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When Myth becomes Medical Fact People suffer unnecessarily The Case of Mistaken Identity of How Pellagra Sine Pellagra now thought to be a rare disease became known as Celiac Disease today A Grey Paper


Posterboy

When Myth becomes Medical Fact people suffer unnecessarily; the case of mistaken Identity: How Pellagra now thought to be rare today

Celiac.com Sponsor (A13):
became known as Celiac Disease — A White Paper better said as a Grey paper or ahead of Print Paper

To Who Ever might read this......may it be a blessing to you......this is the Capstone blog post to more than 12 Plus years of research.

May it bless you to read it.  Blessed are those who read it and understand and put into practice in their lives, I pray!

I called this a grey paper and or white paper because it is the first time I know this conclusion/hypothesis has appeared in print in any form

(note: this is a REPOST from a former blog post) and 2) it has not been proofed by other medical reviewers).  These thoughts are my own and

do not reflect the opinions of Celiac.com. and should not be considered an endorsement by them.....but is for use only as education on the part

of the reader......but hopefully after you have read it all (or other Posterboy blog post) you will not have any remaining questions.....

Getting a Peer review paper published requires you agree with the previously published papers and since this is “A New Thinking’ in Celiac disease

it is rejected and thus can’t be published by Peer review journals……thus making it a Grey Paper…..kind of like MedRxiv.org etc. and

preprint editions on COVID-19 papers etc.…….the results are NO less valid but not approved (as of yet) by their peers.

See this article about this topic of Grey Papers or Prepint findings not medically reviewed…..

https://newatlas.com/medical/anti-inflammatory-drugs-risk-chronic-back-pain/

Quoting their results

“The researchers are aware their findings will likely be controversial as treating acute pain with anti-inflammatory drugs

has been standard practice for decades. Speaking to STATnews Mogil said the research team faced challenges getting

the new study published in a journal as peer-reviewers were concerned at the radical implications of the findings.

Medical researchers don’t like surprises…..it means they have been wrong about their conclusions all this time…..and that makes them look bad……

and they don’t like that…..so they won’t print any “New and Original” thinking that contradicts their established Dogma (teaching) about the topic.

Now begins the Posterboy blog that is modified to show that when Pellagra Sine Pellagra showed up in Wheat based “Food stuffs”…..

it was not properly understood as a lesser form of Pellagra that showed up almost exclusively in Corn based “Food Stuffs”

and was mistakenly given a new and trendy diagnosis of Celiac disease and/or NCGS instead thus passing into history as Medical Fact

too this day a Case of Mistaken Medical Myth.

Note: For simplicity this Posterboy blog mentions Pellagra and not Pellagra Sine Pellagra, though Pellagra is also Pellagra Sine Pellagra

plus Skin issues etc. Really in most cases 2/3 of the time only Pellagra Sine Pellagra ever develops……unless you also develop Skin issues

like DH, Acne, Psoriasis, LUPUS or Sjorgen’s disease etc……then you have developed full blown Pellagra going misdiagnosed……

otherwise the information contained below is accurate as I can make it…..keeping in mind I wrote this originally from the viewpoint

that Wheat (IE Gluten) was triggering Pellagra (aka Low or NO Stomach Acid) where before it was being triggered by Corn and this confused

the medical (and still does) to this day.  If you want to see other Posterboy blog posts on Celiac.com just search for the Posterboy

of both Pellagra Sine Pellagra and Celiac disease.

Pellagra is/was first identified as occurring in Corn based feed stuffs it is/was only natural that when STRESS (WWII) triggered it.....

(Celiac Disease/Pellagra by another name) in wheat based grain diets that doctor’s didn’t see the similarities. So a new disease was

being described/created to explain why wheat consuming people developed a malabsorption syndrome that could/would be mistaken

for Pellagra if the diet was Corn based.

So this medical myth became medical fact in the 50’s and it has not been challenged really until the functional medicine doctor Prousky

conclusively proved Niacin treats digestive problems just as Pellagra Preventive Factor Vitamin B-3 did then protect (cause remission) people

from Diarrhea, IBS, and other GI problems not yet classified in the early 20th century so too can/does Niacin(amide) (I believe) now treat

Celiac disease today because Celiac disease was the first time Pellagra was described in a wheat based diet. The One (Pellagra faded away)

and is replaced now by Celiac disease.

See Dr. Alessio Fasano’s 5 myths about (of) Gluten in the Washington Post a founder and director of the Center for Celiac Research

at Massachusetts General and Author of Gluten Freedom.

https://www.washingtonpost.com/opinions/five-myths-about-gluten/2015/12/18/a803377e-a279-11e5-ad3f-991ce3374e23_story.html

I want to talk about his 5th myth today.  5) If you have Celiac disease as a child, you will outgrow it.

In the same point he contradicts himself (as people often do when they don’t understand the cause of something) when he says to close his point

quoting Fasano “Another milestone was when we determined that people can develop celiac disease at any time in their lives, even into old age.

Now we know it is a permanent condition, and the best medical intervention we have is a gluten-free diet.”

Which is it Doc? You don’t grow out of it but you can grow into it?

Is it a genetically triggered disease which patients can’t outgrow? Or is it a disease triggered in time

http://www.bloomberg.com/news/articles/2010-09-27/celiac-disease-incidence-increases-as-people-grow-older-u-s-study-shows

If you doc are saying your chance of Celiac disease increases with time as you cite then clearly genetics is not the trigger?

Clearly doctor you don’t understand the trigger.

It makes more sense to say if as child you encountered something in your environment that triggered Celiac disease then you could get better

if the trigger (STRESS) was removed just as in older individuals who had not YET encountered stress in their live HAVE not yet triggered

Celiac disease genes in their life.

One has been substituted for the other. A myth has become (medical) fact. It happens a lot more than you think.

See Dr. Dana Myatt’s seven-not-surprising-health-updates-from-2015 she call’s them kindly calls them “updates” but they were really myths. 

Something told as truth/fact but still persists though proven untrue.

If Dr. Fasano is still telling people it is genetic (only) disease but in the same post says you can develop it in old age ONE is wrong?

OR it doesn’t well explain what is actually happening.

To investigate further his comments in point 5 Dr. Fasano cites Dr. Dicke’s work in the 1950’s

“After watching the mortality rate of children with Celiac disease drop during World War II,

Dicke suspected that the decline might be related to the scarcity of bread at that time.

