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Celiac.com 04/17/2024 - Maintaining optimal health involves ensuring that our bodies receive essential nutrients, including magnesium, a vital mineral crucial for various bodily functions. Magnesium deficiency can arise from various factors, including medical conditions like celiac disease, poor absorption, increased need, or excessive elimination. Understanding the signs, causes, and remedies for magnesium deficiency is essential for overall well-being. Identifying Magnesium Deficiency Symptoms Magnesium deficiency symptoms may initially manifest subtly, including muscle spasms, fatigue, decreased appetite, and nausea. However, if left unaddressed, more severe effects such as abnormal heart rhythm, seizures, anxiety, and personality changes may occur. As these symptoms overlap with those of other health conditions, a blood test from a medical provider is crucial to confirm magnesium deficiency accurately. Causes of Magnesium Deficiency Malabsorption due to gastrointestinal conditions like celiac disease or inflammatory bowel disease can hinder magnesium absorption. Additionally, certain medications and increased magnesium needs, such as during pregnancy or in athletes, can contribute to deficiency. Factors that affect magnesium elimination, like alcohol consumption or medical conditions such as kidney disease, also play a role. The Role of Magnesium in the Body Magnesium plays a vital role in numerous bodily processes, including muscle and nerve function, heart rhythm maintenance, blood sugar control, bone health, and blood pressure regulation. Furthermore, magnesium influences hormone balance related to sleep, circadian rhythm, and mood regulation, and can alleviate conditions like migraine headaches. Sources of Magnesium To address magnesium deficiency, both oral supplements and magnesium-rich foods can be beneficial. Supplements, such as magnesium glycinate or magnesium citrate, offer an easily accessible solution, although they may cause mild gastrointestinal side effects. Alternatively, incorporating magnesium-rich foods like pumpkin seeds, almonds, spinach, soy, and black beans into one's diet can help meet daily magnesium requirements. Frequently Asked Questions About Magnesium What is the best magnesium supplement? Magnesium glycinate and magnesium citrate are generally well-tolerated forms of magnesium supplements. Are there supplements best avoided when taking magnesium? Calcium supplements should be taken separately from magnesium to prevent competition for absorption. What medications interfere with magnesium: Certain medications, including proton pump inhibitors, antibiotics, diuretics, and chemotherapy drugs, can hinder magnesium absorption and should be managed accordingly. In conclusion, recognizing the signs of magnesium deficiency, understanding its causes, and knowing how to address it through supplementation or dietary adjustments are essential for maintaining optimal health. Consulting healthcare providers for accurate diagnosis and personalized treatment plans is vital in managing magnesium deficiency effectively. This article is not intended to offer medical advice, and is for informational purposes only. Please consult a medical professional for personal advice on celiac disease, magnesium deficiency, and/or any other medical concern.

Celiac.com 02/14/2024 - Rising celiac disease rates pose a significant health challenge, yet the environmental triggers behind the rise remain elusive. Among the various potential factors, iron deficiency has emerged as a potential contributor to the development of celiac disease. A recent study, employing Mendelian randomization (MR), sought to investigate the intricate relationship between iron status and the prevalence of celiac disease. Understanding Mendelian Randomization Mendelian randomization (MR) is a powerful method that explores potential causal relationships between an exposure and an outcome. In this case, the researchers delved into the connection between genetic variants associated with iron status and the presence of celiac disease. Research Design The study adopted a two-sample MR approach, utilizing single nucleotide polymorphisms (SNPs) linked to iron status. These SNPs were derived from a meta-analysis of three genome-wide association studies (GWAS). The association between these SNPs and celiac disease was then assessed using GWAS summary statistics from the UK Biobank, which included data from 336,638 white British individuals, 1855 of whom had celiac disease. Key Findings - Higher Iron Status Inversely Related to Risk of Celiac Disease The team identified four SNPs strongly associated with systemic iron status. Notably, these were not linked to known risk factors for celiac disease. The harmonized analysis revealed a compelling association: higher iron status was inversely related to the risk of celiac disease. The odds ratio per one standard deviation increase in serum iron was 0.65, with a 95% confidence interval of 0.47 to 0.91. Crucially, leave-one-out analyses consistently supported these findings, and no single SNP disproportionately influenced the association. Importantly, all three assumptions of MR appeared plausible, strengthening the credibility of the study's conclusions. Conclusion and Implications The study's groundbreaking discovery that genetically lower iron levels are associated with an increased risk of celiac disease holds significant implications for prevention strategies. By shedding light on the potential role of iron status in the development of celiac disease, this research opens avenues for targeted interventions and preventive measures. As the scientific community continues to unravel the complex factors contributing to celiac disease, studies like these pave the way for a deeper understanding of the condition and, ultimately, more effective strategies for its prevention and management. This research not only adds valuable insights to the celiac disease puzzle but also underscores the potential impact of addressing iron status in the broader context of preventive healthcare. Read more in BMJ Open Gastroenterology

