Category Archives: Celiac

A Devastating Delay Celiac or Pellagra and the Clinical Gap/diagnosis of Implementation in recognizing one for/over the other; Which twin to choose/save

A Devastating Delay Celiac Pellagra and the Implementation Clinical Gap in recognizing one for over the other: Which twin to choose/save

I was inspired today for two reasons.

1) my brother recently had an emergency that required hospitalization and two stents to be put in his heart.  Every Hour Counts/Every Person Counts

2) this new research about Zika and the implementation gap/clinical delay in recognizing a disease in clinical setting.

http://www.nejm.org/doi/full/10.1056/NEJMp1707273

AS someone who has had BOTH Celiac and Pellagra.  I can tell you that it can be difficult to tell them apart sometimes (most times). In many respects they look like twin(s).

Both have GI problems as a presenting symptom’s.

Both have Skin Issues in their presentations (clinical appearance). Both can have dementia/neurology symptoms.

SO you can see how easily one can be confused for the other?

And often one twin (disease) is picked over the other.

What does this have to do with Zika.  Only this

Quoting the New England Journal of Medicine from the article and applies here when contemplating any disease’s symptom’s.

“Translational gaps are not unique to Zika; similar challenges exist throughout the health care system. According to several estimates,

it takes an average of 17 years for research evidence to reach clinical practice. 2

One study showed that patients receive only about 55% of the recommended processes involved in medical care. 3”

So let’s say.  Today they find a miraculous cure for Celiac disease or NCGS… it would take on average 17 years for doctor’s in Clinical settings  to apply these technique’s to eradicate new Celiac cases/disagnoses from occurring.

Now in this hypothetical case (which doesn’t exist yet) it would take another 17 years on average for doctors if they knew today that Pellagra  (which they don’t) can mimic Celiac disease in a Clinical setting.

But one does exist (it is not hypothetical) – a cure for Pellagra exists today.

It has in fact existed for 100+ years and still doctors don’t recognize it today.

Every hour/patient matters.

And why I have tried diligently to educate other Celiac’s of this maddening fact.  In 2015 a medical association was established of Pellagra occurring in/with a Celiac diagnosis.

http://pubs.sciepub.com/ijcd/3/1/6/ 

Quoting from section 3.

Pellagra and Celiac disease in this ground breaking research.

Pellagra and celiac disease  “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 celiac disease [38]. The skin manifestations in pellagra might have some additional etiologies, since multiple nutrient deficiencies are at the origin of the cutaneous manifestations in celiac disease. The following nutritional deficiencies inducing skin rashes, were describe in celiac disease: Zinc, Iron, Vitamin A, E, B12, niacin, folate, selenium and essential fatty acids [39, 40].”

So if their (NEJM) timeline is correct.  It will be 2032 at the earliest for the Clinical delay to catchup to research.

As I mentioned earlier it has been 100+ years since doctors’ have seen Primary Pellagra in a Clinical setting.

http://blogs.creighton.edu/heaney/2013/11/18/pellagra-and-the-four-ds/

And it isn’t Primary Pellagra that is the problem here.

It is a phenomen that is called Secondary Pellagra.  It didn’t know what it was either.  And I have studied the topic extensively.

See this link from the doctor’s healthy press (Yes doctors have to look things up too) that explains the difference very well.

https://www.doctorshealthpress.com/food-and-nutrition-articles/pellagra-vitamin-b3-deficiency-causes-symptoms-and-treatment/

I will quote for reference.

1. Primary Pellagra

“This form of vitamin B3 deficiency is related to a lack of nutrition, such as not getting enough eggs, meat, seafood, or green vegetables in your diet.

Alcoholism is often a factor with primary pellagra, for the reason highlighted above.

2. Secondary Pellagra

Those who regularly consume sufficient amounts of vitamin B3 may still deal with this condition. Secondary pellagra is the result of improper absorption

of the nutrient, whether as a whole or partially. This is observed with gastrointestinal diseases that do not accept the niacin.” (Celiac disease)

It is me again pellagra and celiac posterboy.

So now we know what else it (Celiac disease) could be?

Now the question remains will it take another 17 years for the doctor’s to have you checked for it  or for you to believe a Vitamin might help you?

Now Pellagra (and other B-Vitamin diseases) can be tricky to diagnose.

Because for some diseases there are not good/reliable “blood serum” test’s to confirm the clinical suspicions.

A cause and effect method is often used.  If taken the B-Vitamin (NIACIANAMIDE) helps your GI problems then Pellagra or at least Secondary Pellagra was a contributing factor in your GI problems.

Dr. Prousky tested this theory. You guessed it almost 17 years ago.   Next year will be 17 years and still this modern research has not trickled down to a Clinical setting.

http://www.yourhealthbase.com/database/niacin-treats-digestive-problems.htm

And why I have been inspired to share my Celiac story of the road not taken.

The Pellaga road was not taken in my diagnosis either.  The doctor’s did not know this could be a valid reaction to NCGS or Celiac Disease.

Knowledge is power.  Now you have the knowledge to do different and probably better than you are doing now if Secondary or Rebound Pellagra is causing some of your same GI problems and this is making your original Celiac disease symptom’s even worse.

This is mostly for those still looking for answer’s despite being gluten free for 2 or 3 years and are still having “control” issues or

have become ultra sensitive to many more proteins (food allergens) like even Corn for example.

Pellagra was first diagnosed with corn based food stuffs.  And promptly forgotten years ago.

See this great newspaper summary of how “Pellagra in the South” presented itself 75+ years ago.  It is actually a fairly new article about this topic.

Only a year old.  And found it amazing that others (though few) still talk about it today.

http://www.timesfreepress.com/news/life/entertainment/story/2016/jul/12/clif-cleaveland-pellagrand-history-south/375065/

But doctor’s haven’t yet figured out that Rebound/Secondary Pellagra is estimated to occur in 58% (majority) of first diagnosed NCGS or Celiac patients.

If the normal clincal adoption curve applies here then it will be another 15 year before doctor’s acknowledge that indeed the corn allergy occuring in Celiac’s

is really from Secondary Pellagra.

