What does 'borderline' mean in blood test results???

[lumalist]

Hi everyone, 

I'm new here but hoping you can all help me. 

A bit of background: I've recently been referred to a private gastroenterologist for stomach pains, blood in stool, and a constant flux from constipation to diarrhoea amongst other things. The only other time I've experienced this was 5/6 years ago when over the space of 18 months to 2 years I lost a lot of weight and had extreme bouts of anxiety, skin changes (rashes across my cheeks), mouth ulcers and other disconcerting symptoms. Rather foolishly, despite never having heard of coeliac disease,  I thought my best treatment was to simplify my diet, which meant I cut out gluten in the process. I did go to my GP about the weight loss and rashes but no treatment was given and coeliac disease was not mentioned. I've now been strictly gluten free for 4/5 years with no reintroduction - I tried but felt awful. 

Fast forward to now and I've been having bowel pain since the  summer. My gastroentorologist took the following blood tests all while I am still eating a strictly gluten free diet. He said this is a negative for celiac disease, but I'm interested in what each part means and whether these shed any other insight into my poor bowels! Grateful for any view you can provide. 

Results: 

• Anti Endomysium (IgA) = negative
• Anti- Tiss. Transglutaminase IgA = 3.7 units/ml 
  • (Range <3 u/ml = negative; 3-5 u/ml = borderline; >5 = positive)
• Deamidated Gliadin IgA = 1.0 u/ml 
  • (Range <10 = negative; 10-15 = borderline; >15 = positive) 
• Deamidated Gliadin IgG = 11.2 u/ml
  • Range: <10 = negative; 10-15 = borderline; >15 = positive  

Appreciate any input you can provide - thank you in advance! 

[kareng]

If you have Celiac and have been gluten-free, you shouldn't be having all these bowel issues.  They need to look and see what is currently the problem.  

[Posterboy]

lumalist,

I am not good with the tests.  I am surprise though that you are considered borderline after 4 to 5 years gluten free.

People are usually considered refractory after no improvements seen after 2 years gluten free.

It is possible something else is causing your rash and GI problems as kareng wisely notes then you might consider Pellagra.

Celiac.com featured an article about this why might be so a little bit ago.

https://www.celiac.com/articles/24658/1/A-Differential-Diagnosis-How-Pellagra-Can-be-Confused-with-Celiac-Disease/Page1.html

The skin rashes you have been having might indicate a case of Pellagra undiagnosed.

Most doctor's don't know to look for it today.

The Mdguidelines website indicates that “The diagnosis of pellagra is straightforward when the classic rash is present but may be elusive if there are only gastrointestinal and/or neurological manifestations.”

And why I believe in many cases Pellagra goes undiagnosed today.

A simple urine test is all that is needed to determine if you have Pellagra and the doctors’ have not recognized it in a clinical setting.

Good luck on your journey.

*** this is not medical advice but Knitty Kitty on this board used it (Niacin) to help her DH rash.  Search for Pellagra on this site if you want to read my experience with Niacinamide (the non-flushing form of Niacin) that I believe helped me with my constipation and diarrhea problems you describe.

Or see my blog post where I describe how "I had Celiac disease but developed Pellagra" where  I summarize my experience with Niaicnamide

Again your experience might be different but if you are still struggling on a gluten free diet then it worth looking into.

I found that when I took Niacinamide until my stool sunk where before it floated even on a gluten free diet and began to burp distinctly my flares and cross contamination issues  have been in control since.

This will take about 3 months of taking Niacinamide 3/day until this is your new normal (your stool sinks and you burp).  B-Vitamins need to be taken 2 to 3 times a day to overcome a deficiency since they are water soluble in two to three hours you will be low again unless taken though out the day for maximum benefit.

Don't take Niacin at more than 250mg and that with food or it (Niacin) will cause flushing/hives for 30 minutes or so causing you to stop taken Niacin before it is doing any good.

Find a Slo-Niacin or Niacinamide and you will get all the benefits of the Vitamin without the characteristic flushing of Niacin.

If Niacin aka Nicotonic Acid is the only form (you can find) the flushing will stop in 2 or 3 days but it is better to find the Niacinamide form to avoid this flushing.

Again I hope this is helpful.  But this is why most people don't/won't take Niacin because it's characteristic flushing and don't benefit from it the way they  should.

But have your doctor test you first is what I recommend but if they won't or it is not convenient taking the Vitamin and your C and D improving is considered enough to confirm a diagnosis in the absence of urine test to confirm the diagnosis.