Celiac.com 04/03/2023 - People with celiac disease must follow a gluten-free diet for their entire lives in order to stay healthy. But, gluten-free foods are traditionally high in salt, sugar and fat, among other things. So, what's the impact of a gluten-free diet on the nutritional levels of people with celiac disease? A team of researchers recently looked at studies of adults and children with celiac disease who followed a gluten-free diet, to see if they were getting the proper nutrients in their diets. The Research Team The research team included Monica Gessaroli, Leonardo Frazzoni, Usama Sikandar, Gabriele Bronzetti, Andrea Pession, Rocco Maurizio Zagari, Lorenzo Fuccio & Maria Luisa Forchielli. They are variously affiliated with theDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; the IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; and the Health Sciences and Technologies Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy. The Gluten-Free Diet Nutritional Study The researchers searched through several databases for studies, conducted through October 2022, that looked at the nutrient intake of celiacs who followed a gluten-free diet. They used statistics to combine the results from different studies and see if there were any patterns. They found thirty-eight studies covering a total of 2,114 patients. On average, people with celiac disease on a gluten-free diet consumed 1,995 calories per day. Almost half of these calories came from carbohydrates, 16% from proteins, and 36% from fats. Teenagers consumed the most fats, while adults did not get enough dietary fiber. Calcium, magnesium, and iron intake was particularly low in teenagers, while vitamin D intake was low for all age groups. Conclusion In conclusion, people with celiac disease who follow a gluten-free diet may not get enough essential nutrients, and may consume too much fat. Since a gluten-free diet is a lifelong treatment, it is important to regularly check on people's nutrient intake to prevent other health problems, and to take supplements if needed. That means that people with celiac disease should work with their doctors to create a plan for monitoring their nutrition over time. Read more in European Journal of Clinical Nutrition

Celiac.com 02/22/2023 - When people with celiac disease consume wheat or gluten, they typically suffer damage to the lining of the small intestine, along with associated symptoms of the damage, including nutritional deficiencies. Most women with celiac disease follow a gluten-free diet. But, we still don't know very much about the potential long-term impact of a gluten-free diet on the nutritional, body composition, and other factors in women with celiac disease. To better understand the issue, a team of researchers took a closer look at this issue. The team studied a group of just over fifty adult Saudi females with celiac disease, all of whom had followed a gluten-free diet for more than one year. The study included a complete analysis of anthropometric data, levels of vitamins B12 and D, and a complete blood count. Even though it's a small study, the results are concerning. That's because all of the patients were deficient in micro and macro-nutrients, including vitamin D, folate, calcium, and iron. Moreover, nearly half of the patients had reduced total body fat, while nearly two out of three had decreased levels of visceral fat. We already know that most adult celiacs suffer from micronutrient deficiencies. We also have a good idea of which deficiencies are the most common. The team's findings echo those of earlier studies, which have shown that gluten-free foods often have poorer nutritional quality than similar non-gluten-free foods. This means that people with celiac disease who follow a gluten-free diet may be at risk for poor nutrition or malnutrition. To ensure proper nutrition for people with celiac disease, especially women, it's important to remain extra vigilant about getting food with enough nutrition, fiber, and other essential nutrients to promote good health. This may include working with a dietitian or nutritionist to create a well-balanced meal plan, and supplementing with vitamins and minerals, as needed. Women with celiac disease who are following a gluten-free diet, and those who care for them, should take this study seriously, share it with your doctor or nutritionist, and take steps to make sure they remain healthy. Read more in Nutrients

Celiac.com 10/22/2022 - Close to one quarter of the world’s population, in both industrialized and developing countries, suffer from iron deficiency and/or iron deficiency anemia. Although it is a widespread problem, those who are gluten sensitive should be particularly careful to monitor their iron status regularly. Iron deficiency is not only an important sign of undiagnosed celiac disease, it may also reflect some degree of intestinal damage—and most of our iron is absorbed in the same part of the intestine as calcium. The jejunum is the site of most of the damage caused by gluten, which may explain the significant overlap between gluten sensitivity and iron deficiency anemia. The two primary causes of iron deficiency are either inadequate absorption of iron or excessive blood loss, and intestinal bleeding is common among the gluten sensitive. Iron deficiency can also result from vitamin A deficiency, which can also be a feature of celiac disease. Several years after I began following a gluten-free diet, a blood test that was part of a regular physical exam revealed that I was mildly anemic. By now you may be wondering, just as I did, what the difference is between iron deficiency and iron deficiency anemia. Simply put, iron deficiency anemia is where the hemoglobin content of one’s blood is below normal. This means that there are fewer blood cells that carry oxygen to be distributed throughout the body. My greatest concern with my own inclination to anemia, both before and after diagnosis, is that iron deficiency can impair memory and reduce learning acuity. Most of this impact occurs prior to the development of anemia. Iron deficiency first depletes iron stores in a wide range of tissues and organs before it causes significant losses to hemoglobin. Iron is needed to make several neurotransmitters including dopamine, serotonin, and norepinepherine. These neurotransmitters are involved in a wide range of brain activities related to alertness, attention, remembering, learning, and a variety of other brain functions. Some researchers at the University of Maryland have reported that iron deficient adolescent girls show a significant improvement in IQ test scores after only 8 weeks of taking iron supplements. There are many other symptoms of iron deficiency, including shortness of breath, light-headedness, lethargy, and pale skin. However, it is important not to just rush out and start taking iron supplements. Iron overdose can cause damage to the liver, the heart, or the pancreas. The body must maintain an exquisitely careful balance for optimal health. Further, a significant number of celiacs also suffer from hereditary hemochromatosis which is a condition in which the body is overly thrifty, storing too much iron. Supplementing iron in such a case could have some very serious consequences. Regular testing is an important strategy. Iron deficiency or anemia is more likely to be ignored or to be given less attention simply because of the frequency with which it occurs. However, it is a particularly important issue to those who are gluten sensitive, if only from a quality-of-life perspective. Even if peace of mind is the only result of getting regular check-ups that include a complete blood count, our reward is large. Similarly, early detection and reversal of iron deficiency before it causes memory disturbances and other unwanted symptoms, or before it goes on to develop into anemia, could be a huge dividend to collect from paying careful attention to our iron levels.

