Vitamin D: “You Are What You Absorb!”

“You are what you absorb!” If you are eating foods rich in Vitamin D and are not absorbing it, you are only as good as what you are able to absorb! (Think Celiac, think Leaky Gut or Gluten Intolerance/Sensitivity). Vitamin D plays a big role in our immune system, our hearts, bone strength and even cancer.  Do you know your levels? If not, you should ask your doctor to order the blood work the next time you are in for a check up.

I will go over why we have Vitamin D Deficiencies, Symptoms of Deficiencies, How Much Vit D is enough and How Much is Too Much; or toxic. (Recently, my doctor had to reduce my Rx of Vit D) You will see that it really depends on who is looking at your levels! I use myself as an example and also went to several different sources for this blog post and I think you will find the information very interesting.

First, I will be giving you information that I get from Amy Myers, MD.  This is the most thorough information I have seen on Vitamin D and it is easy to read and understand, even if you don’t have the letters “MD” after your name.  Everyone should get their levels checked because 36% of healthy adolescents and 57% of adults in the US have a deficiency. According to Dr Myers, they believe those numbers may be even higher because the previous recommended levels of vitamin D were too low!

Dr Myers says; “The widespread deficiency of Vitamin D is concerning because it plays an important role in many areas of our health. It contributes to bone strength, heart health, and cancer prevention. And, it plays a hugely important role in your immune system and can be a determining factor in whether or not you develop an autoimmune disease.”

There are 3 reasons this occurs:

1. We don’t get enough sun exposure, we do we put sunscreen on & reduce it by 90%

2. Our diets lack vitamin D (salmon, fish liver oil, organ meats, beef liver, egg yolk)

3. Fat Malabsorption

The two foods most fortified with Vitamin D are breakfast cereals and milk.  Mmmmm, I am screwed because cereals contain gluten and milk is; well, it is milk and I can’t have that!

Fat Malabsorption: One thing that surprised me is that she talked about fat malabsorption. Vitamin D is fat soluable. So, that means that your gut will have to absorb fat in order to absorb Vitamin D. (Could this be why my cholesterol is low; usually between 118-127?)

–Vitamin D also needs Vitamin K because it works in tandem with Vitamin D and makes sure the Vitamin D ends up in our bones and not in our arteries.  She also says to make sure we have Vitamin E and Vitamin A because they work with Vitamin D as well.

I know I have fat malabsorption. This, has always been a problem for me and it also contributed to a lot of clogged toilets prior to my celiac diagnosis. If I eat anything fatty, I see it in the toilet, it looks like a bunch of oily and undigested fat. (I ate some wings on the Sunday of Memorial Weekend and it is a good thing we were at home on Memorial Day!)

Vitamin D is a fat-soluble vitamin, meaning your gut has to be able to absorb dietary fat in order to absorb Vitamin D. The saying goes “you are what you eat,” but in reality, Dr Myers says that “you are what you absorb”.  She goes on to say; “if you have a leaky gut because of inflammatory foods such as gluten, infections, or toxins, your ability to absorb nutrients and vitamins may be severely compromised”.

I had to beg a doctor to check my levels and when they were finally checked, my results were  2 and a 7;  I was given an Rx . I was definitely feeling better, my neuropathy went away and on my last check up, I was at 50 thanks to 50,000 IU Rx supplementation. But I was having some complications that my Endocrinologist was not taking into consideration. (more on this later)

However, Dr Myers suggest we aim for between 60-90 ng/ml. (I address the different recommended levels in a chart below) For more information from Dr Amy Myers on Vitamin D and it’s Impact on your Immune System (Protective Immunity and it’s role in Autoimmune Disease and How to Increase your Vitamin D with Vitamin K) Click Here for info from Dr Amy Myers

Symptoms of Vitamin D Deficiency?

