Appropriate Nutrient Supplementation In Coeliac Disease
The title of this post, is the same as that of this article on PubMed.
I choose this article, as the abstract gave a good list of related problems to coeliac disease.
This is the abstract.
Reduced levels of iron, folate, vitamin B12, vitamin D, zinc, and magnesium are common in untreated celiac disease (CD) patients probably due to loss of brush border proteins and enzymes needed for the absorption of these nutrients. In the majority of patients, removal of gluten from the diet leads to histological recovery and normalization of iron, vitamin, and mineral levels. Iron deficiency anemia is the most common extra-intestinal sign of CD and usually resolves with adherence to a gluten-free diet. However, deficiencies of both folate and vitamin B12 may persist in some patients on a gluten-free diet, thus requiring vitamin supplementation to improve subjective health status. Similarly, exclusion of gluten from the diet does not always normalize bone mineral density; in these cases, supplementation of vitamin D and calcium is recommended. Resolution of mucosal inflammation may not be sufficient to abrogate magnesium deficiency. Since gluten-free cereal products have a lower magnesium content as compared with gluten-containing counterparts, a magnesium-enriched diet should be encouraged in CD patients. In this article we discuss the frequency and clinical relevance of nutrient deficiency in CD and whether and when nutrient supplementation is needed.
I am coeliac and was diagnosed at fifty, by by a mixture of the suspicions of an elderly locum, the very modern genetic test and the classic endoscopic test , in the last few years of the twentieth century.
I have to admit, that being diagnosed was a bit of a surprise.
Nitrous Oxide–Induced Vitamin B12 Deficiency
The title of this post, is the same as that of this peer-reviewed paper on the National Library of Medicine.
This is the abstract.
Nitrous oxide is a gas that is odorless, colorless, and has a sweet taste at room temperature. Nitrous oxide has several uses, including in surgery and dentistry (referred to as “laughing gas”), in automotive racing, and in aerosol spray propellants. The aerosol spray propellants that typically use nitrous oxide are whipped cream canisters and cooking sprays. Unfortunately, these over-the-counter household items are a source of nitrous oxide that can be used for recreational use. The most popular is the use of industrial-grade canisters having the slang term “whippets.” The nitrous oxide can be extracted by pushing the nozzle down slightly to the side and catching the released gas with a balloon. The contents of the balloon can then be directly inhaled, giving an instant feeling of euphoria. This is not a benign means to achieve a euphoric state but can cause severe nitrous oxide–induced B12 deficiency, which is presented in this case report.
An estimated 800,000 young adults abuse inhalants every year, and almost 11% of high school seniors report using inhalants at least once in their lifetime . Heavy inhalant abuse can result in a variety of side effects, including cardiac arrhythmias, hypoxia, metabolic acidosis, and neurologic deficits. Of all inhalants, nitrous oxide is particularly toxic due to its conversion of the active monovalent form of vitamin B12 to its inactive bivalent form. We present a case of subacute combined degeneration of the spinal cord due to nitrous oxide–induced vitamin B12 deficiency.
Basically, don’t inhale nitrous oxide, unless it’s being administered by a anaesthetist or a dentist.
Interestingly, because I was an undiagnosed coeliac my vitamin B12 was running on empty for much of the first fifty years of my life.
As my B12 was so low and didn’t really respond to regular injections, I was sent off to Addenbrooke’s, where they quickly diagnosed coeliac disease.
I wonder what would happen to an undiagnosed coeliac, who was low in B12, who got addicted to nitrous oxide.
The abstract implies that inhalants can cause cardiac arrhythmias, which has this Wikipedia entry, where this section talks about atrial fibrillation.
Arrhythmia affects millions of people. In Europe and North America, as of 2014, atrial fibrillation affects about 2% to 3% of the population. Atrial fibrillation and atrial flutter resulted in 112,000 deaths in 2013, up from 29,000 in 1990. However, in most recent cases concerning the SARS-CoV‑2 pandemic, cardiac arrhythmias are commonly developed and associated with high morbidity and mortality among patients hospitalized with the COVID-19 infection, due to the infection’s ability to cause myocardial injury. Sudden cardiac death is the cause of about half of deaths due to cardiovascular disease and about 15% of all deaths globally. About 80% of sudden cardiac death is the result of ventricular arrhythmias. Arrhythmias may occur at any age but are more common among older people. Arrhythmias may also occur in children; however, the normal range for the heart rate varies with age.
