Co-Morbidity in Celiac Disease and Why Correctly Diagnosing it as Pellagra can lead to symptom relief in possibly the over half of Celiacs’ Co-Morbid with Pellagra

Co-Morbidity in Celiac Disease and why correctly diagnosing it as Pellagra today can lead to symptom relief.

************** As always say this is not medical advice, it should not be considered such. Always talk to your doctor before changing your regimen.

This information should not be used to diagnose your-self. But it has been my experience and the experience of my friends who take Niacinamide 3/day for 6 months that their “gluten allergy” goes into remission after they begin BURPING without bloating indicating Co-Morbid Pellagra.

Here is what happened and why Pellagra today is confused for NCGS/ Celiac disease or other GI problems like IBS, etc.

And here is why you should look beyond Celiac to Pellagra for your GI problems.

So now I try to educate as best I can that if people look beyond Celiac to Pellagra they often get better.

I have written a similar post to this one but people don’t seem to get it.  Entitled Can Pellagra and Celiac Disease be present in the same person; ie, Co-Morbidity: A fellow sufferer’s story by the Celiac Posterboy and can be found at this link

Co-Morbidity is difficult to recognize but not hard to prove.   You just have to take Niacinamide 500 mg 2 or 3 times a day/daily  for 6 months or so to see if there is a cause and effect i.e., it induces burping where it did not occur before without bloating and your stool SINKS where it floated before.  A cause and affect relationship.

The website Gluten free works recognizes a Niacin deficiency in Celiac’s but like identical twins has trouble diagnosing the correct twin.

This article is 5+ years old but they argue for a Niacin deficiency in Celiac’s and not the Co-Morbid “evil twin” of Pellagra in the same person.

I am quoting from  Cleo Libonati, RN, BSN is CEO and co-Founder of Gluten Free Works, Inc. and She is the author and publisher of the highly recommended celiac disease reference guide, Recognizing Celiac Disease where she summarizes the difficulty very well of identifying one twin from the other and her work entitled “A Niacin Deficiency in Celiac Disease which can be found at this link

Niacin Vitamin B3 deficiency in celiac disease gluten free works

“Niacin, also called vitamin B3, is required by all the cells of our body making it essential for vitality and life itself.

Niacin is essential for keeping our skin and digestive tract healthy, our brain and nervous system  functioning normally, certain key cell processes repaired, our adrenal glands producing steroid hormones at demand levels, sex glands producing the hormones estrogen, progesterone and testosterone and, most especially, for producing energy to keep our body alive.1

When absorbed from the small intestinal tract, niacin becomes part of a process including more than 200 enzymes involved in metabolism of carbohydrates, proteins and fatty acids, that is, chemical reactions that maintain life.1 Niacin is stored by the liver.2

Niacin must be digested to release its absorbable forms, nicotinamide and nicotinic acid. These molecules are absorbed across the intestinal lining at low concentrations by sodium-dependent facilitated diffusion, meaning they need help to get into the bloodstream.1 Niacin is absorbed at higher concentrations by passive diffusion, meaning the niacin molecules simply cross through the lining.2 That said, absorption is hampered by the swelling and thickening of the intestinal lining that occurs in celiac disease.  Removing gluten reduces the inflammation and allows the lining to heal, facilitating passage of niacin through the lining into the bloodstream.

Intriguing animal research by Sandhur et. al. has shown that niacin deficiency itself sensitizes the intestinal mucosa of rats to gluten in wheat, barley, rye, oats and corn and induces susceptibility to gluten toxicity by means of cellular dysfunction.3 Human research needs to investigate this effect of niacin deficiency in human celiac disease.

Niacin Deficiency

Niacin deficiency due to malabsorption is common in celiac disease before gluten is removed from the diet.1 Niacin deficit can be aggravated by a lack of niacin, or the amino acid tryptophan, in the diet. Our body uses tryptophan to make niacin as a back up mechanism.  Smoking also impairs absorption of niacin.2

Lack of niacin in the diet comes from choosing foods that are low in niacin. An example of how this can happen is if we used plain corn flour rather than masa flour for baking gluten-free recipes and purchased tortilla chips, tacos and snack foods made from plain corn flour.  Plain corn flour is low in niacin and its niacin cannot be digested. Whereas, the niacin in masa flour is made digestible.  Masa is the result of soaking corn in lime, a strong alkali that releases the bound niacin so that it can be digested.2 Lime would be listed as an ingredient on the product’s nutrition label.

Lack of tryptophan in the diet is due to choosing foods that lack this amino acid and avoiding those that are rich in tryptophan, such as eggs and meat. Conversion of tryptophan to niacin requires adequate levels of tryptophan and adequate levels of iron, riboflavin, or vitamin B6.2 Tryptophan-to-niacin conversion can easily be subverted if tryptophan itself, or the co-factors iron, riboflavin or vitamin B6, are deficient.