Still, it would be decades before the notion that you can outgrow Celiac disease was challenged.”

Let’s consider our environment here for a second – WWII. I would say that is a pretty STRESSFUL environment to say the least.

Any war is stressful but a world war could/might trigger any number of syndromes. So the further we get away (in time)

from that stress it only makes sense these children’s health would improve tremendously.

And while there was a scarcity of wheat and any food stuffs to a degree (specifically high quality meat proteins known to hold Pellagra at bay)

what was not taken into account when considering the possible causes of Celiac disease was you guessed environment (STRESS).

Have you experience a lot of stress in your life. Then you are experiencing what researchers are now discovering (again) 

Lifestyle is risk factor for Celiac Disease

and you can develop Celiac Disease at any age (see citation above “Celiac disease risk increases as you grow older

(again at ANY AGE) as Fasano himself has proven (again not genetics only) there is a trigger he is still missing because

he doesn’t understand completely why this is happening.

Now if stress was the only trigger then Celiac disease would of/have shown up in other theaters’ of war presumably

the pacific theater as well. But here it is silent.

Let’s see if we can’t figure out why?

The answer lies in food fortification?

I quote “In the U.S., only 40 percent of the nation’s manufactured flour was enriched, because smaller companies continued

to produce cheaper unenriched flour to compete with larger manufactures. In 1942, the U.S. Army decided it

would purchase only enriched flour.”  Which lead to all (100 percent) of the flour being enriched with what was

called the Pellagra Preventive Factor at the time the newly discovered third Vitamin or

what we know today as Vitamin B-3 Niacin. 

See this article entitled "Food fortification spurred by military purchases"  https://www.eurekalert.org/news-releases/634050  for a great summary.

And while flour as a rule was scarce in Europe during WWII especially in latter years what is often overlooked is that the flour

that did arrive now had Pellagra Preventive Factor enriched in it aka Vitamin B-3 or Niacin today put the Celiac crisis in remission.

A Pellagra outbreak was already successfully quelled once with fortified food stuffs when the Red Cross reversed its incidence during

the great flood of 1927 by following Goldberg’s directive of distributing yeast a good nutritional source of Vitamin B-3.  See this link

http://www.encyclopediaofarkansas.net/encyclopedia/entry-detail.aspx?entryID=2230

Remember Celiac Disease was not classified as a definable disease until the 1950’s when Dicke hypothized that the lack of wheat in the diet

improved what was then also known as Gee-Herter’s disease when really it was the presence of Pellagra Preventive Factor as correctly

hypothized by Goldberg in the 20’s that caused Pellagra to go into remission in the European theater.

I note again for emphasis “After watching the mortality rate of children with Celiac disease drop during World War II,

Dicke suspected that the decline might be related to the scarcity of bread at that time”

If stress is a trigger for disease and it is. WWII should of increased Celiac disease UNLESS enriched bread with Pellagra Preventive Factor

became MORE common and it did halfway through/during WWII in 1942 exactly when we might suspect improvement in Pellagra patients

if indeed Celiac disease (Pellagra misdiagnosed) was now being diagnosed in patients who primary dietary staple was wheat and not Corn Maize

where/when it was  first described/diagnosed in the “War on Pellagra” as summarized well by Dr. Heaney here

http://blogs.creighton.edu/heaney/2013/11/18/pellagra-and-the-four-ds/

Because Pellagra is/was first identified as occurring in Corn based feed stuffs it is only natural that when STRESS (WWII)

triggered it in wheat based grain diets that doctor’s didn’t see the similarities. So a new disease was being described/created

to explain why wheat consuming people developed a malabsorption syndrome that could/would be mistaken

for Pellagra if the diet was Corn based. But we got lucky in a way. The US Army knowing the old adage “an army marches on its stomach”

got smart and begin requiring all its flour to be enriched thus not only reversing a developing epidemic

(Pellagra confused for Celiac disease in Europe) but the US Army not only fighting/keeping in remission Pellagra in its own soldiers

but the whole country and continental Europe benefited.

For when the Army required enriched flour the country went from 40 percent enriched flour to 100% enriched flours and this

new developing epidemic of Celiac disease went into REMISSION too (just as Pellagra too was beaten in the poor South) indicating

an environmental trigger 70+ years ago and still (confused) experts in the field saying things like myth #5 not only can you not grow out

of it as a child but YOU can grow in to it as an adult.  Stop the Madness!

How much longer must people suffer before we relearn histories lesson’s that STRESS triggers sickness and Vitamin’s make us healthy?

I sometime think we have been hit with this “genetic stick” so much if we don’t understand something well it must be genetic then.

We don’t understand it so it must be genetics.

Some researchers’ are finally waking up and saying NO Lifestyle is risk factor for Celiac Disease you can get Celiac disease at ANY age.

But even doctor’ Fasano doesn’t understand STRESS is the trigger!

Why else quoting Fasano again would you say “The fact that about 1 percent of the population is affected by Celiac disease,

while almost 100 percent of humankind is exposed to gluten-containing grains, is evidence that these grains are safe for most people”

and in the same article say “ Another milestone was when we determined that people can develop Celiac disease at

any time in their lives, even into old age.”

IT IS NOT GENETICS’ ALONE if you can increase your risk at ANY age. Their might be a pregenetic disposition if STRESS is high enough.

Then after saying that we “determined that people can develop Celiac disease at any time” he says exactly the OPPOSITE thing.

Quoting Fasano again in his VERY next statement “Now we know it is a permanent condition, and the best medical intervention

we have is a gluten-free diet. “

NO doctor it is not permanent or you could not develop it at ANY age. The best medical intervention is vitamins specifically

Pellagra Preventive Factor now known as Niacin(amide) Vitamin B-3 as Prousky proved over almost 15 years ago Niacin

treats digestive problems.

See this Italian Study on Pregnant women prove this summarized by Very Well health that I have subtitled

“First Comes Baby, then Comes Celiac Disease”

https://www.verywell.com/can-pregnancy-trigger-celiac-disease-562302

I could go on . . . all the inconsistencies trying to fit a round peg into a square hole. EVEN though he say’s and research (HIS) bares it out

that it NOT genetic’s alone he (Fasano) can’t let go of his genetic paradigm . . . you want to say . . .

wait a minute this disease develops at any age but you still say it is permanent.

