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How Low B Vitamins can Trigger a Celiac diagnosis and be Mistaken for a Genetic Disease To Whomever May Read This, (Thank you for taking the time to read it and I hope it helps you the way it did me! and if it does tell others....is all I ask)....because I know there are many more fellow sufferers still looking for answers... (because many/most B-Vitamin deficiencies up to 80 percent of the time (especially a Thiamine Deficiency) is going undiagnosed or misdiagnosed in other diseases)....and probably a Riboflavin Deficiency too because they occur together.... Read the blog post and you will see what I mean.... Note: this Posterboy blog post will have 2 portions…. A high level summary and an Appendix/Addendum list of available resources that support these suppositions… Depending on whether you have read the other Posterboy blog post(s) will determine how you want to read this one…. If this is your first then read it all…IF you have read other Posterboy blog posts…then just jump to the Appendix where the references/additional resources are….and all the dirty details... The Posterboy blog post starts now…entitled "How Low B Vitamins can Trigger a Celiac diagnosis and be Mistaken for a Genetic Disease" For a while now (10 to 12+ years now)…..I have been studying B-Vitamins to see what role if any they (B-Vitamins) might have in regulating our Immune System and if they could be the trigger for my GI problems or could have been mistaken for my Celiac disease diagnosis…. Note: I did not say my Celiac disease….but my diagnosis as a Celiac….see Appendix for other possible triggers. I had written two previous articles/Posterboy blog posts one about Thiamine (Beri Beri) aka Vitamin B1 and one about Niacin (Pellagra) aka Vitamin B3. Provided here for easy reference.....if you want to go back and read them sometime... Both play a critical role in our immune system and down regulate inflammation pathways in the body… This Posterboy blog post/article unites the two into an "Elegant Theory" of how and why these occur together in Celiac disease. I had previously done an unpublished article/blog post on Riboflavin….which I might share in the future (but probably not at this point) This Posterboy blog post will serve as the argument (thesis) that Riboflavin deficiency is common in Celiac’s going commonly undiagnosed/misdiagnosed….much like the other B-Vitamin deficiencies of Thiamine (B1) and Niacin (B3) in Celiac’s. I have now found that it is a cascade of all three of these B-Vitamins and maybe 4 (beyond the scope of this blog post Vitamin B6)….. B1, B2, B3 work synergistically together to control inflammation in the body. I found first that Pellagra could be common in Celiac’s going undiagnosed/misdiagnosed…. Then I found that Beri Beri might also be the reason for Celiac’s thin Villi…. SO I had to write about it/that too!.....but no ONE Vitamin/Mineral answered all the questions…. So that made me think I could be wrong about the Pellagra question (in part) at least… IF there is NO SKIN issues IE DH with your Celiac diagnosis then you have NOT YET developed Pellagra…. but more appropriately Pellagra Sine Pellagra…..or Pellagra without skin issues…. And brings me to the point of my current Posterboy blog post. I believe that most Celiac’s have developed Pellagra Sine Pellagra. Now granted they developed Beri Beri FIRST….because B-Vitamin deficiencies NEVER happen alone…. It (Celiac disease) is a sequalae (aftermath) of B-Vitamin deficiencies…and possibly some Minerals like Magnesium and Zinc and Copper etc….(Again beyond the scope of this post) See this Posterboy blog post to see how nutrients (IE Vitamin and Mineral Deficiencies), Genetics and your Environment (STRESS) interact…. To produce disease… So how did I arrive at Pellagra Sine Pellagra instead of Pellagra or Beri Beri (only)…. Because you definitely develop Beri Beri (FIRST)…..why not continue on the Pellagra tack… There is a couple of distinguishing features between the two most notably the level of SKIN involvement…. Pellagra is a very VISUAL disease…..IF you don’t have DH or other Skin problems then you have not yet developed Clinical Pellagra…. But Pellagra Sine Pellagra a Riboflavin deficiency has all the same symptoms of Pellagra without the pervasive skin issues… Make no mistake about it….I had already developed Beri Beri first (horrible fatigue) and Peripheral Neuropathy etc…. They typically occur together…..because as noted earlier B-Vitamin deficiencies don’t occur alone… ONE will affect the others… And why I landed on B2 (Riboflavin) instead of B3 (Niacin)…. The 2nd clue was the pervasive Iron deficiency issues most Celiac’s develop. Is Notable that Iron Deficient Anemia aka IDA is very common in Celiac’s… And people have forgotten how