You have probably heard this phrase there is a “generation gap” … well if the trend holds in clincial adoptation and bleeding/leading research then indeed it will be another “generation” before this “Clincial Gap” will be closed.

Then and only then will people begin to listen  and get better .  . .And I hate that for those still suffering … because every hour/patient/person matters.

****this is not meant to bee medical advice only the path I took.  Yours might be different. But there is a 50/50 chance it might help.

I don’t know what else to say but I wanted to say/share what happened to me with the hopes it might help those many/most who might be (are) still be suffering from rebound/Seconardary Pellagra (if you are reading this/the Celiac Posterboy blog) or a friend who was/have been

triggered by their NCGS/Celiac disease.

You can rebound from Pellagra.  I have praise bee to God!

The Celiac diagnosis might still be retained if Secondary or Primary Pellgra was not the cause but if it (Pellagra) was the primary cause

then the Secondary Celiac diagnoses/symptom’s will improve with Niacinamide supplementation taken 2 to 3 times a day for 6 months I truly believe.

I have emphasized the NIACINAMIDE form on my blog posts/in my threads because it is the non-flushing form of Niacin.

**** Again this in not medical advice.  One size does not fit all.  Some people do respond to supplementation.  Some do not.  You will only know if you try… . and sometimes you might have to try more than once to find the right form/Vitamin you need to take and why I have emphasized the Niacinamide form

so you can learn from my mistakes!

This is not the end of your journey… this is only beginning . . you will still want to supplement with the other (now) missing nutrients like Vitamin D (if you are low) or a good B-complex etc. and the Magnesium Citrate/Glycinate (mentioned in another blog post) But I must end for now.  I hope to update my celiac posterboy blog sometime in the future (about the supplementation question and what helped me) but can’t do so now.

This celiac posterboy blog is complete as I see it.  I will continue to post as I learn new things.

Like how I learned two are two forms of Pellagra. Primary and Secondary Pellagra which type do you have?

After 250+ pages of blogging you will either be convinced or not.  I can’t change your mind.  You will either continue suffering or decide to try the Niacinamide.

If you have a GI problem of any kind like IBS, GERD, UC, Chron’s, NCGS or Celiac disease there is a good (better than 50/50) chance Pellagra is you Primary disease and the other GI acronyms are your Secondary disease.  And the(y) doctor(s) has chosen the wrong (identical/ twin) disease and a cure/remission is far from your eyes.

But if they look beyond your Celiac/NCGS diagnosis to a valid differential diagnosis of Secondary/Rebound Pellagra – it can make all the difference.

https://celiacposterboy.wordpress.com/2016/02/16/look-beyond-celiac-to-pellagra-for-your-gi-issuesproblems/

You can rebound from Pellagra and this Primary cause of GI problems should be eliminated first before a Celiac disease is proclaimed the proper/valid diagnosis.

As always search for the “Celiac Posterboy” or “Celiac Poster boy” or “Fight Gluten Win” or “Fight GERD Win” if you want to read all my celiac posterboy blog posts for as I have said elsewhere in this blog and it bears repeating “To Educate is to Free” Truly.

https://celiacposterboy.wordpress.com/2016/01/23/to-educate-is-to-free-part-two/  (A Physician’s Guide)

If you think your doctor is interested and would be willing to trial you on Niacinamide to see it could help your GI problems.

My doctor has and is better and his patients have rebounded from undiagnosed Secondary Pellagra!  Only if he/she/they would think of it as the Primary disease many Secondary Celiac disease symptoms/patients could/would get better! Because they have identified the wrong disease in the first place … people suffer unnecessarily.

Don’t suffer any longer.  Eliminate today Pellagra as a possible differential diagnosis and take Niacinamide 3/day for 6 months.

Don’t suffer another 17 years before the doctor’s clinical gap is closed before they recognize Celiac disease as Pellagra in the vast majority of their GERD/ NCGS/IBS/UC/Chron’s patient in/at its earliest Secondary stage before it’s the Primary presenting symptom’s.  Secondary (Primary) Pellagra is not as rare as doctor’s think it is!

See how many GI diseases can be eliminated when you get the Primary disease (Pellagra) treated FIRST! And not LAST!

See my celiac posterboy blog link that explains why this is today.

https://celiacposterboy.wordpress.com/2016/02/19/when-myth-becomes-medical-fact-people-suffer-unnecessarily-the-case-of-mistaken-identity-how-pellagra-now-thought-to-be-rare-became-known-as-celiac-disease-a-white-paper/

But if you don’t get the correct diagnosis/disease in the beginning then you don’t get better.

Oh you cope, manage, continue to have flares get more sensitive to other proteins lactose, soy, corn (there is that corn thing again) etc.

You are said to be a Celiac who is super sensitive?

There is no hope for you now?  The doctor’s don’t know why you continue to have problems.

You have removed gluten from your diet… you should get better.

But you never do . .. . you just get more sensitive and more sensitive to more food allergens (proteins) that your body can no longer digest (Corn anyone).

Stop the Madness!!!!! (Errors)

Get the right disease Pellagra and get better the way other Celiac’s have!

Pellagra was FIRST diagnosed in corn consuming patients 100+ years ago and yet this is lost on doctors’ today! But is often the LAST disease considered today long after you have received your NCGS/Celiac diagnosis despite having trouble with Corn. .  .  you are just a “super sensitive” Celiac.

I will say it again!!!!  For Emphasis!!!  Maybe if I say it enough people will get it!

Stop the Madness!!!!! (Errors)

Get the right disease Pellagra and get better the way other NCGS/Celiac’s have!

See this link also https://www.celiac.com/articles/24919/1/Are-Doctors-Missing-90-of-Celiac-Disease-Cases/Page1.html if doctor’s are missing 90% of Celiac’s they are missing nearly 100 percent of Pellagra patients because 58% (majority) of the time Pellagra is the parent disease (co-morbid) and Heartburn (GERD), IBS, NCGS,  and Celiac disease it’s evil step children and you forgot to be an Alcoholic or Homeless person the only subset of the population that Pellagra is diagnosed in today!

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 often enough (2 to 3 times a day) long enough (6 months at a minimum).  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 and your stool begins to SINK where it probably floats now.  Most people will burp when taking Niacinamide in 4 to 6 months or less taking it 3/daily — ie with each meal. (Especially if you are not already taking an acid reducer like a – Proton Pump Inhibitor (PPI’s etc.)

