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Vitamin C Deficiency

vitamin c gluten celiac disease symptomWhat Is Vitamin C?

[dropcap]V[/dropcap]itamin C, also called ascorbic acid or ascorbate, is an essential water soluble vitamin.

Fresh supplies of vitamin C are required every day to perform vital roles throughout the body among which are the production of connective tissue such as skin, blood vessels and bone, anti-inflammatory responses and anti-oxidant performance. See below for all roles.

Vitamin C fights for us! It has an anti-cancer effect stemming from its role as a potent anti-oxidant in blood plasma and within cells. It also protects nucleic acids (DNA) from oxidative damage and inhibits the formation of nitrosamines (carcinogenic compounds formed in the digestive tract).

Importantly, vitamin C can regenerate vitamin E from an oxidized state after vitamin E performs its own anti-oxidant role against free radicals and vitamin C works together with other anti-oxidants, such as beta-carotene and glutathione, to increase their overall anti-oxidant effect.

A study investigating the specific anti-inflammatory and anti-oxidant micronutrients that reduce oxidative stress found that in adolescents with metabolic syndrome (MetS) the lower the vitamin C level in blood the worse the MetS status and blood uric acid level.  MetS prevalence was estimated at 7% among boys and 3% among girls.1

Vitamin C reverses osteoporosis by reducing or preventing oxidative stress that destroys living bone tissue. Osteoporosis is a disorder of bone inflammation that results in thin, weak bones that may easily fracture. In normal bone structure, vitamin C is required to form collagen, which is living bone tissue.

In humans, vitamin C reduces the duration of common cold symptoms, even if its effect is not clear.2

Vitamin C must be obtained from food daily because our bodies, unlike monkeys and other animals, cannot produce it.

Urinary excretion of vitamin C cannot be detected when vitamin intake is below the required levels. On the other hand, when intake exceeds saturation in the body, the vitamin and/or its metabolites are actively excreted into urine to prevent excessive toxicity of the vitamins.3

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

Sources:
  1. TGBeydoun MA, Canas JA, Beydoun HA, Chen X, Shroff MR, Zonderman AB. Serum antioxidant concentrations and metabolic syndrome are associated among U.S. adolescents in recent national surveys. J Nutr. 2012 Sep;142(9):1693-704. doi: 10.3945/jn.112.160416. [↩]
  2. Shaik-Dasthagirisaheb YB, Varvara G, Murmura G, Saggini A, Caraffa A, Antinolfi P, Tete’ S, Tripodi D, Conti F, Cianchetti E, Toniato E, Rosati M, Speranza L,Pantalone A, Saggini R, Tei M, Speziali A, Conti P, Theoharides TC, Pandolfi F. Role of vitamins D, E and C in immunity and inflammation. J Biol Regul Homeost Agents. 2013 Apr-Jun;27(2):291-5. [↩]
  3. 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. eCollection 2014. [↩]

Cardiomyopathy, Idiopathic Dilated

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

What Is Idiopathic Dilated Cardiomyopathy?

[dropcap]I[/dropcap]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?

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?

Low Plasma Proteins

Image of a protein molecule.
Image of a protein molecule.

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?

Sources:
  1. Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier. [↩] [↩]

Hashimoto’s Disease (Autoimmune Thyroiditis Causing Hypothyroidism)

DyspareuniaWhat Is Autoimmune Thyroiditis (Hypothyroidism)?

[dropcap]A[/dropcap]utoimmune thyroiditis, also called Hashimoto’s thyroiditis or Hashimoto’s Disease, is an autoimmune destruction of thyroid tissue characterized by insufficient thyroid hormone circulating in the body that causes formation of a goiter (enlarged thyroid gland) and hypothyroidism.

Hypothroidism refers to the condition of markedly reduced secretion of thyroid hormone. There are other causes of hypothyroidism besides Hashimoto’s thyroiditis.

Hashimoto’s thyroiditis is often associated with other autoimmune diseases such as celiac disease.

In Hashimoto’s thyroiditis, a profusion of antibodies are produced, which build up in the blood. Left untreated so that much of the thyroid gland is destroyed, this condition may progress to the very serious and life-threatening condition called myxedema.

Note: In myxedema, protein, electrolytes, and water abnormally accumulate in between cells which produce firm, inelastic puffy skin that is cool, dry, rough, scaly, and may appear yellow; in some people, areas such as the ankles become crusty with a look of tree bark. Many systemic changes develop shown by significant slowing of mental and physical functions. Please see below.