No your argument has holes in it that doesn’t fit the disease patterns. But Epigenetics (Environment/Stress) triggering this disease does.

And Epigenetics is reversible just as Fasano research bares out IS triggerable at any age.

And other researchers agree Researchers have not been able to explain why Celiac Disease develops until now;

Part 2 Epigenetics (STRESS) discovered as the cause of Celiac Disease/NCGS by the Celiac Posterboy.

“According to Dr. Decker Butzner, a Calgary-based pediatric gastroenterologist, there are another triggering factor which

we’ve never understood…[t]here is an environmental trigger.“

To summarize I will quote for emphasis me The Celiac Posterboy what I said earlier in this blog post because

“Pellagra is/was first identified as occurring in Corn based feed stuffs it is/was only natural that when STRESS (WWII) triggered it

(Celiac Disease/Pellagra by another name) in wheat based grain diets that doctor’s didn’t see the similarities. So a new disease was

being described/created to explain why wheat consuming people developed a malabsorption syndrome that could/would be mistaken

for Pellagra if the diet was Corn based.”

So this medical myth became medical fact in the 1950’s and it has not been challenged really until the functional medicine doctor Prousky

conclusively proved Niacin treats digestive problems see above citation just as Pellagra Preventive Factor Vitamin B-3 did then protect

(cause remission) people from Diarrhea, IBS, and other GI problems not yet classified in the early 20th century so too can/does Niacin(amide)

(I believe) now treat Celiac disease today because Celiac disease was the first time Pellagra was described in a wheat based diet.

The One (Pellagra faded away) and is replaced now by Celiac disease.

See my earlier post  where I quote Dr. Heaney of Creighton University and he says as much “Pellagra is a disease of the past”

see this link for the whole article Dr. Heaney does correctly state” it is doubtful today that most health professionals (doctors)

would recognize it if a case (of Pellagra) happened to come to their attention.”

http://blogs.creighton.edu/heaney/2013/11/18/pellagra-and-the-four-ds/

And why should they when Celiac disease has replaced it (Pellagra) today!

Well it is not as in the past as people/doctor’s think it just known (goes) now as Celiac disease TODAY! unless your an alcoholic and homeless.....

then the doctor's can spot it.....but only if you are also a drinker etc.....it is affluent confirmation basis.....or as Dr. Derrick Lonsdale call's it...

High Calorie Malnutrition.....but we know from the Russian Japanese War Circa 1904 to 1905 and the Japanese Navy/Army Beri Beri

can still develop even in well fed troops if their Carbs to Protein ratio exceeds 15 to 1 Carbs to Protein ratio etc...

See this article about it....https://medium.com/war-is-boring/eating-too-much-rice-almost-sank-the-japanese-navy-f985772c81a6

And is a precedent for how Pellagra Sine Pellagra and/or Pellagra showed up in the middle of WWII in Wheat Based Food Stuffs

and the doctor's after the war..... created a new disease from the symptom's......and it has been wrong ever since IMHO.

I called this a white/grey paper because it is the first time I know this conclusion/hypothesis has appeared in print in any form.

How do we know this is true? We can’t really UNLESS we are willing to try The Niacin (Niacinamide) Challenge and

see if your digestive problems don’t’ go into remission as Prousky proved almost 15 years ago this year.

You can find the Niacinamide Challenge by Googling for it and you should see it by the Celiac and Pellagra Posterboy.....

What have you got to loose.....it is a water soluble Vitamin shown to help GI problems....

We can’t really prove this until medical trials are performed. “Keys” as I call them.  Or can we....see the Addendum at the

end of the blog post.....I think we can and I have found the research that show 50+ years old Celiac's were shown to

have trouble with Tryptophan metabolism.....showing at least Metabolically Pellagra is occurring in Celiac's and it

has been over looked by modern medicine in this genetic age when it is/was Epigenetics all along!

See my blog post To Educate is to Free by the Celiac Posterboy if you want to read more about this.

There are reason’s the doctor’s don’t find Pellagra instead of Celiac disease it is partly because they are commonly

taught that “Pellagra is a disease of the Past” to quote Dr. Heaney.

But we can “buzz” the doctor’s with this information till they submit to either let you take the Vitamin see my post

 Who’s Afraid of a B Vitamin or through your improvement/remission assent to do “key” studies proving (again) what the Canadian research

Prousky discovered 15 years ago this year that “Niacin(amide) treats digestive problems”

And what’s worse 35+ years ago researchers proved that Celiac disease happens when we get low in stomach acid

or have NO stomach acid to protect us against the proteins in our diet we are eating…….

See this research that show NCGS and Celiac disease start with Low and/or NO Stomach Acid in the case of DH especially.

Entitled “Gastric morphology and function in dermatitis herpetiformis and in Celiac disease”

https://pubmed.ncbi.nlm.nih.gov/3992169/

Where they note quoting

“The frequency of achlorhydria (aka NO stomach acid) was significantly higher in patients with dermatitis herpetiformis

than in 69 patients with celiac disease.”

And it is worth noting……this study was in ACTIVE Celiacs ……not in candidates….so we can say with Certainty……

this is happening in Celiac’s and continues to --- TOOOOOO! this day!

Because we can say with certainty (above 90+ percent) in DH patients and Celiac’s will have little to NO stomach acid.

Quoting again….

“Antrum-sparing chronic atrophic gastritis was present in 92% of the achlorhydric patients, (remember this is in ACTIVE Celiac disease)

and hypergastrinaemia and serum parietal cell antibodies were found in most of them.”

And yet the doctor’s toooooo this day are still groping in the dark still looking for answers in all the wrong places…….

I said it here first healing for Celiac’s begin in the STOMACH because it protects us from the (now) harmful proteins IE food allergen

like CASEIN and GLUTEN that are still passing into our (your) small intestines UNDIGESTED.

I always say share – share what you learned here today! (Class/reader) because a lot of people are suffering unnecessarily

while the doctor’s find the right (keys’) disease.

Tell someone (share) is all I ask Are You a Starfish (Part 2 – of a Former Sufferer’s Journey) tell others is all I ask –

when you are BURPING for the first time in years or (EVER) – tell a friend about this blog is all I ask but don’t let the chain break with you.

There a lot of starfish (sufferers’) who need help.

See my Celiac Posterboy WordPress blog entry To Educate is to Free Part Two: A Physician’s Guide

If you want to try and educate your doctor and think he will listen.