Riboflavin aka Vitamin B2 plays an important role in Iron deficient anemia… https://pubmed.ncbi.nlm.nih.gov/31318024/ Riboflavin deficiency individuals often have fertility problems as well… I too had these same problems that got better after Riboflavin supplementation… Riboflavin again aka Vitamin B2 can cause people to have Hypothyroid problems…..which again was me three…. got better after Riboflavin supplementation… Reason number 4) Anxiety can be the first sign of a Riboflavin deficiency check that one off too! Reason number 5) Riboflavin is the trigger for a Homocysteine problem…..commonly diagnosed as MTHFR Gene defect…. https://chrismasterjohnphd.com/blog/2019/02/26/mthfr-just-riboflavin-deficiency/ Check, Check, Check, Check, Check….I had all the signs of a Riboflavin deficiency and the doctor’s missed them ALL! Not to mention the hallmark angular cheilitis (Leaky Lips) for years…..and the doctor could only recommend for/to me was to stop leaking my lips sooooooo much! ALL this symptom’s and more got better after supplementing with Riboflavin…. SO that is why I know Pellagra Sine Pellagra happened to me and is also happening in other Celiac’s going undiagnosed/Misdiagnosed. The Iron Deficient Anemia…..can be treated (in many if not most cases) with either/by treating your Low Stomach Acid or by taking Riboflavin and/or Copper. See this research entitled “Is achlorhydria (No Stomach Acid) an (independent) cause of iron deficiency anemia” https://pubmed.ncbi.nlm.nih.gov/25994564/ The answer was a resounding yes! So, I had developed low/NO stomach acid as the trigger for my Celiac/NCGS diagnosis… AND just what another intrepid research discovered/studied 35+ years ago and was promptly forgot and never believed….the more things change…the more they stay the same! See this research entitled “Gastric morphology and function in dermatitis herpetiformis (DH) and in Celiac disease” https://www.ncbi.nlm.nih.gov/pubmed/3992169 That should be the end of the discussion…..but It won't be....while their patients suffer...they will do more studies about it! Quoting the whole abstract for emphasis! Abstract “Gastric acid secretory capacity was evaluated in 116 patients with dermatitis herpetiformis by means of the pentagastrin test. Endoscopic gastric mucosal biopsy specimens were obtained from both the body and the antrum in 90 of them. Forty-eight patients (41%) had a maximal acid output less than 10 mmol/h, and 30 of them (26%) were achlorhydric. T he frequency of achlorhydria increased with age, and 27 out of 58 patients (47%) more than 50 years old were achlorhydric. Antrum-sparing chronic atrophic gastritis was present in 92% of the achlorhydric patients, and hypergastrinaemia and serum parietal cell antibodies were found in most of them. The prevalence of chronic gastritis of the body and of the antrum increased with age. There was no correlation between atrophic gastritis or achlorhydria and small-intestinal villous atrophy, the results of the D-xylose test, and blood folate and serum zinc determinations. The transferrin saturation index was lower in patients with achlorhydria. The frequency of achlorhydria was significantly higher in patients with dermatitis herpetiformis than in 69 patients with celiac disease.” Note: 90+ percent of Celiac’s have NO stomach acid (at all)….this is not counting the percent of Celiac’s where just Low in Stomach acid….mind you This was not in NCGS but a study of Celiac’s who were already diagnosed as Celiac’s…. But EVEN this is not enough to get some people to believe!!!! The research is out there…..this is a Classic example of Co-Morbidity….IE a Sequelae of one condition triggering the other! The aftermath of B-Vitamin and Mineral deficiencies of Zinc, Magnesium, B1 (Thiamine), B2 (Riboflavin), B3 (Niacin) and possibly Copper is being diagnosed as NCGS and/or as Celiac disease diagnosis IMHO! It is my hope by sharing this old research rediscovered that at least ONE other person will believe me (YOU) and be helped! Use a Celiac disease diagnosis as the way back. . . . not the end of the road for your health but the beginning of your way back to health! As the I have the Lord being my help! As I am fond of saying “To Educate is to truly free!” Where there is a free exchange of knowledge there is health and peace for one’s soul and body! So, what can I do NOW about this know that I know B-Vitamins might help my Celiac diagnosis? There is “No Formula” but this is the best advice I can offer you. Take a B-Complex AND a Benfotiamine (Fat Soluble B-1) or other Fat Soluble B-1s like AlliThiamine or Lipothiamine (harder to find) AND a Magnesium Citrate (with meals) or Magnesium Glycinate (anytime) 2x to 3x a day (with meals) for 3 to 6 months. (IF you are not taking an acid reducer like a PPI or H2 Blocker (better of the two kind