Celiac.com 08/13/2022 - Celiac disease is an autoimmune gastrointestinal disorder that may occur in genetically susceptible individuals triggered by the ingestion of gluten-containing grains such as wheat, barley and rye. Of the many autoimmune disorders, celiac disease represents one of the few where the etiological agent is known and the disease subsides and goes in remission once the etiological agent is withdrawn from the diet. Celiac disease is characterized by malabsorption resulting from inflammatory injury to the small intestinal mucosa, which, when prolonged, can cause malnutrition. The classic symptoms of celiac disease include diarrhea, weight loss and malnutrition. However, only a small percentage of patients with celiac disease present with the classic symptoms. Consequently, the clinical spectrum of celiac disease has grown much broader to include patients without classic symptoms. It is not uncommon for the initial symptoms to be non-gastrointestinal or for gastrointestinal symptoms, if present, to be mild or intermittent. Some of the common non-gastrointestinal manifestations include short stature, iron and folate deficiency, anemia, bone loss, aphthous stomatitis, arthralgia, dental enamel defects, etc. The inclusion of a wider range of clinical presentation has led to greater numbers of individuals diagnosed with celiac disease later in life than ever before. Adults may present with iron deficiency, macrocytic anemia and hypocalcaemia. Studies have found the prevalence of celiac disease to be highly variable from population to population (1) and the true prevalence has been difficult to ascertain. The disparate criteria used in the diagnosis of celiac disease are often the cause. If only the clinical criteria are used in determining prevalence, the incidence of celiac disease is much lower as compared with incidence established by serological methods (2) . Using serological methods of diagnosis, the incidence of celiac disease in the general population is approximately one in 200. Diagnosis of celiac disease based on clinical criteria can therefore be misleading and may lead to serious delays in proper diagnosis. Frequently, delays in diagnosis extend 10-13 years from the first clinical presentation of symptoms. Failure to diagnose celiac disease early on may predispose an individual to long-term complications such as splenic atrophy and intestinal lymphoma. The incidence of lymphoma arising in the context of celiac disease is difficult to ascertain. One study has shown incidence of lymphoma involving the gastrointestinal tract in patients with celiac disease to range from 3.6 percent to 40 percent (3) . In another recent study, celiac disease was found to be associated with significantly elevated risk for intestinal lymphoma, especially for non-Hodgkin’s (4) . A gluten-free diet normalizes the mucosa and helps reduce the malignant potential. Histological examination of the small intestinal biopsy is considered to be the gold standard for diagnosing celiac disease, but it has its own limitations. Certain studies have shown some patients with latent or even active celiac disease that may have normal histopathology(5). Serological Methods of Detecting Celiac Disease The revised European Society of Pediatric Gastroenterology and Nutrition (ESPGAN) criteria for diagnosis of celiac disease include only a single biopsy with clear-cut remission of clinical symptoms on a gluten-free diet (6). Positive serology at the time of diagnosis with a decline in antibody levels on a gluten-free diet contributes to the diagnosis. The various serological tests employed in the work-up of patients suspected to have celiac disease include anti-gliadin antibody (AGA), anti-endomysial antibody (EMA), anti-reticulin antibody (ARA) and anti-tissue transglutaminase (tTG) antibody tests. Antibodies to gliadin and tTG are detected by the ELISA method, whereas endomysial and reticulin antibodies are detected by indirect immunofluorescence. EMA are very specific indicators of celiac disease. One study (7) concludes that “EmA-IgA is 100 percent sensitive and specific in active, untreated IgA-sufficient celiac disease patients when performed by an established laboratory.” tTG has been identified as the endomysial antigen. This discovery has enabled development of automatable ELISA methods for detecting antibodies in the sera of patients with celiac disease. Many laboratories have opted to use the tTG antibody method in screening for celiac disease. In these laboratories, it may be the only assay used for detection of celiac disease cases. Various studies on the efficacy of the tTG antibody method for screening have found the specificity and sensitivity of this method to range from 90 percent to 95 percent (8). Assays using human tTG have been described to improve the sensitivity of detection of tTG antibodies. Surprisingly, in a recent report by the Medicines and Healthcare Products Regulatory Agency (MHRAM) on various anti-tTG IgA isotype assays the specificities were found to be good but assay sensitivity was often poor, indicating considerable variation in reliability of detection. One limitation of existing serological methods is that, with the exception of IgG–gliadin, they detect only the IgA isotype of the antibodies; hence, IgA deficient celiac disease patients may yield false negative serology (9) . This may compromise the utility of the serum antibody methods in detecting all celiac disease cases (10). What is IgA deficiency? In the blood there are proteins called immunoglobulins that generally provide immunological protection. There are five types of immunoglobulins, known as IgG, IgA, IgM, IgE, and IgD. IgG and IgM provide protection in the circulatory system whereas IgA is transported to the surface of mucosal surfaces such as in the gastrointestinal tract and oral mucosa, safeguarding these mucosal surfaces from infection. Certain individuals that fail to produce the IgA immunoglobulin are referred to have selective IgA deficiency. The cause of this selective IgA deficiency is not known. What is known is that patients with selective IgA deficiency have a defect in differentiating B cells (one of the white cell types) into cells that manufacture immunoglobulins called plasma cells. The concentration of IgA in the plasma of normal individuals is about 300 mg/dl. In individuals with selective IgA deficiency the IgA levels are less than 0.05 mg/dl. IgA deficiency is one of the most common immunodeficiencies, found in one in 500-700 healthy blood donors (11). In most situations, these IgA deficient individuals are healthy. Those who develop symptoms suffer from sino-pulmonary infections, allergies, and autoimmune disorders, especially celiac disease (12). The incidence of IgA deficiency in celiac disease patients is between 2-3% representing a 10-15 fold increase over the general population. Familial inheritance of IgA deficiency occurs in 20% of cases. While the selective defect of B cells limits the number of IgA secreting plasma cells, IgA deficient individuals have normal function of IgG and other immunoglobulin secreting plasma cells. Celiac disease patients with IgA deficiency produce IgG immunoglobulin normally, and the antibodies to EMA, tTG and gliadin are of the IgG isotype rather than IgA. To prevent false negative results in IgA deficient cases of celiac disease, it is necessary to include serological methods that can detect antibodies of IgG isotype. How can we detect Celiac Disease in patients with IgA deficiency? In patients with known selective IgA deficiency, the IgG antibody levels for EMA, tTG and gliadin can be measured and are very effective in identifying patients with celiac disease. However, one generally does not know if the individual is IgA deficient. Until specific tests for IgA levels are performed, the IgA status of an individual may never be known. As IgA deficiency is more prevalent in the celiac population than the general population, it has been proposed that all patients who are considered for celiac disease be tested for IgA levels to identify cases of IgA deficiency. Checking all routine samples referred to a laboratory for celiac disease testing, Lock and Unsworth found that testing for IgA levels in identifying IgA deficient celiac disease patients is excessive and more likely to identify non-celiac disease cases (13). They concluded that testing of IgA levels is not cost effective. Testing for IgG antibodies to EMA, tTG or AGA, however, is cost effective. Detection of these antibodies either individually or in combination helps to identify all cases of IgA deficient celiac disease on normal diets. Using this method, we reported the first IgA deficient celiac disease case in 1989. Since then, others have reported on large populations of IgA deficient celiac disease and non-celiac disease cases and found the serological methods to be effective (see table on pg. 17). The levels of these antibodies are also of interest, as antibody level tends to correlate with the severity of the disease. When a patient is on a gluten free diet, the levels of these antibodies will decrease and eventually disappear, suggesting that the patient is in remission. Thereafter, tests for antibody levels could be checked annually or bi-annually to ensure the individual’s dietary compliance. Intake of gluten in individuals who are in remission will result in the re-appearance or increase of these antibodies in the serum (see figure below).