I argue (maintain) theorize that based on triggers in our environment we get low in stomach acid and THEN develop Celiac disease

and if you want to read more about how there are two Types of Celiac disease please see and read this Posterboy blog posts

that explains how there are two types of Celiac disease today a Type I (one you are born with) and Type II (one triggered by the stresses of life

and is reversible for any thing triggered is reversible once you understand it).

Blessed is everyone who reads and understands it…..because then healing and recovery  can take place.

And before everyone gets all upset…..this what even modern medical science has confirmed today!

That Tryptophan heals Villi in Celiac’s proving in IMHO that Pellagra is going undiagnosed in Celiac’s and especially Dermatitis Herpetiformis

patients aka DH in Celiac’s and other skin diseases in Non-Celiac’s.......I say it is about TIME! ......they are 50+ Years late according to the research!

https://www.news-medical.net/news/20201022/Tryptophan-found-in-turkeys-can-accelerate-intestinal-healing-in-people-with-celiac-disease.aspx

Sadly it will take another 20+ years (a generation) for medical practice to catch up to medical science (IF then Sadly)…..

remember the research on Low (really) NO Stomach acid in Celiac’s and DH patients is over 35+ years old……

and they (doctor’s) still don’t get it today!

*** Remember: This is not medical advice and should not be considered such. Results may vary. Always consult your doctor before making any changes

to your medical regimen. But mine has taken The Niacinamide Challenge and his digestive/GI problems are in remission.

The Celiac and Pellagra Posterboy by the Grace of God,

2 Corinthians (KJV) 1:3,4 3) “Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort;

4) who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble (starfish), by the comfort wherewith

we ourselves are comforted of God.”

2 Timothy 2: 7 “Consider what I say; and the Lord give thee understanding in all things” this included.

 

ADDENDUM

Found this research this week that confirms the same thing 50+ years ago that modern medical science has forgotten. 

That Abnormal Tryptophan Metabolism is Occurring in Celiac disease confirming a diagnosis of Pellagra at worst and Pellagra Sine Pellagra at best!

https://pubmed.ncbi.nlm.nih.gov/14169518/

It is worth noting that this is BEFORE Celiac disease was known as a “Genetic Disease” and we have been wrong EVER Since IMHO!

Those who don’t learn from history are doomed to repeat it!

To whom ever has read down to the end of this Celiac Posterboy "Magnum Opus" blog post may God be with you in your continued journeys  in life!

And God Speed as you continue in your recovery.  If this blog post has helped you in anyway......check back in and let other knows it was helpful

to you....... PTL!

11 Comments


Recommended Comments

Scott Adams

Posted

Remember that stress in medical terminology is not necessarily equated with mental stress, although it can be, it includes anything like a virus or other outside things that may create stress within the body’s immune system.

I disagree 100% that celiac disease isn’t a lifelong condition because I was formally diagnosed with celiac disease over 25 years ago, and I have taken large amounts of B vitamins including a standalone niacin supplement for many years now. If I get gluten contamination I still have severe reactions to it. According to your hypothesis this would not be happening because I have large quantities of B vitamins, including niacin, in my system, yet this is not stopping the autoimmune process that is caused by gliadin in those who are sensitive.

Scott Adams

Posted

PS: I do believe that Pellagra could be a stressor event that might trigger celiac disease, and Pellagra may be more common than doctors realize.

Posterboy

Posted

Scott,

I have a two or three ideas about what could be happening with/to you.

I don't remember if you said or not.....if you did I didn't pick up on it.....

I know Ennis_Tx was a long term user of PPIs......do you or did you at one time use PPI's?

Taking PPI's have been shown to be a CAUSAL trigger (due to the low stomach acid they trigger) for Celiac disease.

Here is the article Celiac.com did on the topic.

And do you drink alcohol with any frequency? Alcohol has also been shown to trigger gluten antibodies.

Here is the article on it as it was featured again on Celiac.com

If you have done or do either of these (Now) especially the PPI's then you could be counter balancing the benefit you expect tor receive from taking a B-Vitamin.  And is it  a B-Complex you are taking (I wasn't sure) or only the Niacinamide etc? Or only do you also take a fat soluble Thiamine like Benfotiamine etc?

It is important because a Magnesium deficiency could lead you to be low in Thiamine triggered by the Low Stomach Acid triggered by the use of PPIs or STRESS  in your life 6 months before....

See below how the FDA warned on low Magnesium when taking PPIs years ago....but people are still taking them regularly to this day....despite evidence to the contrary...

And it is worth noting often that the PPI had to be stopped EVEN when supplementing with Magnesium to recover from low blood Magnesium levels etc.

Here is the warning on using PPIs and low Magnesium levels for others who might come across this blog post.

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-low-magnesium-levels-can-be-associated-long-term-use-proton-pump#:~:text=FDA Drug Safety Communication%3A Low magnesium levels can,small intestine ulcers%2C and inflammation of the esophagus.

And it is worth nothing.....we know Low Magnesium will lead to low and/or refractory Low Thiamine levels....

This is important because we NOW Know what triggers an auto-immune state in our bodies biochemically......it is triggered when get too low in Acetylcholine...

And why Celiac.com also did an article on the new research about what turns the body from anti-inflammatory to inflammatory (or auto-immune state on)......I think this article goes in to more details and explains it a little better IMO.

https://www.medicalnewstoday.com/articles/321624#From-inflammatory-to-anti-inflammatory

Are you sure it was gluten and not some other protein in your diet like Lactose or more correctly said Casein....the protein part of Milk.

It is also worth noting that Casein in your diet can also lead to Refractory Celiac disease.....or Celiac disease that does not get better after eating gluten free.

See this research about it entitled "[Anti-tissue transglutaminase antibodies not related to gluten intake]" IE triggered by Cow's Milk Protein".

https://pubmed.ncbi.nlm.nih.gov/29555204/

I know it happens a lot more than people realize is why I mention it.....

quoting they conclude by noting...

"CMP (aka Cows Milk Protein IE Casein) ingestion after an exclusion diet can induce an increase in anti-tTG in some coeliac subjects. CMP can produce this immune response if there were no gluten transgressions"

As I understand it this can potentially happen in about 40% of Celiac's and explains perfectly why people still struggle on a Gluten Free diet......when they know they are 100% gluten free to the best of their ability....

