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Anemia, Iron Deficiency

Red Blood Cell Comparison. Courtesy medindia.com
Red Blood Cell Comparison. Courtesy medindia.com

What Is Iron Deficiency Anemia?

[dropcap]I[/dropcap]ron deficiency anemia is a blood cell disorder that is characterized by formation of small, pale red blood cells, causing tissue hypoxia. Hypoxia is the inability to meet the demands of the body for oxygen.

Q: Why do small, pale red blood cells cause tissue hypoxia?

A: Small, pale red blood cells (erythrocytes) cause tissue hypoxia because they are not able, as do normal erythrocytes, to pick up adequate oxygen from the lungs and carry it to cells that use oxygen.

Red blood cell production and function are dependent on a sufficient level of iron in the body and also the ability to use available iron to make hemoglobin in red blood cells.

Hemoglobin is a protein that binds oxygen in red blood cells to be carried by the bloodstream to cells throughout the body. In iron deficiency anemia,  hemoglobin in females is below 12.5g/dl (normal range is 12.5 to 16g/dl) and in males it is below 13.5g/dl (normal range is 13.5 to 17.5g/dl).

Iron must be obtained from the diet, since the body cannot make it, but there are various factors that can interfere with absorption and use in the body, causing anemia. Iron absorption from the gut first requires ionization, or gaining a positive electrical charge, in the strongly acidic environment of stomach juice. Ionized iron, only, can be absorbed in the duodenum, which receives the acidic contents of the stomach before it is neutralized further along.

Dietary iron can be heme or non-heme depending on the food source. Heme iron obtained only from animal food sources is absorbed into the bloodstream by active transport across the brush border (microvilli) which cover the multitudinous villi of the small intestinal lining.

Non-heme iron obtained from plants must bind with apoprotein after entering the enterocyte (surface cell of small intestinal lining) to be ferried to the underlying basolateral membrane and exited by active transport into the bloodstream.

Frequently, chronic anemia due to iron deficiency is accompanied by increased platelets, and this thrombocytosis resolves with iron repletion (normal iron level). Conversely, in severe iron deficiency anemia, patients may have thrombocytopenia (low platelets), which also resolves with iron therapy.1

What Is Iron Deficiency Anemia In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Koury M and Rhodes M. How to approach chronic anemia. Hematology Am Soc Hematol Educ Program. 2012;2012:183-90. doi: 10.1182/asheducation-2012.1.183. [↩]

Amino Acid Deficiency (Essential)

phWhat Are Essential Amino Acids?

[dropcap]A[/dropcap]mino acids are small molecules, or subunits, that link together in various combinations to make up big, complicated proteins. As such, amino acids are commonly referred to as “the building blocks” of proteins.

Q: How many amino acids are used in our body?

A: There are 20 amino acids that are used within our body to synthesize or produce our unique human proteins.  Of these amino acids,  9 are termed essential, meaning our bodies require them to live but cannot make them. Therefore, the essential amino acids must come from the food we eat, whether from plant or animal sources.

The essential amino acids include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.

What Is Deficiency Of Essential Amino Acids In Celiac Disease and/or Gluten Sensitivity?

Phosphorus Deficiency

burger_21119511What Is Phosphorus?

[dropcap]P[/dropcap]hosphorus is an essential mineral present in every cell of the body mostly in the form of phosphate.

About 85% of phosphorus is present in bone making up a major component of bone formation. As a component of calcium phosphate, phosphorus constitutes 45% of skeletal bone weight while calcium constitutes 40% to support the body.1.

Phosphorus is required for normal tooth development. Inadequate phosphorus in early childhood development makes for defective tooth enamel in permanent teeth.

Phosphorus is crucial for the production of ATP (adenosine triphosphate), a molecule within cells that the body uses to store energy, and is required for production of phosphocreatine to power muscles.  Functions are more fully described below.

One gram of protein in food provides approximately 15 mg of phosphorus. In an adult, the body content of phosphorus ia about 700 grams.

What Is Phosphorus Deficiency In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. http://www.nlm.nih.gov/medlineplus/ency/article/002424.htm [↩]

Potassium Deficiency

Luscious Figs For Potassium.
Luscious Figs For Potassium.

What Is Potassium?

[dropcap]P[/dropcap]otassium is a mineral that is crucial for life being essential for every cell, especially nerve and muscle function.