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.

By The Celiac Posterboy who writes/blogs about the digestive disorders that Pellagra causes today often presenting as other diseases such as GERD, IBS, UC, Chrons or other GI problems and even NCGS and in Time Celiac Disease.

For many Celiac diagnosis’ take 12+ years often. (There is that “Clinical Gap” again) a devastating delay in finding the Correct (Primary) diagnosis as Pellagra Undiagnosed!

It takes 4 to 6 months to overcome your dependency on this Vitamin for your mucus membranes (GI lining) to heal itself.   (These are meant to be conservative times you might experience relief before this time but do not stop taking the Vitamin for at least 6 months because you need a reserve against future stresses/trauma).

Ephesians 1:3 3Blessed be the God and Father of our LORD Jesus Christ, who hath blessed us with all spiritual blessings in heavenly places in Christ:

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

I write this celiac posterboy blog that you may find help/hope in your time of suffering praise bee to God! And because by God’s grace he helped me find my help and am only trying to help those who are still suffering unnecessarily!

2 Corinthians 1: 3, 4

Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort;

Who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble, by the comfort wherewith we ourselves are comforted of God.

Good luck on your continued journey! The road not taken (differential diagnosis) can lead you back if you take the right road.

87% of the time a/the correct diagnosis is not the one you received or you would get better like  I have!  And others’ who have taken the Niacinamide Challenge.

https://celiacposterboy.wordpress.com/2014/12/03/the-niacin-niacinamide-challenge/

May it (Lord willing) be as famous as the “Ice Bucket” challenge for then “Gluten Juneteenth” will have been proclaimed to those who are still suffering and have not heard! YET!

https://celiacposterboy.wordpress.com/2014/07/16/gluten-juneteenth/

I have been blogging about this topic for 3+ years and still people have never heard of this once common epidemic forgotten almost 75+ years ago.

And to this today Pellagra is still being confused for various GI diseases.

https://celiacposterboy.wordpress.com/2016/09/19/how-pellagra-is-often-confused-with-many-gi-diseases-like-uc-gerd-ibs-chrons-ncgs-and-even-celiac-disease-or-other-digestive-problems-in-its-late-stages-part-2-the-science-of-pellagra-a-hidden/

I must stop for now.   I consider this celiac posterboy blog complete but know I will post again sometime . . . but I can’t say for sure when.

Until then glory bee to God if you find this Celiac posterboy blog and find help through a Bee Vitamin the way I have have.  Praise God!

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

Celiac Posterboy by the grace of God,

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Is is NCGS/Celiac or Low Stomach Acid Misdiagnosed: A Differential Diagnosis how truly LOW stomach acid can mimic many of the symptoms one develops taht eventually become misdiagnosed as first a NCGS patient and finally a Celiac Patient by the Celiac Posterboy

Is it NCGS or low stomach acid mis-diagnosed

Low Stomach Acid and Celiac Disease

I had written a smaller shorter post previously that seem to resonate with people and am now including updated post(s) that include more of the things I have learned since then.

Here is the link if you want a “cliff notes” version of this longer more technical post. https://celiacposterboy.wordpress.com/2014/07/16/is-it-ncgscd-or-low-stomach-acid-mis-diagnosed/

This will be a two part post as this post became too long to manage as one post.  I hope this is helpful.

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.

Dear Gluten Intolerant,

Low stomach acid has now been linked to a probable cause of damage to the Small Intestine before and/or occurring with a Non-Celiac Gluten Sensitivity (NCGS) or Celiac diagnosis.

See this research as reported on celiac.com that discusses the increased risk of/for someone to develop celiac disease after taking PPI’s.

http://www.celiac.com/articles/23432/1/Do-Proton-Pump-Inhibitors-Increase-Risk-of-Celiac-Disease/Page1.html

Note how the article starts quoting

“Rates of celiac disease and the use of drugs to inhibit the secretion of stomach acid have both increased in recent decades. A research team recently set out to explore the association between anti-secretory medication exposure and subsequent development of celiac disease.”

If these medicine are lowering stomach acid what cause effect relationship does/ could this have on Celaic/NCGS diagnosis is what he is postulating.

He goes on to say without being very technical (read the whole article for yourself) that

“The data clearly show that patients who use anti-secretory medications are at much greater risk for developing celiac disease following the use of these medicines.

The fact that this connection persisted even after the team excluded prescriptions for anti-secretory medicines in the year preceding the celiac disease diagnosis suggests a causal relationship”.

If even after a year OFF these medicines your chances of developing Celiac Disease (CD) not to mention even NCGS which is much more prominent surely the researcher is correct in postulating that there is a cause and effect relationship between low stomach acid and NCGS and/or Celiac disease.

Surely there is something we can learn here.

I now postulate some homework for the reader of this blog post.

Do some research for yourself and see if achlorhydia or hypochlorhydia symptoms don’t at least resemble in some manner all of the GI symptoms you have been having. (I note some of the many symptom’s low stomach acid can present with below as referenced from Dr. Myatt’s online article “What’s Burning You” for easy reference (It might not be what you think (my words))

It is important to note here that “some” symptoms does not mean all but many or several.

It is called a differential diagnosis.

It is an important diagnostic tool in medicine. Think of the tv show “House” where they spend the whole hour/over a week times going through the ‘differential diagnosis’ in short any one symptom can/have many different causes.

The trick is how to quickly eliminate possible outcomes as symptoms (many) go up.

All is usually never meet because that would make the disease in full outbreak and obvious even to the layman a condition described as “frank” or “classic” Scurvy or Rickets as an example.

Sadly too often after 8 to 10+ years of testing after all the differential diagnosis’s are ruled out you are said by process of elimination to have Celiac Disease if you are lucky or maybe NCGS and not some other acronym GI disease as I like to refer to them as a group.

GERD,IBS,UC, Chrons etc because if they turned down that street … . you are/could be in/at a dead end for they stop looking at the trigger (gluten) as the cause of your gastric upset/digestive disorder(s).

