Skip to content

Addison’s Disease (Primary)

Underarm showing skin darkening, which is a feature of Addison's Disease
Underarm showing skin darkening, which is a feature of Addison’s Disease

What Is Primary Addison’s Disease?

Addison’s disease is an autoimmune destruction of the adrenal glands by autoantibodies that target the adrenal cortex, or outer part of these glands, and is characterized by a slow progressive failure of the adrenal glands to adequately produce its steroid hormones.

Symptoms of adrenal fatigue or failure may not develop until the majority of adrenal tissue is destroyed. When untreated, progression leads to coma, called Addisonian crisis, which is a medical emergency.

There are two adrenal glands each located on top of a kidney and enclosed in a connective tissue capsule. Each is a small, triangular shape that is made of two parts: the outer region and the inner region.

The inner region, called the adrenal medulla, produces epinephrine and norepinephrine chemicals that are needed to deal with stress.

The outer region, called the adrenal cortex, produces adrenocortical (steroid) hormones and releases them into the bloodstream in response to pituitary stimulating hormone from the brain.

Q: What is the function of steroid hormones produced by the adrenal glands?

A: Functions of the three steroid hormones produced by the adrenal glands are:

  1. Glucocorticoids restrain inflammation and metabolism of carbohydrates, fats and proteins to maintain a normal glucose blood level. The major glucocorticoid is hydrocortisone.
  2. Mineralocorticoids regulate the retention and excretion of fluids and electrolytes by the kidneys. The most important mineralocorticoid is aldosterone.
  3. Androgen (testosterone) is a male sex hormone.

Secondary adrenal insufficiency may develop from other causes that are not immune related such as chronic infections, tumor, and medications.

What Is Addison’s Disease In Celiac Disease and/or Gluten Sensitivity?

Cardiomyopathy, Idiopathic Dilated

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

What Is Idiopathic Dilated Cardiomyopathy?

Idiopathic 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?

Anemia, Iron Deficiency

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

What Is Iron Deficiency Anemia?

Iron 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. [↩]

Dermatomyositis

Obesity_001_[1]

What Is Unexplained Weight Gain?

U nexplained weight gain is characterized by increased body mass due to excess fat accumulation that is not desired by the individual.

A body mass index (BMI) of 25 to 30 signifies being overweight.

What Is Unexplained Weight Gain In Celiac Disease and/or Gluten Sensitivity?

Vitamin B3 (Niacin) Deficiency

SumptuousTuna For Niacin.
Sumptuous Tuna For Niacin.

What Is Vitamin B3 (Niacin)?

Niacin is an essential water-soluble B vitamin that is required by all cells of the body.

During digestion of food containing it, niacin (the form in food) is changed in the small intestines to the active form niacinamide (niacin plus an amide group), which is then absorbed into the bloodstream. 

Niacinamide is converted by the body into co-enzymes which are present in all cells. These are niacinimide adenine dinucleotide (NAD) and NADP. NADP is formed when the body adds a phosphate to NAD.

Q: How do these enzymes work?

A: These enzymes function in oxidation-reduction reactions essential for release of energy from carbohydrates, fats, and proteins and are needed as components for more than 200 enzymes involved in metabolism.

In addition to producing energy, niacinamide is essential for healthy skin and the mucosal lining of the digestive tract, normal functioning of the brain and nervous system, and production of steroid hormones in adrenal glands and hormones in sex glands.  Functions are more fully described below.

Urinary excretion of niacin 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.1

What Is Niacin 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. eCollection 2014. [↩]

Vitamin B6 (Pyridoxine) Deficiency

Lots of Pyridoxine In This Pie...Chicken, Cheese,Spinach, Tomato
Lots of Pyridoxine In This Pie…Chicken, Cheese,Spinach, Tomato

What Is Vitamin B6 (Pyridoxine)?

Pyridoxine is an essential vitamin that is required for the health of nerves, bones, blood, arteries, blood sugar, the immune system and metabolism of proteins.

Two important functions of pyridoxine involve coenzymes that are involved in regulating the metabolism of proteins like methionine and tryptophan and their intermediate amino acid building blocks.

In total, the coenzymic form of vitamin B-6, pyridoxal phosphate (PLP), serves as a coenzyme for over 140 enzymes in human metabolism.1  Functions are more fully described below.

Magnesium is required for pyridoxine to actually attach to enzymes dependent on it.

Because pyridoxine is excreted from the body by the kidneys, urinary excretion of it 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.2

Smoking blocks use of pyridoxine.

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

Sources:
  1. Gregory JF 3rd1, Park Y, Lamers Y, Bandyopadhyay N, Chi YY, Lee K, Kim S, da Silva V, Hove N, Ranka S, Kahveci T, Muller KE, Stevens RD, Newgard CB, Stacpoole PW, Jones DP. Metabolomic analysis reveals extended metabolic consequences of marginal vitamin B-6 deficiency in healthy human subjects. PLoS One. 2013 Jun 11;8(6):e63544. doi: 10.1371/journal.pone.0063544. [↩]
  2. 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. [↩]

Folate Deficiency (Folic Acid)

Lovely Lettuce Briming With Folates.
Lovely Lettuce Brimming With Folates.

What Is Folate?

Folate, also called folic acid or vitamin B9, is a family group of essential water-soluble B vitamins needed to produce healthy blood cells and other tissue cells.

Folate is required for healthy blood cells, the metabolism of at least 5 amino acids, the production of DNA, RNA and tRNA (genetic material), the normal development of a baby in the womb, male and female fertility, and regulation of homocysteine (amino acid) by reduction of harmful blood levels in conjunction with vitamin B6 and vitamin B12.

Urinary excretion of folate cannot be detected when vitamin intake is below the required levels. On the other hand, when intake exceeds saturation in the body, the vitamins and/or their metabolites are actively excreted into urine to prevent excessive toxicity of the vitamins.1

What Is Folate 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. eCollection 2014. [↩]

Vitamin B12 Deficiency

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

What Is Vitamin B12?

Vitamin 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

What Is Vitamin B12 Deficiency Anemia? V itamin B12 deficiency anemia is a megaloblastic anemia that is characterized by defective DNA synthesis of red blood cells due to a lack of vitamin B12. Vitamin B12 is…