Unexplained bruising + more

[Jeffguy77]

About 4 months ago I developed what I perceived to be swelling in my upper right abdomen. I had originally thought that I had liver damage. Days later I developed a bruise in the same area. I had blood work done, ultrasound, CT scan, endoscopy, and colonoscopy. Everything looked completely fine aside from my blood work showed that I tested positive for Celiac Disease. The biopsy confirmed this. I honestly don't experience hardly any gastro symptoms at all. No constipation, hardly any nausea. The symptoms that I've been having are unexplained/easy bruising (many times I feel the bruise has appeared and I never hurt that area, cold hands/feet occasionally, slight numbness in hands, and twitching. My bloodwork has shown that all my levels are "normal" for the various vitamins that we're tested but I really don't have a true baseline blood test for when I was healthy, so I'm not sure if my body's levels should be higher. Has anyone else experienced these symptoms (especially the bruises and twitching)??? My celiac disease diagnosis just happened last week so I am only now beginning a Gluten-Free diet. 

[cristiana]

Hello and welcome to the forum Jeffguy

I believe low vitamin K and anemia can both cause someone to bruise easily.  When you say all your blood tests have been normal, are you well within the normal range for vitamin K, B12 and iron, or just on the cusp of what is within range?  It could be that once your levels increase a bit you will find these symptoms pass.

Twitching was a big thing for me - my eyes, my cheeks, and calf muscles.   I think this was in part low iron, but also low magnesium.  I still get the twitches sometimes and usually magnesium sorts them out.  Also, gluten in my system causes twitching, I tend to get it a few days after a glutening episode.

Vitamin C supplements could also help with bruising.

Cristiana

[trents]

JeffGuy77, what is your age? Is your platelet count within normal range? Do you take blood thinner meds or frequently use NSAID products like aspirin or Advil? Are you taking supplements like fish oil or vitamin E that tend to make platelets more slippery?

Sounds like you have some neurologic damage from years of undiagnosed/untreated celiac disease. By the way, it is very common to not have GI issues with celiac disease. We call that "silent celiac disease". It usually takes much longer for silent celiacs to get diagnosed because they don't have classic GI symptoms.

What vitamins were tested? Can you be more specific? Would you feel comfortable in posting your lab work for us to look at so we can see what has been done and what has not in the way of blood work?

[Jeffguy77]

5 hours ago, trents said:

JeffGuy77, what is your age? Is your platelet count within normal range? Do you take blood thinner meds or frequently use NSAID products like aspirin or Advil? Are you taking supplements like fish oil or vitamin E that tend to make platelets more slippery?

Sounds like you have some neurologic damage from years of undiagnosed/untreated celiac disease. By the way, it is very common to not have GI issues with celiac disease. We call that "silent celiac disease". It usually takes much longer for silent celiacs to get diagnosed because they don't have classic GI symptoms.

What vitamins were tested? Can you be more specific? Would you feel comfortable in posting your lab work for us to look at so we can see what has been done and what has not in the way of blood work?

I can't quite figure out a way to attach my blood test results so here is a link to a google doc I made. Any insight might help. I was thinking that my vitamin B12 levels are on the low side and I might give magnesium a go. 

Here's the link to my blood work. https://docs.google.com/document/d/1RKmzG-Nx4X2zJScUeQmNcWd9boCXNf0hlHSPgLB2qqw/edit?usp=sharing

[trents]

27 minutes ago, Jeffguy77 said:

I can't quite figure out a way to attach my blood test results so here is a link to a google doc I made. Any insight might help. I was thinking that my vitamin B12 levels are on the low side and I might give magnesium a go. 

Here's the link to my blood work. https://docs.google.com/document/d/1RKmzG-Nx4X2zJScUeQmNcWd9boCXNf0hlHSPgLB2qqw/edit?usp=sharing

What's interesting in your celiac antibody results is that the tTG-IGA is negative but the Endomysial Antibody IGA (aka, "EMA" is positive. Those two antibody tests are generally thought to be similar in what they are measuring with the EMA being the most specific for celiac disease test available. But it is also less sensitive. Kudos for your physician for running more than just the tTG-IGA as most will not. Your high A/G ratio might suggest you increase your fluid intake: https://www.healthline.com/health/a-g-ratio-high#high-a-g-ratio

You only have a small time window to edit posts so if you are going to attach something, have it ready. Look under the three dots in the upper right corner of a new post window or used the paperclip in the lower left corner of a new post window.

Can you post the vitamin tests that were run?

Edited June 29, 2023 by trents

[Jeffguy77]

10 minutes ago, trents said:

What's interesting in your celiac antibody results is that the tTG-IGA is negative but the Endomysial Antibody IGA (aka, "EMA" is positive. Those two antibody tests are generally thought to be similar in what they are measuring with the EMA being the most specific for celiac disease test available. But it is also less sensitive. Kudos for your physician for running more than just the tTG-IGA as most will not. Your high A/G ratio might suggest you increase your fluid intake: https://www.healthline.com/health/a-g-ratio-high#high-a-g-ratio

You only have a small time window to edit posts so if you are going to attach something, have it ready. Look under the three dots in the upper right corner of a new post window or used the paperclip in the lower left corner of a new post window.