The links I provided will go into more detail but good luck and I hope this is helpful.

posterboy,

 

[lumalist]

Thanks @kareng and @Posterboy 

What I don't understand is why after almost 5 years on a gluten free diet (with no cheating - beauty products too) I have borderline antibodies..? It just doesn't make sense to me...

@Posterboy Could this really be Pellagra? Other issues I have (perhaps unrelated) have been: gum problems, poor enamel on my teeth and ongoing cavities, hair loss, autoimmune thyroid disease, cystic acne and hyper pigmentation (non responsive to Roaccutane) and polycystic ovarian syndrome... in your research have you come across these being linked too? 

Perhaps another piece of info that may hint at Pellagra - I was raised on a pescetarian diet (fish but no meat). Oddly despite never having eaten meat I had the weirdest craving for a steak right around the time my symptoms were at their worst. I have very low iron (12 at my last blood test a few weeks ago), however my GP says it's 'normal' for me to have low iron as I seem to function ok in other ways. Could this also be linked to Pellagra? 

[Posterboy]

lumalist,

It is not common (considered rare) because mainly there is not a lot of studies about this topic but I want to thank Knitty Kitty for these references.  But it is really more about awareness.

AWOL Cast Iron stomach talks about here their reaction to corn.

Follow this thread "that darn corn"

Here is the link as quoted from PedMed that explains how some Celiac's also react to corn in their diets triggering possibly similar antibiotic affects.

Open Original Shared Link

Entilted "Maize prolamins resistant to peptic-tryptic digestion maintain immune-recognition by IgA from some celiac disease patients."

And too your 2nd question.

Yes it really can be Pellagra. Again this mainly more about awareness since most people are not aware it (Pellagra) often occurs together with a Celiac diagnosis.

The knowledge of how Pellagra presents these days is very limited since doctor's like they are told in Celiac's patients (at least too a few years ago) were told they (doctor's) might only see one two Celiac's in their practices in their lifetimes.

And so it becomes a self fulfilling prophecy and they don't (or didn't) until their was more education about the awareness of  how prevalent  Celiac really turned out to be.

Let's  put this way  -- A lot more prevalent than doctor's realized.

And so is Pellagra today because they only diagnosis it if you are in a subset of the population and the awareness/knowledge of Pellagra in a Celiac is 10 or 15 years behind the awareness of where Celiac is today.

The International Journal of Celiac Disease makes note of this in their research.

When the discuss how Pellagra and Celiac disease are related (Co-Morbid) in a Celiac diagnosis are surprised to find that in 58% of Celiac's -- can also be diagnosed with Pellagra.

See this link Open Original Shared Link

Quoting

3. Pellagra and celiac disease

"The two diseases can be connected in two aspects. 58% of pellagra patients were shown to have malabsorption and many had intestinal pathology on biopsies ^{[Open Original Shared Link, Open Original Shared Link]}. Alternatively, Pellagra was described in celiac disease ^{[Open Original Shared Link]}. The skin manifestations in pellagra might have some additional etiologies, since multiple nutrient deficiencies are at the origin of the cutaneous manifestations in celiac disease. The following nutritional deficiencies inducing skin rashes, were describe in celiac disease: Zinc, Iron, Vitamin A, E, B12, niacin, folate, selenium and essential fatty acids ^{[Open Original Shared Link, Open Original Shared Link]}."

Yet they are unsure why this is?

Because doctor's are still not aware that a Niacin deficiency can trigger some of the same symptom's now  (today) exclusively proscribed to those consuming gluten.

But the above research says (as seemingly has been your experience) corn can also trigger an antibody response even when you are 100 percent gluten free.

Why is this? Or How can this be?

Gluten free discusses why this possible when they talk about a Niacin deficiency in Celiac patients.

Open Original Shared Link

Right in the middle of their great work on what Pellagra a Niacin deficiency in Celiac's  looks like they explain how a Niacin deficiency itself can cause our membranes (leaky gut) to become weak and sensitized to gluten and other grains including corn

Quoting

"Intriguing animal research by Sandhur et. al. has shown that niacin deficiency itself sensitizes the intestinal mucosa of rats to gluten in wheat, barley, rye, oats and corn and induces susceptibility to gluten toxicity by means of cellular dysfunction.³ Human research needs to investigate this effect of niacin deficiency in human celiac disease."