So in summary if 3 or 4 or 5 or 6 of these symptoms overlap “many of’ these symptoms could be Low Stomach Acid related.

IF that is the cause/case for you then there is hope! For remission!

From Dr. Myatts’ Online article what’s burning you? http://healthbeatnews.com/whats-burning-you/

Diseases Associated with Low Gastric Function

Low stomach acid is associated with the following conditions:

* Acne rosacea

* Addison’s disease

* Allergic reactions

* Candidiasis (chronic)

* Cardiac arrhythmias

* Celiac disease

* Childhood asthma

* Chronic autoimmune hepatitis

* Chronic cough

* Dermatitis herpeteformis

* Diabetes (type I)

* Eczema

* Gallbladder disease

* GERD

* Graves disease (hyperthyroid)

* Iron deficiency anemia

* Laryngitis (chronic)

* Lupus erythromatosis

* Macular degeneration

* Multiple sclerosis

* Muscle Cramps

* Myasthenia gravis

* Mycobacterium avium complex (MAC)

* Osteoporosis

* Pernicious anemia

* Polymyalgia rheumatica

* Reynaud’s syndrome

* Rheumatoid arthritis

* Scleroderma

* Sjogren’s syndrome

* Stomach cancer

* Ulcerative colitis

* Vitiligo

When low in stomach acid we become low in essential nutrients

Quoting from Dr. Myatts “what’s burning you” article

“Our bodies need 60 or so essential nutrients. “Essential” means that the body MUST have this nutrient or death will eventually ensue, and the nutrient must be obtained from diet because the body cannot manufacture it. Many of these essential nutrients require stomach acid for their assimilation. When stomach acid production declines, nutrient deficiencies begin.

Calcium, for example, requires vigorous stomach acid in order to be assimilated. Interestingly, the rate of hip replacement surgery is much higher in people who routinely use antacids and acid-blocking drugs. We know that people who have “acid stomach” were already having trouble assimilating calcium from food and nutritional supplements due to lack of normal stomach acid production. When these symptoms are “band-aided” with drugs which decrease stomach acid even more, calcium assimilation can come to a near-halt. The result? Weak bones, hip fractures and joint complaints resulting in major surgery.

Jonathan Wright, M.D., well-known and respected holistic physician, states that “Although research in this area is entirely inadequate, its been my clinical observation that calcium, magnesium, iron, zinc, copper, chromium, selenium, manganese, vanadium, molybdenum, cobalt, and many other micro-trace elements are not nearly as well-absorbed in those with poor stomach acid as they are in those whose acid levels are normal. When we test plasma amino acid levels for those with poor stomach function, we frequently find lower than usual levels of one or more of the eight essential amino acids: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Often there are functional insufficiencies of folic acid and/or vitamin B12.”

Remember, these are essential nutrients. Deficiencies of any single one of them can cause serious health problems over time. Weak bones, diminish immune function, failing memory, loss of eyesight and many other “diseases of aging” are often the result of decreased stomach function.”

It is me again reader.

So low stomach acid is the triggering agent (often) for low nutrients.

Make too much sense!

Now don’t take Vitamin’s for this condition where low Vitamins/Minerals are known to be low in patients who have this condition because … . (if you do you won’t need to keep coming back to the doctor) I can almost hear the doctor say now.

Of course he/she doesn’t say that … just that the “average person” doesn’t need to take Vitamins.

Well I hate to break it too you … . but if you are having GI problems and reading this blog post on the celiac posterboy’s blog then you are not the “average” person.  You my friend or a sufferer or a friend of a sufferer still looking for answers.

If that is you then consider taking either powdered stomach acid – Betaine HCL or taking Niacinamide to help you reset your stress clock.

A Canadian researcher wrote about this connection 15+ years ago but still most doctors’ don’t understand this connection between about how “Niacin treats digestive Problems”

Here is the full link so you can research it more yourself. http://orthomolecular.org/library/jom/2001/articles/2001-v16n04-p225.shtml 

And you might not after a first reading.

I didn’t believe it myself for over a year .  . . but every time I thought about it – it (Low Stomach Acid) made/makes the most sense to me.

**** Note: research this yourself.  Here is a link about how to take Betaine HCL (powdered stomach) for maximum effectiveness. http://20somethingallergies.com/how-much-hcl-do-i-take-learn-to-test-for-your-correct-dose/

Don’t take my blog post as medical advice.  It is only what I did … it might not work for you but I think it is worth a try especially if you are not now taking an acid reducer. (see notes below about why this might) be more difficult if you are already taking an acid reducer … because the rebound wall (see/google chris kresser  what everybody should know about stomach but doesn’t) keeps us locked in … sometimes for years.

Since I was not taking acid reducers at the time I took Betaine HCL my stomach problems improved and I am sharing this now in the hopes it might help yours too!

Now back to (really) LOW stomach acid being diagnosed as HIGH stomach acid these days.

How can we know if it truly high or low?  You’ve heard the phrase timing is everything well it is here too!

Timeline is important in any diagnosis.

IF your stomach acid was HIGH as you often hear (everywhere) you hear take a Proton Pump Inhibitor aka acid reducer’s for heartburn/GERD (medical name for heartburn) then eating food (carbs, greasy things) wouldn’t bother you.

The acid would cut it up but if it is already low/weak then even a little acid can burn your esophagus which is not coated like the stomach to protect you from high acid.

BUT if it is low to start with then food will WEAKEN our/your acid so that you lose the food fight your in and things (carbs/fats) become to ferment, rancidify and cause heart burn.

Leading in time to Non-Celiac disease first and with enough injury (and time) to Marsh lesions qualifying you for diagnosis as a Celiac candidate/ patient.  See above link between/about PPI’s in the year preceding a Celiac diagnosis.

If you (can) be that patient and weight the xx number of years for all this damage to occur, there is a better way it is called digestion!

A virtuous cycle can replace the vicious cycle you are now in – it is caused digestion.

Digest your food with healthy stomach acid and your body will thank you for it with the God given burp.

A healthy child burps (at 6 months of age normally) and a healthy adult should too and you will again after taken Niacinamide 3/day for 6 months or this is not the right diagnosis.

*********Note this is not medical advice only my experience with Niacinamide and my many years researching this topic as a fellow (now former) sufferer.