Doctors tell me, that my stroke was caused by atrial fibrillation.
Hospital Pioneers Cancer Service For Over 70s That Saves Lives And Money
The title of this post, is the same as that of this article in The Times.
This is the sub-heading.
Treatment is adapted to take into account age-related illnesses, such as heart disease, diabetes and dementia.
These three paragraphs outline, what the Christie Hospital is doing.
The Christie Hospital in Manchester is pioneering a specialist cancer service for elderly patients under plans to tackle a “silver tsunami” of cases.
More than 200 patients have been treated by the new team, which was set up to meet the more complex care needs of an ageing population.
The service has nearly halved the number of unplanned hospital admissions among older cancer patients, improving survival and quality of life.
But it’s the graph that follows that I find interesting.
It shows the cancer incidence rate (per 100,000 population) in 2020 by gender and age at diagnosis.
I am a control engineer and statistician and one of the most interesting things in a graph like this is the rate of increase or in this graph’s case the rate of decrease, as the graph effectively has the present at the top.
I have used an old trick and looked at the difference between the groups and the difference between the difference.
Note.
- It seems that the rate of increase of cancer diagnosis with age seems to increase with ages of 60-64 and 25-29.
- This would seem to correspond to those born before 1960 and those born before 1995.
- As a coeliac, I know that the first test for coeliac disease, which used endoscopy was introduced around 1960.
- The modern genetic test for coeliac disease was developed in the 1990s.
Is it coincidence, that the rate of increase of cancer diagnosis with age seems to increase, when a better diagnosis for coeliac disease was introduced?
These are my thoughts!
Coeliac Disease And Me
I am coeliac and I was born in 1947. I wasn’t diagnosed as coeliac until 1997.
I was an unhealthy child, with all sorts of avenues being chased, so in the end they just took my tonsils out.
- It should be remembered, that there was no test for coeliac disease in children until 1960.
- I’ve also only met one coeliac older than me and both her parents were GPs and she was diagnosed by food elimination.
- In fact, I never met a coeliac until I was about 25. He was the two-year-old son of one of C’s friends.
At fifty, an elderly locum gave me a present of a blood test to clear up my long-term health problems. The results showed that my body had very little Vitamin B12. Injections didn’t improve the level, so my GP sent me to Addenbrooke’s.
It was a Monday and all the consultant did was ask a nurse to take several vials of blood. He didn’t ask me any relevant questions or even touch me.
On the Wednesday morning, I got a letter from the hospital saying I was probably coeliac and it would be confirmed by endoscopy.
I must have been one of the first to have been diagnosed by a genetic test on a sample of blood.
Coeliac Disease And My Youngest Son
My youngest son was born in 1972 and after my diagnosis, my late wife felt he was coeliac, as physically he was so like me. But neither him nor our other two sons would get themselves tested.
I am now sure he was coeliac, as his daughter was born with a congenital hernia of the diaphragm and Swedish research says can happen with coeliac fathers. Luckily, she was born in the Royal London Hospital and thanks to heroic surgery at a few days old, she survived and is now in her first year at Southampton University.
Sadly my youngest son died of pancreatic cancer in 2011.
Coeliac Disease And Cancer
Nottingham University have shown that if you are coeliac and stick to a gluten-free diet, you are twenty-five percent less likely to suffer from cancer.
Cancer in the Over Sixties
The following is an extract from A Thought On Deaths Of The Elderly From Covid-19, which I wrote in April 2020.
How many undiagnosed coeliacs are there in those over seventy, who because they are coeliacs, have a compromised immune system?
I would be undiagnosed but for that elderly locum!
How many other coeliacs are there in the UK population?
- Age UK has a figure of twelve million who are over 65 in the UK.
- If 1-in-100, as stated by Coeliac UK, in the UK are coeliac, that is 120,000 coeliacs over 65, who are too old to have been diagnosed as a child, because no test existed.
Note that as of today 177,388 have been diagnosed with Covid-19.
Could the drop in the cancer rate of those born before 1960 be because of the availability of a test for coeliac disease, so that if they were a sickly child like me, they would be diagnosed? As I said earlier diagnosed coeliacs have a lower cancer rate than the general population.
Cancer in the Under Thirties
I was diagnosed in 1997 by a genetic blood test and there is no doubt that I have coeliac disease.
As the test is so simple, I wonder what proportion of coeliacs born since the Millennium have been diagnosed.
And how does this contribute to the drop in cancer cases?