Can you post the vitamin tests that were run?

I'll definitely work on taking in more fluids. The vitamin tests and more should all be there on the 2nd and 3rd page. At least they should. Will the document allow you to scroll down? I'll try to update.

[trents]

Yes, sorry. I didn't even try to scroll down earlier. It's there. The only vitamin test I see there is B12. RBC is high and that can also point to dehydration:

"If the liquid part of the blood, known as plasma, gets too low, the red blood cell count seems to go up. This happens in dehydration. However, the red blood cells are simply more tightly packed. The number of red blood cells stays the same." https://www.mayoclinic.org/symptoms/high-red-blood-cell-count/basics/causes/sym-20050858

Medical professionals recommend drinking 64 oz. of free fluid daily. That doesn't include water content in solid food. It can be a challenge. High alcoholic and caffeinated beverages have a diuretic effect so look at that if it applies. If you perspire a lot due to strenuous exercise or live in a hot climate you may need more fluid.

I don't know how old you are but all in all, you CBC and CMP look pretty good.

Edited June 29, 2023 by trents

[Jeffguy77]

3 minutes ago, trents said:

Yes, sorry. I didn't even try to scroll down earlier. It's there. The only vitamin test I see there is B12. RBC is high and that can also point to dehydration:

"If the liquid part of the blood, known as plasma, gets too low, the red blood cell count seems to go up. This happens in dehydration. However, the red blood cells are simply more tightly packed. The number of red blood cells stays the same." https://www.mayoclinic.org/symptoms/high-red-blood-cell-count/basics/causes/sym-20050858

Medical professionals recommend drinking 64 oz. of free fluid daily. That doesn't include water content in solid food. It can be a challenge. High alcoholic and caffeinated beverages have a diuretic effect so look at that if it applies. If you perspire a lot due to strenuous exercise or live in a hot climate you may need more fluid.

I don't know how old you are but all in all, you CBC and CMP look pretty good.

I'm 35 years old. Do you recommend that I go back to my primary care doctor and ask for a vitamin or a minerals blood panel? How should I go about getting tested for everything? I normally feel good during the day until about 5pm and then I'm absolutely exhausted. I really do feel like there is some type of deficiency holding me back.

[trents]

We commonly recommend the shotgun solution to supplements for those newly diagnosed with celiac disease. First of all, let me say that I would be surprised if your physician would be willing to order a comprehensive vitamin and mineral panel to check for deficiencies. Conventional medicine does not give much attention to those kind of things unless there is an obvious connection between some health problem and a vitamin or mineral deficiency. We're talking about things like rickets or beriberi that are needed to get their attention with regard to vitamin and mineral deficiencies. They would much rather treat the symptom with a prescription medication than they would the cause by adjusting diet or taking supplements. Second, the RMDA for vitamins and minerals and the blood levels of these things they test for may be enough to prevent obvious disease but may not be optimal. Third, celiac disease which has been undiagnosed and untreated (with a gluten free diet) for some years, invariably results in vitamin and mineral deficiencies. celiac disease blunts the villi that line the small bowel. This is the area of our intestinal tract where all of our vitamins and minerals are absorbed. This blunting or wearing down by the inflammation of gluten ingestion in celiac disease can greatly reduce the surface area of absorption. Third, there is no reason not to take supplements as long as you take them in safe amounts. It might interest you to know that high doeses of B vitamins are not toxic because they are water soluble and the excess is peed out. Really, the only vitamin we need to be careful with as far as dosage is D3. But even with that one, safe levels are much higher than was thought some years ago.

So, back to the shotgun approach. We commonly recommend and adult multivitamin, sub lingual B12, a high potency B-complex, 5000 to 10,000 IU of D3 daily, magnesium glycinate or magnesium citrate (two of the more assimilable forms (as opposed to magnesium oxide) and zinc. Make sure all vitamins and supplements are gluten-free as wheat starch can be used as a filler in pills. Costco's Kirkland Signature and Nature Made products are a good choice. If they are gluten free (and most of them are) it will say so on the bottle. The magnesium citrate or glycinate you may need to get off of Amazon or at a health food store. Go easy on the magnesium as it can cause loose stools. Titrate up until you find that point and back off a little. I take a 100 mg of mag glycinate in the morning and 100 mg in the evening.

Edited June 29, 2023 by trents

[cristiana]

Hi again,

I remember reading on this forum some years ago that in Japan anything under 500 for B12 is considered too low.  I haven't got the time to find the post, but you may be more successful. 

Anyway, if this is right, I would say increasing your B12 is worth a try.  I can't remember my readings on diagnosis but they were considered low normal by the NHS and I was never advised to supplement by my GP.  However, my private nutritionist took one look at the figures and said "I'm surprised they didn't give you a B12 injection".   

I take Solgar's sublinguals.

