Celiac Disease and Folate Deficiency
In 1912, Dr Casimir Funk discovered the first B vitamin. He was the first to isolate vitamin B3 (niacin). After a strange series of events, and discussion of a cast of scientific experts, the first Nobel Prize for vitamin research was jointly awarded to Eijkman and Hopkins in 1929.
Over 100 years later, Valente and colleagues report lower serum folate in men and women with celiac disease vs healthy controls. Men and women with celiac disease had significantly lower serum folate concentrations than controls, 5.7 vs 11.7 ng/mL and 8.8 vs 13.4 ng/mL, respectively. Among the 20 celiac patients and 39 healthy controls, everyone (100%) had inadequate intakes of folate. Roughly 2/3 were not consuming adequate amounts of vitamin B12. Individuals with celiac disease had a 5x greater risk of folate deficiency (vs healthy controls).
Celiac disease is an autoimmune disorder characterized by inflammation and loss of small intestinal function. Five things you need to know about gluten can be found here. The National Foundation for Celiac Awareness estimates that 1% of the US population has celiac disease, 83% of whom remain undiagnosed. More information on gluten protein and its immunogenic peptide residues can be found here.
The only treatment is the total exclusion of gluten from the diet. By not eating bread or other foods containing wheat flour, individuals with celiac disease miss the benefits of mandatory folate fortification. Maybe more countries should consider rice fortification?
Measuring B vitamin status has its challenges. Apparent subclinical deficiencies in vitamin B6 can be induced by experimental protocols. Researchers are still exploring the best strategy to measure vitamin B12 status. Nevertheless, today’s main citation demonstrates the need to measure vitamins in blood to ensure that dietary intake is maintaining vitamin concentrations within normal levels.
Valente FX, Campos T, Fernando de Sousa Moraes L, Hermsdorff HHM, Cardoso L, Pinheiro-Sant-Ana HM, Gilberti FAB, Peluzio M. B vitamins related to homocysteine metabolismo in adult celiac disease patients : a cross-sectional study. 2015 Nutr J doi : 10.1186/s12937-015-0099-8
Yen-Ming Chan, Amanda J MacFarlane, and Deborah L O’Connor. Modeling Demonstrates That Folic Acid Fortification of Whole-Wheat Flour Could Reduce the Prevalence of Folate Inadequacy in Canadian Whole-Wheat Consumers. 2015 J Nutr doi:10.3945/jn.115.217851
da Silva VR, Rios-Avila L, Lamers Y, Ralat MA, Midttun O, Quinlivan EP, Garrett TJ, Coats B, Shankar MN, Percival SS, Chi YY, Muller KE, Ueland PM, Stacpoole PW, Gregory JF 3rd. Metabolite Profile Analysis Reveals Functional Effects of 28-Day Vitamin B-6 Restriction on One-Carbon Metabolism and Tryptophan Catabolic Pathways in Healthy Men and Women. 2013 J Nutr. doi:10.3945/jn.113.180588
Rios-Avila L, Coats B, Chi Y-Y, Midttun O, Ueland PM, Stacpoole PW, Gregory III JF. Metabolite profile analysis reveals association of vitamin B-6 with metabolites related to one-carbon metabolism and tryptophan catabolism but not with biomarkers of inflammation in oral contraceptive users and reveals the effects of oral contraceptives on these processes. 2015 J Nutr doi: 10.3945/jn.114.201095
Min Kyaw Htet, Umi Fahmida, David I. Thurnham, Lwin Mar Hlaing, Arwin Akib, Budi Utomo and Lisa A. Houghton. Folate and vitamin B12 status and dietary intake of anaemic adolescent schoolgirls in the delta region of Myanmar. 2015 Br J Nutr doi:10.1017/S0007114515001609