Most potassium is intracellular, meaning it is found within cells while sodium, its opposing mineral (both electrolytes), is found in the fluid surrounding cells.

In muscle contraction, exchange of potassium and sodium takes place so that potassium moves out of muscle cells and sodium moves into them.

With muscle relaxation, potassium moves back into the cells and sodium moves out. Functions are described below.

Importantly, a recent study investigating the association between the metabolic syndrome and potassium intake in the general population found a significant inverse association between potassium intake and metabolic syndrome in adults. That is, the lower the potassium intake, the greater the odds of developing metabolic syndrome. After adjusting for various lifestyle and dietary confounders, subjects in the highest quartile of potassium intake had 39% lower odds for metabolic syndrome compared to those in the lowest quartile. This association was consistent for both sexes. Among the components of metabolic syndrome, potassium intake was inversely related to abdominal obesity and fasting hyperglycemia in multivariate analysis.1

What Is Potassium Deficiency In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Shin D, Joh HK, Kim KH, Park SM. Benefits of potassium intake on metabolic syndrome: The fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). Atherosclerosis. 2013 Sep;230(1):80-5. doi: 10.1016/j.atherosclerosis.2013.06.025. [↩]

Vitamin B12 Deficiency

Clams Are Chock Full of Vitamin B12.
Lovely Clams For Vitamin B12.

What Is Vitamin B12?

[dropcap]V[/dropcap]itamin B12, also called cobalamin, is a highly complex vitamin that functions in two coenzyme forms: adenosylcobalamin and methylcobalamin.

These forms of the vitamin play important roles in the physical and chemical processes by which amino acids become proprionate, proprionate that becomes acetate,  and single carbons.

Q: Why are these steps important?

A: These steps are essential for normal function in the workings of all cells, especially for those of the digestive tract, bone marrow and nervous tissue.

Vitamin B12 is mainly excreted through bile into the duodenum (first part of the small intestine) for excretion in stool.1 However, if vitamin B12 is needed, it is reabsorbed in the ileum (end of the small intestine) while excess is excreted in stool and very little in urine.2

The blood level of vitamin B12 in healthy people ranges between 140 and 750 pg/ml.

What Is Vitamin B12 Deficiency In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Shibata K, Hirose J, Fukuwatari T. Relationship Between Urinary Concentrations of Nine Water-soluble Vitamins and their Vitamin Intakes in Japanese Adult Males. Nutr Metab Insights. 2014 Aug 5;7:61-75. doi: 10.4137/NMI.S17245. [↩]
  2. Shinton N K. Vitamin B 12 and folate metabolism. Br Med J. Feb 26, 1972; 1(5799): 556–559. [↩]

Sarcoidosis

X-ray of lungs in sacroidosis showing honeycoming. Courtesy Wikimedia.
X-ray of Lungs in Sacroidosis Showing Honeycoming. Courtesy Wikimedia.

What Is Sarcoidosis?

[dropcap]S[/dropcap]arcoidosis is a multisystem granulomatous disease characterized by hard granulomas and inflammation of the alveoli in lungs that occurrs in 80% of patients.

Alveoli are the tiny one cell thick round structures that are clustered at the ends of air passages in the lungs where oxygen from air inhaled is exchanged for carbon dioxide from blood which is breathed out.

Q: What are granulomas?

A: Granulomas are collections of macrophages (white blood cells) that targeted and enclosed but failed to destroy a foreign substance that entered the body.  In turn, the macrophages become encased by other immune cells and fibroblasts and collagen. They can occur in any organ.

Presently, the etiology, or cause, of sarcoidosis is unknown, although it is thought the predisposition is genetic with a local immune mechanism. This disease has flares when active and remissions when symptoms subside.

Referral to a specialist is important for proper treatment and monitoring. The main treatment for severe active sarcoidosis is prednisone, a type of steroid that reduces inflammation in the body. In most people, prednisone relieves symptoms within a couple of months, although most people need to take prednisone for 12 months or longer. Long-term use of prednisone, especially at high doses, can cause serious side effects. Side effects include bone loss, elevated blood sugar, and high blood pressure.

When wheezing and coughing are a problem, inhaler devices are used to deliver medicine into the lungs in order to help open the airways.1

Ibuprofen is prescribed if sarcoidosis is causing joint pain. Steroid creams are prescribed for skin problems.

