Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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What Is Idiopathic Hypoparathyroidism?
Idiopathic hypoparathyroidism is a metabolic condition that results from reduced secretion or impaired action of parathyroid hormone (PTH) which results in a combination of low calcium and elevated phosphorus levels in the body.
Calcium and phosphorus are minerals that act in opposition to each other in the body. Idiopathic means the cause is not known.
Parathyroid hormone is produced by the four pea sized parathyroid glands that are located on the thyroid gland in the front of the neck. Partly because the thyroid and parathyroid glands share the same anatomic place in the body and partly because they have similar names, they are often confused although they have completely different actions.
Q: What does parathyroid hormone do in the body?
A: This vital hormone maintains a correct balance of calcium and phosphorous in the bloodstream and ultimately has an effect on all organs because of the complexity of intracellular calcium physiology.1
Parathyroid hormone is required to sustain life, therefore undetected or misdiagnosed hypoparathyroidism may pose a significant threat to health outcomes, as its presence may increase disease and mortality in affected individuals.
The clinical consequences of parathyroid hormone deficiency or impaired receptor action involve many body functions. In some patients, however, its manifestation may be non-specific, and in these cases the correct diagnosis may be easily missed.
Digestive manifestations of hypoparathyroidism are few and consist mainly of steatorrhea due to insufficient meal-stimulated cholecystokinin secretion by the duodenal mucosa.2
Laboratory measurements show hypocalcemia (low blood calcium level), hyperphosphatemia (high blood phosphate level), and inappropriately low or undetectable parathyroid hormone levels. Treatment consists of oral calcium supplementation and vitamin D derivatives.3
Idiopathic hypoparathyroidism is rare, although there is a growing incidence of the autoimmune form of hypoparathyroidism, which may occur in combination with other autoimmune diseases such as celiac disease.
What Is Idiopathic Hypoparathyroidism In Celiac Disease and/or Gluten Sensitivity?
- Idiopathic hypoparathyroidism is both an atypical sign and an associated disorder of celiac disease.
- The parathyroid glands are the main regulator of plasma calcium and have a direct influence on the digestive tract. The main manifestation of hypoparathyroidism is steatorrhea due to a deficit in exocrine pancreas secretion. The association with celiac sprue may contribute to malabsorption.4
- Alternately, there may be shared determinants of susceptibility or perhaps a direct immunological relationship. In such patients, both gluten free diet and correction of the hypoparathyroid state may be necessary to correct malabsorption.5
- The performance of intestinal biopsy in evaluating malabsorption is very important for correct treatment of idiopathic hypoparathyroidism.6
How Prevalent Is Idiopathic Hypoparathyroidism In Celiac Disease and/or Gluten Sensitivity?
- Documentation shows idiopathic hypoparathyroidism occurs in celiac disease, but is rare.7
What Are The Symptoms Of Idiopathic Hypoparathyroidism In Celiac Disease and/or Gluten Sensitivity?
Idiopathic hypoparathyroidism is marked these symptoms, mostly owing to inadequate calcium:
- Wheezing.
- Mood changes.
- Urinary frequency.
- Lassitude/fatigue.
- Nervous hyperexcitability.
- Paresthesias (numbness especially in hands and feet).
- Muscle cramps.
- Carpalpedal spasms.
- Chronic tetany.
- Hyperreflexia.
- Convulsions.
- Cataract.
- Weakened tooth enamel.
- Brittle nails.
- Basal ganglia calcifications in the brain that cause Parkinson-like symptoms.8
How Does Idiopathic Hypoparathyroidism Develop In Celiac Disease and/or Gluten Sensitivity?
- Idiopathic hypoparathyroidism in celiac disease results from calcium and phosphorus malabsorption. Alternately, there may be shared determinants of susceptibility or perhaps a direct immunological relationship.9
- Owing to malabsorption, inadequate calcium from food forces the body to take calcium from bone tissue in order to maintain normal blood levels, but this situation is self-limiting. Here is the normal mechanism: the hypothalmus in the brain constantly monitors blood for correct levels of many chemicals, one of which is calcium. When it detects low calcium blood levels, the hypothalmus signals the pituitary gland nearby to secrete parathyroid stimulating hormone (PSH). The purpose of PSH is to prompt the parathyroid glands to produce and secrete parathyroid hormone which subsequently acts to pull calcium from bone tissue into the blood. In idiopathic hypoparathyroidism, the glands fail to adequately secrete parathroid hormone and blood calcium cannot be normalized.
Does Idiopathic Hypoparathyroidism Respond To Gluten-Free Diet?
Yes. Celiac disease-related malabsorption in idiopathic hypoparathyroidism responds to gluten free diet and oral calcium supplementation and vitamin D derivatives.10,8
The treatment of fat malabsorption in idiopathic hypoparathyroidism comprises: medium-chain triglycerides diet, correction of hypoparathyroidism, administration of vitamin D, and normalization of hypocalcemia.11
6 Steps To Improve Idiopathic Hypoparathyroidism In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:
- 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.12
- The intestinal lining may take up to a year to heal.
- 2 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).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.13
- 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.13
- 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.13.
- 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.13
- 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.13
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.13
- 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 green leafy vegetables such as lettuce and kale, also 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.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4 Manage Your Medications Safely:
Certain medications deplete calcium which is the cause of hypoparathyroidism. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
ANTACIDS / ULCER MEDICATIONS
- Pepcid®, Tagamet®, Zantac® deplete Calcium.
- Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Calcium.
ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.
- Tetracyclines deplete Calcium.
ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.
- Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Calcium.
- Aspirin and Salicylates deplete Calcium.
ANTICONVULSANTS
- Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Calcium.
ANTIVIRAL AGENTS
- Foscanet depletes Calcium.
DIURETICS
- 5Nutritional Supplements To Help Correct Deficiencies:
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.
- Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
- Vitamin D3 as prescribed following blood test for status.
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.
- 6Manage Natural Remedies:
- 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.
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.
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.
What Do Medical Research Studies Tell About Idiopathic Hypoparathyroidism In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“Idiopathic hypoparathyroidism and celiac disease in two patients with previous history of cataract.” This case report describes the diagnosis of two patients with idiopathic hypoparathyroidism and celiac disease. Both had undergone surgery for cataract previously. The patients presented with tetany in the absence of gastrointestinal complaints. Investigations showed severe hypocalcemia, hypoparathyroidism, flattening of duodenal villi histologically, and diffuse cerebral and basal ganglia calcifications on CT scan. After a gluten-free diet with calcium supplementation, the clinical situation and biochemical values improved.14
CASE REPORT SUMMARIES
“Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report.” Myopathy due to idiopathic hypoparathyroidism is very unusual. This case report describes the course of a 30 years-old man referred with complaints of sporadic muscle pain and mild global (all body) weakness for 10 years. His physical examination showed normal strength in distal muscle and slightly weakness in the pelvic and scapular girdles with no atrophy. Deep muscle reflexes were slightly hypoactive. Trousseau’s and Chvostek’s signs were absent. He had bilateral cataract and complex partial seizures. His laboratory tests showed decreased ionised and total calcium and parathyroid hormone and increased muscle enzymes. EMG and muscle biopsy was compatible with metabolic myopathy.
After treatment with calcium and vitamin D supplementation he showed clinical, neurophysiological and laboratorial improvement. In conclusion: patients with muscle symptoms, even when non-specific and with normal neurological examination, should have serum calcium checked, as myopathy due to idiopathic hypoparathyroidism, even being rare, is treatable and easy to diagnose.15
- Abboud B, Daher R, Boujaoude J. Digestive manifestations of parathyroid disorders. World J Gastroenterol. 2011 Sep 28;17(36):4063-6. doi: 10.3748/wjg.v17.i36.4063. [↩]
- Abboud B, Daher R, Boujaoude J. Digestive manifestations of parathyroid disorders. World J Gastroenterol. 2011 Sep 28;17(36):4063-6. doi: 10.3748/wjg.v17.i36.4063. [↩]
- Krysiak R, Handzlik-Orlik G, Kedzia A, Machnik G, Okopień B. Hypoparathyroidism: the present state of art. Wiad Lek. 2013;66(1):18-29. [↩]
- Abboud B, Daher R, Boujaoude J. Digestive manifestations of parathyroid disorders. World J Gastroenterol. 2011 Sep 28;17(36):4063-6. doi: 10.3748/wjg.v17.i36.4063. [↩]
- Matsueda K, Rosenberg IH. Malabsorption with idiopathic hypoparathyroidism responding to treatment for coincident celiac sprue. Digestive Diseases and Sciences. Mar 1982;27(3):269-73. [↩]
- Matsueda K, Rosenberg IH. Malabsorption with idiopathic hypoparathyroidism responding to treatment for coincident celiac sprue. Digestive Diseases and Sciences. Mar 1982;27(3):269-73. [↩]
- Matsueda K, Rosenberg IH. Malabsorption with idiopathic hypoparathyroidism responding to treatment for coincident celiac sprue. Digestive Diseases and Sciences. Mar 1982;27(3):269-73. [↩]
- Krysiak R, Handzlik-Orlik G, Kedzia A, Machnik G, Okopień B. Hypoparathyroidism: the present state of art. Wiad Lek. 2013;66(1):18-29. [↩] [↩]
- Matsueda K, Rosenberg IH. Malabsorption with idiopathic hypoparathyroidism responding to treatment for coincident celiac sprue. Digestive Diseases and Sciences. Mar 1982;27(3):269-73. [↩]
- Sari R, Yildirim B, Sevinc A, Buyukberber S. Idiopathic hypoparathyroidism and celiac disease in two patients with previous history of cataract. Indian J Gastroenterol. 2000 Jan-Mar;19(1):31-2. [↩]
- Abboud B, Daher R, Boujaoude J. Digestive manifestations of parathyroid disorders. World J Gastroenterol. 2011 Sep 28;17(36):4063-6. doi: 10.3748/wjg.v17.i36.4063. [↩]
- 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. [↩]
- 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. [↩] [↩] [↩] [↩] [↩] [↩]
- Sari R, Yildirim B, Sevinc A, Buyukberber S. Idiopathic hypoparathyroidism and celiac disease in two patients with previous history of cataract. Indian J Gastroenterol. 2000 Jan-Mar;19(1):31-2. [↩]
- Nora DB, Fricke D, Becker J, Gomes I. Hypocalcemic myopathy without tetany due to idiopathic hypoparathyroidism: case report. Arq Neuropsiquiatr. 2004 Mar;62(1):154-7. Epub 2004 Apr 28. [↩]