Celiac.com 10/05/2021 - People with celiac disease, a chronic autoimmune disorder of the small intestine, must eat a gluten-free diet to avoid numerous symptoms and long-term issues, including atrophy of the intestinal villi that leads to altered nutrient absorption. But what about nutrient absorption for celiac patients following a gluten-free diet? A team of researchers recently set out to describe the nutritional imbalances which may be found in adults with celiac disease following a gluten-free diet. The research team included Aner Cardo, Itziar Churruca, Arrate Lasa,Virginia Navarro, Maialen Vázquez-Polo, Gesala Perez-Junkera and Idoia Larretxi. They are variously affiliated with the GLUTEN3S Research Group, Department of Nutrition and Food Science, University of the Basque Country, 01006 Vitoria-Gasteiz, Spain; with Bioaraba, Nutrición y Seguridad Alimentaria, 01006 Vitoria-Gasteiz, Spain; and with Centro Integral de Atención a Mayores San Prudencio, Ayuntamiento de Vitoria-Gasteiz, 01006 Vitoria-Gasteiz, Spain. Nutritional deficiencies will diminish as the gut heals over the first year on the gluten-free diet. This is confirmed by both biochemical data, and a reduction in symptoms. However, for patients on a strict gluten-free diet, with full mucosal recovery, measuring nutrient intake makes more sense than measuring deficiencies. Consumption of macronutrients are marked by low complex carbohydrate and fiber intakes, along with high fat (especially SFA) and sugar intakes. This profile is associated with eating gluten-free products, with their relatively poor nutritional profile, along with poor or imbalanced diet. The most common micronutrient deficiencies include iron, calcium and magnesium and vitamin D, and E, along with certain group B vitamins. Nutritional follow-up and nutritional education could help celiacs learn to eat a nutritionally balanced gluten-free diet. Read more in Nutrients 2021, 13(8), 2877