with less long term side effects) ) you will begin to burp continuously even up to 2 hours after you have finished your meal….. and between meals with the smallest snack… producing the biggest BURPS you have had in years, and years. Don’t stop for at least 6 months….don’t stop taking them when you begin burping (again without bloating/gas distension) BUT continue for 6 months till BURPING without these other symptom’s and a regular movement will become your new normal. You are now again digesting proteins in your diet triggering a food allergy. What I didn’t know at the time was that Pellagra is a “Capstone” diagnosis and not the “Cornerstone” disease. Pellagra is definitely happening in Celiac’s because Tryptophan has been shown the ability to be a therapeutic for Celiac’s. See this research about it… https://www.eurekalert.org/pub_releases/2020-10/aaft-tri101920.php Here is another article about the same research indicating Tryptophan as Therapeutic treatment for Celiac’s… https://www.news-medical.net/news/20201023/Intestinal-microbiota-offers-new-prospects-for-treating-celiac-disease.aspx Confirming that when you develop “Leaky Gut Syndrome(s)” you have developed Pellagra. But Pellagra does not happen alone and is not the trigger….it is the combination of multiple B-Vitamin deficiencies beginning with Low Thiamine (B1), then Low B2 (Riboflavin) and finally Low Niacin (B3) aka Niacinamide presenting as DH in Celiac’s… I did not develop Pellagra but Sine Pellagra instead! Note: as to not overpower the reader (you) with too much information see addendum/appendix for more reference’s resource where you can read to your Heart’s content (as much) or as little as you need to help you understand these “Lost Connections” explaining how the Chicken came before the Egg (Diagnosis). First you develop Low B-Vitamin deficiencies (IE Thiamine deficiency or undiagnosed Beri Beri) THEN your Villi Thin and THEN you develop Pellagra Sine Pellagra a Riboflavin deficiency leading (in time) finally to a/your Celiac diagnosis! Also Note: SIBO and Cows Milk Protein IE Casein (not Lactose as is commonly believed) might also be a problem for you. See the Appendix for more details. 2 Timothy 2: 7 “Consider what I say; and the Lord give thee understanding in all things” this included. I hope this is helpful but it is not medical advice. Posterboy by the Grace of God, ADDENDUM/Appendix Resources Thiamine the Overlooked Vitamin That Improves Autoimmune Disease And Autonomic Dysfunction https://awaken.com/2021/02/the-overlooked-vitamin-that-improves-autoimmune-disease-and-autonomic-dysfunction/ The issues/symptoms of a Thiamine deficiency hide in other diseases…. It is only suspected (tested) for in diseases with high clinical suspicion such as Alcoholics and Anorexic’s etc…. Also here is a nice overview of how to recognize a Thiamine deficiency… https://healthprep.com/articles/fitness-nutrition/guide-symptoms-thiamine-deficiency/#:~:text=Weight loss may occur in a thiamine deficiency,individuals called AMP-activated protein kinase (AMPK) becomes impaired. Here is the best thread on a Thiamine deficiency and its many presentations/faces/symptoms on Celiac.com for more resources on Beri Beri in GI diseases like Celiac disease and IBS etc. Recently Celiac.com wrote an article linking AnitGAD antibodies to Celiac disease. So that set me out to see if there was a link between Gluten Ataxia and AntiGAD antibodies…. And it turns out AntiGAD antibodies are diagnostic confirmation of a Thiamine deficiency in Celiac’s manifesting themselves as Gluten Ataxia… See this research that explains the connection… entilted “Wernicke's encephalopathy: an excitotoxicity hypothesis” https://pubmed.ncbi.nlm.nih.gov/9346467/ This confirms exactly what is happening in other GI diseases like UC and Chrons. See this research entitled "Wernicke Encephalopathy in Crohn's disease and Ulcerative Colitis" https://www.sciencedirect.com/science/article/pii/S0899900721000447 AS if often the case in WE the treatment is too little too late….let's not let the same thing apply/happen to Celiac disease patients too! IF the research on UC and Chrons’ is to be believed Low Thiamine level’s can be a predictor of disease severity and recovery. NOW a similar study needs to be done to confirm my many years of research proving once and for all…. A Thiamine deficiency is the trigger for Thin Villi! Note: The Hormones Matter website is the best Thiamine resource on the web….and EON Health is a close second. Zonulin a Marker for Niacin deficiency Links/Resources https://alobar.livejournal.com/2930798.html#%2F2930798.html Dietary Tryptophan Enhanced the Expression of Tight Junction Protein ZO-1 in Intestine: Trp enhanced tight junction protein