Q: What thyroid tissue is targeted for destruction?

A: In Hashimoto’s thyroiditis, high levels of autoantibodies target thyroglobulin and thyroid peroxidase, leading to inflammation and destruction of the thyroid gland. The resulting fibrosis or scarring of the gland results in lack of thyroid hormone production.

The thyroid gland consists of a large number of closed vesicles that contain a homogenous substance called colloid, which contains the thyroglobulin. Thyroglobulin is an iodine-containing protein secreted by the thyroid gland and stored within its colloid, from which the thyroid hormones thyroxine (T4) and triiodothyroinine (T3) are derived.1

T3 is the active hormone and is made from T4. Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Thyroid hormone production is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain. Normally, when thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary decreases TSH production.

Hashimoto’s disease, with or without the development of hypothyroidism, is treated with synthetic thyroxine, which is man-made T4. Health care providers prefer to use synthetic T4, such as Synthroid® (Levothyroxine), rather than synthetic T3, because T4 stays in the body longer, ensuring a steady supply of thyroid hormone throughout the day. The thyroid preparations made with animal thyroid are not considered as consistent as synthetic thyroid.2

What Is Autoimmune Thyroiditis In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Taber’s Cyclopedic Medical Dictionary. 19th ed. F.A. Davis Company. Philadelphia, PA. [↩]
  2. National Endocrine and Metabolic Diseases Information Service. [↩]

Failure To Thrive And Growth Retardation

failure to thrive babyWhat Is Failure To Thrive And Growth Retardation?

[dropcap]F[/dropcap]ailure to thrive (FTT) and growth retardation are conditions affecting children characterized by weight consistently below the 3rd percentile for age or a decrease in the expected rate of growth based on the child’s previously defined growth curve, irrespective of whether below the 3rd parcentile.1

Q: Why do failure to thrive and growth retardation occur?

A: Failure to thrive and growth retardation occur because there is inadequate nutrition for weight gain and growth to occur.

What Is Failure To Thrive And Growth Retardation In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Arnason JA, Gudjonsson H, Freysdottir J, Jonsdottir I, Valdimarsson H. Do adults with high gliadin antibody concentrations have subclinical gluten intolerance? Gut. 1992 February; 33(2): 194–197. [↩]

Juvenile Autoimmune Thyroid Disease

Goiter in Grave's disease. Courtesy Wikimedia.
Goiter in Grave’s disease. Courtesy Wikimedia.

What Is Juvenile Autoimmune Thyroid Disease?

Juvenile autoimmune thyroid disease is an autoimmune disorder occurring in childhood that targets and damages the thyroid gland, often causing goiter. It is characterized by abnormal circulating thyroid hormone levels in the bloodstream.

Recent evidence suggests that thyroid autoimmunity originates from an interaction of genetic, endogenous and environmental factors which end up activating thyroid-specific autoreactive T-lymphocyte cells in susceptible children.1

Q: What is the thyroid gland?

Thyroxine molecule, chemical structure. Thyroid gland hormone that plays a role in energy metabolism regulation. It is a iodine containing derivative of thyrosine. Atoms are represented as spheres with conventional color coding: hydrogen (white), carbon (grey), oxygen (red), nitrogen (blue), iodine (purple).
Thyroxine molecule. Atoms are represented as spheres with conventional color coding: hydrogen (white), carbon (grey), oxygen (red), nitrogen (blue), iodine (purple).

A: The thyroid is an endocrine (hormone secreting) gland that produces thyroid hormones in response to the action of thyroid stimulating hormone (TSH) produced by the pituitary gland, and releases them into the bloodstream to be quickly carried to their site of action.

The three thyroid hormones are thyroxine, called T4, triiodothyronine, called T3, and calcitonin. T4 and T3 hormones control the rate of metabolism, meaning 1) the rate of food usage for energy production, 2) the rate of protein production and breakdown in most tissues, 3) the heart rate and force of heart muscle contraction, 4) body temperature, and 5) the rate of growth and development in children.

Dietary iodine and selenium are required for T3 production. Specifically, selenium is part of the enzyme that converts T4 to the active form, T3. Calcitonin hormone is needed to build and maintain dense bones and regulate calcium blood level. The thyroid gland is located in the front of the neck at the top of the trachea (windpipe).