Vit D Deficiency is common in people with untreated Celiac Disease but you don’t have to be a Celiac to have a Vitamin D deficiency; which effects digestive, glandular, immune, integumentary, muscular, nervous and skeletal systems via:

Impaired bone mineralization, muscle weakness, alterations in maintenance of calcium and phosphorous hemeostasis, metabolic functions, male reproduction and is implicated in psoriasis.  Also, Bone Pain, Easy Fractures, osteopenia/osteoporosis, (bone thinning), osteomalacia (bone softening), in adults, affecting the spine with vertical shortening of the vertabrae, the pelvis with flattening and narrowing of the pelvic outlet and the lower extremities with bowing in the long bones, muscle weakness, defective coordination for walking, osteomalacic myopathy and spasm, psoriasis, decreased male fertility.

In young children, development of rickets with bone bending of the weak shaft and delayed walking in 1-4 year olds. In older children walking is painful with development of bow-legs and knock-knees.

*These symptoms are often seen as a result of  malabsorption in Celiac Disease. Celiac related deficiency responds to the gluten free diet and supplementation produces rapid resolution of symptoms.  Source: Recognizing Celiac Disease by Cleo J. Libonati, RN, BSN

HOW MUCH IS ENOUGH VITAMIN D?

There are different recommended levels depending on who is looking at your results as seen in the chart below. My endocrinologist was fine with me at 50 ng/ml; see the chart below. However, my Internist (my new General Practitioner) thinks that is too high. (this will all make sense at the end of this) I did some checking and all sources say something different.  Below is what I found:

NIH (National Institute of Health) also has some different info: 

nmol/L**	ng/mL*	Health status
<30	<12	Associated with vitamin D deficiency, leading to rickets in infants and children and osteomalacia in adults
30 to <50	12 to <20	Generally considered inadequate for bone and overall health in healthy individuals
≥50	≥20	Generally considered adequate for bone and overall health in healthy individuals
>125	>50	Emerging evidence links potential adverse effects to such high levels, particularly >150 nmol/L (>60 ng/mL)

* Serum concentrations of 25(OH)D are reported in both nanomoles
per liter (nmol/L) and nanograms per milliliter (ng/mL).
** 1 nmol/L = 0.4 ng/mL

Reference Intakes

Intake reference values for vitamin D and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of The National Academies (formerly National Academy of Sciences) [1]. DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These values, which vary by age and gender, include:

• Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy people.
• Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.
• Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects [1].

The FNB established an RDA for vitamin D representing a daily intake that is sufficient to maintain bone health and normal calcium metabolism in healthy people. RDAs for vitamin D are listed in both International Units (IUs) and micrograms (mcg); the biological activity of 40 IU is equal to 1 mcg (Table 2). Even though sunlight may be a major source of vitamin D for some, the vitamin D RDAs are set on the basis of minimal sun exposure [1].

Table 2: Recommended Dietary Allowances (RDAs) for Vitamin D [1]

Age	Male	Female	Pregnancy	Lactation
0–12 months*	400 IU (10 mcg)	400 IU (10 mcg)
1–13 years	600 IU (15 mcg)	600 IU (15 mcg)
14–18 years	600 IU (15 mcg)	600 IU (15 mcg)	600 IU (15 mcg)	600 IU (15 mcg)
19–50 years	600 IU (15 mcg)	600 IU (15 mcg)	600 IU (15 mcg)	600 IU (15 mcg)
51–70 years	600 IU (15 mcg)	600 IU (15 mcg)
>70 years	800 IU (20 mcg)	800 IU (20 mcg)

* Adequate Intake (AI) Click Here to go to NIH

Symptoms of Too Much Vitamin D (toxicity):

According to the Mayo Clinic, the main consequence of vitamin D toxicity is “a buildup of calcium in your blood (hypercalcemia), which can cause poor appetite, nausea and vomiting. Weakness, frequent urination and kidney problems also may occur. Although vitamin D toxicity is uncommon even among people who take supplements, you may be at greater risk if you have health problems, such as liver or kidney conditions, or if you take thiazide-type diuretics. As always, talk to your doctor before taking vitamin and mineral supplements.”  Mayo Clinic Too Much D

So, who do you listen to? Well you always listen to your doctor, but again, I think you need to listen to your body (and so does your doctor). On the mega Rx dose of Vitamin D, I was definitely having increased urination, more frequent kidney stones and I also take two thiazide-type diuretics.  So, my GP (internist) looked at my numbers and the other factors adversely  affecting my health and reduced my dosage. We will do blood work in 6 weeks to see what the result is, but I have not had any major stones. (FYI: I recently changed my GP to an Internist who looks at the whole picture and how everything affects my overall health. Not only does she understand Celiac Disease, she and her daughter have Celiac Disease and I believe this is the best decision that I have made for my health!)

