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Itchy (Pruritic) Skin  

tongue in B12 deficiencyWhat Is Beefy Red, Smooth, Burning Tongue?

B eefy, red, smooth, burning tongue is an inflammatory alteration in tongue tissue characteristic of vitamin B12 deficiency.

Inflammation makes the tongue red and sore which, when untreated, progresses to atrophied papillae (shrunken taste buds) that makes the tongue smooth.

Q: Why does vitamin B12 alter the tongue?

A: Vitamin B12 is essential for the metabolism of all cells, especially for those of the digestive tract of which the tongue is an organ.1

These easily seen changes to tongue tissue are an important diagnostic feature of deficient vitamin B12, which causes other devastating unseen damage, because the discomfort generally causes the individual to seek medical care.

What Is Beefy Red, Smooth, Burning Tongue In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]

Bleeding, Occult Gastrointestinal

Erosions Of The Esophagus Can Be A Cause Of Gastrointestinal Bleeding.
Erosions Resulting From Esophagitis Can Be A Cause Of Gastrointestinal Bleeding.

What Is Occult Gastrointestinal Bleeding?

Occult gastrointestinal bleeding is characterized by unseen or minute quantities of blood in stool. The origin of bleeding is from mucosa that lines the inside of the digestive tract at a site that must be found by medical testing and procedures to look at the lining.

Q: What tests and procedures are performed to locate the bleeding?

A: The simplest test to discover blood that cannot be seen is the stool test. This consists of a card with 3 spaces for 3 separate  stool collection over 3 separate days. A tiny smear of stool is placed on a test card space on each of three days. Then the card is examined for a reaction that indicates the existence of blood in the stool.

If the stool test is positive, the origin of bleeding must be located. This search requires certain procedures that look at the mucosal lining directly by a gastroenterologist, usually under light sedation.

  • Gastroscopy procedure can visualize the upper gastrointestinal tract, which includes the esophagus and stomach.
  • Endoscopy procedure can also visualize the upper small intestine. However, endoscopy procedure is limited in that it cannot visualize the middle small intestine (jejunum).
  • Colonoscopy can visualize the end of the small intestine and colon all the way to the rectum.
  • Capsule endoscopy procedure.  If  gastroendoscopy and colonoscopy fail to discover the source of bleeding, the physician may administer a capsule endoscopy which visualizes the entire gastrointestinal tract. In this procedure, the patient swallows a capsule size camera (encased) which takes constant pictures over the course of a day until expelled through the rectum.  Of course, the patient must be able to swallow the large size capsule.

What Is Occult Gastrointestinal Bleeding In Celiac Disease and/or Gluten Sensitivity?

Cutaneous Vasculitis 

Heart showing dilated cardiomyopathy at autopsy. Courtesy
Enlarged heart showing dilated cardiomyopathy at autopsy. 

What Is Idiopathic Dilated Cardiomyopathy?

I diopathic dilated cardiomyopathy (IDCM) is a disorder of myocardial (heart muscle) function characterized by dilation or enlargement of the cardiac chambers and reduction in the ability of the ventricles (lower chambers) to contract with the required force needed to pump blood out of the heart to the body.

Idiopathic means the cause is not known.

Q: What is the prognosis for idiopathic dilated cardiomyopathy?

A: This disorder often results in symptomatic heart failure due to the inability of the heart to pump blood as required to supply the body with oxygen and meet metabolic needs.

What Is Idiopathic Dilated Cardiomyopathy In Celiac Disease and/or Gluten Sensitivity?

Pityriasis Rubra Pilaris

Vitamin C Deficiency: Clean Teeth with Swollen Gums.
Vitamin C Deficiency: Swollen Gums.

What Are Bleeding / Swollen Gums?

B leeding and/or swollen gums is  an inflammatory disorder characterized by changes in gum integrity that may result in tooth loss.

Sponginess of the gum (swelling) indicates inflammation, called gingivitis. 

Q: What causes gingivitis?

A: Gingivitis that is caused by inadequate dental hygiene shows as pockets of swollen gum between or along the base of teeth where sticky plaque was allowed to build up. Plaque holds bacteria that inflames the gums where it occurs.

Gingivitis that is caused by vitamin C deficiency, pregnancy, certain drugs such as the anti-epileptic drug phenytoin, and leukemia affects the whole gum irrespective of mouth care.