Who Is Affected in the General Population? Autoimmune thyroid disease is the most common etiology of acquired thyroid dysfunction in pediatrics. It is more common in females and usually occurs in early to mid-puberty. Presentation is rare under the age of 3 years, but cases have been described even in infancy.2 

What Is Juvenile Autoimmune Thyroid Disease In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Gopalakrishnan S, Marwaha RK. Juvenile autoimmune thyroiditis. J Pediatr Endocrinol Metab. 2007 Sep;20(9):961-70. [↩]
  2. Cappa M, Bizzarri C, and Crea F. Autoimmune Thyroid Diseases in Children. Journal of Thyroid Research. Volume 2011 (2011), Article ID 675703, 13 pages. http://dx.doi.org/10.4061/2011/675703 [↩]

Bronchoalveolitis Leading to Bronchitis and Pneumonia

bronchoalveolitisWhat Is Lymphocytic Bronchoalveolitis?

[dropcap]L[/dropcap]ymphocytic bronchoalveolitis is a pulmonary disorder characterized by lymphocytic airway inflammation of the bronchi (main passageways branching from the windpipe), bronchioles (small passageways), and alveoli (air sacs) at the end.

The chronic, productive cough that develops and worsens with progression is due to increased mucus secretion in the large and small airways.

If infection develops in the bronchioles, it is call bronchopneumonia. If infection develops in the alveoli, it is called interstitial pneumonia. The most common organism causing infection is staphylcoccus aureus.

Q: What effect does inflammation have on the lungs?

A: Alveoli are air sacs, each only one cell thick, where oxygen is obtained by the bloodsteam from air breathed into them and carbon dioxide is released from the bloodstream to air that is breathed out of air sacs. Two things happen:

  1. Inflammation  impairs exchange of gases in alveoli, resulting in lack of sufficient oxygen (O2) for body cell functions, called hypoxia, and build-up of carbon dioxide (CO2) in blood, called CO2 retention.
  2. Inflammation narrows passageways, which reduces the movement of air to and from the alveoli, and this puts stress on the right side of the heart.

Lymphocytes, which are a type of white blood cell, can be collected and assessed by a procedure called bronchoalveolar lavage to determine the degree of involvement.

What Is Lymphocytic Bronchoalveolitis In Celiac Disease and/or Gluten Sensitivity?

PMS (Premenstrual Syndrome) 

PMSWhat Is PMS (Premenstrual Syndrome)?

[dropcap]P[/dropcap]remenstrual syndrome is a menstrual disorder that occurs regularly during the last week of the luteal phase of the menstrual cycle and starts to subside a few days before menstruation begins and is absent the week following menstruation. It is characterized by distressing mental, emotional, and physical features.

Symptoms must occur most months in the year previous to diagnosis. Currently, the American Psychiatric Association terms this disorder “premenstrual dysphoric disorder” (PMDD).

What Is Premenstrual Syndrome In Celiac Disease and/or Gluten Sensitivity?

Erythema Nodosum 

Crohnie_sores_4[1]What Is Erythema Nodosum?

[dropcap]E[/dropcap]rythema nodosum is an inflammatory disorder involving the deep dermis layer of skin and subcutaneous fat septa that underlies the skin. It is characterized by eruptions of recurrent or persistent multiple painful, red nodules under the skin that leave a bruised appearance when healing and do not scar.

The lower legs are most affected, but sores can appear anywhere there is subcutaneous fat.

Q: How do the nodules develop in erythema nodosum?

A: The edges of nodules are poorly defined, and the nodules vary from 2-6 cm.

During the first week of eruption, nodules become tense, hard, and painful. During the second week, they change color from bright red to bluish or livid and may become soft, but do not ulcerate. As absorption progresses, the color gradually fades to a yellowish hue, resembling a bruise. This disappears in 1 or 2 weeks as the overlying skin sloughs off and is replaced.1

The eruptive phase of erythema nodosum begins with flulike symptoms of fever and generalized aching followed by a painful rash within 1-2 days.  Aching legs and swelling ankles may occur and precede the eruption or appear during the eruptive phase and may persist for weeks.2

Currently, the most common cause of erythema nodosum is streptococcal infection in children and streptococcal infection and sarcoidosis in adults.3 Most sores in infection-induced erythema nodosum heal within 7 weeks, but active disease may last up to 18 weeks.

In contrast, 30% of idiopathic erythema nodosum cases may last more than 6 months. Idiopathic means that the cause is not known.

What Is Erythema Nodosum In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. http://emedicine.medscape.com/article/1081633-clinical#a0217 [↩]
  2. http://emedicine.medscape.com/article/1081633-clinical [↩]
  3. http://emedicine.medscape.com/article/1081633-overview#a0199 [↩]