Cristiana

[Jeffguy77]

16 hours ago, trents said:

We commonly recommend the shotgun solution to supplements for those newly diagnosed with celiac disease. First of all, let me say that I would be surprised if your physician would be willing to order a comprehensive vitamin and mineral panel to check for deficiencies. Conventional medicine does not give much attention to those kind of things unless there is an obvious connection between some health problem and a vitamin or mineral deficiency. We're talking about things like rickets or beriberi that are needed to get their attention with regard to vitamin and mineral deficiencies. They would much rather treat the symptom with a prescription medication than they would the cause by adjusting diet or taking supplements. Second, the RMDA for vitamins and minerals and the blood levels of these things they test for may be enough to prevent obvious disease but may not be optimal. Third, celiac disease which has been undiagnosed and untreated (with a gluten free diet) for some years, invariably results in vitamin and mineral deficiencies. celiac disease blunts the villi that line the small bowel. This is the area of our intestinal tract where all of our vitamins and minerals are absorbed. This blunting or wearing down by the inflammation of gluten ingestion in celiac disease can greatly reduce the surface area of absorption. Third, there is no reason not to take supplements as long as you take them in safe amounts. It might interest you to know that high doeses of B vitamins are not toxic because they are water soluble and the excess is peed out. Really, the only vitamin we need to be careful with as far as dosage is D3. But even with that one, safe levels are much higher than was thought some years ago.

So, back to the shotgun approach. We commonly recommend and adult multivitamin, sub lingual B12, a high potency B-complex, 5000 to 10,000 IU of D3 daily, magnesium glycinate or magnesium citrate (two of the more assimilable forms (as opposed to magnesium oxide) and zinc. Make sure all vitamins and supplements are gluten-free as wheat starch can be used as a filler in pills. Costco's Kirkland Signature and Nature Made products are a good choice. If they are gluten free (and most of them are) it will say so on the bottle. The magnesium citrate or glycinate you may need to get off of Amazon or at a health food store. Go easy on the magnesium as it can cause loose stools. Titrate up until you find that point and back off a little. I take a 100 mg of mag glycinate in the morning and 100 mg in the evening.

I do take a multi-vitamin and that does contain a lot of the vitamins you are describing. Are you saying, continue to take the vitamin BUT on top of that take for example 5,000 to 10,000 IU more of D3? Thank you for your response. I plan to make a run to the store today.

12 hours ago, cristiana said:

Hi again,

I remember reading on this forum some years ago that in Japan anything under 500 for B12 is considered too low.  I haven't got the time to find the post, but you may be more successful. 

Anyway, if this is right, I would say increasing your B12 is worth a try.  I can't remember my readings on diagnosis but they were considered low normal by the NHS and I was never advised to supplement by my GP.  However, my private nutritionist took one look at the figures and said "I'm surprised they didn't give you a B12 injection".   

I take Solgar's sublinguals.

Cristiana

Thank you. I found the article and it looks like not only Japan but most of Europe consider under 500 to be low in B 12.

[cristiana]

Glad you found it.  Interesting about Europe.  My private nutritionist would have been aware of that information, by the sounds of it.

[trents]

28 minutes ago, Jeffguy77 said:

I do take a multi-vitamin and that does contain a lot of the vitamins you are describing. Are you saying, continue to take the vitamin BUT on top of that take for example 5,000 to 10,000 IU more of D3? Thank you for your response. I plan to make a run to the store today.

Thank you. I found the article and it looks like not only Japan but most of Europe consider under 500 to be low in B 12.

Continue to take the multivitamin you are currently using as long as it is gluten free. I'm saying add to that a high potency B-complex, D3 (5k IU should do it), mag citrate or mag glycinate and zinc. Even though the multivitamin you currently take has most of these already, the amount is insufficient to jump start healing and recovery.

[Jeffguy77]

40 minutes ago, trents said:

Continue to take the multivitamin you are currently using as long as it is gluten free. I'm saying add to that a high potency B-complex, D3 (5k IU should do it), mag citrate or mag glycinate and zinc. Even though the multivitamin you currently take has most of these already, the amount is insufficient to jump start healing and recovery.

What number would be considered high potency for B12 and also the B complex? I just looked at 3,000 mcg B 12 but the B complex doesn’t seem to have a number. 

[trents]

 

40 minutes ago, Jeffguy77 said:

What number would be considered high potency for B12 and also the B complex? I just looked at 3,000 mcg B 12 but the B complex doesn’t seem to have a number. 

3000 mcg of sublingual b12 should be plenty.

Where are you shopping? What is the brand of the B-complex? It is odd that it does not give amounts/percentages of RMDA on the packaging. If it doesn't, I'd look elsewhere. Like I said, Costco is a good place to look.

Edited June 29, 2023 by trents

[trents]

For comparison sake, here is what my Kirkland Super B-Complex shows on the back of the bottle:

Vitamin C 200 mg - 222%

Thiamin 100 mg - 8,333%

Riboflavin 20 mg - 1,538%

Niacin 25 mg -158%

B6 3 mg - 176%

Folate 666 mcg DFE (400 mcg folic acid) - 167%

B112 100 mcg - 4,167%

Biotin 300 mcg -1,000%

Pantothenic Acid 5.5 mg 110%