More Research Needs To Be Done
It is obvious to me, that research needs to be done into the link between undiagnosed coeliacs and cancer.
It might be prudent to test every cancer patient for coeliac disease. My GP told me, that the test is not expensive and generally gives the right result.
Coeliac Journey Through Covid-19 – Coeliac Diagnosis
Coeliac Diagnosis
My health was very variable as a child.
I would often have months off school and my health only really improved, when my parents bought a second home in Felixstowe, where we spent most of our holidays.
Perhaps it was the sea air, as going to Liverpool University didn’t seem to adversely affect my health.
I had been having gut problems for years and then in Autumn 1997, I didn’t see my GP, but a very elderly locum, who as I had recently had my fiftieth birthday, gave me a present of my first blood test.
It turned out that I was very low on B12 and a course of B12 injections was arranged.
As the injections didn’t raise my levels, an appointment was made to see a consultant at Addenbrooke’s Hospital in Cambridge.
It was a Monday, when I went to the appointment and after a quick chat and no examination, the consultant said that they would take some blood. Which they did!
Within forty-eight hours a letter arrived on my door-mat saying that I was probably coeliac and it would be confirmed by endoscopy.
Two endoscopies without sedative or anaesthetic were performed and I was confirmed as coeliac.
The first was performed by Dr. Richard Hardwick and the second by Dr. Rebecca Fitzgerald.
My gut health has been better since, I’ve been on a gluten-free diet, backed up by three-monthly B12 injections.
A few years later, I was talking to a gastroenterologist in Cambridge and he told me that he thought he had more coeliac patients than any other in England.
The manager of Carluccio’s in the city, also told me that they sold a very high percentage of gluten-free food.
Were Cambridge testing a genetic test for coeliac disease or was it just a Whack-A-Coeliac policy?
They certainly had everything geared up for high-speed diagnosis. They even did the endoscopies without a sedative, so they didn’t need any recovery beds.
The Luck Of The Genes
There’s an article in The Times, which is entitled When It Comes To Success, Luck Can Trump Intelligence.
It got me thinking about my life.
I have been pretty successful in life, and I put it down to winning the gene lottery, with a part-Jewish father and a part-Huguenot mother, who taught me hard work and everything they knew. So were my genes forged by religious persecution in the harsh conditions of the ghettoes of Europe?
But luck has always played a great part in my success. On the way, three or four successful men have chosen me for projects and I’ve repaid them by succeeding. I’ve been at the heart of the creation of two world-changing companies.
But the luck turned bad, a dozen years ago. My wife and our youngest son died from cancer and I had a serious stroke.
But the genetic lottery of being coeliac and therefore having B12 injections, has meant, I’ve made a good recovery from the stroke. The B12 injections is a stroke recovery method from the States, but is considered quackery over here. I believe it saved my life.
And then during the pandemic, those coeliac genes and the gluten-free diet I need for health, seem to have protected me from a severe dose of the covids. I’ve yet to find a fellow coeliac, who has had one either. Scientific research from Italy and Sweden, is also backing up my observations.
Lady luck has smiled on me. Or does the devil, look after her own?
High Risk Of Coeliac Disease In Punjabis. Epidemiological Study In The South Asian And European Populations Of Leicestershire
The title of this post, is the same as that of this peer-reviewed paper on PubMed.gov.
This is the abstract of the paper.
The purpose of this study was to measure the incidence of coeliac disease in different ethnic communities and investigate the hypothesis that the incidence is decreasing in most European countries and the role incomplete retrieval of data may play. In a retrospective study of histologically confirmed cases of coeliac disease between 1975 and 1989 in the City of Leicester, 106 patients with coeliac disease were identified. Of these 86 were European and 20 Asian. The overall incidence of coeliac disease in Europeans was 2.5/10(5)/year (95% CI 2-3.2), in Gujaratis 0.9/10(5)/year (95% CI 0.4-1.8), and in Punjabis 6.9 (95% CI 3.2-12.3). These differences were independent of religious belief. The relative risk to Punjabis compared with Europeans is 2.9 (95% CI 1.5-5.3; chi 2 = 12.5, p < 0.01) and to Gujaratis 8.1 (95% CI 3-22.4; chi 2 = 25; p < 0.001). Gujaratis were at 0.4 risk of Europeans (90% CI 0.2-0.8; chi 2 = 6.7; p < 0.01). The incidence in the urban populations of Leicester was 6/10(5)/year (95% CI 1.3-1.9) which was significantly lower than the 3.2/10(5)/year (95% CI 2.7-3.8; chi 2 = 5.6; p < 0.001) in surrounding rural areas. This study shows that the incidence of coeliac disease in Punjabis (Sikhs, Hindus and Muslims) is 8 times higher than in Gujaratis (Hindus and Muslims) and 4 times higher than in Europeans in Leicester.