Celiac.com 02/27/2020 - One interesting question we see regularly here at Celiac.com is: Does having no half-moons on your fingernails mean you have celiac disease? Certainly, symptoms of celiac disease include problems with skin, hair and nails, and even seemingly harmless defects in dental enamel. The Celiac Disease and Gluten-Free Forum includes numerous entries on celiac disease and various finger nail abnormalities, including Beau's lines, brittle nails, clubbing of toenails, ridges in fingernails, and more, but the science here is thin. There just haven't been many studies on fingernails and celiac disease. These conditions B-12 Deficiency is Common in People with Celiac Disease B-12 deficiency is one of the most common vitamin deficiencies faced by people with celiac disease. While B-12 deficiency is common among people with celiac disease, evidence regarding nails and people with celiac disease having no half-moons on their fingernails is largely anecdotal. Claims pop up in a number of health web sites. Here are a few examples: Low Vitamin B-12 Signs Blue Nails: Window to Micronutrient Deficiency Whatever effects low B-12 may have on half-moons on fingernails, vitamin B-12 deficiency may cause potentially serious symptoms including: Bleeding gums Bone Pain Brown spots on skin Burning sensations, especially on the thighs Depression Diarrhea Difficulty walking Exhaustion or fatigue Heavy menstrual bleeding Loss of Balance Memory problems Nose bleeds Numbness Pain or twitching in legs Sensitivity to noise Tingling in feet or hands So, while there is no solid scientific answer to the question, the anecdotal evidence is abundant, with many people with celiac disease claiming a connection. Could low B-12 cause changes to your fingernails? Possibly. In any event, if you experience a loss of half-moons on your fingernails, or suspect vitamin B-12 or other deficiency, see a doctor.

This article appeared in the Summer 2008 edition of Celiac.com's Scott-Free Newsletter. Celiac.com 06/16/2008 - Do vitamin D deficiency, gut bacteria, and timing of gluten introduction during infancy all combine to initiate the onset of celiac disease? Two recent papers raise the potential that this indeed may be the case. One paper finds that when transgenic mice expressing the human DQ8 heterodimer (a mouse model of celiac disease) are mucosally immunized with gluten co-administered with Lactobacillus casei bacteria, the mice exhibit an enhanced and increased immune response to gluten compared to the administration of gluten alone.[1] A second paper finds that vitamin D receptors expressed by intestinal epithelial cells are involved in the suppression of bacteria-induced intestinal inflammation in a study which involved use of germ-free mice and knockout mice lacking vitamin D receptors exposed to both friendly and pathogenic strains of gut bacteria.[2] Pathogenic bacteria caused increased expression of vitamin D receptors in epithelial cells. Friendly bacteria did not. If one considers these two papers together, one notices: (1) Certain species of gut bacteria may work in conjunction with gluten to cause an increased immune response which initiates celiac disease; (2) The presence of an adequate level of vitamin D may suppress the immune response to those same gut bacteria in such a way as to reduce or eliminate the enhanced immune response to gluten caused by those gut bacteria, thus preventing the onset of celiac disease. Vitamin D has recently been demonstrated to play a role in preserving the intestinal mucosal barrier. A Swedish study found children born in the summer, likely introduced to gluten during winter months with minimal sunlight, have a higher incidence of celiac disease strongly suggesting a relationship to vitamin D deficiency.[3] Recent studies found vitamin D supplementation in infancy and living in world regions with high ultraviolet B irradiance both result in a lower incidence of type 1 diabetes, an autoimmune disease closely linked to celiac disease.[4][5] Gut bacteria have long been suspected as having some role in the pathogenesis of celiac disease. In 2004, a study found rod-shaped bacteria attached to the small intestinal epithelium of some untreated and treated children with celiac disease, but not to the epithelium of healthy controls.[6][7] Prior to that, a paper published on Celiac.com[8] first proposed that celiac disease might be initiated by a T cell immune response to "undigested" gluten peptides found inside of pathogenic gut bacteria which have "ingested" short chains of gluten peptides resistant to breakdown. The immune system would have no way of determining that the "ingested" gluten peptides were not a part of the pathogenic bacteria and, thus, gluten would be treated as though it were a pathogenic bacteria. The new paper cited above[1] certainly gives credence to this theory. Celiac disease begins in infancy. Studies consistently find the incidence of celiac disease in children is the same (approximately 1%) as in adults. The incidence does not increase throughout life, meaning, celiac disease starts early in life. Further, in identical twins, one twin may get celiac disease, and the other twin may never experience celiac disease during an entire lifetime. Something other than genetics differs early on in the childhood development of the twins which initiates celiac disease. Differences in vitamin D levels and the makeup of gut bacteria in the twins offers a reasonable explanation as to why one twin gets celiac disease and the other does not. Early childhood illnesses and antibiotics could also affect vitamin D level and gut bacteria makeup. Pregnant and nursing mothers also need to maintain high levels of vitamin D for healthy babies. Sources: [1] Immunol Lett. 2008 May 22. Adjuvant effect of Lactobacillus casei in a mouse model of gluten sensitivity. D'Arienzo R, Maurano F, Luongo D, Mazzarella G, Stefanile R, Troncone R, Auricchio S, Ricca E, David C, Rossi M. [2] The FASEB Journal. 2008;22:320.10. Meeting Abstracts - April 2008. Bacterial Regulation of Vitamin D Receptor in Intestinal Epithelial Inflammation Jun Sun, Anne P. Liao, Rick Y. Xia, Juan Kong, Yan Chun Li and Balfour Sartor [3] Vitamin D Preserves the Intestinal Mucosal Barrier Roy S. Jamron [4] Arch Dis Child. 2008 Jun;93(6):512-7. Epub 2008 Mar 13. Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis. Zipitis CS, Akobeng AK. [5] Diabetologia. 2008 Jun 12. [Epub ahead of print] The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide. Mohr SB, Garland CF, Gorham ED, Garland FC. [6] Am J Gastroenterol. 2004 May;99(5):905-6. A role for bacteria in celiac disease? Sollid LM, Gray GM. [7] Am J Gastroenterol. 2004 May;99(5):894-904. Presence of bacteria and innate immunity of intestinal epithelium in childhood celiac disease. Forsberg G, Fahlgren A, Hörstedt P, Hammarström S, Hernell O, Hammarström ML. [8] Are Commensal Bacteria with a Taste for Gluten the Missing Link in the Pathogenesis of Celiac Disease? Roy S. Jamron

