Do you know someone who bruises easily? Do the marks develop into dark bluish swellings that hurt and take a long time to go away? If you have celiac disease, perhaps you had this problem before starting the gluten-free diet.
Easy bruising is a type of ecchymosis, or superficial bleeding under the skin or mucous membrane, common in untreated celiacs - and may be the only symptom of celiac disease. While always a sign of an underlying problem, easy bruising in celiac disease results mainly from vitamin K deficiency induced by malabsorption of nutrients. Vitamin K deficiency impairs the body’s normal coagulation process and ability to form a clot in response to bleeding.
Easy bruising must be taken seriously because vitamin K deficiency may become life-threatening, requiring rapid vitamin K medication. The good news is that vitamin K deficiency usually resolves quickly in 2 to 3 weeks on a strict gluten-free diet.
A bruise is normally a flat reddish-purple discoloration or mark that develops from trauma, such as a blow, to soft tissues. It results from damage to underlying capillaries in the skin or mucous membranes. The damaged capillaries leak blood into the skin until the normal clotting mechanism stops it.
Easy bruising in vitamin K deficiency, however, is very different from normal flat discolorations. Light trauma produces large superficial bleeding into subcutaneous tissue, usually with swelling and discomfort. These marks are dark, usually bluish from blood accumulation and do not resolve normally. In addition, easy bleeding affects other parts of the body and may produce easy nosebleeds, bleeding gums, bleeding in the digestive tract presenting as dark or black stool, blood in the urine or bleeding in internal organs such as the ovaries, adrenal glands or the peritoneal cavity (lining of the abdomen). Bleeding in the brain produces sudden stroke.
Newborn infants, born to mothers who are vitamin K deficient, are at high risk for hemorrhage. To prevent this possibility, babies born in hospitals are given a dose of vitamin K before leaving the maternity unit.
Other Causes of Easy Bruising
Older persons are prone to bruising because their capillaries are more easily damaged from trauma. To add to elder problems, the top layer of skin may lose its anchoring so that it slides over the lower dermis in response to stretching or twisting, thus damaging capillaries that then leak. The blood leaks under the skin, causing a flat mark that does not hurt.
Some common medications are prescribed for the purpose of “thinning blood” such as aspirin, Coumadin, Plavix and the fast-acting injection, Heparin. These medications slow the ability of blood to clot so that bleeding from capillary damage takes longer to stop, resulting in easy bruising.
Other possibilities of blood-thinning substances include the overzealous use of some dietary supplements like fish oil, vitamin E and ginkgo. In this case, easy bruising comes from consuming several substances that, when combined, increase the overall effect of impairing normal clotting.
If easy bruising does not resolve on the strict gluten-free diet, your health care provider will look into other causes, such as adverse effects of medications like corticosteroids or other conditions like liver cirrhosis, platelet disorders, or bone marrow disorders that may include cancers like bone tumor, leukemia and multiple myeloma.
What can we do to limit bruising and swelling?
Apply a cold compress or ice pack immediately after injury for 10 minutes on and 10 minutes off. Repeat until swelling or discoloration stops. After the swelling has gone down and the color is changing to green or yellow, apply a warm compress to help the blood resorb faster. It is important not to restart the bleeding with heat.
What can we do to improve our blood’s ability to clot normally on the gluten-free diet?
Eat foods that are rich in vitamin K. We must absorb vitamin K from our diet or from certain bacteria that produce it in our intestinal tract, since we cannot make it from scratch. However, the supply from intestinal bacteria may not be reliable or sufficient to prevent deficiency if there is dysbiosis (unbalance of good and bad bacteria), diarrhea or the colon is diseased.
Fruits and vegetables are best sources of vitamin K in food. These include dark green leafy vegetables, broccoli, cabbage, turnip greens, chick peas, and soybean oil. Seaweed is very rich. Beef and pork are good sources in meat.
Some plant sources are able to strengthen capillary walls. Lemon juice has a long history of preventing bruising and tissue swelling from leaking capillaries. Citrus fruits, in general, are a rich source of bioflavonoids that help prevent easy bruising, including hesperidin, diosmin, and rutin. Another good source of rutin is the vegetable buckwheat (no relation to wheat).
Avoid or limit foods like garlic and ginger, when vitamin K levels are low, as these foods may aggravate bleeding by further impairing the blood’s ability to clot.
------------------------ Author Information: Cleo Libonati, RN, BSN Cleo Libonati is president/CEO and co-Founder of Gluten Free Works, Inc. She is the author of Recognizing Celiac Disease. She can be reached by E-mail.