I find the last sentence in particular very significant.
I’m no medic, but I think it is reasonable to assume, that in a particular community for every diagnosed coeliac, there will be several undiagnosed coeliacs out there.
In this overview of coeliac disease on the NHS web site, this is said about the incidence of coeliac disease.
Coeliac disease is a condition that affects at least 1 in every 100 people in the UK.
But some experts think this may be underestimated because milder cases may go undiagnosed or be misdiagnosed as other digestive conditions, such as irritable bowel syndrome (IBS).
Reported cases of coeliac disease are around 3 times higher in women than men.
The one-in-100 figure is often used in web pages in European countries or Australia, Canada and the United States, so I’ll go along with that.
So does that mean that Punjabis living in Leicester, have a one-in-twenty-five likelihood of being coeliac?
Whether you have been diagnosed though, is a matter of pure luck.
I had been having gut problems for years and then one Autumn, I didn’t see my GP, but a very elderly locum, who as I had recently had my fiftieth birthday, gave me a present of my first blood test.
It turned out my B12 levels were very low and after several months of B12 injections, which made little difference to my B12, my GP decided to send me to a consultant at Addenbrooke’s Hospital in Cambridge.
My appointment was on a Monday morning and consultant took about ten minutes to ask a few questions, after which he said they would take a few bloods.
On the Wednesday morning, I received a letter that said, that I was probably suffering from coeliac disease and this would be confirmed by endoscopy.
Was I diagnosed solely by analysis of my blood? This was in 1997, which is after the date of the Leicester study.
Two endoscopies without sedative or anaesthetic were performed and I was confirmed as coeliac.
The first was performed by Dr. Richard Hardwick and the second by Dr. Rebecca Fitzgerald.
Both doctors feature in this story on the Cambridge University Hospitals web site, which is entitled Familial Gastric Cancer – Case Study.
My problems have been minor compared to the two sisters in the story.
My luck had been good and I recommend that everyone who feels they could be coeliac should get themselves tested.
Cases Of Covid-19 In Leicestershire
This article on the Leicester Mercury is entitled 11 Areas Of Leicestershire Have Among Worst Infection Rates in the UK.
In Coeliac Disease: Can We Avert The Impending Epidemic In India?, I started like this.
The title of this post, is the same as that of this article on the Indian Journal Of Research Medicine.
With the high levels of COVID-19 in Leicester and an Indian population who make up 28.3 % of the population of the city, I was searching the internet to see if there was any connection between those of Indian heritage and coeliac disease.
I know you should not try to prove a theory. But as a coeliac, I’m very interested to see how the millions of diagnosed coeliacs on a gluten-free diet like me, are faring in this pandemic.
I then talk about some extracts from the Indian research.
In a section entitled, which is entitled All Wheats Are Not Equal, I say this.
The other dimension to this problem is that not all wheat is alike when it comes to inducing celiac disease. The ancient or diploid wheats (e.g. Triticum monococcum) are poorly antigenic, while the modern hexaploid wheats e.g. Triticum aestivum) have highly antigenic glutens, more capable of inducing celiac disease in India, for centuries, grew diploid and later tetraploid wheat which is less antigenic, while hexaploid wheat used in making bread is recently introduced. Thus a change back to older varieties of wheat may have public health consequences.
So did all these factors come together to create the high levels of Covid-19 in Leicestershire?
Conclusion
I am getting bored with saying this. More research needs to be done!
Rescued By A B12 Injection
Last week, I wasn’t feeling too well, as I wrote in The Hour Change Has Completely Knocked Me Out.
I had a whole raft of symptoms.
- Not being able to get dressed.
- Sleeping all the time.
- Poor hand-eye co-ordination.
- Dizziness, which got me to hospital.
Then on Tuesday, this week, I had my three-monthly B12 injection.
And all the symptoms disappeared.
Vitamin B12 For Stroke Recovery: Understanding The Benefits & Safety Tips
The title of this post, is the same as that of this article on the FlintRehab web site.
I have posted the link, as I was talking to a doctor earlier and they might like to look at it.
Consider.
- I am coeliac on a strict gluten-free diet.
