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Have Low Gamma CT And Alkaline Phosphatase, Celiac's Disease, Anemia And Diabetes. Related? Supplements?

Posted on Fri, 7 Sep 2012

Question: I have a low gamma GT and Alkaline Phosphatase. I am diabetic type 1 diagnosed with an antibody test 1 yr ago, Celiac and suffer from anemia as well. Are these related and is there a supplement I should be taking? I have been low in Magnesium and blood pressure. I take magnesium supplements, iron supplements, long acting and short acting insulins and have increased my salt intake. I would like to be able to have more energy and feel that I am eating right for my type. I am fairly slim (111 lbs and 5ft 4in) and used to be very active. I am awaiting IV therapy for iron. I have copied my latest blood test results below in case it is helpful.

Thanks so much!

A1C 6.3
Tissue Transglutaminase Ab IgA 56
WBC 5.4
RBC 3.94 tera/L
Hemoglobin 112
Hematocrit 0.35
MCV 90 fl
MCH 28.4 pg
MCHC 316 g/L
RDW 14.4 %
Platelet Count 243 giga/L
Differential
Neutrophils 2.8 giga/L
Lymphocytes 2.0 giga/L
Monocytes 0.4 giga/L
Eosinophils 0.1 giga/L
Basophils 0.1 giga/L

Biochemical Investigation of Anemias
Iron 6 umol/L
TIBC 57 umol/L
Iron Saturation 0.11
Vitamin B12 323 pmol/L

Potassium 4.2 mmol/L
Creatinine 63 umol/L
Estimated GFR 94 mL/min
Calcium 2.38 mmol/L
Albumin 43 g/L
Total Bilirubin 7 umol/L
Alkaline Phosphatase 39 U/L
Gamma GT <10 U/L
AST 17 U/L
Magnesium 0.87 mmol/L

Thyroid
TSH 2.8

Serum Proteins
IgA 1.85

Answered by Dr. Anantharaman (2 hours later)

Hi,

Thanks for writing in. I have read through your reports.

Type1 DM and celiac disease are closely related. Roughly 6% of type1 DM patients have celiac disease. In fact its recommended that we do an annual screening for celiac disease in all individuals with type1 DM.

I see that you have mild anaemia and iron deficiency, you will definitely benefit from IV iron therapy. The low magnesium and Iron may be a manifestation of malabsorption. You need to consult with a dietitian experienced in treating celiac disease patients to see if there is any gluten in your diet, in addition to taking iron and magnesium.

It will be useful also to get a 25(OH) vitamin D and take a intramuscular supplementation if the level is low. It will be also useful to discuss your low energy levels with your endocrinologist- after an examination he might want to test you for adrenal insufficiency- also a possibility in your case.

There is really no clear explanation I can think of for the low alkaline phosphatase levels that is consistent with the problems you have.

I would also like to know a little bit more about your menstrual cycles are they regular is there any excess bleeding - these could again contribute to the anaemia. Your glycemic control seems to be fine with a very small dose of insulin.

Do write back with any clarification /queries.

Regards
Anantharaman

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Anantharaman (42 hours later)

Thank you Dr. Anantharaman, this is very helpful. I do not take a Vitamin D supplement but do notice I feel much better when I have sunlight, so I will add this to my routine.

I have regular cycles now, however it seems that it is somewhat abnormal in duration. For example, it will always start on the full moon for a few days, stops for another few days, and starts again the next week. It is not heavy, in fact it is light unless I go running or have other heavy exercise. I have also noticed that the bleeding stops if my blood sugar levels go up.

Is there a good supplement to help the menstruation to complete normally? I have heard that maca supplements can be good. I eat soy products but wonder if they may interfere. I do not eat any grains, sugar or dairy but eat all types of meat and seafood. I'm sure diet is quite important as well. I've read about XXXXXXX cider vinegar and wonder if it may help me as well.

I forgot to mention that my recent test for the celiac antibody (TTG) was elevated to 56, where it should be under 20. I do not eat gluten and my kitchen at home is gluten free, my bath products are also gluten free! I have stopped eating out - hopefully this will help the levels to come down.

Thanks very much for your help!

Answered by Dr. Anantharaman (11 hours later)

Hi,
Thanks for writing again. From what you say you don't have any gluten exposure but you still have some malabsorption - it would be worthwhile reviewing your diet in detail with a dietitian to see if we are missing some thing .your menstrual bleeding doesn't seem to be contributing to the anaemia so we should focus on the celiac disease and see if we can improve it.Till we do its justifiable that you take i.v iron to improve your anaemia.as far as the vitamin D Is concerned you may not be able to get any vitaminD during winters at Vancouver by just exposure to sunlight as you live at a northerly latitude.it is better to take a vitamin D supplement after checking the levels . Vinegar is good if you add it to your food it reduces the post meal glucose rise. I researched the maca supplements it seems okay for you to take it but consult your dietitian to see if it's gluten free.

Regards
Anantharaman

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharaman (12 hours later)

Thanks very much - I will first check the Vitamin D levels before taking a supplement. I have been in touch with a dietician who works with both diabetic and celiac patients. It is very problematic here to ensure gluten free foods as even some types of rice are contaminated however there are organizations working to improve this. Thank you for looking into the maca supplement - it is always XXXXXXX if the food is in a powder form, very difficult to ensure it's gluten free.

Thanks so much for your help! I'm sure many of the issues I'm having are due to celiac problems. I will look to improve that first, as I was unaware it can have such a disruptive effect.

Answered by Dr. Anantharaman (14 hours later)

Hi,

You are welcome always to clarify anything regarding your health in the future. It is difficult to live with both Celiac and type1 DM, but you seem to be coping well. Work closely with your dietitian and endocrinologist. I think you should start feeling better soon.

Regards
Anantharaman

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Shanthi.E