Clinical proof of malaborption reversal post GF diet?

[coppertopz]

Hi there, This is my first post and I apologize if it's in the wrong place. I couldn't find this topic.

I have iron-deficiency anemia that my dr. surmises is from the CD. I've been on a GF diet since Feb and my blood tests came back last week with my Ferritin cut in half - meaning the iron stores are not being refilled. This would suggest that I am failing at my GF diet since iron is not being absorbed.
Saw my hematologist this week who stated that there are no clinical studies showing that the intestines will start absorbing iron again even while on a GF diet and that my main goal is to heal the intestines so that I don't get malignancies or add'l diseases, but that iron absorption is unlikely

Does anyone know anything to the contrary or have you heard similar?Thanks! This is a fantastic forum!


_________________
36 y/o CD Dx: Feb 2005. Positive Blood Test and Biopsy. Pernicious Anemia Dx: July 2001. (They got it backwards! )
Asymptomatic except for anemia and some bone loss.

[aklap]

Hi Coppertopz,

Welcome to the board!! No need to apologize - we're usually pretty laid back around here.

I see you also have Pernicious anemia - are you taking B-12 shots or sublingual B-12 supplements?

I don't understand why your iron absorption would not return to normal once your intestines have been healed...but then I'm not a doctor BUT I do know how to read I have a friend that has CD (and is a nurse), she knows many people that their anemia disappeared on a GF diet. Some were on tranfusions & iron IV's!!!

It may take awhile for you to completely heal. I've seen some reports of up to 2 years.

I was able to find a few things for you:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2035309&dopt=Abstract

Iron deficiency in coeliac disease is mild and it is detected and corrected by gluten-free diet.

Acta Paediatr Scand. 1991 Feb;80(2):190-3. Related Articles, Links

Stahlberg MR, Savilahti E, Siimes MA.

Children's Hospital, University of Helsinki, Finland.

In 54 children with coeliac disease, mild iron deficiency anaemia or evidence of iron deficiency without anaemia were common at the time of diagnosis. Treatment with a gluten-free diet without iron medication eliminated all evidence of iron deficiency and completely normalized laboratory values. Subsequent challenge with gluten resulted in the rapid reappearance of suboptimal iron balance as evidenced by a decrease in serum ferritin concentration.

PMID: 2035309 [PubMed - indexed for MEDLINE]



http://www.baylorhealth.edu/proceedings/15_1/15_1_waldo.pdf
• • •
Case 1: A 14-year-old male student presented for a routine
athletic physical examination. He reported no cardiovascular or
gastrointestinal symptoms and had gained weight. His examination
was normal; however, his blood hemoglobin was 11.6 g/dL,
with microcytic red blood cells and a ferritin level of 5 ng/mL.
Upper and lower endoscopic findings were macroscopically normal.
Biopsy of the proximal duodenum showed villous atrophy
and lymphocytic infiltrate in the lamina propria. Subsequent serologic
studies revealed an anti-immunoglobulin A (IgA) tissuetransglutaminase
antibody level of 6.88 units (normal is <1.0),
and the anti-IgA endomysial antibody titer was positive (1:640).
A gluten-free diet was instituted, and after 1 year the blood hemoglobin
was 15.7 g/dL with restoration of ferritin and all serologic
levels to normal. The student remains without symptoms
and plays linebacker on his varsity football team.
Case 2: In 1992, a 41-year-old woman, referred by her gynecologist,
presented with a blood hemoglobin of 6.7 g/dL. She was
on hormone replacement therapy with no menstrual bleeding.
Her ferritin was unmeasurable. The patient denied any symptoms
or weight loss, and except for pallor, her examination results were
normal. Iron repletion with oral elixir increased her blood hemoglobin
to 12 g/dL in 1 year, without elevation of the ferritin. In
November 2000, a bone mineral density study revealed severe
osteoporosis requiring therapy with alendronate. She remained
asymptomatic. Serologic studies for celiac sprue were obtained.
The anti-IgA tissue transglutaminase antibody level was 5.1 units.
The anti-IgA endomysial antibody titer was positive (1:320).
After 5 months on a gluten-free diet, her study results returned
to normal and she remained without symptoms.

http://sickle.bwh.harvard.edu/fe-def.html

Sprue, both of the tropical and non-tropical variety (celiac disease), can also interfere with iron absorption. Degeneration of the intestinal lining cells along with chronic inflammation causes profound malabsorption. The anemia due to chronic inflammation and iron deficiency often is complicated further by nutritional deficiency. Celiac disease frequently improves dramatically with a gluten-free diet. Some patients with deranged iron absorption lack gross or even histologic changes in the structure of the bowel mucosa. The disease can be mild to the point that it produces few or no symptoms (Corazza et al., 1995). A gluten-free diet improves bowel function in many such patients, with secondary correction of the anemia.


http://www.guideline.gov/summary/summary.aspx?ss=14&doc_id=3058&string=

American Gastroenterological Association medical position statement: celiac sprue.

Routine full blood count, urea and electrolytes, liver function tests, serum iron or ferritin, folate or red blood cell folate, and B12 should be measured at initial diagnosis. Liver function tests may be mildly abnormal in patients with celiac disease, even when associated hepatic disorders are absent. Specific deficiencies of iron and folic acid should be therapeutically corrected, although they will not normally be required long-term after introduction of a gluten-free diet. B12 levels usually normalize without specific therapy. A dual energy x-ray absorptiometry scan should be undertaken to seek evidence of osteoporosis because this usually improves on a gluten-free diet, although specific therapy may required.

http://www.mayoclinicproceedings.com/inside.asp?AID=901&UID=8934

Cardiomyopathy Associated With Celiac Disease

The classic symptom of the disease is malabsorption manifesting as diarrhea, iron deficiency anemia, and weight loss. Other manifestations include osteomalacia, coagulopathy, and peripheral neuropathy. A gluten-free diet usually results in complete resolution of the symptoms and correction of the metabolic abnormalities.
_________________
Al

“We cannot all do great things, but we can do small things with great love.” Mother Teresa

[coppertopz?notloggedin]

You are a wealth of knowledge. Thank you so much for this info! I'm definitely going to send it to my hematologist!

In answer to your question re: PA - I take the shots - it's once every few months (since B-12 is trace amount) and don't want another pill to have to remember to take. The B-12 is is great shape - it's the iron stores that aren't doing so well (I've been getting iron infusions once a year since '01.).

Another question for you - do you get the antibody test regularly to see how you're doing?

THanks again!

[aklap]

Hi Copper,

Thanks!! It's not that I know a lot...I just know how to look to find it I think your Doc should sit down at the ol' computer and take a look! hehehehe. Google is a fantistic thing!!!!

Glad to hear you are watching the B12!!

As for antibody followup...I do not. I am self dx'ed because none of the docs could figure it out why I felt like cr@p all the time. I still don't think they'd believe me. I have not been back to my doc for this type of thing since - that was 2.5 years ago. I did have biopsies taken, but were negative. I think there was only 3 or 4 taken so, that's not a fair assesment. Myself I believe I have Non-Celiac Gluten Sensitivity. Since I've been GF, I have none of the problems I had for 1.5 years. I did have the IgA (i think) done by one doc (unbeknownst to me at the time, I saw it when I got my copies of my labs), after I had been GF for awhile - it was normal. But it should be - every 6 to 12 months follow up should be done to make sure.
_________________
Al

“We cannot all do great things, but we can do small things with great love.” Mother Teresa