Hi all, everybody with a CFS, Fibromyalgia or IBS diagnosis should be tested for Celiac, unfortunately the medical profession has been largely asleep on this subject for a long time, it effect about one in a hundred people and there is on average a ten year delay in diagnosis! And is frequently misdiagnosed as CFS, Fibro and IBS
There is also a belief amongst a lot of doctors and people that its not that serious, it can be very serious, because it causes malabsorbtion of numerous vitamins and minerals such as B12, iron, vitamin D, Zinc etc so people can end up with multiple illnesses all caused by celiac, So people end up with the symptoms of B12 deficiency found here
http://vitamins.lovetoknow.com/Vitamin_B12_Deficiency_Symptoms and iron deficiency found here
http://www.essortment.com/symptoms-iron-deficiency-46101.html and vitamin D deficiency
http://www.antioxidants-4-life.com/vitamin-d-deficiency-symptoms.html and zinc deficiency
http://www.improve-mental-health.com/zinc-facts.html etc, B12 and iron deficiencies can be fatal if there not treated, if a doctor doesnt think of testing for celiac then theres no way a doctors going to work out whats going on based on symptoms because all these deficiencies cause so many symptoms, and people get dumped in the CFS, Fibro, IBS group and left to suffer.
This article explains some of the problems with it
http://www.bmj.com/content/338/bmj.a3058.short/reply
1. Celiac Disease: The Great Imitator
o Shirwan A. Mirza, MD, FACP, FACE, Clinical Assistant Professor of Medicine
Auburn, NY 13021
The article on celiac disease by Roger Jones and Sarah Sleet is well written.[1]
We will do our patients and the health care system a great service if we put celiac disease on the top of the list of differential diagnoses of many clinical scenarios.
We all remember that in the medical school we used to call syphilis the great imitator of neurological disorders. I believe now celiac disease should assume that title. I am an endocrinologist and screen for celiac disease likely as frequently as any gastroenterologist.
Celiac disease is an endocrine cousin: It causes as much fatigue as hypothyroidism. It causes menstrual irregularities likely via nutritional deficiencies.It causes miscarriages (should be thought of in women with recurrent miscarriages), causes infertility (should be thought of before embarking on costly fertility treatments), psychiatric problems such as anxiety and depression, poor memory and concentration via vitamin B12 deficiency or insufficiency.
Celiac disease causes vitamin D deficiency, in itself another disease mostly missed and it causes severe fatigue, muscle aches and weakness and tremendous bone pains usually misdiagnosed as fibromyalgia. Celiac disease should be thought of in investigating osteoporosis with severe reduction in Z-scores.
Celiac disease causes unexplained elevation in liver enzymes, including alkaline phosphatase, which could rise partly due to its bone component due to osteomalacia and vitamin D deficiency. celiac disease can cause explained seizures and electrolyte imbalances such as hypocalcemia, when the vitamin D deficiency is severe.
Celiac disease could cause peripheral neuropaty via vitamin B12 deficiency. Celiac disease can cause skin rash and should be in the differential diagnosis of such disorder.
Celiac disease is associated with other autoimmune disorders such as type 1 diabetes, and should be in the differential diagnosis of hypoglycemia in every patient with type 1 diabetes.
Celiac disease can cause low night vision via vitamin A deficiency and every patient with vitamin A deficiency should be screened. Patients, especially women with alopecia should be screened for iron and zinc deficiency, both are nutritional factors in hair growth. Zinc deficiency can also cause dyguisia, recurrent upper respiratory infections, and low night vision.
Patients with hypothyroidism whose TSH is always high despite huge doses of levothyroxine must be screened for celiac disease provided they take leveothyroxine on an empty stomach without food or coffee or other medications for at least an hour before breakfast.
Celiac disease could also an underlying cause for elevated homocysteine and abdominal bacterial overgrowth causing even more gastrointestinal symptoms such as pain or bloating.
Shirwan Mirza, MD, FACP, FACE
References:
1. Published 19 February 2009, BMJ 2009;338:a3058 Practice Easily Missed? Coeliac disease Roger Jones, Wolfson professor of general practice, Sarah Sleet, chief executive
2. Celiac disease. Guandalini S, Setty M. Curr Opin Gastroenterol. 2008 Nov;24(6):707-12.
3. Celiac disease. Catassi C, Fasano A. Curr Opin Gastroenterol. 2008 Nov;24(6):687-91.
Competing interests: None declared
The other problem is that even when patients get diagnosed with celiac, a lot of doctors tend to forget that the patient still has vitamin and mineral deficiencies which should be tested for and treated, some of these deficiencies will correct over time, as your body start absorbing properly but the process can be greatly speeded up by supplements and things like B12 injections.
