Low Plasma Proteins

What Are Low Plasma Proteins?

[dropcap]L[/dropcap]ow plasma proteins found in blood indicates an abnormal blood level.

Plasma proteins are any of the proteins that constitute about 6% to 7% of the blood plasma in the body. They include albumin, fibrinogen, prothrombin, and the gamma globulins. All plasma proteins except the gamma globulins are produced in the liver.¹

Q: Which protein is most abundant in blood?

A: Of the dozens of plasma proteins, albumin makes up more than half. Albumin level is the most frequently tested in the presence of weight loss and other signs of poor nutrition. Albumin helps maintain water balance that affects osmotic pressure, increase blood viscosity, and helps maintain blood pressure.¹

Other commonly tested blood proteins are globulins which make up about a third of plasma proteins. Lab reports show the ratio between albumin and globulin, as well as, their individual values. Fibrinogen, essential for clot formation, makes 7% of plasma proteins while regulatory proteins, which include enzymes and hormones, make up 1%.

What Are Low Plasma Proteins In Celiac Disease and/or Gluten Sensitivity?

• Relationship between low plasma protein levels and celiac disease. Low plasma protein levels are a classic feature of malabsorption in untreated celiac disease.

• Relationship between low plasma protein levels and malabsorption. Low plasma proteins are symptomatic of malabsorption characterized by low albumin, transferrin, transthyretin, and retinol-binding protein levels.

• Relationship between low plasma protein levels and low albumin levels. Low albumin levels (>35g/dl) with half-life of 3 weeks affect maintenance of osmotic pressure in blood vessels and performance as a carrier for many substances in the blood.²

• Relationship between low plasma protein levels and intestinal damage. Low albumin has a high predictive value for the identification of patients with intestinal damage and low predictive value as a marker of absent intestinal damage.³

• Relationship between low plasma protein levels and gluten free diet. Serum proteins and albumin values at diagnosis of celiac disease were shown to rise significantly during the year of gluten free diet.⁴

How Prevalent Are Low Plasma Proteins In Celiac Disease and/or Gluten Sensitivity?

Low plasma protein levels are a common serology result in untreated patients with celiac disease.⁵

What Are The Symptoms Of Low Plasma Proteins?

• Low plasma protein levels are marked by fluid retention and malnutrition including muscle wasting, weakness, poor muscle tone, fatigue, and dermatitis.²

• Muehrcke’s lines are specific for hypoalbuminemia (low albumin). Muehrcke’s lines are pairs of transverse white lines that extend all the way across the nail with pink in between them. The lines represent an abnormality of the vascular nail bed and disappear while the nail is depressed and blood is squeezed from the vessels beneath the nail. Because the lesion is in the nail bed, it does not move with nail growth.⁶

How Do Low Plasma Proteins In Celiac Disease and/or Gluten Sensitivity Develop?

• Low plasma protein levels result from protein maldigestion and malabsorption in celiac disease.
• As a consequence of low stomach acid.
• Albumin is made by the liver according to available protein from the diet absorbed as amino acids, the building blocks of protein.

Do Low Plasma Proteins Respond To Gluten-Free Diet?

Yes. Celiac disease-related low plasma protein levels quickly respond to a strict gluten free diet containing adequate protein. Their levels depend on continued dietary compliance.³

6 Steps To Improve Low Plasma Proteins In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both blood proteins and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁷
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁸
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁸
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁸.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁸
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁸
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁸[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain medications cause protein deficiency that leads to low plasma proteins.  Ask your doctor or pharmacist about this possible adverse effect. Do not stop prescribed medications without supervision.

 This is not a complete listing.

•  Alka Seltzer®, Baking Soda deplete Proteins.

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Low Plasma Proteins In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Celiac Disease: Presentation of 109 Children.” In this study, clinical and laboratory features of 109 patients with celiac disease were retrospectively evaluated to determine presentation and manifestations. Of 109 patients with celiac disease, 66 (60.6%) were classical type, 41 (37.6%) were atypical type and 2 (1.8%) were silent type. The mean age was 8.81 ± 4.63 years and the most common symptom was diarrhea (53.2%) followed by failure to thrive, short stature, and abdominal pain. Paleness (40.4%), underweight (34.8%), and short stature (31.2%) were the most common findings.

