Wednesday, September 10, 2008

Useful Resources - After Diagnosis Follow-up - Nutritional Deficiencies

After I was diagnosed with Celiac Disease this summer, my Doctor informed me that several follow-up tests should be performed to verify if I had any Nutritional Deficiencies. My doctor ordered a few blood tests called "CBC" or Complete Blood Count and a test for Vitamin D levels.

From the results of these tests, my Doctor determined that my Vitamin D levels were too low. Low levels of Vitamin D can lead to many issues in the human body. In Celiac's, it could lead to Osteoporosis/Osteopenia. This ended up being the case for me.

My Doctor did several things as a result of this Vitamin D deficiency.
  1. Wrote a prescription for Vitamin D for 6 weeks. The dosage was 50,000 IU. The normal suggested dosage for adults is 400 IU per day. This was to boost as much Vitamin D into my system as quick as possible to try to make up for the deficiency.
  2. Ordered me to undergo a Bone Density Scan Test also know as a "Bone Densitometry Test" and/or dual-energy x-ray absorptiometry (DXA or DEXA) . See more about this test here.
I had the Bone Density test here in Raleigh at Wake Radiology in their West Raleigh office near Rex Hospital (West Raleigh Office - 4301 Lake Boone Trail - First Floor -Raleigh, NC 27607 - Ph 781-6707 - Mon-Fri 8am-5pm). The procedure took about 30 minutes from start to finish and was completely painless (other than hearing my diagnosis from the technician). Normally, 60 year old women are getting this test so they were a bit taken back to see me and my results. Regardless, I had the following areas scanned: wrists, forearms and ankles in addition to the normally scanned areas of the spine and hips. Patients with Celiac Disease will often see loss of bone density due to malabsorption in the small bones of the body first so it is important to make sure these areas are included in the scan.

The test results will be listed as follows:
  • T score — This number shows the amount of bone you have compared with a young adult of the same gender with peak bone mass. A score above -1 is considered normal. A score between -1 and -2.5 is classified as osteopenia, the first stage of bone loss. A score below -2.5 is defined as osteoporosis. The T score is used to estimate your risk of developing a fracture.
  • Z score — This number reflects the amount of bone you have compared with other people in your age group and of the same size and gender. If this score is unusually high or low, it may indicate a need for further medical tests.
My results were a T score of -2.4 which is technically classified as osteopenia, but very close to osteoporosis. One Standard Deviation difference in a T-score equals a 10-15 percent decrease in bone density. For example, a person with a T-score of -2.5 has a 10-15 percent lower bone density than a person with a T-score of -1.5. When my doctor reviewed the test results, he called me to recommend I take at least 800 IU daily of Vitamin D and schedule a follow-up appointment with him in 6 months. As a result, I am taking a Gluten Free Daily Multivitamin (found at Whole Foods) in the morning which contains 400 IU Vitamin D and then another 400 IU Vitamin D pill (found at Lowe's foods) in the evening. FYI - Vitamin D only pills are pretty difficult to find in my experience.

The Good news - my Doctor informed me that as time passes and I remain on the Gluten Free Diet, my Nutritional Deficiencies should disappear and my bone density issues should be reversible.

If you are a newly diagnosed Celiac and your doctor has not ordered any follow-up tests, then you should either demand they do or switch doctors. The results of Nutritional Deficiencies is not something to mess around with as you can see in my case.

For more information on Osteoporosis, please visit the National Osteoporosis Foundation website.


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