Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency
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Vitamin D plays a critical role in skeletal and muscle health, while iron enables the transport of oxygen in blood cells. Together, the nutrients are predominantly sourced from food, but if their absorption is disrupted, a deficiency may ensure. Severe cases of coeliac disease, which can lead to a critical lack of nutrients, are sometimes indicated in patients with several deficiencies at once.
In 2022, EMJ Reviews reported on the case of a 36-year-old who had moved to a country where food items were fortified with vitamins and minerals.
Her report stated: “At that time she noticed muscle aches, fatigue, migraine-life headaches, recurrent painful mouth ulcers, upper respiratory allergies, wheezing and disturbed sleep.
“Soon, her menstrual periods started becoming irregular but there was no menorrhagia or clots.”
The female also noticed that her headaches had become more frequent, her respiratory complaints had worsened, and she’d developed an intolerance to dairy products with abdominal bloating, cramps and increased stool frequency.
Issues with balance persisted with her eyes open and closed, making it difficult for her to get up from her chair.
With an adequate diet consisting of fortified foods, the female’s case was suggestive of gastrointestinal malabsorption.
Subsequent tests revealed the presence of deficiencies in iron and vitamin D.
This finding, in addition to the patient’s multi-organ symptoms, led researchers to believe the patient had adult coeliac disease.
This is because the occurrence of several body systems displaying symptoms, particularly outside of the gastrointestinal system, is often described as an atypical manifestation of coeliac disease.
Increased stool frequency, in particular, is a common feature of coeliac disease, as are other gastrointestinal issues.
Diarrhoea is also a common characteristic of coeliac disease and is caused by the body’s failing to fully absorb nutrients.
This malabsorption of nutrients can also lead to stools containing unusually high levels of fat, mentally known as steatorrhea.
Although the condition generally damages the upper part of the small intestine, the entire small bowel can be affected.
In fact, coeliac disease causes iron deficiency anaemia because the part of the intestines that is damaged by gluten is also responsible for iron absorption.
The patient’s report suggested that the presence of iron deficiency in the absence of blood loss, coupled with the presence of vitamin D deficiency, despite eating vitamin D-rich foods, strengthened the case for coeliac disease.
It’s consistently been shown that the malabsorption of many nutrients like iron, vitamin D, and zinc, is a common feature in patients with untreated coeliac disease.
Research published in the journal Nutrients showed that approximately 46 percent of patients with coeliac disease have decreased bodily iron storage and 32 percent have iron deficiency.
Iron deficiency has many causes, including a diet that’s low in iron, trauma, or heavy menstrual bleeding.
When none of these issues is the cause, the presence of coeliac disease may be indicated.
To correct the patient’s symptoms, researchers advised her to adhere to a gluten-free diet, which she agreed to.
After four weeks of receiving oral iron and vitamin D and oral calcium supplements, her symptoms improved.
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