In the case of Vitamin D deficiency unless you live in a warm climate and sunbath religiously, you wont get enough vitamin D naturally and again will be left to suffer, and even if you are tested and treated chances are that your doctor will use the out of date reference ranges which are miles lower than they should be and left to suffer again.
Correct Vitamin D levels are explained in these articles
http://www.vitamindcouncil.org/health/deficiency/am-i-vitamin-d-deficient.shtml and
http://www.thorne.com/altmedrev/.fulltext/13/1/6.pdf
It has also recently been found that your immune system is incapable of working without sufficient Vitamin D so your likly to have chronic viral and bacterial infections as well
http://www.sciencedaily.com/releases/2010/03/100307215534.htm
Heres an article about how vitamin D gets misdiagnosed as Fibromyalgia
http://www.easy-immune-health.com/fibromyalgia-and-vitamin-d.html#axzz16q2gPmFV
This is another article that gives more information on vitamin D and the amounts that can be needed to achieve the correct levels
http://www.bmj.com/content/336/7657/1318.extract/reply#bmj_el_198052
1. Vitamin D deficiency
o Shirwan A. Mirza, MD, FACP, FACE, Private Practice
New York, USA
I am surprised that some of our colleagues still question the adequacy of the clinical evidence for the benefits of vitamin D. The reference range of 25 hydroxy vitamin D 75-150 nmol/l in Europe (32-100 ng/ml in the USA) is wide enough to prevent that. In my experience of treating more than 2000 patients with vitamin D deficiency in the cloudy upstate New York, you need to give almost 300,000-500,000 IU of vitamin D2 to raise 25, hydroxy vitamin D by 10 ng/ml. Intoxication with vitamin D ( a serum level of 375 nmol/l or 150 ng/ml)is nearly impossible when patients are given reasonable doses under medical supervision. This unfounded fear of vitamin D intoxication has been cited in European countries like Germany as a reason not to fortify milk with vitamin D. Vitamin D benefits mirror the widespread presence of vitamin D receptors in the body. Most people think that vitamin D impacts only the bones. If this was the case, why would you find vitamin D receptors in lymphocytes, brain, heart, blood vessels, prostate, colon, breasts, thyroid, ovaries, testicles, lungs ...? Many observational studies have clearly shown the anti-cancer effects of vitamin D, its favorable effects in preventing auto-immune disorders such as multiple sclerosis and type 1 diabetes. Vitamin D is crucial for muscle strength, hence the fatigue as a prominent symptom of vitamin D deficiency. Proximal myopathy is a cardinal feature of osteomalacia, which can lead to falls and fractures.
If you want to see more patients with vitamin D deficiency, look in your own practice: those patients with fatigue, aches and pains, and proximal muscle weakness are very likely to be vitamin D deficient. Those patients who present with atypical chest pains, in whom cardiac causes have been ruled out, most likely have rib pains rather than the fashionable term "costochondritis" (press on the xiphoid process gently to see the exquisite tenderness. Those patients with tender bones (they don't like to be touched) are very likely to have vitamin D deficiency. Vitamin D is a public health problem. It is the duty of governments to revise the reference ranges of vitamin D to make it in line with the numbers mentioned by Dr. Holick. These governments should also update the required daily dose of vitamin D (1000-2000 IU of vitamin D3 a day).
Dermatologists should soften their stance on sun exposure. 5-10 minutes of daily sun exposure is considered a judicious dose of sun rays for vitamin D production.
1. Holick MF. Vitamin D deficiency. N Engl J Med
2007;357:266-8
2. Holick MF.
Resurrection of vitamin D deficiency and rickets
J. Clin. Invest; 2006: 116(8): 2062-2072
Competing interests: None declared
If anyones interested in learning more about vitamin D theres a book available on Amazon by the world expert in it Dr Michael Holick
http://www.amazon.com/Vitamin-Solution-3-Step-Strategy-Problem/dp/1594630674
Hope this helps someone
All the best