Deficiency Symptoms

Inadequate levels of niacin slows metabolism and impairs functioning of the brain and nervous system, digestion, skin, DNA repair and other key cell processes, and steroid and sex hormone production. Severe deficiency of niacin causes the disease pellagra.2

Mild Niacin Deficiency Symptoms:

1. Problems with metabolism: muscle weakness, lack of energy, weight loss, decreased tolerance to cold.

2. Problems with the nervous system: irritability, dizziness, fatigue, poor concentration, poor memory, anxiety, apathy, depression, headache, neuritis (numbness, burning in various parts), tremors, restlessness and hyperactivity in children.

3. Problems in the digestive tract: anorexia, distorted taste, indigestion, scarlet colored tongue, burning of the mouth, throat, and esophagus, abdominal discomfort and distention, nausea, diarrhea or constipation.

4. Problems with the skin and mucous membranes: sensitivity of skin exposed to sunlight causing a red, itchy, scaly rash that resembles mild sunburn, and inflammation of mucous membranes of vagina and urethra.1

Severe Niacin Deficiency Symptoms (Pellagra):

Severe niacin deficiency is called pellagra. Pellagra is characterized by the classic 4 “Ds”…watery Diarrhea, severe Dermatitis, advancing Dementia and Death.

1. Diarrhea can be bloody and other digestive disturbances worsen with vomiting.

2. Dermatitis develops symmetrically in areas exposed to sunlight with hyperpigmentation (dark color), thickening and cracking of the skin, itchy red wet areas from chafing, and “necklace” sores on the lower neck.2 Subcutaneous fibrosis and scarring within the skin may be seen in late stages. A bright red swollen tongue which in chronic stage is fissured and is similar to raw meat.4 Inflammation of other mucous membranes worsens with increasing deficit.

3. Dementia is due to neuronal loss (death of nerve cells) with development of amnesia, disorientation, confabulation, and delirium.

4. Death ensues eventually if the niacin deficiency is left untreated.2,3 “

It is me again reader.

She gets it well but she doesn’t know what twin it is she is identifying. If she got the wrong one (disease) then the suffering continues’ often for years but if the Co-Morbidity is treated then improvement can be shown in as little as 6 months’ time. . .

Quoting the Celiac Posterboy in another post “Now if the symptoms’ are similar it is easy to confuse one disease for the other and if not well understood they might be considered “exceptional” or, i.e., not well understood.

How do we know this? The Journal of Celiac in another issue entitled Celiac Disease Intestinal Heart and Skin Interconnections when listing common aspects of both diseases’ says and I quote “The two diseases can be connected in two aspects. 58% of pellagra patients were shown to have malabsorption and many had intestinal pathology on biopsies [36, 37]. Alternatively, Pellagra was described in CD.”

Not only did/does the Journal of Celiac cite common symptom’s 58 percent of the time in Celiac and Pellagra but they also cite that Pellagra has been described in a Celiac Disease diagnosis.

I would argue that it should be the other way around if the majority (58 Percent) of the time Pellagra symptoms are described in a Celiac diagnosis it stands to reason that medical science is identifying the wrong disease.

I ask again “if you have the wrong disease would you get better!”

See this link to Creighton University where they cover why Doctors are not even looking for Pellagra anymore in their patients.

And therefore doesn’t find it!  But find Celiac disease instead.

I summarize this information at this wordpress blog post

Where quoting Dr. Heaney he correctly states “it is doubtful today that most health professionals would not recognize it (Pellagra) if a case happened to come to their attention” Today!

Pellagra is not a disease of the past as Dr. Heaney say but a disease that is not being diagnosed today!

And why I keep trying to educate people of this fact.

These D’s a Celiac patient encounters are not the sign of several different diseases but one parent disease Pellagra with many children.”  

Quoting the Celiac Posterboy again “Pathology presumably would qualify the Pellagra patient as a Celiac Patient if the Pellgarin was first diagnosed as a Celiac first as often is the case TODAY!” in the majority of Celiac, NCGS, IBS, and I believe UC and Chron’s patients too!

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

In case this is the only post you read I will repeat here for knowledge sakes ****** the number one mistake people make when taking Niacinamide is they don’t take it long enough.  It should as I have said elsewhere in this blog it should be taken UNTIL you are burping and I might add burping without bloating.  Most people will burp when taking Niacinamide in 5 to 6 months or less of taking it (Niacinamide) 3/daily — ie with each meal.

It takes 5 to 6 months to overcome your dependency on this Vitamin for your mucus membranes (GI lining) to heal itself.

Once repaired you can maintain them barring some future stress/trauma depleting your reserves at which time Heartburn/GERD/IBS symptoms will return and you will lose your burp again.