If you look up the Sanhdur et. al research they quote it is over 30+ years old and I agree completely indeed  quoting  again more  "Human research needs to investigate this effect of niacin deficiency in human celiac disease." -- 

Which is why Pellagra - a Niacin deficiency -- can/could be the root cause of your reaction to the corn still in your diet.

More research was done 25+ years ago on this very fact of how a Niacin deficiency can cause our membranes to become inflamed.  I want to thank Knitty Kitty here again because she dug up this research first.

See how  the "Pathological effects of pellagra (a Niacin deficiency) on the esophagus" improved on Niacin supplementation.

Open Original Shared Link

The esophagitis they described might be called Eosinophilic Esophagitis (EoE) today and quoting "The esophagitis improved in five patients following six to seven days of vitamin therapy." Over half of those who had  an inflamed throat improved in less than week.  So they stopped the study early.

Who knows how much better they would of gotten in a month or two if they were allowed to continue taking the Vitamin.

But you can find out yourself by taking Niacinamide -- the non-flushing form of the Vitamin 3/day for 3 to 4 months.  The approximate time your body can store B-Vitamins in the liver.

You should being burping regularly in this time and your C and D should slow down to once a day and your stool will SINK where it now flows (probably) a sign of completed digestion after your body's mucus membranes get better.

As to your other problems like the cystic acne.  It fit's the D's of Pellagra very well.

Dermatitis, Dementia (anxiety, depression etc), Digestive Problems (C and D etc).

And when Pellagra was first diagnosed in Italy the word itself mean's "Rough/Sour skin" and typically is how it is classically diagnosed today among those who are not alcoholic . . . but if you get Digestive issues first it confuses doctor's today.

See this link on mdguidelines for diagnosing Pellagra today.

Open Original Shared Link

Where I quote " The diagnosis of pellagra is straightforward when the classic rash is present but may be elusive if there are only gastrointestinal and/or neurological manifestations."

And this becomes a self fulfilling prophecy.  GI problems can't be Pellagra because we didn't present today with the "keys" the doctor's were looking for to unlock the right illness.

So they used the GI key to unlock the Celiac diagnosis instead.

But 75+ years ago they knew that any 3 of the D's  opened the same door -- Pellagra.  Unfortunately today the (the D's of Pellagra) all open other disease's (door's) and rarely do they (doctor's) match up their keys' (the D's) to the Pellagra door (diagnosis) today.

Dr. Heaney of Creighton University summarizes it well in his blog about Pellagra and the 4 D's.

Open Original Shared Link

Quoting "In the United States, at least, pellagra is a disease of the past – fortunately – and it is doubtful today that most health professionals would recognize it if a case happened to come to their attention."

I would say unfortunately is not being diagnosed enough just like Celiac disease wasn't being diagnosed 15 or 20 years ago Pellagra is still 15 or 20 years behind in the recognition it deserves today.

Fortunately for us it can be easily diagnosed with a urine test if you can get your doctor to do it or by taking the Vitamin to prove cause and affect or as the mdguidelines say in their prognosis section

Quoting  "The prognosis for individuals with pellagra is excellent. Niacin(amide) supplements and a nutritionally balanced diet are effective treatments and result in a complete resolution of symptoms in most cases."

Sorry so long but  I had a lot of ground to cover.

But I hope this is helpful.

2 Timothy 2: 7 “Consider what I say; and the Lord give thee understanding in all things” this included.

posterboy by the grace of God,

 

 

[lumalist]

Not too long @Posterboy at all, thank you for explaining so well. I am hopeful that this could be the answer I have been searching for. 

I have two more questions for you: 

- Is it possible to check for a B3 deficiency with a blood test rather than a urine test? I've seen the former advertised online but can't find how to get a urine test. 

- What dosage of B3 would you recommend? Aside from the effects of flushing, is there any other reason to recommend niacinamide over niacin itself? 

Thanks! 

[Posterboy]

3 hours ago, lumalist said:

Not too long @Posterboy at all, thank you for explaining so well. I am hopeful that this could be the answer I have been searching for. 

I have two more questions for you: 

- Is it possible to check for a B3 deficiency with a blood test rather than a urine test? I've seen the former advertised online but can't find how to get a urine test. 

- What dosage of B3 would you recommend? Aside from the effects of flushing, is there any other reason to recommend niacinamide over niacin itself? 

Thanks! 

lumalist,

It is possible to check by blood work too.  Sometimes both are performed to confirm the other.