What Are Bleeding / Swollen Gums In Celiac Disease and/or Gluten Sensitivity?

Melanoma

Enamel_celiac[1]What Are Dental Enamel Defects?

D ental enamel defects (DED) comprise a variety of abnormalities in the dental enamel of the second or permanent teeth and of primary or baby teeth.

Teeth may appear with pits, thin or missing enamel, non-white enamel (yellow, orange, or gray colored teeth), and demarcated opacities (very white spots) even if teeth are white.

Q: What is enamel?

A: Dental enamel is the shiny, hard, white, dense, inorganic substance covering the crowns of the teeth. The crown is the tooth portion above the gum. Under the enamel is hard dentin which surround the living pulp. In teeth with missing enamel, the areas with exposed dentin appear dull and tan colored.

What Are Dental Enamel Defects In Celiac Disease and/or Gluten Sensitivity?

Ichthyosis, Acquired  

cheilosisWhat Is Cheilosis?

C heilosis is a painful feature of nutritional deficiencies, especially riboflavin and/or pyridoxine deficiency, and less frequently, from vitamin B12, folic acid, and iron. It is characterized by redness of the lips with cracking and weeping in the corner of the mouth.

Q: What is the consequence of weeping at the corners of the mouth?

A: The open sores that develop at the corners of the mouth invite infection by candida albicans, a yeast organism, and less commonly by bacteria normally present on the skin such as staphylococcus aureus.

These sores make opening the mouth very painful and so restrict eating, talking, socializing, and dental care.

What Is Cheilosis In Celiac Disease and/or Gluten Sensitivity?

Hangnail

Aphthous_ulcer[1]What Are Aphthous Ulcers?

A phthous ulcers, also called canker sores, are a chronic disorder of soft mouth tissue characterized by small, painful purpuric, papular, or erosive lesions that are often surrounded by erythematous (red) margins.1

Q: What soft mouth tissues develop canker sores?

A: Canker sores can erupt on the mucosal surface of the inside lip, sides of mouth, under the tongue and along the side of the tongue. When they are forming, the area swells into a papule, or small bump. Later, the surface erodes and a crater forms with firm pus.

What Are Aphthous Ulcers In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Lahteenoja H, Toivanen A, Viander M, Maki M, Irjala K, Raiha I, Syrjanen S. Oral mucosal changes in coeliac patients on a gluten-free diet. European Journal of Oral Sciences. Oct 1998;106(5):899,8p. [↩]

Follicular Hyperkeratosis (goose flesh or corkscrew hair)

increased appetite gluten celiac symptomWhat Is Increased Appetite?

I ncreased appetite is the increased desire for food.

Q: What causes appetite.

A: Appetite is caused by hunger.

The brain monitors nutritional needs and employs a hunger mechanism to alert us when fresh food is needed. Hunger is mainly caused by the need for protein. Low blood sugar also triggers hunger.

The tempting sight, smell, taste and expectation of food stimulates involuntary sensory nerves. By reflex action, these sensory nerves cause muscle and sensory activity in various digestive organs. Salivary glands in the mouth begin to secrete saliva as stomach glands and muscles become active.1

What Is Increased Appetite In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Cleo Libonati. Recognizing Celiac Disease. Gluten Free Works Publishing, Fort Washington, PA 19034 USA [↩]

Erythema Nodosum 

anorexia nervosa celiac disease gluten symptomWhat Is Anorexia?

A norexia or loss of appetite is a reduced desire to eat which can cause unintentional weight loss.

Anorexia is a feature of many disorders caused by malutrition such as celiac disease and aging or gastrointestinal problems such as chronic gastroenteritis, and dysgeusia (loss of taste).

Q: Are there other conditions that cause anorexia?

A: Other underlying problem include medication side effects, infection, chronic pain, depression, grief, dehydration, hormonal dysfunction such as thyroid disease, primary hyperparathyroidism, or Addison’s disease, autoimmune mechanisms such as sarcoidosis,  and cancer growth.

What Is Anorexia In Celiac Disease and/or Gluten Sensitivity?

Erythema Elevatum Diutinum (EED)

unexpected weight loss celiac disease symptomWhat Is Unexpected Weight Loss?

U nexpected weight loss is unintentional loss of body mass composition or inability to gain weight marked by decreased serum proteins and increased stool fat.1

What Is Unexpected Weight Loss In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]