And back to the Acetylcholine link.....when we get low in Thiamine we will deplete our Acteylcholine low enough to trigger an auto-immune condition because Thiamine is in the path of Acetylcholine production in the body and why you could still be having an auto-immune reaction to proteins in your diet....

And while Scott I know you have read this article I am reposting it here for others who might come across this blog post (for easier access for them to read instead of having to find it again) and not be aware the role Thiamine plays in Thinning Villi revealed in a Celiac diagnosis which might really be  hidden Beri Beri instead.

I hope this is helpful but it is not medical advice.

Posterboy,

Scott Adams

Posted

I don't take PPI's, and only took them for a month or so way back at the time when I was diagnosed over 25 years ago. I'm a moderate drinker and stick mostly to red wine...I take magnesium citrate, thiamine, B-complex, etc., regularly, so none of this explains away celiac disease. Yes, I'm sure that when I've ingested gluten that it triggers issues, and it's not casein--I eat casein regularly without issues (but could not until ~1-2 years after my diagnosis and my gut healed).

Sorry to pour water on your theory, but I just don't believe that all of the leading celiac disease researchers in the world are mistaken about what celiac disease is, and I've spent 25+ years summarizing their research on it. They know quite a lot about the disease, and they would have figured out by now if it were simply Pellagra in disguise.

Your theory also does not explain the genetics linked to celiac disease, but celiac disease research has explained this.

Again, I view your theory more as vitamin & nutrient deficiencies may, along with other environmental things like viruses, be a trigger of celiac disease in those who are genetically susceptible to it.

Posterboy

Posted

Scott, (Et al to Others that might read this)

The Problem with a Celiac diagnosis (in general), IMHO is that other things can also trigger the same conditions attributed to Only Celiac Disease......and it simply not true that only gluten triggers Villi blunting etc.

In addition to PPIs......NSAIDs have also been know to trigger Villi blunting? Are you taking any of these type medicines for pain.

See this article that summarizes the link of NSAIDs to gut disease...

https://www.thedailybeast.com/research-shows-link-between-nsaid-use-and-gut-disease

The original research is actually over 30+ years old......and the doctor's almost never mention it to this day.....they know about the kidney damage but forget to mention the GI link etc......though they are aware of the Aspirin link to a bleeding stomach/ulcer.....and why as I noted.....the medical researchers as I noted....had trouble getting the "New and Different" research on the topic published.....the same as I have (by the way)....because it goes against established "Dogma IE teaching" on the topic etc.

I had a similar issue with the "Stan" BPs medicines......like Losartan etc.....

See this thread where I start a topic on my issues with my BP medicine which has a FDA warning on it for Villi Blunting.....

And as Plumbago points out is is a "Class Warning" of all Stan BP medicine's not just Losartan....

The test for Celiac disease is not specific enough when Several different things cause the same problems IMO....

This does not include SSRIs.......do you take any of these medicines for depression etc.  (depression is common in Celiac's as you know).......and yes I have also taken them.....but don't need to now that I have found Magnesium and Thiamine and Riboflavin and Niacinamide etc....

See this nice discussion thread about this Villi blunting action in PPIs and NSAIDs as started by Knitty Kitty....

And presumably these medicines could be causing the same Villi Blunting attributed to only gluten......and could cause you to be reacting to gluten (even if your full of B-Vitamins etc.) as if it was an auto-immune reaction etc....

Also the fact that Genetics is not the (only) trigger for Celiac disease has been "Debunked" by the latest study/research on the topic...

https://www.genengnews.com/news/dna-has-relatively-little-say-in-disease-risk-usually/

Granted it is only a couple years old.....and it will take awhile for the "New and Different" thinking on this topic to take hold....I call it the Long Tail of memory....

Even when "New and Different" thinking as debunked the "Dogma" on a particular topic.....it takes another Generation IE approx. 20 years to incorporate the New thinking into medical practice....

quoting from the Genetic Engineering News 

“It is becoming increasingly clear,” explained Wishart, “that the risks for getting most diseases arise from your metabolism, your environment, your lifestyle, or your exposure to various kinds of nutrients, chemicals, bacteria, or viruses. (Note: Not Genetics as is commonly reported and putatively believed and still reported despite new and clear evidence to the contrary)

Notice that Wishart referred to most diseases. According to Wishart and colleagues, these include many cancers, diabetes, and Alzheimer’s. In fact, for such diseases, the genetic contribution to disease risk is just 5–10%. There are diseases, however, for which the genetic contribution is about 40–50%. These diseases include Crohn’s disease, celiac disease, and macular degeneration."

Celiac disease is no more than 50% triggered by Genetics.....not the 90% to 100% as is commonly believed??? and repeated.....if you have the genes  or certain genes.....you will get Celiac disease....

NO, there is a trigger in your environment it is not genetics alone.......and most certainly not (gluten alone) if Cows Milk Protein, and SSRIs and, NSAIDs and oh yes even Chicken meat in some people who trigger gliadan antibodies.....and in another thread recently Trents I believe quoted that even Rice can trigger the same reactions....and don't forget Oats and yes Corn too!

The test for NCGS and/or Celiac disease is just not specific enough IMHO....

And why I do believe I received the right diagnosis......I definitely did react once to gluten.....I don't any more....PTL!

(To Others, I detailed my experience) about my gluten journey in this Posterboy blog post....pay attention to the last two posts.....they focus on my journey up to the point I joined Celiac.com to share my journey if you don't have time to read it all.....where I explain my Road Way Back/ Timeline and "The Golden Cross of Digestion" and how I am still golden after all these years....

(To Others) I also recommend this Posterboy blog post.....because it is well commented and it will do you good to read the comments....

This reply is getting a little long (again)......and why I will have to quit this forum some day......it just takes too long, to write out,,,,again and again (long and rambling reply's) and I just don't have that much time any more these days.....but I digress.

What I wanted to get too was this point......the point where the Medical community decided it was a "Genetic Disease".......this before they knew (Poor Nutrition triggered an Immune Response) and they still don't acknowledge it to this day......Vitamins and Minerals regulate or immune system.....and when they first saw this....they missed it.....and it has been wrong ever since...