ZO-1… https://www.researchgate.net/publication/312962348_Dietary_Tryptophan_Enhanced_the_Expression_of_Tight_Junction_Protein_ZO-1_in_Intestine_Trp_enhanced_tight_junction_protein_ZO-1 Dietary l-tryptophan alleviated LPS-induced intestinal barrier injury by regulating tight junctions in a Caco-2 cell monolayer model https://pubmed.ncbi.nlm.nih.gov/30977499/ Intestinal permeability IE Leaky Gut and oxidative stress in patients with alcoholic pellagra (reversed with Niacinamide) https://pubmed.ncbi.nlm.nih.gov/16713031/ Which is what the latest research confirms Tryptophan can be used in Celiac’s to heal Villi https://www.news-medical.net/news/20201022/Tryptophan-found-in-turkeys-can-accelerate-intestinal-healing-in-people-with-celiac-disease.aspx Does Going Gluten Free Provide Relief or All Celiacs? The answer is NO! https://medicalxpress.com/news/2021-02-gluten-free-diets-cure-all-celiac-disease.html And why I recommended B-Vitamins as an adjunct treatment for Co-Morbidities that happen in Celiac’s. This a complimentary approach. See this Posterboy blog post that discusses the B-Vitamins that might help treat a Celiac diagnosis About 40 pct of Celiacs are NOT helped when they go gluten free. This is about what else someone can do that is still triggering Villi blunting when eating gluten fee is not enough to heal your Villi??? Three or four of the most common triggers (IMO) for continued GI inflammation (Issues) in IMO are Milk (Cows’ Milk Protein) aka CMP in the literature. See this great Celiac.com article about how Milk in peoples diet can also trigger Villi Blunting… A reaction to Cows Milk Protein (Casein) can happen in up to 40 percent of Celiac’s… See this nice study on the issue of Caseins’ also triggering an Immune response in Celiac’s Entitled “IgA anti-gliadin antibody immunoreactivity to food proteins IE Cows Milk Proteins” https://www.tandfonline.com/doi/full/10.1080/09540100400003204 You can just read the abstract and not surprising it is 15+ years old and only recently Celiac.com did an article on it….. people can’t wait another 15 years for the medical community to pick up on this connection and why I am writing this blog post NOW! 2) SIBO can happen in the Majority of Celiac’s Note: This study is about SIBO happening in Celiac’s already treated with a gluten free diet. Almost 2/3 of Celiac’s symptoms got better after treating their underlying causes for a Celiac diagnosis such as SIBO in this study. 3) B-Vitamins that become low when one has SIBO You will find this a common theme…..after treating Celiac disease…..continued symptoms continued until the underlying cause(s) like SIBO, Cows Milk, Low/NO stomach acid or Medicines keep triggering Villi blunting… I can only tell you it helped me to treat my underlying cause’s like Low Stomach Acid and my B-Vitamin deficiencies going undiagnosed as part of Celiac disease diagnosis. See this new research that verify this fact from 2020 just a year old…from Chicago University https://medicalxpress.com/news/2020-02-mouse-celiac-disease-treatments.html Where they note quoting “Even while maintaining a strict gluten-free diet, 40% of celiac disease patients still show signs of inflammation and villous atrophy, or damage to the villi, the small, finger-like protrusions in the small intestine that help absorb nutrients. Therefore, treatments that can reverse or prevent the disease are greatly needed to improve quality of life for people with celiac.” Tryptophan can do that. So can B1 (Thiamine), B2 (Riboflavin) and B3 (Niacin) if you can believe the latest research on this topic. Some of it is 15 or 20 years old now….and doctors are not aware of this groundbreaking research. 4) Low/NO Stomach Acid See this research discovered 30+ years ago entitled “Gastric morphology and function in dermatitis herpetiformis (DH) and in Celiac disease” https://www.ncbi.nlm.nih.gov/pubmed/3992169 Celiac’s are suffering now and can’t wait another 10 or 15 years before they rediscover this research on their own! I wrote a Posterboy blog post about this too about how Low/NO Stomach acid could be the trigger for a subsequent Non Celiac Gluten Sensitivity diagnosis aka NCGS ….but few people seemed to understand it… Recently PPIs use has shown to trigger a Celiac diagnosis…..and yet nonchalantly this research is minimized…. among other medicines that can also trigger Villi Blunting (Atrophy) with use… See this Celiac.com thread about it…how PPIs, NSAIDS and SSRIs use were found to be associated with Villi Atrophy and subsequent Celiac diagnosis. See also this thread about how some Blood Pressure Medicine might blunt your Villi…. Back to the discussion at hand….how Zonulin can be a biological marker for a Niacin deficiency… This is important because Niacin is used in Stomach Acid production…. Zonulin as a marker for a (Low) Niacin levels aka Deficiency confirms IMHO a metabolic trigger for Pellagra