I hope you found this information helpful.

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Guess Who Came to Dinner?

Yes, that is Dr. Alessio Fasano, of the Center for Celiac Research and Treatment at Mass General. We had the pleasure of having Dr Fasano and his son back in the cafe for dinner this week. I was able to ask him a few questions in between.

I chose the questions that I get asked about the most by customers and those that affect me as well. My questions were about Gluten/Celiac Disease and it’s role in Autism, our Kidneys, our Skin and our Brains. I also asked about Glyphosate (Round Up) and it role, if any, in Celiac Disease.

Autism:

As many of you know, I have two nephews with Autism, so I have always been very interested in the connection between Celiac Disease, Gluten and Autism. Dr Fasano and Autism Speaks have been looking for a connection between Autism and Celiac Disease anf gluten . As of now, Dr. Fasano says that “about 5% of Children with Autism have Celiac Disease and most are Gluten Intolerant.”  Dr Fasano says “we know Gluten is a factor in Autism but we don’t know why.”

Glyphosate (Round Up) Sprayed on Crops:

Over the past year or so there has been a lot of information circulating on the web about Glyphosate, which is the ingredient used in Round Up weed killer.  It is also used on our crops to increase the yield before harvesting. Corn is one of those crops. So, I asked him about the connection, if any, between glyphosate (Round Up) being sprayed on our crops and if it is contributing to gut permeability (leaky gut) leaving us open to Celiac Disease.  He said that “we don’t know enough about it yet”. That tells me there are more studies that need to be done.

Celiac Reactions & Complications; Kidneys, Skin and Brain:

Kidneys: I also shared with Dr Fasano what my Nephrologist has told me about Celiac Disease and IgA Nephropathy (Berger’s Disease); the filters on my kidneys don’t work right and the little doors to the filters are getting the wrong message. So, I asked him what his thoughts were. He said;  “absolutely, it is very closely related to Celiac and sometimes the soldiers (immune cells), leave the intestine and attack other tissues, like those in the kidneys” (gallbladder, thyroid, brain, etc.).

I was telling him about my severe reaction after accidentally getting “glutened” in Jan 2015 and a new symptom I had after this episode. Normally for me, within a few hours I have severe acid reflux, the next morning I have a migraine followed by diarrhea and vomiting at the same time, then I get major bloating and knife like pains in my stomach. Then, within 24 hours I get flu like symptoms, severe fatigue and can not get off the couch.

Skin: On about day 3 or 4 I get a Dermatitis Herpetiformis (DH) rash and that itches and oozes and hurts and then the joint pain kicks in. I told him that I had a bad case of DH on my scalp, buttocks and arms and before I could say it he said: “it took 8 months to clear up”.  He was right on the money, I got “glutened” in January (I did a blog post about this) and it did not clear up until the end of August! (It cleared up because I had no further exposure to gluten. DH is most often misdiagnosed as eczema. It (the rash) can be biopsied for a Celiac Diagnosis, if you have this, bring it to you Gastroenterologist’s attention.)

Brain: By day 4 I had Ataxia (walking into walls, tripping and falling and speech issues).  New Symptom for Me: However, this time, by day 5 or so, I had MS like symptoms in my right arm and leg with heavy twitching. I had to pull over and it lasted for several minutes. He said “absolutely, it’s the inflammation; because it can affect the brain”.

I hope you found this information helpful. It was a pleasure having Dr. Fasano and his son back at One Dish Cuisine Cafe, Deli and Bakery! I know you want to know what Dr Fasano had for dinner. He and his son enjoyed our Eggplant Parm. Also, I know someone will say that the cafe looks different in the photo. It does look different because this photo was taken the last time he was here, for his book signing, in 2014.

 

After Celiac: Vitamin Deficiencies, Symptoms, Testing

I am shocked by the number of customers who tell me that they were diagnosed with Celiac Disease, were told to “just eat gluten free” and then sent on their way.  No follow up appointments made and no other tests done. In this post, I tell you what tests should be done, which vitamin & nutritional deficiencies are common and the symptoms of those deficiencies.