It a (Niacin deficiency) is usually performed as part of a B Vitamin Complex test where multiple B-Vitamins are tested in one blood sample.

These B-Vitamins are not part of your typical blood panel and will have to be requested to be checked for and since you are not in what is considered at risk (like an alcoholic) population they might resist your suggestion.  Even though B Vitamins are known to be helpful for Celiac's and most GI patients due to our poor nutritional state doctor's rarely think to check our B-Vitamins levels unless they are checking your homocysteine level's.

The site LTO has a great overview of the necessary steps. 

Open Original Shared Link

As to form.  It doesn't matter as much as frequency.

B-Vitamins (because they are water soluble) should be taken multiple times a day.

3/day works well for most people.

Smaller doses say 250mg Niacinamide or Niacin 3/day works 30 to 40 percent better than 500mgs 2/day for example.

Above 250mg Niacin also (commonly known as Nicotinic acid the same way Vitamin C is known as Asorbic Acid) should always be taken with food to lessen the flushing affect.

Niacinamide can be taken with meals and without.  So it is easier to take Niacinamide more frequently because you don't have to remember to eat for example before you take it.

Slo-Niacin can work too but I would still take it (IHN) aka Slo-Niacin with food.

See this Townsend Letter article where IHN aka Slo-Niacin was used to help raise peoples stomach acid to healthy level in less than a month.

Open Original Shared Link

what ever is easier to find will work the same if taken frequently.  Note:  inositol hexaniacinate (IHN) aka Slo-Niacin (in the townsend letter's conclusions)  though it releases Niaicn slowly to relieve flushing.  The IHN was still  taken 3/day to achieve this affect.

As long as Niacin is the active ingredient it will cause burping in approximately 3 months time.

I took it as 500mg Niacinamide 2/3 a day because it was easiest to purchase in large quantities and I knew it would avoid the flushing often associated with people stopping Niacin before it does any good.  

I recommend at least one 300 count bottle approximately a 3 month's supply and maybe a 2nd bottle depending on how many D's of Pellagra you might be experiencing.  Two large bottles that size cost less than 50 dollars.  The only thing I know that helped me and others as much as Niacin is/was Magnesium as a Citrate/Glycinate (see below) where I mention how Magnesium can help your energy levels and chronic fatigue.

this is assuming your are not taking an acid reducer like Prilosec or Nexium common PPI's that inhibit stomach acid production.

Taking Tums or Rolaids will not affect Niacinamide/Niacin's ability to work you just wont need the antacids in a couple months.

As for other other reasons to take Niacinamide over Niacin.  Both forms have benefits for different reasons.

Niacin specifically can help cholesterol levels where Niacinamide will not help your cholesterol and why Niacin is commonly found on pharmacy shelves.  You usually have to go to a speciality store like the Vitamin shop or Whole foods to find the Niacinamide form and often the Magnesium Citrate but find the right form and it can really makes a difference I think in how much easier it is to take.

thus it (Niacin) is cheaper and cheaper always wins on the counter for availability -- sadly not effectiveness.

The same is true for Magnesium -- Commonly sold as an Oxide though it is not bioavailable to the body.

Take some Magnesium Citrate too 3/day and it will really boost your energy levels, help cramps, and give your restful dreams.  But be sure find the Citrate or Glycinate form to help absorption of  the Magnesium.  Take it Magnesium Citrate (Gycinate does not have this problem) at lest 3 hours apart to avoid the flush that can occur in people at 300mg or more when someone first begin taken it (Magnesium Citrate.  Again this is a cost issue.

Though Magnesium Citrate can now be found in the Nature's Made brand it is still not commonly available because it cost pennies on the dollar more.  when you do find Magnesium Citrate it is sold in smaller dosages to make up for the higher cost.  So you have take 150mg 4/day Magnesium Liquidgels to make up what you get out of the 200mg Magnesium Citrate 3/day at the Vitamin shope for example.

Keep your doses 3 hours apart 200mg 3/day and this shouldn't be a problem.

But back to Niacinamide I think of Niacinamide as the bioavailable form of Niaicn which is converted in the liver to Niacinamide so by taken it as Niacinamide in the first place you save the conversion and thus the flushing associated with Niacin.

*** this is not medical advice -- just my personal experience with taking Niacinamide and Magnesium Citrate.  I hope your experience is similar.

Once again I had a lot ground to cover.

I hope this is helpful.

posterboy by the grace of God,