Celiac.com 07/29/2020 - Vitamin and micronutrient deficiencies are common in people with both treated and untreated celiac disease. Fortifying processed foods with vitamins and micronutrients is common method for enhancing public health. In the latest iteration of that practice, researchers Dr David Aldridge and PhD student David Willer, from Cambridge University and UK company BioBullets, have figured out a way to deliver fortified levels of vitamins in bivalve shellfish such as oysters, clams and mussels by using new micro-encapsulation technology. The resulting shellfish offer a way to get high levels of vitamins into people with vitamin deficiencies. The results offer promise for people with chronic vitamin deficiencies, including those with celiac and other diseases. The team is now working with major seafood manufacturers to further test and optimize the efficacy of their "Bio Bullets" micro-encapsulation process. Shellfish fed Vitamin A and D fortified microcapsules for eight hours while being held in cleansing tanks after harvest, showed the most promise. Aldrige and Willer found that fortified oysters provide about 100 times more Vitamin A, and over 150 times more Vitamin D, than natural oysters, and far more than Salmon, a good natural source for these nutrients. In fact, a serving of just two supercharged shellfish a day met the U.S. recommended daily allowance for both vitamins A and D. The shellfish are also environmentally friendly, and highly sustainable, with a lower energy demand than animal meat, fish, or many plant crops such as wheat, soya, and rice. Fortifying shellfish with vitamins offers a "cheap and effective way to get micronutrients into a sustainable and delicious source of protein. Targeted use of this technology in regions worst affected by nutrient deficiencies...could help improve the health of millions," says Willer. Obviously, some people cannot eat shellfish, but the vast majority of people can, including people with celiac disease. For people with celiac disease who face challenges with vitamin and micronutrient deficiency, fortified shellfish could offer a tasty, easy way to load up on essential vitamins, which will likely improve overall health and wellbeing. This technology could be a gamer changer for both celiacs, and for other people across the globe who are suffering from vitamin and micronutrient deficiencies. Read more in Newfoodmagazine.com

Celiac.com 07/14/2020 - Nutrient deficiencies are common in people with celiac disease, and closely tied to many of its physical expressions. Even though these deficiencies are potentially important, researchers don't really have much good information on their pattern and frequency in celiac patients, or on their potential usefulness at the time of diagnosis and during follow-up. A team of researchers recently set out to develop an overview of nutrient deficiencies in children and adults with celiac disease, both upon diagnosis and after treatment with a gluten-free diet. They also sought to better understand the potential role of nutritional deficiencies in the development of celiac disease. The research team included Johanna M. Kreutz, Marlou P. M. Adriaanse, Elisabeth M. C. van der Ploeg, and Anita C. E. Vreugdenhil. They are variously affiliated with the Department of Dietetics; and the Department of Paediatrics and NUTRIM School of Nutrition and Translational Research in Metabolism at Maastricht University Medical Centre in Maastricht, The Netherlands. To compile their overview, the team conducted searches on Medline, Pubmed and Embase up to January 2019. Even with high variability in the reported deficiencies, the team observed that nutrient deficiencies are common in children and adults with celiac disease, both at diagnosis and during gluten-free diet treatment. Nutrient deficiencies can arise from poor diet, and/or reduced absorption due to intestinal damage. Most deficiencies can be reversed by long-term gluten-free diet and/or supplemental nutrients. However, some nutritional deficiencies are more stubborn, and some may get worse with a gluten-free diet. The team's results highlight a lack of good evidence on the benefits of nutritional supplements in celiac management, which invites further study. Do you or a loved one take nutritional supplements to help support your celiac disease treatment? If so, please share your thoughts below. Read more in Nutrients. 2020 Feb; 12(2): 500