going undiagnosed in Celiac disease. The IJCD noted this association of Pellagra in Celiac’s in 2015…..where they noted the majority or 58 percent approximately of Celiac’s would be Co-Morbid with their Celiac disease. It just nobody has followed up on these associations…..because you can’t see Pellagra in people until Skin Rashes develop….. by then DH has been diagnosed as a symptom of Celiac disease and by then you are too late! Doctors can’t see how these two diseases are connected but researchers can……. and fellow sufferers who have suffered at the hands of Doctor’s ignorance of the 4 Ds of Pellagra…. They get a D+ on recognizing Pellagra, Beri and Beri and Pellagra Sine Pellagra in Celiac disease today! IT is no one’s fault….IT is the process. There are not good B-Vitamin tests to determine the status of B-Vitamin deficiencies in Celiac’s and other GI patients. The FIRST good study about this is the link I noted above that confirmed the SEVERITY of the Thiamine deficiency IE Beri Beri predicted the SEVERITY of UC and Chron’s patients! Provided here again for easy reference… See this research entitled "Wernicke Encephalopathy in Crohn's disease and Ulcerative Colitis" https://www.sciencedirect.com/science/article/pii/S0899900721000447 Why would we not think it would be the same for Celiac disease! And IF the research is to be believed low Zonulin levels are an indicator of Low Niacin levels aka Pellagra in it’s most severe presentation of perfuse Skin Lesions….being diagnosed as DH today! ETA: Found only this month (week) while writing this article/blog post Very recent research Circa 2021 also confirmed that eating gluten free alone does not heal all Celiac’s making supplementation with B-Vitamins (IMHO) and Magnesium, in part, an essential treatment for those suffering from inflammation not due to gluten! See this research entitled “Do gluten-free diets provide a cure-all for celiac disease” and the answer is unequivocally NO… In a subset of Celiac’s. https://medicalxpress.com/news/2021-02-gluten-free-diets-cure-all-celiac-disease.html Quoting their conclusion(s) A significant number of patients previously thought to be well-treated by a gluten-free diet may in fact require additional interventions to fully curb their gut inflammation. Don’t be surprised if takes another 10 or 15+ years of “more study” to confirm these findings! Each generation much pass on their knowledge to the next….or it soon becomes lost again… This is my humble attempt to pass on that knowledge. To quote Isaac Newton “I do not know what I may appear to the world, but to myself I seem to have been only like a boy playing on the seashore, and diverting myself in now and then finding a smoother pebble or a prettier shell than ordinary, whilst the great ocean of truth lay all undiscovered before me.” — Isaac Newton I did this first for myself…..with the hope that it might help others someday. 3 Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort; 4 Who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble, by the comfort wherewith we ourselves are comforted of God. It is my sincerest hope that I was able to throw a few “Starfish” back. But I fear I have not helped enough! http://www.starrbrite.com/starfish.html The Starfish Story Original Story by: Loren Eisley "One day a man was walking along the beach when he noticed a boy picking something up and gently throwing it into the ocean. Approaching the boy, he asked, What are you doing? The youth replied, Throwing starfish back into the ocean. The surf is up and the tide is going out. If I don’t throw them back, they’ll die. Son, the man said, don’t you realize there are miles and miles of beach and hundreds of starfish? You can’t make a difference! After listening politely, the boy bent down, picked up another starfish, and threw it back into the surf. Then, smiling at the man, he said I made a difference for that one!" Part 4 Additional Resources Is COVID 19 primarily a GI disease first See this research entitled “Severe COVID19 Is Fueled by Disrupted Gut Barrier Integrity” https://www.medrxiv.org/content/10.1101/2020.11.13.20231209v1.full Is “Leaky Gut Syndrome” a sign of Vitamin/Mineral deficiency See this research entitled “Regulation of the intestinal barrier by nutrients (Nutrition): The role of tight junctions” https://onlinelibrary.wiley.com/doi/10.1111/asj.13357 And this one entitled Intestinal permeability and oxidative stress in patients with alcoholic pellagra https://pubmed.ncbi.nlm.nih.gov/16713031/ See also the is Live Journal article about how Zonulin can be a “Marker for Niacin Issues”….IE is Zonulin a sign of Pellagra going undiagnosed or Misdiagnosed as Celiac disease today! https://alobar.livejournal.com/2930798.html#/2930798.html I can also recommend this blog post on Zinc deficiency by Blue Sky