Celiac disease symptoms

[Churro]

Last month I got blood tests done. My iron level was at 205 ug/dL and 141 ug/dL iron binding capacity unsaturated, 346 ug/dl total iron binding capacity, 59 transferrin % saturation. My ferritin level was at 13 so I got tested for celiac disease last week. My tTG-IgA is <.05, DGP IgA is 4.9 and ferritin level is 9. My doctor didn't order other celiac disease tests. In 2021 I was dealing with severe constipation and hemorrhoids. I'm no longer dealing with constipation. I still deal with hemorrhoids but only about once a week. Also, I've been dealing with very pale skin for at least 5 years. Do you think I have celiac disease? 

[trents]

Welcome to the celiac.com community, @Churro!

Several things need to be said here:

1. Your physician neglected to order a "total IGA" test to check for IGA deficiency. If a person is IGA deficient, the results of other IGA antibody tests specific to celiac disease will not be valid. A total IGA test should always be ordered when checking for celiac disease with blood IGA antibody test. You should ask your physician to order a total IGA test.

2. Iron deficiency anemia can also give distorted IGA celiac disease blood antibody tests.

3. If you were already on a gluten-free diet or had been restricting gluten consumption for weeks/months prior to the antibody testing blood draw, then the test results would not be valid. Accurate celiac disease blood antibody testing requires you to have been consuming significant amounts of gluten for a significant time period leading up to the blood draw. It takes time for the antibody levels in the blood to build up to detectable levels.

4. Your low iron levels and other symptoms could be due to celiac disease but could also be caused by lots of other medical issues.

[Churro]

Thanks for your insight. I've been eating wheat bread at least 5 times a week for several months. I've been eating chicken or eggs 5 days a week for at least a year. 

[trents]

To give you a frame of reference for pretesting gluten consumption necessary to ensure valid antibody testing, here is the current recommendation for those who have been on a gluten free diet: The daily consumption of at least 10g of gluten (about the amount in 4-6 slices of wheat bread) for at least two weeks.

Not sure why you mentioned eggs and chicken. They are not sources of gluten. Was that in reference to dietary iron consumption?

[Churro]

I do eat 4 slices of wheat bread with almond butter. Yes it was a reference to my iron consumption. 

[trents]

Get your total IGA checked to make sure your celiac antibody test scores are trustworthy. 

 

Edited January 10 by trents

[Churro]

Thanks for your assistance. 

[RMJ]

I agree with @trents, they should have run a total IgA. 

What was the normal range for the DGP IgA test?  Different labs use different units thus have different normal ranges.

[Churro]

<=14.9

[Churro]

Someone said this could be due to my hemorrhoids. On March 17, 2024 my ferritin level was 23.

[trents]

It's not uncommon to experience some bleeding with hemorrhoids but I doubt enough to materially effect your iron levels.

About your constipation. Are you getting enough fiber in your diet? 25-30 grams per day is the adult recommendation. Eggs and chicken have zero fiber. One medium apple or one average banana will have about 3 g. of fiber. A serving of oatmeal will have 3-4 g. Just to give you an idea. It's harder than you think to get 25-30 g of fiber. You have to plan for it and work at it. Getting plenty of hydration is important as well.

[Churro]

Everyday I eat a medium to large apple in the morning and a large banana at night. I eat a cup of oatmeal in the evening. The ezekiel wheat bread I eat has a good amount of fiber. I haven't dealt with constipation for at least a year. Most of the time my feces are soft. 

[trents]

Sorry, I see that now as I reread your original post. You say you have hemorrhoids "only once a week" now. When I develop hemorrhoids, which is once every few years now, it generally takes 3-4 days for healing to take place. So, it doesn't seem like you could have much relief time between episodes if you have them weekly. Have you had a lower GI scoping done recently?

[Churro]

No I haven't had one since 2021. I rarely have more than 1 per week. 

[trents]

If you have hemorrhoids 1x weekly I don't see how you have time to heal from one episode before you experience another one, unless each one is a very minor event.

Have you consulted a physician about your hemorrhoid issue? It's not normal to be having an episode every week unless it is really one episode that is not completely healing between weekly flareups.

Edited January 11 by trents

[Churro]

Thanks for your input. 

[Wheatwacked]

Non-Celiac Gluten Sensitivity (NCGS) can be associated with low ferritin and iron deficiency.

Once Celiac Disease (1% of the population affected) has been ruled out by tests the next step is to check for Non Celiac Gluten Sensitivity (10% of the population affected) by eliminating gluten for a trial period, then re-introduce Gluten Challange.

Have you been supplementing Iron? How are your liver enzymes? Low levels of ferritin indicate iron deficiency, while  59% transferrin saturation indicates high iron levels.  Possibly indicating Fatty Liver Disease.  Choline is crucial for liver health, and deficiency is a known trigger for Non-Alcoholic Fatty Liver.  Some experts say that less than 10% eat the the Food and Nutrition Board established Adequate Intake that are based on the prevention of liver damage.

Quote

 

Most people in the United States consume less than the AI for choline. An analysis of data from the 2013–2014 National Health and Nutrition Examination Survey (NHANES) found that the average daily choline intake from foods and beverages among children and teens is 256 mg for ages 2–19 [14]. In adults, the average daily choline intake from foods and beverages is 402 mg in men and 278 mg in women.   https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

 

Severe constipation and hemorrhoids may be linked to a bile or choline deficiency. 

"Ninety-five percent of phospholipids (PLs) in bile is secreted as phosphatidylcholine or lecithin."  Fatty acid composition of phospholipids in bile in man  

Deficiency of these bile salts causes the bile to get thick. Some people with Celiac Disease are misdiagnosed with Gall Bladder bile issues.  Removal of the gallbladder provides only temporary relief.

Whether or not celiac disease or NCGS are your issues you need to look at your vitamin D blood level. 

Quote

"The prevalence of vitamin D insufficiency (VDI) and sufficiency was 40.9% and 34.5%."   https://pmc.ncbi.nlm.nih.gov/articles/PMC9573946/#:~:text=Based on the most recent,were predictors of severe VDD.

 

[Churro]

I'm no longer dealing with constipation. I got my liver test last month and it was in normal range. Two years ago I did have a vitamin D deficiency but I'm know taking vitamin D3 pills. Last month I got my vitamin D checked and it was in normal range. I don't believe I've had my choline checked. However, I do drink almond milk eat Greek yogurt on a daily basis.