Other testing is imperative, especially if you have gone a long time with undiagnosed Celiac Disease. If your regular physician diagnoses you, I highly recommend seeing a Gastroenterologist and a Dietitian who are well versed in Celiac Disease. Why? Because Celiac Disease can cause Anemia, Thyroid Issues, Severe Vitamin Deficiencies, etc. Follow up is also imperative to make sure that your small intestine is healing and that you are truly eating a gluten-free diet.

With all of the places out there offering a “GF Menu”, but not willing to  guarantee it is truly GF, there is a lot of cross contamination going on. I hear this from so many customers who come in and say they eat at “any place that has a GF Menu“. Then they are feeling sick and go back to their doctor and get follow up antibody tests done and their levels are still high;  their Celiac cannot go into remission because they are still ingesting gluten in small amounts. Needless to say, we see them a lot more when they are trying to get their levels down.

In 2011 I wrote extensively about this and sent it out once a year in my newsletter. In 2015, I transferred it to my blog so you can see it anytime. For more detailed information check out my blog post  under “Vitamin Deficiencies”.  I also tell you what the symptoms of the deficiencies are. (click on the blue link below and it will take you right to the article and scroll down to see the list of the 26!)

26 Nutritional and Vitamin Deficiencies in Celiac Disease & Symptoms

In a nut shell, here are just a few of the tests that should be done when diagnosed:

-Celiac Antibodies: IgA, tTg

-Anemia: Hemoglobin, B-12, Folate, etc. (I had Anemia)

-Vitamins & Minerals: B-6, Vitamin D (I had severe deficiencies)

-Mineral Profile

-Renal and Electrolyte Profile (I have Kidney Disease)

-Thyroid: TSH (thyroid stimulating hormone) (I have Hashimoto’s Disease)

-Lipid Profile

-A1C (Diabetes; I put this one on the list; I have pre-diabetes)

Just so you know,  I am not the only one talking about this.. Beyond Celiac; formerly NFCA (National Foundation for Celiac Awareness) put some basic information up as well. It tells you what tests should be run and what your follow up testing for life should be. However, it is nowhere near as involved as what I give you in my previous blog post.

Please be diligent with your health!

Follow Up Testing (Beyond Celiac)

 

Celiac Disease and Your Kidneys

Over the years I have put a few articles in my newsletter about Kidney Stones, Berger’s Disease (IgA Nephropathy) and Celiac Disease; because I am affected by all three.  Some of our customers are going through the same issues, some have had kidney transplants, some are awaiting transplants and some are just experiencing Kidney Stones.  The following information was originally in a 2012 newsletter and a 2014 Newsletter. I have compiled them both into one article for the blog. As usual, I will use my own situation so you can relate to it. The bottom line here is for you to be aware.

For most of my life I battled bladder infections and surgery and constant kidney stones and kidney infections. If any of you have battled kidney stones and also have Celiac Disease; you will be glad to know that there is a reason why.  I was having stones way before being told I was Celiac and many years later I was told by doctors that there was absolutely no correlation between stones or Celiac Disease. Well, times have really changed.

A few years ago between November and December I was once again battling constant kidney stones. I decided to find a new Nephrologist and he really gave me an education after 3 weeks of constant stones and lab tests. He asked me what I was eating different in November and December of every year (when I always experienced the most stones). I had an ah-ha moment! Every year my mother in law would send us a big box of awesome mixed nuts from Michigan; I would eat some every night when I got home. No doctor ever had asked me what I was eating differently.

There is a strong correlation between Celiac Disease, Kidney Stones and Berger’s Disease. My new doctor even explained it to me in a way that I could actually understand it and he even drew pictures for me!  If you are gluten free and casein free like I am, the lack of calcium can also cause stones, I pass calcium and oxalate stones.  So , if you, your child, or a loved one suffers from stones, this is well worth reading and it is great just to be aware.  I will first discuss Kidney Stones and then I will discuss Berger’s Disease (IgA Nephropathy) as well.