- Since the coeliac diagnosis in 1997, I have had a B12 injection every three months.
- I had a serious stroke ten year ago.
- Some doctors feel, I have made an excellent recovery from my stroke.
Could my regular B12 injections have aided my recovery?
Note, that I have cleaned up the Vitamin B12 tag in this blog.
I Was Struggling In The Heat
Early last week, I was struggling in the heat.
On Wednesday, I had my three-monthly B12 injection injection and since then I’ve been feeling a lot better.
Yesterday, when I went to see the Oxted Viaduct, I climbed a couple of short hills in the heat and had no problem.
I have my B12 injections because I’m coeliac and I was at one time low on B12.
Given too, that some web sites report than B12 helps stroke recovery, does that explain, why I made a better than some recovery from my stroke?
At least three doctors, I’ve met, have used the word remarkable when talking about my stroke recovery.
I certainly would create a fuss, if the GP, thought I should stop taking B12. But then I’ve been taking it for at least thirty years.
Why Do More Elderly Men Die Of The Covids Than Women?
I asked this question of the Internet and found this article from The Times, which is entitled Why Are Men More Likely To Die From Covid Than Women?.
These are the first two paragraphs.
On Valentine’s Day last year, researchers at China’s Centre for Disease Control and Prevention submitted one of the first studies into who was dying of the new coronavirus that was spreading through Wuhan.
Two clear findings jumped out. Firstly, the virus appeared to hit the elderly hardest. Secondly, if you were a man, you were much more likely to die.
The article goes on to say, that men are 24 percent more likely to die.
I am coeliac and here are some facts about coeliac disease.
This page on the NHS web site is an overview of coeliac disease.
There is a sub-section called Who’s Affected?, where this is said.
Coeliac disease is a condition that affects at least 1 in every 100 people in the UK.
But some experts think this may be underestimated because milder cases may go undiagnosed or be misdiagnosed as other digestive conditions, such as irritable bowel syndrome (IBS).
Reported cases of coeliac disease are around 3 times higher in women than men.
It can develop at any age, although symptoms are most likely to develop:
during early childhood – between 8 and 12 months old, although it may take several years before a correct diagnosis is made
in later adulthood – between 40 and 60 years of age
People with certain conditions, including type 1 diabetes, autoimmune thyroid disease, Down’s syndrome and Turner syndrome, have an increased risk of getting coeliac disease.First-degree relatives (parents, brothers, sisters and children) of people with coeliac disease are also at increased risk of developing the condition.
The three most important facts in this are.
- The condition affects 1 in every 100 people in the UK.
- Reported cases are three times higher in women than men.
- First degree relatives of coeliacs are at increased risk of developing the condition.
I am sure my father was an undiagnosed coeliac.
When I was born in 1947, there was no test for coeliac disease in children, as one wasn’t developed until 1960.
Testing for many years was by the Gold Standard of endoscopy, which for a child is not an easy procedure.
I’m certain, that in 1997, I was one of the first to be diagnosed in a General Hospital by genetic testing.
At fifty, a locum had given me a blood test and I had been found to be very low on B12. Despite a course of injections, it refused to rise so I was sent to Addenbrooke’s Hospital, where I saw a consultant, who gave me a short chat and then got a nurse to take some blood samples.
Two days later, I received a letter, saying I was probably coeliac and it would be confirmed by endoscopy.
I can’t think how else it was done so quickly, unless they were using a genetic test.
I went gluten-free and the rest as they say is history.
In some ways there’s been two of me.
- BC – Before Coeliac – Frequently unwell, lots of aches and pains and weak mentally.
- AD – After Diagnosis – Healthier, few aches and pains and much stronger mentally.
My immune system appears to be much stronger now!
I believe my son was also coeliac.
Undiagnosed coeliacs tend to have poor immune systems and he died of pancreatic cancer at just 37, because he refused to get himself tested.
As there was no test for coeliac disease in children until 1960, anybody over sixty has a higher chance of being coeliac with a poor immune system and be at higher risks from both the covids and cancer.
It should be noted that according to the NHS, there are three times more female coeliacs than male.
Could this be explained by the fact that undiagnosed coeliac disease can be a cause of female infertility? So when a lady has difficulty conceiving, doctors test for it. So perhaps, by the time they get to 70 a higher proportion of female coeliacs have been diagnosed, compared to male ones, which may explain why more elderly men than women die of the covids.
More research needs to be done.
The Anonymous Widower 