See this research before Celiac disease was a "Genetic disease" only...... and they knew it to be a "Metabolic disease" triggered by a Vitamin deficiency.

https://dm5migu4zj3pb.cloudfront.net/manuscripts/104000/104975/cache/104975.1-20201218131406-covered-e0fd13ba177f913fd3156f593ead4cfd.pdf

I will quote their summary/conclusion revealing this is happening in Celiac....which they knew 50+ years ago......but has since been almost summarily forgotten and when this was rediscovered that Tryptophan treats/heals Celiac's Villi it was celebrated as a way to possibly treat Celiac disease  (as If they had discovered something new)......but only cautiously admitted this was the trigger and/or cause of Celiac disease.....because this would violate the genetic model......that has so many cracks in it (these days) ......it barely holds water IE (is less or barely 50% genetic)......but when you consider Vitamins and Minerals then the complete model comes into view.....it is 50/50 genetics and your environment IE Malnutrition and Stress trigger genetic diseases or Vitamin and Mineral deficiencies thought to be genetic disease(s) instead....

I wrote about it in this blog post....

We only have one Immune System.......and systemic disease is triggered by Malnutrition....

Here the full citation on this happening in Celiac disease again before Celiac disease was considered a genetic disease....to wrap this up for  now

https://dm5migu4zj3pb.cloudfront.net/manuscripts/104000/104975/cache/104975.1-20201218131406-covered-e0fd13ba177f913fd3156f593ead4cfd.pdf

quoting

Patients with adult celiac disease regardless of the stage of their disease fail to metabolize an
oral tryptophan load normally
. This metabolic failure is characterized by significant increases in
the excretion of kynurenine, xanthurenic acid, and kynurenic acid, findings seen in human subjects
with a deficiency of vitamin B6. This is the first clear-cut evidence for B6 deficiency in adult celiac
disease, and our results suggest that these patients should be given supplementary vitamin B6."

This should be noted has also been shown to be true in Celiac children....

Metabolic Pellagra is happening in Adult Celiac's (at all stages of the disease) and in children as well!

I hope this is helpful but it is not medical advice.

My point always has been and still is....

"Treating your Vitamin deficiencies lets you treat your Co-Morbidity(s)" and supplements/supports your recovery....

As I said in my Posterboy blog post on "Genetics, Nutrition and Stress, the three way model for disease"

"You will feel half-dead if you continue to have these deficiencies if the doctor don’t also treat you for these

co-morbidities despite being on a gluten free diet!

I know I did….Ignorance kills!....but It maims us first!"

Scott good luck on your continued journey!

And as always  2 Timothy 2: 7 “Consider what I say; and the Lord give thee understanding in all things” this included.

There is more that could be said.....but I need to stop for now!

But this is a good start for any other "Starfish" IE fellow sufferer who might come across this Posterboy blog.... someday....

Where I tried to explain what helped me.....the Lord being my help....PTL!

Posterboy by the Grace of God

Scott Adams

Posted

We know that other things can cause villi blunting, this has been known for a long time, but the type of blunting caused by celiac disease is not identical to that of NSAIDs or other meds or issues that may cause blunting. But either way, we do know that people with celiac disease, and thus have the genetic markers known to be linked to celiac disease, get very specific villi damage to very specific areas of their small bowels, and that this damage does, in a vast majority of cases, go away once the culprit is eliminated--gliadin found in gluten.

You're implying a cure here for celiac disease, which is incorrect, it is non-curable, and everyone with the disease needs to remain gluten-free for life.

It is well known that many celiacs may have additional food intolerance issues, some of which may be temporary until their gut heals, but in some they may be lifelong. These are considered separate issues, and not celiac disease.

As I recall, you were never formally diagnosed with celiac disease, which means that you may have been in the NCGS group, and this is very different, but the diet is the same. It may be possible for some in the NCGS group to eat some gluten, or perhaps even "recover" and eat gluten again, but not much research has been done on this so it remains unknown. If you are fine now eating gluten that is great for you, but you never had celiac disease.

Quote

Also the fact that Genetics is not the (only) trigger for Celiac disease has been "Debunked" by the latest study/research on the topic...

https://www.genengnews.com/news/dna-has-relatively-little-say-in-disease-risk-usually/

You are totally incorrect about your interpretation of this article, and genetics play a crucial role in celiac disease, in fact the likelihood of getting celiac disease without the known genetic markers for it is close to zero, and here is a quote from the article you posted to support your idea that this idea has been "debunked":

Quote

Notice that Wishart referred to most diseases. According to Wishart and colleagues, these include many cancers, diabetes, and Alzheimer’s. In fact, for such diseases, the genetic contribution to disease risk is just 5–10%. There are diseases, however, for which the genetic contribution is about 40–50%. These diseases include Crohn’s disease, celiac disease, and macular degeneration.

Celiac disease is considered a genetic disease by experts, and this means that you need the genetic markers for it AND an environmental trigger that can happen at any point in the lives of those with such markers. No experts on celiac disease dispute this. Experts are still in the process of discovering all genetic markers for the disease. Poor nutrition and nutrient deficiencies may be an environmental factor that triggers celiac disease in those with the genetic markers for it, and some of the research you've posted may be an indicator of this, but more research needs to be done to verify this.

Treating all nutrient deficiencies and fully healing your gut will not allow those with celiac disease to eat gluten again.

 

 

ravenwoodglass

Posted

"Treating all nutrient deficiencies and fully healing your gut will not allow those with celiac disease to eat gluten again."

Gosh I wish that taking vitamins would 'cure' my celiac. Alas in the 20 years since I was diagnosed that has not been the case. Even the tiny amount that I might encounter in my volunteer work at a food panty ( shelving bread for example) is enough for weeks of misery if I don't wash my hands afterward.  Thankfully other workers understand and now handle flour and bread instead of wanting me to do it.

 

Posterboy

Posted

5 hours ago, Scott Adams said:

As I recall, you were never formally diagnosed with celiac disease, which means that you may have been in the NCGS group, and this is very different, but the diet is the same. It may be possible for some in the NCGS group to eat some gluten, or perhaps even "recover" and eat gluten again, but not much research has been done on this so it remains unknown. If you are fine now eating gluten that is great for you, but you never had celiac disease.

Scott and Ravenwoodglass et Al,

I receive an "official" Celiac diagnosis based on elevated antibodies.....with a return to normal after 30 days on a gluten free diet.....it was however not "Biopsy" confirmed....

And I think we are arguing over semantics here.....by the same "Genetic standards" If I remember correctly.....Ravenwoodglass doesn't have the two most common gene types and too would/could not be confirmed medically....

