<<Disclaimer: Verify this information before applying it to your situation.>>

The responses to my question about malabsorption elicited many
responses.  This will be a long post.

Bev in Milwaukee stated that "different nutrients are absorbed in
different areas along the small intestine.  Also, the damage from
celiacs does not occur evenly along the entire small intestine.  This
would explain why some do not absorb iron and others do not absorb
specific B vitamins."

Douglas in Pittsburgh  said "in untreated (by diet) celiacs, classically
malabsorption refers to fats...but the fats take the fat soluble
vitamins (A,D,E,K) with them; and some minerals, notably calcium, form
soaps in the fats, and also exit with them.  Presumably, fat soluble
medicines would also be a problem.

In addition, folic acid is generally malabsorbed by untreated celiacs
for reasons I don't know exactly, and the repair of the intestinal
lining saps the body of the water solubles (Bs generally, and C) which
shows as skin problems, cracking at the corners of the mouth and so on,
because there aren't enough left to maintain the skin properly."

Another take on malabsorption worth sharing is that coated vitamins may
just go right through almost everyone (celiac or not) without ever being
dissolved....with a story about waste from porta-potties to prove the
point.  The lesson is that one should look for natural, uncoated
vitamins.

Someone asked about how to be tested for vitamin absorption or how I
knew I was deficient.  My HMO doctor had me tested for vitamin D when I
was concerned about taking Fosamax for my  poor bone density.  (I read
in the Fosamax material given out with the prescription that you should
not take Fosamax if you are deficient in either vitamin D or calcium and
I wanted to be sure I wasn't.) He wouldn't test for A; said that was not
as easy.  My environmental medicine doctor had hair/blood/urine tests
run and commented on my low B12 and folic acid (some of which seemed to
be assumed from other information given by test results).   Although I
have not been tested for vitamin A, every time I have increased the
amount I take, another symptom of vit. A deficiency goes away.  I am now
taking ***lots*** of everything.

 I was both pleased (misery loves company) and sorry to hear than there
are many long-term celiacs like me who are concerned about malabsorption
even though they are currently gluten- free.  Some, like me, take lots
of vitamins and hope they work.  Sublingual B-12 was recommended.  A
prescription D vitamin, vitamin D-3 was said to be helpful as it could
be absorbed directly.  Enzymes were recommended.  Also very potent
acidophilous pills seem to help gut healing and thereby absorption.  And
several have mentioned Cal Apetite, a specific form of calcium that's
supposed to be good.  Also tips about calcium working better with
vitamin C and other combinations that work together.  This is quite a
tricky science.  And because what you don't absorb depends on where the
damage is in your intestine, this can get even more complex.

Some assume that once one goes off gluten, all will be well and
malabsorption will stop.  I hope they have been able to experience this
for themselves.  My son, also a celiac, but diagnosed at 18 months
rather than my 32 years, may be a good example of this.  He seems
awfully healthy.  However, it is clear that there are a number of us
that have developed so many problems before diagnosis, or by not being
totally gluten-free over many years , that "not eating gluten" is only
part of our solution.

The advice I will act on (having done almost everything else already) is
(1) to see a good gastroenterologist who will see that I get tested for
all possible vitamin and nutrient levels (not an HMO kind of thing)  and
(2) to search further for "my" diet. Douglas from Pittsburgh, again,
says, "many celiacs are intolerant of milk protein, soy, corn or even
rice.  If evidence of malabsorption persists, you might want to try a
rotation diet to check things out."

I am intolerant of them all but don't avoid them as carefully as I avoid
gluten.  I misunderstood from something on the list or a celiac speaker
that **only gluten** damages the gut.  However, it is becoming clear
from information given since then that milk protein can damage the gut
and I believe corn and rice also do for me.  So they don't just cause an
isolated symptom as I was assuming (which I sometimes would decide I
could tolerate) but really set me back in terms of overall intestinal
health.  And that means malabsorption of vitamins and calcium and that
means osteoporosis and other premature aging phenomena (heart attacks,
Alzheimers, etc.).

I should mention that this is what I have learned and inferred from
those who responded, none of whom identified themselves as medical
specialists.  It would be very helpful if some of the specialists on our
list would comment on this summary.

****For those concerned about hormones, Fosamax, etc.:****

Barb in Washington mentioned a sublingual formula of triple estrogen
that was prescribed by her Naturopath.   Because it is supposedly
utilized immediately rather than going through the gut, it avoids
malabsorption and she has no adverse symptoms.

Reesa said that estrogen should be taken at night because absorption is
better then.

Bev mentioned a man in her (CD) group who "takes Fosamax with no
problems and it helps him- --& his level of absorption is low because of
long term celiac damage which can never be reversed."   Someone said no
studies of Fosamax have been done on celiacs.  A doctor (not on list)
said there are no studies about what happens when you stop taking
Fosamax (as some celiacs do occasionally because it gets to their
stomachs) and she thinks there might be a reversal of the bone density
gains.  I will probably do what I have done with estrogen.....take it
and hope I made the best pre-full-research guess.

Thanks for all the information.

Sue in Maryland