Iron deficiency anemia (81.6%), zinc deficiency (64.1%), prolonged prothrombin time (35.8%), and elevated transaminase levels (24.7%) were the most common laboratory findings. Eight percent of patients had at least 1 autoantibody, and 28 of 52 patients had low BMD. Four of 38 patients had abnormalty in electroencephalograms. The prevalance of selective immunoglobulin (Ig) A deficiency was 9.1%. Histocompatibility antigen HLA-DQ and/or DQ8 genotypes were found in 91% of patients. Abdominal distention, iron deficiency, prolonged prothrombin time, hypoalbuminemia, and elevated transaminase levels were more significantly frequent in the classical type than atypical type.⁹

“Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage.” This study reporting data on long-term control of celiac disease and its correlates demonstrated that celiac disease is often poorly controlled in the majority of patients on long-term treatment with a Gluten Free Diet due to lack of adherence to strict gluten free diet. Intestinal damage at follow-up was absent in only 43.6% and EMA were present in the serum of 24.9%.

In patients with noncontrolled celiac disease, albumin protein level in long-term treatment was low and/or lower than pretreatment and correlated with the presence of intestinal damage.¹⁰

“Low plasma cholesterol: a correlate of nondiagnosed celiac disease in adults with hypochromic anemia.” This study defining the correlates of celiac disease in 100 anemic adults without overt malabsorption demonstrated that patients with hypochromic anemia had significant albumin difference (-9.4%) compared to celiac disease patients without anemia.¹¹

“Restoration of body composition in celiac children after one year of gluten-free diet.” This study evaluating effect of gluten-free diet by anthropometric, biochemical, and bone densitometric assessment performed in 23 celiac children aged 1 to 12 years at diagnosis and one year after gluten free diet demonstrated that a year of gluten free diet allows virtually complete return in body mass composition. At diagnosis, the patients had height, arm muscle triceps, skin folds, subscapular skin folds, fat area index, and bone mineral content significantly lower than controls. Serum proteins and albumin values rose significantly during the year of gluten free diet.¹²

CASE REPORT SUMMARIES

“Large-droplet liver steatosis in celiac disease.” This case report of a 25 year old woman with swelling of the lower limbs documents development of serious diffuse large droplet steatosis as a result of malnutrition due to unrecognized celiac disease later confirmed by small bowel biopsy finding of total villus atrophy. Albumin, prothrombin time, and trace elements normalized with gradual improvement in amino transferase levels on gluten free diet.¹³

Sources:

1. Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier. [↩] [↩]
2. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩] [↩]
3. Ciacci C, Cirillo M, Cavallaro R, Mazzacca G. Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion. 2002;66(3):178-85. [↩] [↩]
4. Rea F, Polito C, Marotta A, et al. Restoration of body composition in celiac children after one year of gluten-free diet. Journal of Pediatric Gastroenterology and Nutrition. Nov 1996;23(4):408-12. [↩]
5. National Institutes of Health, “National Institutes of Health Consensus Development Conference Statement, Celiac Disease,” August 9, 2004; 1-14. [↩]
6. Fawcett RS and Linford S. Nail Abnormalities: Clues to Systemic Disease. Am Fam Physician. 2004 Mar 15;69(6):1417-1424. [↩]
7. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
8. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
9. Zarife Kulo Z et al. Celiac Disease: Presentation of 109 Children. Yonsei Med J. 2009 October 31; 50(5): 617–623. [↩]
10. Ciacci C, Cirillo M, Cavallaro R, Mazzacca G. Long-term follow-up of celiac adults on gluten-free diet: prevalence and correlates of intestinal damage. Digestion. 2002;66(3):178-85. [↩]
11. Ciacci C, Cirillo M, Giorgetti G, et al. Low plasma cholesterol: a correlate of nondiagnosed celiac disease in adults with hypochromic anemia. American Journal of Gastroenterology. Jul 1999;94(7):1888-91. [↩]
12. Rea F, Polito C, Marotta A, et al. Restoration of body composition in celiac children after one year of gluten-free diet. Journal of Pediatric Gastroenterology and Nutrition. Nov 1996;23(4):408-12. [↩]
13. Husova L, Senkyrik M, Lata J, et al. Large-droplet liver steatosis in celiac disease. Vnitrni Lekarstvi. Mar 2004;50(3):244-8. [↩]