And is truly my heartburn with this topic.....other (Maybe many other types) of genes.....could also have a gene type (as yet undiscovered or linked to Celiac disease) and THEY would not by the medical community be diagnosed as a Celiac "Officially" instead only have NCGS based on the "Accepted" Gene type for Celiac disease...

And I know you know this Scott.....it is disingenuous at best to say the risk is practically zero.....if you don't have the two main types...

When Celia.com has several  threads about people trying to get an "Official Diagnosis" of Celiac disease only to be told they don't have the right "Genes" etc...

And new Haplotypes are still being discovered for Celiac disease...

Less than 2 years ago see this research in children...

And see the link I provided in the forum entitled "DQ typing in the diagnosing of celiac's" without calling out the results

https://www.ncbi.nlm.nih.gov/pubmed/11922565

quoting their results.

RESULTS:

"Of the 59 patients evincing only minor small bowel mucosal changes or positive celiac disease serology, 22 (37%) were negative for DQ2 and DQ8.""

celiac's here DQ2 and DQ* and assume that ONLY those with those genes can get celiac disease it is just not right.

they conclude " The low specificity of this test must, however, be borne in mind." of DQ2 and DQ8 and not the other way around. at least 50% of those who could have celiac disease is actually excluded with gene typing.

this is proven in this research entitled "Relative and SPOUSES are at risk of (Celiac disease) auto-immune diseases" . .. because they have the same stressors (NOT Genes)

https://www.sciencedaily.com/releases/2015/06/150630121402.htm

Why else could/would Spouses (who have NO common genes (we would presume) have higher risk unless it is triggered by common (STRESS and or Nutrition) in their environment which as spouses they share....

My concern is for those like Ravenwoodglass who "at least 50% of those who could have celiac disease is actually excluded with gene typing."

That leaves a whole swath of people who could never get an "Official Diagnosis" based on the current genetic model....

And why I argue as the latest Genetic research bears out.....it much more a 50/50 even spit than 90% Genetic's with only a 10% environmental trigger.....

See also this thread....

Or see this thread where the opposite thing is happening....

The Genetic model and "Proven biopsy" model IMO opinion is broken and needs to be updated to include Environment factors IE an Epigenetic model....

And it is too "Northern European" centric IMO....by only focusing on Northern European Genes....a whole swath of the World's population is left out!

And see this research on this topic that bears  this out....

Entitled "Frequency distribution of HLA DQ2 and DQ8 in celiac patients and first-degree relatives in Recife, northeastern Brazil" over 10+ years old.....and the current model of genetics for Celiac  would still exclude them as having Celiac disease AFAIK and they too would only be given a NCGS diagnosis.....because they didn't have the right Genes???

https://pubmed.ncbi.nlm.nih.gov/21484038/

Where they note....

"B1*02 was the most frequent allele in both groups (94% in the patients and 89% in the control relatives).

Conclusions: In this study, celiac disease was associated with the genotypes DQ2 and DQ8. DQ2 predominated, but the distribution of the frequencies was different from what has been found in European populations and was closer to what has been found in the Americas. The high frequencies of the HLA genotypes DQ2 and DQ8 that were found in first-degree relatives would make it difficult to use these HLA genotypes for routine diagnosis of celiac disease in this group."

And that is all I am saying if you want to keep the "Genetic Model" for Celiac disease.....update to include the latest gene types or admit the latest research is correct and include in an updated model of Epigenetics.........no more than 50% of the trigger for Celiac disease is genetic.....according to the latest finding...."Debunking" the long held belief only these two gene types can get Celiac disease......

NO other gene types are getting Celiac disease and the model has not been updated to include these yet!

Welcome those who have other gene types and Celebrate they have found Celiac.com and don't discourage them by telling them NO you can only have NCGS instead.....is all I am saying....

Treat your Co-Morbid deficiencies and if you still have GI issues then you could still have Celiac disease EVEN if your Gene's are not the "right type" to receive an "Official diagnosis"....

It takes on average 18 to 20 years IE a generation to incorporate "New thinking" at the clinical level.

This forum is the "Boots on the Ground" for those seeking a Celiac diagnosis and instead of encouraging them you send them away packing and often in tears.....just my two cents worth....for whatever it is worth.....

Supplements help them now.....maybe not heal....(I know that is a tricky word) but it can ameliorate those who have also developed Pellagra Sine Pellagra or Pseudo Pellagra as I did! as part of there Celiac diagnosis journey! and have co-morbid vitamins deficiencies from Celiac disease....

And we know for a (Medical) fact impaired Tryptophan metabolism is the Pathogenesis for IBS....

see this research entitled "Tryptophan: ‘essential’ for the pathogenesis of irritable bowel syndrome?"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266036/

And new recent research has shown there is indeed a "Two Way Street" or Bidirectional link between Celiac disease and IBS.

See this research about this connection entitled "Celiac Disease and IBS/IBD Show Strong Bidirectional Link"

https://www.medscape.com/viewarticle/975276

IMO instead of denying these connections we need to do more research IMHO confirming these connections....

The IJCD itself nearly 7 years ago began talking about these connections between Pellagra and Celiac disease and what I used to, in part, to develop this theory....which they say is over 50%.....which actually greater than the genetic component according the the latest research on the topic.....

http://pubs.sciepub.com/ijcd/3/1/6/

I got to stop for now.....

As always I hope this is helpful but it is not medical advice.

Posterboy by the grace of God,

ravenwoodglass

Posted

"Ravenwoodglass doesn't have the two most common gene types and too would/could not be confirmed medically."

I am officially diagnosed with celiac by a GI doctor. I had both neuro symptoms and DH and daily and nightly D for years. Thankfully my diagnosis came before gene testing was considered the be all and end all of diagnosis. Unfortunately one of my children who was diagnosed by both blood and biopsy 6 months after I was chose to get their genes tested after entering college. Since she didn't have DQ 2 or DQ 8 her diagnosis was recinded and she went back to eating gluten. DQ 9 is now recognized as a celiac gene in newer research that can be found on peer reviewed medical sites. I don't have time today to provide links but the info is out there if you care to look for it.

Scott Adams

Posted

Quote

And I know you know this Scott.....it is disingenuous at best to say the risk is practically zero.....if you don't have the two main types...

My comment stands as posted, and is not limited to only DQ2 or DQ8...it includes all known genetic markers to date, including DQ9 and several other markers. Without any of these marker celiac disease is highly unlikely, but there are likely some minor markers that are yet to be discovered.