Let me make these disclaimer(s).

If you are a) experiencing heartburn that causing vomiting (with unintended weight loss) you may have a special case of heartburn that feels like heartburn (on steroids) that is really Bile Reflux and taking Stomach is not something you should do without medical advice and supervision.

See this NYtimes article that discusses the many complications often seen with Bile Reflux patients and why it is treated as Heartburn often and why Bile Reflux is especially hard to recover from.

http://www.nytimes.com/2009/06/30/health/30brod.html

b) you are already taking an acid reducer then the chance you will get better (off of acid reducers completely) is only 50/50 on your first try but going low CARB can help your transition.

Otherwise most people will get better when taking BetaineHCL for gastric support and Niacinamide to help them/you reset your digestive processes.

See this online article about how Jo Lynne Shane got off Nexium for good. http://www.jolynneshane.com/how-i-got-off-nexium-for-good.html

and her Epilogue http://www.jolynneshane.com/epilogue.html

You will see she still struggles some but is much better when she let her natural digestive juices do their job.  I call it the “Natural Order of Things”.

See this article about the digestion process being a North South Affair from the bodywisdom website http://bodywisdomnutrition.com/digestion-a-north-to-south-process/

Also see these posts by the Celiac Posterboy that explain in more detail how to get off of Nexium/Prilosec for good and why this (low stomach) is happening and/or how LOW stomach acid is mimicking IBS, GERD, NCGS and/or Celiac disease in its’ most advanced state is happening and what you can do get off of Nexium or Prilosec for good.

https://celiacposterboy.wordpress.com/2014/10/15/way-back-from-nexium/ 

https://celiacposterboy.wordpress.com/2016/07/08/why-burping-is-good-and-bloating-is-bad-by-the-celiac-posterboy-and-how-to-begin-to-burp-without-being-bloated-a-healthy-state-of-good-digestion/ 

Taking it (Niacinamide) (or any B-Vitamin) should be taken 2 to 3/day (too keep up serum levels) for 3 to 4 months (the time you can store B-Vitamins) in the liver mostly.

Once you have a distinctive BURP that displaces the bloating and sense of “I am going to explode” if I eat another bite (though you haven’t eaten half your meal) then normal digestion is occurring again.

If you stool did not sink before this process (of taking Niacinamide begun) and burping became your “new normal” then it (your stool) will begin to sink too!

Burping without bloating is the “Natural Order” of good digestion.

This (low stomach acid) thing is a vicious cycle. STRONG stomach acid makes it a virtuous circle/cycle.

All heartburn is not equal. IF your stomach acid is truly high then it WILL occur between meals when there is no food to tamp down the fire (occurring in your stomach) not your esophagus.

The excess pressure from fermented carbs push open the trap door allowing the low acid you have to burn the lining of your uncoated esophagus.  (More on that later) in the next post.

As always search for the “Celiac Posterboy” or “Celiac Poster boy” or “Fight Gluten Win” or “Fight GERD Win” if you want to read all my blog posts for as I have said elsewhere in this blog and it bears repeating “To Educate is to Free” Truly.

But I think you will find in 3 to 4 months of taking Niacinamide 3/daily that  as a healthy child burps at 6 months? right that is how we know it’s digestive system is strong enough to digest real food.  That it it’ true for adult’s as well.

See my the “Way Back” http://www.celiacposterboy.com/Epilogue-Way-Back-002.htm Celiac Posterboy.com page about the process you have to go through with your mind to convenience your brain what your body already knows when you begin BURPING for the first time in years and year that something knew and wonderful is now happening – Digestion in all its beautiful glory! and Gluten and Lactose need not be(e) a problem for you any longer.

But it will take probably a year to convenience your MIND what your body already knows that is why the “2 proofs” are so important to understanding that something NEW different and WONDERFUL is now happening to you – DIGESTION as it was meant to happen.   The “Natural Order” of things.

You are/will bee BURPING in 4 to 6 months Praise/Thanks be(e) to God!

After 6 months of no flareups or “accidental” glutening’s even when your friends still suffer from “good” compliance/control from background gluten or gluten cross contamination issues  18 to 20 hours after the “glutening” you will be once a day regular.

Your mind will slowly catch up. To what your body already knows. Niacin treats digestive problems http://www.yourhealthbase.com/database/niacin-treats-digestive-problems.htm

This research is 15+ years old and doctors have not caught up to this fact either.  You needn’t suffer any longer if your LOW stomach acid is being misdiagnosed as NCGS, GERD, Heartburn, IBS, and yes even Celiac Disease then remission from LOW stomach is possible.

It worth noting again with the same emphasis I started this blog post with that 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.

For I have found if people finds success in other non-traditional ways i.e, Vitamins etc..  .. people get frustrated by this and will often attack people who are saying different things.

You don’t need a Vitamin etc?

WELL if you are reading this blog post either you or a friend is still suffering and I can’t say for 100% percent certainty this will help you the way it did me.  I can say for 100% certainty it helped me!

And I pray to God it helps you too!

I really believe God helped me to understand these things for myself 2 Tim 2:7 and I am just trying to help others’ as I have received help of God 2 Cor 1: 3,4 .

Tell someone (share) is all I ask Are You a Starfish (Part 2 – of a Former Sufferer’s Journey) tell others is all I ask – however that is (facebook, twitter, comment on my blog, email a friend this link or link this blog to yours, reblog on your site (cite your source) or review my book on Amazon when you are BURPING for the first time in years or (EVER) – tell a friend about the/this Celiac Posterboy blog post

Or my book/ebook  “How to Fight Gluten/GERD and Win” is all I ask but don’t let the chain break with you. There a lot of starfish (sufferers’) who STILL need help.

And maybe you are one of them!   Starfish/reader If you are one of those one who is still suffering from a medical misdiagnosis if so remission is possible!  I did not say “cure” but remission is possible.

This is longer than I planned as most of my posts seem to be but when you are trying to fight error and confusion it takes a lot of (un)learning to educate ourselves.

(Digestive) Peace is possible but it takes works to educate ourselves to the real cause.

As I have said elsewhere in this blog.  It not a long way back if you know the way.  Let me be your guide way back for God being my help I have found digestive peace.  Praise bee to God!