Sarcoidosis affects 10 to 20 person per 100,000.

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

Sources:
  1. National Heart, Lung, and Blood Institute [↩]

Short Stature

Short StatureWhat Is Short Stature?

[dropcap]S[/dropcap]hort stature means the individual has not reached a normal height as a result of failure to thrive and severe growth delay in children.1

What Is Short Stature In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Catassi C, Fasano A. Celiac disease as a cause of growth retardation in childhood. OpinionCurrent  in Pediatrics. Aug 2004;16(4):445-9. [↩]

Primary Hyperparathyroidism

What Is Primary Hyperparathyroidism?

Tissue changes in hyperparathyroidism. Courtesy Quizlet.com
Tissue Changes in Hyperparathyroidism Causing Brown Tumor. Courtesy Quizlet.com

[dropcap]P[/dropcap]rimary hyperparathyroidism is a parathyroid disorder characterized by excessive secretion of parathyroid hormone by one or more parathyroid glands for more than 6 months.

In primary hyperparathyroidism, blood calcium levels are high while phosphorus levels are decreased due to the action of parathyroid hormone.

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.

Parathyroid hormone normally keeps calcium and the opposing mineral phosphorus levels in balance by drawing calcium as needed from bones to increase it in blood and releasing excess phosphorus through the kidneys to decrease blood levels.

Primary hyperparathyroidism is commonly caused by an adenoma (tumor) in a parathyroid gland (80%) or 15% due to hyperplasia of gland tissue (overgrowth). It is seldom associated with autoimmune disorders. However, cancer is a  possibility.

Q: What is a parathyroid adenoma?

A: A parathyroid adenoma is usually a solitary, well circumscribed, soft, tan reddish-brown nodule with a capsule. Gland tissues outside of the adenoma are normal or slightly shrunken (not needed anymore).1

Untreated, primary hyperparathyroidism results in cyst formations in bone marrow (osteitis fibrosa cystica) and brown tumors in bone tissue. Cysts contain large amounts of fibrous tissue with areas of hemorrhage. Brown tumors contain aggregates of osteoclasts (bone cells), hemorrhage and giant cells resembling neoplasms.2

Here is the symptomatolgy: “Painful Bones, Renal Stones, Abdominal Groans, and Mental Moans.”

What Is Primary Hyperparathyroidism In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. http://quizlet.com/32428692/pathology-of-parathyroid-and-bone-flash-cards [↩]
  2. http://quizlet.com/32428692/pathology-of-parathyroid-and-bone-flash-cards/ [↩]

Anorexia or Loss of Appetite

anorexia nervosa celiac disease gluten symptomWhat Is Anorexia?

[dropcap]A[/dropcap]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?

Diarrhea, Acute

Infant with Acute Diarrhea and Swollen Belly - Hallmarks of Celiac Disease.
Malnourished Infant With Acute Diarrhea and Swollen Belly.

What Is Acute Diarrhea?

[dropcap]A[/dropcap]cute diarrhea is a small intestinal motility disorder characterized by excessively rapid movement of intestinal contents through the small intestine with excessive loss of fluid and electrolytes that leads rapidly to a life threatening hypokalemia (low potassium blood level) and acidosis.

Q: What is hypokalemia?

A: Hypokalemia is characterized by dehydration that may result in vascular collapse, muscular malfunction that may result in paralytic ileus (bowels do not move), paralysis (cannot stand), and respiratory hypoventilation (shallow breathing) or failure, metabolic acidosis resulting from diarrhea, and impaired nerve conduction.1

While diarrhea may be a common symptom of small bowel mucosal disease, the consequent malabsorption can lead to substantial malnutrition and nutrient deficiencies. The small intestine, unlike the colon, has been relatively inaccessible, and systematic evaluation is often necessary to identify and treat small intestinal mucosal diseases that lead to diarrhea. All patients with severe diarrhea or diarrhea associated with features suggestive of malabsorption may have a disease of the small intestinal mucosa that requires careful evaluation and targeted management.2

What Is Acute Diarrhea In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩]
  2. Murray JA1, Rubio-Tapia A. Diarrhoea due to small bowel diseases. Best Pract Res Clin Gastroenterol. 2012 Oct;26(5):581-600. doi: 10.1016/j.bpg.2012.11.013. [↩]