Quote

Welcome those who have other gene types and Celebrate they have found Celiac.com and don't discourage them by telling them NO you can only have NCGS instead.....is all I am saying....

We welcome all here, including self diagnosed people with either gluten sensitivity or celiac disease, unlike certain Facebook groups who exclude anyone not officially diagnosed with CD. It makes no difference to me whether someone has CD or NCGS, they are all welcome here and always have been, but do not promote a cure for those with CD based on connecting lots of dots among many decades of different, unrelated studies. There are many studies that show that IBS and celiac disease are not connected, but you exclude those and often pick ones that support your predetermined goal, which seems to be that CD is curable. This isn't correct, and experts with far more medical training and experience with celiac disease than you have unanimously agree--none claim that the condition can be cured, and all agree that a gluten-free diet for life is the only current treatment.

It sounds to me that you may have celiac disease OR NCGS, and there is a big difference. You have chosen to eat gluten and believe you've cured yourself--I suspect you have NCGS.

Posterboy

Posted

On 7/15/2022 at 2:06 PM, Scott Adams said:

Poor nutrition and nutrient deficiencies may be an environmental factor that triggers celiac disease in those with the genetic markers for it, and some of the research you've posted may be an indicator of this, but more research needs to be done to verify this.

Scott et Al,

Research can't be done on this topic.....until it is brought to peoples attention that there is a need to follow this line of thinking.

Despite research showing various factors including Gut Biome can trigger or affect a Celiac's reaction to gluten.....the denial of an epigenetic trigger doesn't do us any favors IMO.

All I am saying it is more 50/50 split and the latest Genetic  research bares this out.

I know you are probably aware of this research but other who read this might not be...

Where 5+ years ago medical researchers concluded the same thing....

quoting from the above article...

"So far, researchers have been unable to explain why 30 per cent of people have genes that can cause celiac disease, but only 2 to 5 per cent actually develop it. Also a mystery is why the disease develops at any age. Higher rates of celiac disease are being driven not just be better testing and awareness, but also by external triggers." IE Not triggered by genetics alone.

Continuing the quote as summarized by Celiac.com

"According to Dr. Decker Butzner, a Calgary-based pediatric gastroenterologist, there are another triggering factor which we've never understood…[t]here is an environmental trigger."

Researchers have known for some time that people with celiac disease have different types of gut bacteria than those without celiac disease, but they didn't whether the changes in gut bacteria were caused by celiac disease, or the other way around.

Verdú's study, which found that the inflammatory response to gluten was impacted by gut microbiota, is the first study to show that it is the gut microbes are likely triggering celiac disease."

Similar research has alos associated the Epstein Barr Virus to being a possible trigger for Celiac disease...

See this entitled "Epstein-Barr virus linked to seven serious diseases"

https://medicalxpress.com/news/2018-04-epstein-barr-virus-linked-diseases.html

I have found one of the best ways to keep H. Pylori and other viruses in check to ensure my stomach acid is strong enough to digest proteins.

And it should come as no surprise too you that Celiac and NCGS patients have a high rate of Low/NO Stomach Acid.

See this research entitled "Gastric morphology and function in dermatitis herpetiformis and in coeliac disease"

https://pubmed.ncbi.nlm.nih.gov/3992169/

And I believe that is what helped me tolerate proteins in my diet. Part of the function of the stomach is to sterilize our foods by breaking down proteins into harmless Peptides and amino acids.

IF NO proteins get through the stomach when IT (stomach acid) is high.....then Casein, Soy, and Gluten can't get through to the small intestine to trigger the immune reaction in the first place.

And we know when we are low in Acetylcholine our immune system is triggered.

This works (in theory) because the same Vitamin deficiencie(s) involved in stomach acid production when low also trigger the immune system.

Meaning our Biofeedback loop is broken and only taken the missing nutrients will quieten the immune system again......or at least that is what I think happen in my case.

We must remember we don't have one Immune System for Lupus and a different one for Pellagra or Celiac disease etc......and why they often bleed over into other disease presentations as Co-Morbidities.

If we hadn't learned recently would was the trigger for the immune system......some of this would be conjecture.....be know we know for certain.....auto-immunity is both a triggerable and reversible condition in IMHO.

I think I quote it before but here it is again ......if somebody wants to read it in more detail...

https://www.medicalnewstoday.com/articles/321624

This research shows the cholinergic system (via acetylchline) triggers the the body into an inflammatory or antiflammatory state....

If you never trigger the underlying cause.....then the immune system stays activated and why taking Benfotiamine (especially) can be helpful to tamp down our immune response to gluten and why I wrote a blog post on it...

And is also why I have argued it is time to consider two types of Celiac disease......a Type I (Genetic in origin) and  a Type II which is Epigenetic (Environmental trigger) in origin.

The purely genetic model no longer explains (to me at least) or best describes what is happening in Celiac's....

But Low or NO stomach acid (makes for a more plausible) cause to Celiac disease IMHO.

And this i exactly what we find when people take PPI's.......it is a CAUSAL trigger for Celiac disease!

And while someone's stomach acid is too low  to digest proteins anymore....our broken feedback system triggers an immune state.

Because the same Vitamin deficiency triggers triggers both states/circumstances it makes sense the one is the trigger for the other....

And why multiple proteins can also trigger an antibody response being attributed to NCGS and/or Celiac disease IMO.....and explains cross reactivity well too!

I just hate that 40 or 50 of 60 year olds etc.....who never had a problem before now have a "forever genetic" disease when we know GERD/Heartbrun is triggered by stress 6 months before.....Is all I am saying.

Which I explained in this Posterboy blog post in more detail about how Infant GERD (as an analogy not due to year or age of the person) grows into NCGS and/or Celiac disease as an adult) if anyone has the time and want to read it in more detail.

If anybody hasn't figured it out yet....It is Low stomach growing into NO stomach and finally the DH of the Celiac diagnosis because NO stomach is highly correlated 90% + correlated with the Skin issues in Celiac disease. 

To show how submerged (overlapping) the diagnosis's have become synonymous with each other....

DH (what become as the Skin issue of Celiac disease) 15+ years before it was ever associated with Celiac disease was treated with Niacin....

https://www.jidonline.org/article/S0022-202X(15)50482-X/pdf

I hope this is helpful but it is not medical advice.

Posterboy,

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