling https://pmc.ncbi.nlm.nih.gov/articles/PMC12014454/ Dental problems can result in vitamin and mineral deficiencies due to Malabsorption in Celiac Disease. The Role of Vitamin B Complex in Periodontal Disease: A Systematic Review Examining Supplementation Outcomes, Age Differences in Children and Adults, and Aesthetic Changes https://pubmed.ncbi.nlm.nih.gov/40218924/
    • trents
      Of course, I thought about the OP not being consistent with the gluten-free diet and about cross reactivity. But you would think those things would show some damage in the biopsy, especially as severe as the symptoms seem to be. SIBO? Perhaps. But then we are probably leaving a celiac diagnosis and that is the question.
    • knitty kitty
      Processed meats and formed meats, like sausage, sandwich meats, chicken nuggets, contain "meat glue" to hold their shape.   This "meat glue" is produced by bacteria and called microbial transglutaminase.  It's the same structually as tissue transglutaminase that our bodies produce in response to gluten.  Microbial transglutaminase provokes the same autoimmune reaction in our bodies as if we had eaten gluten.   Microbial transglutaminase is also used in dairy products like yogurt.   Bacon is high in histamine.  Eating high histamine foods can cause continuing gastrointestinal symptoms.  A low histamine diet helps. Processed gluten free processed foods are not enriched with vitamins and minerals like gluten containing products are.   Deficiencies in Thiamine B1, Niacin B3, and  Vitamin C can also result in gastrointestinal symptoms.   Blood tests for B vitamins are not accurate because they don't measure the amount of a vitamin stored inside cells.  The blood is a transportation system delivering vitamins from the digestive tract around the body.  What's on a truck doesn't tell you that the warehouse is almost empty.   Supplementing with B vitamins is important! Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet https://pubmed.ncbi.nlm.nih.gov/19154566/
    • knitty kitty
      How clean is her gluten free diet?  Is dairy included? Does she eat out?  SIBO?  Thiamine deficiency presenting as Gastrointestinal Beriberi?
    • knitty kitty
      There's more essential vitamins than B12 and Vitamin D!   Thiamine is B1.  Thiamine deficiency causes insomnia. Thiamine deficiency causes changes in brain function resulting in anxiety, insomnia, depression and dementia.  The brain uses more thiamine when stressed emotionally or physically.   Interesting Reading: Subclinical Thiamine deficiency causes anxiety, insomnia and depression... https://www.psychiatryredefined.org/running-on-empty-subclinical-thiamine-deficiency-is-common-and-causes-depression/#:~:text=Early signs of low thiamine,low appetite%2C and sleep disruption. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet https://pubmed.ncbi.nlm.nih.gov/19154566/ Sleep and indolamine alterations induced by thiamine deficiency https://pubmed.ncbi.nlm.nih.gov/6182942/ Thiamine deficiency-induced disruptions in the diurnal rhythm and regulation of body temperature in the rat https://pubmed.ncbi.nlm.nih.gov/9804367/
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