Celiac.com 07/10/2019 - Fewer new celiac patients are being diagnosed with classical malabsorption problems. Has this fact had any impact on nutrient deficiency? A team of researchers recently set out to evaluate micronutrient deficiencies in a contemporary group of adult patients with newly diagnosed celiac disease. The research team included Adam C. Bledsoe MD; Katherine S. King MS; Joseph J. Larson BS; Melissa Snyder PhD; Imad Absah MD; Rok Seon Choung MD, PhD; and Joseph A.Murray MD. They are variously affiliated with the Division of Gastroenterology and Hepatology, the Division of Biomedical Statistics and Informatics, the Division of Clinical Biochemistry, and the Division of Pediatric Gastroenterology at the Mayo Clinic in Rochester, MN; and the Department of Pediatrics at the University of Southern Denmark, Odense. The team conducted a retrospective study of prospective adults newly diagnosed with celiac disease from January 1, 2000, through October 31, 2014, at Mayo Clinic. They collected micronutrient data levels of tissue transglutaminase IgA, 25-hydroxy vitamin D, albumin, copper, ferritin, serum folate vitamin B12, and zinc. The researchers used logistic regression to assess absolute number of deficiencies, and their connections with age, sex, body mass index, presenting symptoms, and tissue transglutaminase IgA. They then compared deficiencies with age- and sex-matched controls from the National Health and Nutrition Examination Survey. The team looked at a total of 196 women and 113 men with celiac disease. The team showed that about 25 percent of those patients showed weight loss, while nearly 60 percent showed zinc was deficient, compared with just with 33.2 percent of controls. Nearly 20 percent of patients showed low albumin compared with just 1.1 percent of controls. More than 6 percent of celiac patients showed low copper levels compared with 2.1 percent of control subjects. More than 5 percent of celiac patients showed low vitamin B12 levels, compared with 1.8 percent of control subjects. Low folate levels were found in nearly 4 percent of celiac patients compared with just 0.3 percent of control subjects. Meanwhile, ferritin was low in 30.8 percent of celiac patients, though no NHANES controls were available for comparison for ferritin. Adults with celiac disease often have micronutrient deficiencies, even though less of them show signs of classical malabsorption. This study supports testing celiac patients for micronutrient deficiencies at the time of diagnosis. Read more at ScienceDirect.com

Celiac.com 07/17/2018 - What can fat soluble vitamin levels in newly diagnosed children tell us about celiac disease? A team of researchers recently assessed fat soluble vitamin levels in children diagnosed with newly celiac disease to determine whether vitamin levels needed to be assessed routinely in these patients during diagnosis. The researchers evaluated the symptoms of celiac patients in a newly diagnosed pediatric group and evaluated their fat soluble vitamin levels and intestinal biopsies, and then compared their vitamin levels with those of a healthy control group. The research team included Yavuz Tokgöz, Semiha Terlemez and Aslıhan Karul. They are variously affiliated with the Department of Pediatric Gastroenterology, Hepatology and Nutrition, the Department of Pediatrics, and the Department of Biochemistry at Adnan Menderes University Medical Faculty in Aydın, Turkey. The team evaluated 27 female, 25 male celiac patients, and an evenly divided group of 50 healthy control subjects. Patients averaged 9 years, and weighed 16.2 kg. The most common symptom in celiac patients was growth retardation, which was seen in 61.5%, with abdominal pain next at 51.9%, and diarrhea, seen in 11.5%. Histological examination showed nearly half of the patients at grade Marsh 3B. Vitamin A and vitamin D levels for celiac patients were significantly lower than the control group. Vitamin A and vitamin D deficiencies were significantly more common compared to healthy subjects. Nearly all of the celiac patients showed vitamin D insufficiency, while nearly 62% showed vitamin D deficiency. Nearly 33% of celiac patients showed vitamin A deficiency. The team saw no deficiencies in vitamin E or vitamin K1 among celiac patients. In the healthy control group, vitamin D deficiency was seen in 2 (4%) patients, vitamin D insufficiency was determined in 9 (18%) patients. The team found normal levels of all other vitamins in the healthy group. Children with newly diagnosed celiac disease showed significantly reduced levels of vitamin D and A. The team recommends screening of vitamin A and D levels during diagnosis of these patients. Source: BMC Pediatrics

Celiac.com 11/04/2015 - A research team that conducted an analysis of the relationship between seronegative celiac disease and immunoglobulin deficiencies also conducted a literature search on the main medical databases, which revealed that seronegative celiac disease poses a diagnostic dilemma. The research team included F. Giorgio, M. Principi, G. Losurdo, D. Piscitelli, A. Iannone, M. Barone, A. Amoruso, E. Ierardi, and A. Di Leo. They are variously affiliated with the Section of Gastroenterology at University Hospital Policlinico, Department of Emergency and Organ Transplantation at University of Bari in Bari, Italy. They note that villous blunting, intraepithelial lymphocytes (IELs) count and gluten "challenge" are the most reliable markers in addressing seronegative celiac disease. They also note that immunohistochemistry/immunofluorescence tissue transglutaminase (tTG)-targeted mucosal immunoglobulin A (IgA) immune complexes in the intestinal mucosa of seronegative celiac disease patients may be useful. In the team's view, tTG-mRNA was similarly increased in seropositive celiac disease and suspected seronegative celiac disease, and strongly correlated with the IELs count. This increase is found even in the IELs' range of 15-25/100 enterocytes, suggesting that there may be a "grey zone" of gluten-related disorders. An immune deregulation, severely lacking B-cell differentiatio, underlies the association of seronegative celiac disease with immunoglobulin deficiencies. Therefore, celiac disease may be linked to autoimmune disorders and immune deficits, known as common variable immunodeficiency (CVID)/IgA selective deficiency. CVID is a heterogeneous group of antibody dysfunction, whose association with celiac disease revealed only by a positive response to a gluten-free diet. The research team suggests a possible familial inheritance between celiac disease and CVID. Selective IgA deficiency, commonly associated with celiac disease, accounts for IgA-tTG seronegativity. Selective IgM deficiency (sIgMD) is rare, with less than 300 documented cases, and is connected to celiac disease in 5% of cases. The team diagnosed seronegative celiac disease in a patient affected by sIgMD using the tTG-mRNA assay. One-year on a gluten-free diet restored IgM levels. This study data support a link between seronegative celiac disease and immunoglobulin deficiencies, and invites researchers to take a closer look at this connection. Source: Nutrients. 2015 Sep 8;7(9):7486-504. doi: 10.3390/nu7095350