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

2 Corinthians (KJV) 1:3,4  3) “Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort; 4) who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble (starfish), by the comfort wherewith we ourselves are comforted of God.”

The Celiac Posterboy by the Grace of God,

Joe “Rock” Pen Name

A Differential Diagnosis: How Pellagra Can be Confused/is Confused with Celiac Disease Today by the Celiac Posterboy

A Differential Diagnosis: How Pellagra Can be Confused /is confused with Celiac Disease Today by the Celiac Posterboy

* Published 01/17/2017 * Journal of Gluten Sensitivity Winter 2017 Issue , Additional Celiac Disease Concerns

Rating:  ****** Five Stars

As Published in the International Journal of Gluten Sensitivity originally appearing on Celiac.com 01/17/2017  See this Link https://www.celiac.com/articles/24658/1/A-Differential-Diagnosis-How-Pellagra-Can-be-Confused-with-Celiac-Disease/Page1.html

A diagnosis of Pellagra will likely have many other disease presentations, not limited to acne, rosacea (dermatitis) skin rashes, depression, anxiety, dementia, etc., as well. Seventy-five or more years ago the symptoms of Pellagra were commonly diagnosed as separate diseases that were known to be of a common cause. Similarly celiac disease today is often referred to as the “tip of the iceberg,” not only because of the large number of undiagnosed people, but also due to the vast range of symptoms and associated diseases and disorders that can be caused by untreated celiac disease. I assert that Pellagra could be, in some cases, related to Celiac disease, and might even cause it.

Today Pellagra has mainly been reserved for subgroups of people like alcoholics or disadvantaged groups like the homeless, who lack good protein sources in their diet to stave it off. Quoting Niki Frost from the Pellagra Disease Blog: “Since pellagra is such a rare disease today, few people recognize it based on their symptoms alone (any of the three D’s: dementia, dermatitis, and diarrhea). Pellagra patients are consequently referred to specialists in fields that are ultimately unrelated to the underlying nutritional deficiency and metabolic nature of the disease.” (1)

Dr. Heaney, Professor of Medicine at Creighton University, actually echo this fact when he says “In the United States, at least, Pellagra is a disease of the past, fortunately, and it is doubtful today that most health professionals would recognize it if a case happened to come to their attention.” (2) Why is this? Because, as mentioned above, doctor’s don’t recognized it today unless they are a specialist, and even then, according to Nicki Frost: “specialists (are) in fields that are ultimately unrelated to the underlying nutritional deficiency and metabolic nature of the disease.” (3) So the cycle repeats.

Since these specialists might not consider people with celiac disease/Non-Celiac Gluten Sensitivity (NCGS) to be in a subgroup which is prone Pellagra, is it possible that some people are misdiagnosed? Skin conditions like acne, dermatitis, eczema, psoriasis, skin lesions, and mouth ulcers can be related to both Pellagra and celiac disease or NCGS. Some of the other signs of Pellagra, other than digestive distress, are dementia related symptoms such as depression, anxiety, brain fog, mental confusion, etc., which are also present in 40 percent of celiac patients. What if doctors haven’t made the right diagnosis in some cases? Many people who might be misdiagnosed with celiac disease but who actually have Pellagra might not get better because they are not treating the right disease.

Pellagra and its associated skin and GI problems are totally reversible with supplementation, which is one of the reasons that many foods are enriched with niacin. Glutenfree Works covers this topic well by noting a casual relationship, but not a causal relationship. They even note that a niacin deficiency itself can cause some of these symptoms. According to Glutenfree Works:

“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. Human research needs to investigate this effect of niacin deficiency in human celiac disease.” (4)

But no one else seems to take note of this amazing fact. The research by Sandhur et. al. is 30+ years old, but is it possible that people are suffering from all kinds of GI problems, possibly even celiac disease, because they are ignorant of this fact?

Around 15 years ago Prousky did follow up human research (5) that supports the idea that Niacinamide can indeed treat different digestive problems. It was this initial research which I read 10+ years ago that lead me to the hypothesis that Pellagra today is might be misdiagnosed as Celiac disease, because doctors are no longer able to recognize Pellagra in a clinical setting, having not seen it 75+ years.

From Dr. Heaney’s blog: “2014 marks the 100th anniversary of the war on pellagra, a war that lasted nearly 25 of those years before victory could finally be declared. You have not heard of the war on pellagra? The celebration is not on your calendar? You’re not alone. Why did it take so long? Was the science so intractable, like the current “war” on cancer? No. It was politics and pigheadedness that were the obstacles.“ Dr. Heaney says: “Nutritional deficiency was not an accepted category of disease when Goldberger started work” on his cause/cure for Pellagra, and I must also mention that it is not looked at today in those diagnosed with celiac disease. (6)

Let’s look into this more if we can. Let’s see what other expert’s say about this. If we look at back issues of The International Journal of Celiac Disease we see a casual link that indicates a co-morbidity of Pellagra in celiac patients of 58%. (7) Note they the International Journal of Celiac Disease is not looking for a causal link but they only report casual association. In the article entitled “Two Exceptional Complications Revealing Celiac Pellagra” the author notes: “pellagra is essentially affecting tissues with a high rate of cell turnover, such as the digestive tract and the skin, and tissues with high energy needs, such as the brain”. (8) If the symptoms are so similar, it might be easy to confuse one disease for the other.

How is this possible? The International Journal of Celiac Disease muses on this point too. When discussing the “exceptional” and not well understood reasons why Pellagra might show up in a celiac diagnosis, they say “Little progress has been made in our knowledge of pellagra…since Goldberger discovered that nicotinamide was a preventive factor in 1926…(P)roof of this is that there have been no changes in treatment or diagnostic criteria in the last 90 years.” The International Journal of Celiac Disease summarizes this case of “Exceptional complications revealing celiac disease and Pellagra illustrates…rare complication revealing celiac disease”. (8)

Since up to 58 percent of celiac patients might be co-morbid with Pellagra, could it be possible that Pellagra is the “parent disease,” and the those diagnosed with celiac disease have symptoms derived from Pellagra? If we follow most normal paths for adoption it will take another 20 years (a generation) for the medical community to accept Pellagra as perhaps the proper diagnosis in some cases. So there is some evidence to suggest that medical science is, perhaps in many cases, identifying the wrong disease. If one is critically low in niacin, the 3 D’s of Pellagra (Dementias, Dermatitis’s, and Digestive Issues) show up.