And the cycle repeats and the Pellagra symptoms come back with a vengeance.

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 regimen.

I don’t know what to more to say that I haven’t said already.

Stop the Madness!  Once you have the Correct diagnosis you get better! Don’t let the “evil twin” of Pellagra make you sick any longer while the doctor’s figure out they have identical symptoms.

Cleo Libonati, RN, BSN,  CEO and co-Founder of Gluten Free Works, Inc  says  “Severe niacin deficiency is called Pellagra” but Mild Niacin deficiency is Pellagra too! Even when it being misdiagnosed as Celiac disease …. and the symptom’s continue to worsen until Pellagra is now being  described but not recognized  in the MAJORITY of Celiac patients today without the doctor’s recognizing the same symptom’s.

It is called a Differential Diagnosis and since nothing is differentiating them TODAY they are being diagnosed interchangeably but the suffering is the same UNTIL or UNLESS you treat the Co-Morbidity.

The problem is they have the wrong disease!

Don’t suffer in the meantime! If the International Journal of Celiac Disease is right and Pellagra is Co-Morbid revealing as Celiac disease the majority of the time?

Then treat the Pellagra with Niacinamide 500mg 3/day for 6 months to see if your GI symptom’s get better!

Either we have found the cure?/remission has occurred or Celic Disease/NCGS is the same disease by a different name aka one has been confused for the other Pellagra a Niacin deficiency is being diagnosed today as Celiac disease.

I repeat for emphasis “Either we have found the cure?/remission has occurred or CD/NCGS/IBS is the same disease by a different name aka one has been confused for the other or Pellagra a Niacin deficiency is being diagnosed today as Celiac disease.

Note: Again I must say this because I am not a doctor ************* This is not medical advice.  I am not diagnosing, treating or recommending  you change your routine before consulting your doctor but my doctor has taken himself and agrees it does’ work even though he did not recognize his keys in a clinical setting. But now that he has been educated as to what are the signs of undiagnosed Pellagra he is using the same keys to now help his remaining patients.

The symptoms’ are subclinical as I say in my book “How to Fight Gluten/GERD and Win or How the Doctor’s Almost Killed Me” (see below the 4th D of Pellagra) and more appropriately often confused for the wrong disease.

It should be briefly noted for those unfamiliar with Pellagra is call the 4 D’s disease (or who have not read my other blog posts’) From my Celiac Posterboy wordpress blog post

“Acute Pellagra is defined as suffering the 3 D’s (4 if you count death) of life.

Dementia (anxiety, depression, panic attacks, etc) Dermatitis (rosea, Psorsias, acne, ezcema etc) and digestive disorder such as (GERD, IBS, Gluten Sensitivity, Celiac Disease, Leaky Gut etc.)

Get the right disease and you will get better! Or suffer the consequences until the doctor’s finds the right keys to diagnose you with Pellagra helping you to recover from your GI problems caused by Co-Morbid Pellagra in as little as 6 months of/by taking 3/day Niacinamide (one 300 count bottle of Niacinamide 500mg is usually enough) until you (begin BURPING)!  Like a healthy baby!

As always’ I hope this helpful and if you want to read the whole blog search for  the “Celiac Posterboy” or “Fight GERD Win” better on Bing.  Good luck on your journey/way back to digestive peace the way  I have found it by God’s Grace for myself and my friend’s and my doctor for

Quoting the Celiac Posterboy “I hope my words and experience will be enough to convenience you that medical science has discovered the cause of most digestive disorder(s) but medical practice (clinicians/practitioner’s) has not (does not) digested/recognized it (Pellagra) (yet) in a clinical setting” Today.

The problem with Celiac disease today is there are many “keys” than can fit in the door and seemingly all the keys work.  200 symptom’s all least by some estimates

INSTEAD of 15 minutes it might take 5 to 10 years until a doctor/practitioner/clinician makes sense of all his or her keys.

The fact that the problem is chronic “of an illness persisting for a long time or constantly relapsing” tells him/her (Doctor) that she/he has not found the right key yet.

Is there a better way more Elegant way?  Yes it called Co-Morbidity.

Quoting the Celiac Posterboy again “Disease need not be CHRONIC when one understands the underlying cause.”

Will you suffer another 5 or 10 years until the practitioner’s figure out their keys?  As I say in my Celiac Posterboy youtube video “this information is not well distributed” or understood today!

Or are you willing to try the to see if your potentially/probable Co-Morbid Pellagra doesn’t get better (go into remission) in 6 months as evidenced by the God given BURP that you haven’t had in years or ever depending on how long you have had Pellagra and the Doctor’s haven’t figured it out yet in a clinical setting.

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

The Celiac Posterboy by the Grace of God!

Joe “Rock” Pen Name


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