07/29/2013 - Rates of celiac disease in Caucasian populations of European origin are pretty well documented, but little is known about its prevalence in non-Caucasians. Also, data shows that celiac disease is one likely cause of iron-deficiency anemia, but little is known about how celiac disease might contribute to iron deficiency in Caucasians, and especially non-Caucasians. A team of researchers recently looked at for links between celiac disease and iron deficiency in both caucasians and non-caucasians. The study team included Joseph A. Murray, Stela McLachlan, Paul C. Adams, John H. Eckfeldt, Chad P. Garner, Chris D. Vulpe, Victor R. Gordeuk, Tricia Brantner, Catherine Leiendecker–Foster, Anthony A. Killeen, Ronald T. Acton, Lisa F. Barcellos, Debbie A. Nickerson, Kenneth B. Beckman, Gordon D. McLaren, and Christine E. McLaren. To find individuals with iron deficiency and to determine celiac disease rates, the team assessed samples collected from participants in the Hemochromatosis and Iron Overload Screening study. They looked at blood samples from white men 25 years or older and women 50 years or older who participated in the Hemochromatosis and Iron Overload Screening study. Individuals with serum ferritin levels ≤12 μg/L were group as iron deficient, while those with serum ferritin levels >100 μg/L in men and >50 μg/L in women served as a control group. The team analyzed all samples for human recombinant tissue transglutaminase immunoglobulin A; positive results were confirmed by an assay for endomysial antibodies. The team assessed patients with positive results from both celiac disease tests as having untreated celiac disease. They excluded from analysis all subjects with a positive result from only one of the two tests. They analyzed HLA genotypes and frequencies of celiac disease between Caucasians and non-Caucasians with iron deficiency. In all, the team found 14 cases of celiac disease among the 567 study subjects (2.5%), and just 1 case of celiac disease among the 1136 control subjects (0.1%; Fisher exact test, P = 1.92 × 10−6). The case of celiac disease in the control group was in a Caucasian control subject. There were no cases of celiac disease found in non-Caucasian controls. All 14 of the cases of celiac disease found by the team were in the Caucasian group of 363 (4%). There were no cases of celiac disease in the non-Caucasian group of 204 cases (P = .003). Overall, individuals with iron deficiency were 28-times more likely to have celiac disease (95% confidence interval, 3.7–212.8) than were healthy control subjects. Also, and interestingly, 13 of 14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype. This study shows that celiac disease is linked with iron deficiency in Caucasians. In fact, among Caucasians, celiac disease is rare among individuals without iron deficiency. It also shows that celiac disease is rare among non-Caucasians—even among individuals with common features of celiac disease, such as iron deficiency. The study team recommends that doctors conduct celiac screening on men and postmenopausal women with iron deficiency. Source: Clinical Gastroenterology and Hepatology. Volume 11, Issue 7 , Pages 808-814, July 2013

Celiac.com 04/28/2010 - Celiac disease primarily impacts the proximal small intestine, and the small intestine is fundamental in maintaining zinc equilibrium within the body. Recently, zinc has been acknowledged for it's importance in upholding the integrity of intestinal mucosa, immunity and proper growth rates in children. Base-line plasma zinc levels are shown to be greatly reduced in over two-thirds of children diagnosed with celiac disease. A study was conducted by the Celiac Disease Clinic in the division of Pediatric Gastroenterology, Post Graduate Institute Medical Education and Research, Chandigarh, India between July 2006 and December 2007, to evaluate plasma levels of zinc in children with celiac disease, correlate plasma zinc levels among celiacs short in stature and with diarrhea, and to compare plasma zinc levels in deficient patients on a gluten-free diet with zinc supplementation, to patients on a gluten-free diet without zinc supplementation. 134 total patients less than 14 years old and newly diagnosed with celiac disease, were enrolled for the study. Each subject enrolled was also evaluated for baseline demographics and social profiles which included an in-depth medical history, physical examination, and thorough blood work. All patients included in the study were placed on a gluten-free diet and received dietary counseling from a physician and experienced dietitian. All patients received a 20 milligram dose of elemental zinc supplementation for 4 weeks. Plasma zinc levels were compared at baseline and also at 4 weeks to determine zinc deficiency. Patients found to be deficient in zinc levels were randomly divided into two groups, Group G and Group G+Z. Group G treatments included a gluten-free diet without zinc supplementation. Group G+Z received a gluten-free diet with zinc supplementation. The results of this study showed that plasma zinc levels had a significant rise in Group G and Group G+Z regardless of zinc supplementation. However, a gluten-free diet alone showed a profound increase in plasma zinc levels, even when compared to gluten-free diet with zinc supplements; thereby indicating that zinc supplementation combined with a gluten-free diet gives no additional benefits to plasma zinc levels. In fact, all celiac patients that maintained a gluten-free diet for this study showed that their ability to absorb zinc had significantly improved. Therefore, it can be concluded that zinc levels rise with a gluten-free diet regardless of zinc supplementation, proving that a completely gluten-free diet is the cure to poor zinc absorption in celiac patients.