Take the “Niacin (Niacinamide) Challenge” and see if taking it three times a day for six months don’t cause a healthy GI pattern, including a once per day bowel movement that sinks and healthy burping without bloating. Taking the niacinamide Challenge may put co-morbid cases of Pellagra, including its digestive symptoms, into remission, and provide relief for many who do not recover on a gluten-free diet alone. The number one mistake people make when taking niacinamide is they don’t take it for long enough. It takes 4 to 6 months to overcome a serious deficiency of this vitamin, and for your mucus membranes (GI lining) to heal itself.

Once you recover you can maintain your health, barring some future stress/trauma that depletes your reserves, at which time heartburn/GERD/IBS/diarrhea/constipation symptoms will return, and you will lose your ability to burp easily again. And the cycle repeats and the Pellagra symptoms come back with a vengeance.

Read more at https://celiacposterboy.wordpress.com/2016/02/19/when-myth-becomes-medical-fact-people-suffer-unnecessarily-the-case-of-mistaken-identity-how-pellagra-now-thought-to-be-rare-became-known-as-celiac-disease-a-white-paper/

References:

1. https://pellagradisease.wordpress.com/

2. http://blogs.creighton.edu/heaney/2013/11/18/pellagra-and-the-four-ds/

3. https://pellagradisease.wordpress.com/

4. http://glutenfreeworks.com/blog/2010/06/23/niacin-vitamin-b3-deficiency-in-celiac-disease/

5. Prousky, Jonathan E. Is Vitamin B3 Dependency a Causal Factor in the Development of Hypochlorhydria and Achlorhydria? Journal of Orthomolecular Medicine, Vol. 16, No. 4, 4th quarter 2001, pp. 225-37. http://www.orthomolecular.org/library/jom/2001/articles/2001-v16n04-p225.shtml

6. http://blogs.creighton.edu/heaney/2013/11/18/pellagra-and-the-four-ds/

7. International Journal of Celiac Disease. Celiac Disease: Intestinal, Heart and Skin Interconnections. 2015, 3(1), 28-30 doi:10.12691/ijcd-3-1-6 http://pubs.sciepub.com/ijcd/3/1/6/

8. International Journal of Celiac Disease. Two Exceptional Complications Revealing Celiac Disease: Ischemic Cardiomyopathy and Pellagra. International Journal of Celiac Disease. 2015, 3(1), 31-32 doi:10.12691/ijcd-3-1-5. http://pubs.sciepub.com/ijcd/3/1/5/

One reviewer/forum member on Celiac.com gave it Five Stars.

Knitty Kitty

Rating:  Five Stars

said this on

18 Jan 2017 1:56:09 PM PST

Hurrah! Wonderful informative article. Should be required reading in the Newbie section. Thanks!

It should be noted that the forum member had already treated her DH with Niacin and already knew of its power to help Dermatitis problems.

Soon after the is article appeared on Celiac.com someone on my Celiac Posterboy blog began taking Niacinamide for her GI problems associated with her Celiac disease that were still having Constipation and Diarrhea problems despite being gluten free and got better (her C&D settled down) shortly after beginning the Niacinamide.

I will let her speak for herself.

1. Mairllyn February 7, 2017 at 3:18 am

I have Celiac and have been having a terrible time with “D” these past 3 months. Read Celiac. com and your article about the Niacinamide was very interesting. Due to the problems with the GI tract, I was using a BRAT diet more often than I should have. While I do take a multi with niacin in it, probably need a lot more. Added the Niacin and Niacinamide and already things are slowing down. Yea! Just had colonoscopy today and EGD to r/o any problems, Doc said that things looked good but he took biopsies to r/o SBIO and/or another type of colitis. Once I added the niacin things started to improve. I am going to take your article to his office when I do my follow up visit. Thanks for writing it.

Link provided below “To Educate is to Free Part 2: A Physician’s Guide where she enthusiastically comments and says thank you.  Be sure to read to the end of the thread/blog post to read her comments for your-self.

https://celiacposterboy.wordpress.com/2016/01/23/to-educate-is-to-free-part-two/

This reminds of a quote from a friend of mine J. Dan Gill who wrote the Theologic book for Laymen “The ONE: In Defense of God” that definitively describes The ONE God of Israel and his Son Jesus Christ (the Anointed “one”) as truly the good news of the Gospel.  In fact John 17:3 describes it as life Eternal.  “And this is life eternal, that they might know thee the only true God, and Jesus Christ, whom thou hast sent.”

Where/when he (Dan) talks about the difference between Truth and Error.

“The Truth is Always Better

The Truth, whatever it is,

Is always better than error,

Whatever it is.”

By J. Dan Gill

The Truth that there is  the FATHER who is the ONE God who had one begotten Son Jesus Christ/Messiah our Lord is truly good news for us. Because He (God) has raised that one man from the dead giving us assurance he someday will raise us too if we are in Christ (The Anointed Jesus)

Acts 17:31 Because he hath appointed a day, in the which he will judge the world in righteousness by that man whom he hath ordained (anointed); whereof he hath given assurance unto all men, in that he hath raised him from the dead.

While this issue of error of getting a wrong diagnosis does not raise to this error of being dead forever (the opposite of eternal life) it can lead to an early grave if you continue to have Pellagra and are not treated for it properly – the 4th D of Pellagra.

The knowledge (truth) that a Vitamin can help us is greater than the error of being misdiagnosed with the wrong disease.

If the International Journal of Celiac Disease is correct there is better than a 50/50 chance you will get better the way Knitty Kitty, Mairllyn, and the Celiac Posterboy has.

Won’t you be the next Celiac to get better (I speak as a man) i.e. come back from the Celiac grave you now find yourself in.

Gluten Juneteenth has been declared (look it up if you don’t know what it means)

https://celiacposterboy.wordpress.com/2014/07/16/gluten-juneteenth/

Because Pellagra is progressive you will die from the 4th D of Pellagra in time.