So, for the newsletter, I decided to see if I could find what my Doctor told me in writing somewhere and I found it in several places. Below is an excerpt from one of the best write ups I have seen on kidney stones; by John Libonati at Gluten Free Works.

Kidney Stones
“In active celiac disease, the normal mechanism to get rid of oxalate (calcium binding with oxalate) is prevented by fat malabsorption. If too many fatty acids are present in the intestine, the calcium binds with them instead and is excreted as waste. The oxalate remains to be absorbed into the bloodstream by the colon where it is then excreted into the urine.  This process is called enteric hyperoxaluria. “Enteric” means intestinal. “Hyper” means high. “Oxaluria” means oxalate in the urine.  Calcium present in the urine binds with the oxalate to form crystals.

In enteric hyperoxaluria, the excess free fatty acids, from fat malabsorption, compete with oxalate for calcium binding, leading to an increased availability of oxalate for absorption (solubility theory). This oxalate is absorbed in the colon, which is made more permeable to unabsorbed bile salts and fatty acids (permeability theory).³

Oxalate that should have combined with calcium in the gut to be properly excreted in stool now shows up in the kidneys where it combines with calcium to be excreted in the urine.

Stones form when the amounts of oxalate and calcium are high, the urine is concentrated and the pH (acidity) is low, all of which allow the calcium and oxalate to precipitate out of the urine to remain in the kidney. To illustrate this problem of concentration, think of stirring sugar into a pitcher of lemonade…add too much sugar and it begins to fall to the bottom of the pitcher.

If nothing changes, stones remain in the kidneys to grow and block the passageways of urine excretion.”  80% of kidney stones are formed from calcium oxalate and this is the form most often found in celiac disease. Calcium oxalate is the combination of calcium and oxalate. Calcium is an important mineral that the body needs for structure and function. Oxalate is found in foods in the form of oxalic acid. Oxalic acid is an extremely strong acid found in many plant foods. 

The 8 foods that increase urinary oxalate excretion are:                                    rhubarb, spinach, strawberries, chocolate, wheat bran, nuts, beets, and tea.          (A Celiac should not be eating wheat anyway!)  However, following a low oxalate diet and gluten free diet is not enough for me, I also take medication to help me.

You will be amazed…. click on link for more info:    http://glutenfreeworks.com/blog/2010/11/17/kidney-stones-renal-calculus-causes-treatment-in-celiac-disease/

Berger’s Disease (IgA Nephropathy) and Celiac Disease

Have you been told your creatinine levels are very high in your urine, blood in your urine, high protein in your urine? You should get checked.  I have battled this for the past 5 years or so and I take 2 medications to help me and I follow a low sodium diet.  The Best information I have found is the following from the Mayo Clinic.

IgA nephropathy (nuh-FROP-uh-the) is a common kidney disease that occurs when an antibody called immunoglobulin A (IgA) lodges in your kidneys. This hampers your kidneys’ ability to filter waste, excess water and electrolytes from your blood. Over time, IgA nephropathy – also called Berger’s disease – can lead to blood and protein in your urine, high blood pressure, and swollen hands and feet.

IgA nephropathy usually progresses slowly over many years, and although some people eventually achieve complete remission, others develop end-stage kidney failure. No cure exists for IgA nephropathy, but certain medications can slow its course.  Keeping your blood pressure under control and reducing your cholesterol levels also may help keep IgA nephropathy in check. (My cholesterol is under 125!)

Conditions or factors that may be associated with the development of IgA nephropathy include:

• Genes. IgA nephropathy is more common in some families and in certain ethnic groups, suggesting a genetic component to the disease.  (My grandfather died of Kidney Failure and he was not a diabetic.)
  
• Cirrhosis, a condition in which scar tissue replaces normal tissue within the liver
• Celiac disease, a digestive condition triggered by eating gluten, a protein found in most grains (I have this.)
  
• Dermatitis herpetiformis, an itchy, blistering skin disease that stems from gluten intolerance  (I have this, DH is now recognized as the skin manifestation of Celiac Disease and is a symptom of CD.)
  
• Infections, including HIV infection and bacterial infections

Link to the Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/iga-nephropathy/basics/symptoms/con-20034366

As usual, I hope you have found this information useful and as always take control of your health!