Someone can be said to “die before their time” don’t let Pellagra steal your time away from you any longer.  You needn’t die before your time if you take the Niacinamide and get better from it.

Taking it and getting better is considered sufficient proof that a Niacin(amide) deficiency was causing the 3 D’s of Pellagra.

See this link from mdguidelines webite http://www.mdguidelines.com/pellagra

A simple urine test is all that is needed to determine if you have Pellagra and the doctors’ have not recognized it in a clinical setting.

They summarize it very well why Pellagra is not being diagnosed today in Doctor’s offices’ across the land.

Pellagra in Italian (the language it was first described in 250+ years ago) meaning “Rough/Sour Skin”

In their diagnosis section quoting  “The diagnosis of pellagra is straightforward when the classic rash is present but may be elusive if there are only gastrointestinal and/or neurological manifestations.”

Today if you fail to get the “classic symmetrical” sun (photosensitive) rash then you fail to get diagnosed as a Pellagrin in the first place then the other Ds’ of Pellagra present such as the Gastrointestinal issues associated with a Celiac diagnois and/or neurological problems like the 40% of those who are get a Celiac diagnosis and are depressed but are diagnosed with it as part of a separate diagnosis from  that of a Celiac diagnosis.

Or if you quoting again don’t have what they (according medical doctor’s diagnosing guidelines)  consider  “Poor dietary habits, such as those found among chronic alcoholics, individuals with severe eating disorders (e.g., anorexia nervosa and bulimia nervosa), and the malnourished also increase the risk of pellagra” then you are not diagnosed today as having Pellagra.  Today you will be diagnosed as a Celiac.

Since you are not one who consumes/relies on a quoting again “a diet high in corn products” then you the wheat consuming Pellagrin are diagnosed as having Celiac today instead.

See my celiac posterboy blog link that explains why this is today.

https://celiacposterboy.wordpress.com/2016/02/19/when-myth-becomes-medical-fact-people-suffer-unnecessarily-the-case-of-mistaken-identity-how-pellagra-now-thought-to-be-rare-became-known-as-celiac-disease-a-white-paper/

But if you don’t get the correct diagnosis/disease in the beginning then you don’t get better.

Oh you cope, manage, continue to have flares get more sensitive to other proteins lactose, soy, corn (there is that corn thing again) etc.

You are said to be a Celiac who is supersensitive?

There is no hope for you now?  The doctor’s don’t know why you continue to have problems.

You have removed gluten from your diet… you should get better.

But you never do . .. . you just get more sensitive and more sensitive to more food allergens (proteins) that your body can no longer digest.

Stop the Madness!!!!! (Errors)

Get the right disease Pellagra and get better the way other Celiac’s have!

Like myself and Mairllyn and Knitty Kitty has done by taking the Niacinamide Challenge

https://celiacposterboy.wordpress.com/2014/12/03/the-niacin-niacinamide-challenge/

And have gotten better.

And my doctor’s IBS patients who have not yet received a NCGS diagnosis or a Celiac diagnosis in time because Pellagra is progressive and the conditions continue to get worse and worse …

Your flare up’s continue (think Chron’s) and the doctor’s don’t know why.  But you do my friend because you have been reading the Celiac Posterboy’s blog and have gotten better from Celiacs’ evil twin – Pellagra.

Please don’t be trapped by  error of  a misdiagnosis any longer!

Bee Freed by the Truth of a correct diagnosis!

Praise bee to God!

See my Celiac Posterboy blog post dedication about the Bee’s Story that I included in my “How to Fight Gluten and Win; Or How the Doctor’s Almost Killed Me” ebook  available on Amazon if this post isn’t enough to convenience you that ignorance might be killing you too maybe if you have been stung by their ignorance of Pellagra today and you are reading this blog.

https://celiacposterboy.wordpress.com/2016/02/13/dedication-the-bees-hive-story-to-the-book-how-to-fight-glutengerd-and-win/

Where I say quoting the Celiac Posterboy

“Learn from my mistakes.  

No man is so dumb as the man who won’t learn from other people’s mistakes.

Take as much honey (knowledge) as you can from my mistakes so bad (lack of knowledge) health will not sting your quality of life.

Is it any wonder God’s promised’ land was described as a land flowing with milk and honey?

Where knowledge (truth) flows there is health of mind and body.”

Don’t be trapped by this error (Medical Myth) any longer.

See my post about why/this is /came to be to our harm.

Linked again here for your convenience of how the Celiac Posterboy freed himself (God being his help) of Pellagra being diagnosed as Celiac Disease today of this medical myth!

https://celiacposterboy.wordpress.com/2016/02/19/when-myth-becomes-medical-fact-people-suffer-unnecessarily-the-case-of-mistaken-identity-how-pellagra-now-thought-to-be-rare-became-known-as-celiac-disease-a-white-paper/

Or as I have entitled this post “A Differential Diagnosis: How Pellagra can/is confused with/as Celiac Disease today!

SADLY! Few listen.  But some (Celiac’s) have heard (listened to) the good news that Pellagra is reversible and have gotten better.  Don’t be the Last!

Praise bee to God!

As always search for the “Celiac Posterboy” or “Celiac Poster boy” or “Fight Gluten Win” or “Fight GERD Win” if you want to read all my blog posts for as I have said elsewhere in this blog and it bears repeating “To Educate is to Free” Truly. See my Celiac Posterboy WordPress blog entry

https://celiacposterboy.wordpress.com/2016/01/23/to-educate-is-to-free-part-two/

If you want to try and educate your doctor and think he will listen.

Truth of the right diagnosis has freed us from the error of the wrong diagnosis.

*** This is not medical advice and should not be considered such. Results may vary. Always consult your doctor before making any changes to your medical regimen. But mine has taken the  Niacinamide Challenge

https://celiacposterboy.wordpress.com/2014/12/03/the-niacin-niacinamide-challenge/ and his digestive/GI problems are in remission.

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

The Celiac Posterboy by the Grace of God,

Joe “Rock” Pen Name

2 Corinthians (KJV) 1:3,4 3) “Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort; 4) who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble,  by the comfort wherewith we ourselves are comforted of God.”