COVID-19 is not just a problem for the elderly population — young and healthy individuals can also end up hospitalized, or even on a ventilator, depending on their genetics.

There are reports of marathon runners under the age of 50 almost dying from COVID-19. I personally am aware of a case of a woman in her early 20s on a ventilator from COVID-19 complications. What is the reason why healthy people in addition to the elderly can succumb to COVID-19?

One key reason is cytokine storm.

What is a cytokine storm?

The term “cytokine storm” encompasses a multi-factorial hyperinflammation associated with increased expression of different cytokines including but not limited to interleukins (IL), chemokines, granulocyte colony-stimulating stimulating factors (G-CSF), and tumor necrosis factor-1a (TNF). …

My first exposure to cases of pediatric celiac disease confirmed what was published in a text I read by Walker-Smith and Murch back in 1999 titled Diseases of the Small Intestine in Childhood. 4th ed. The authors were describing dominant symptoms that differed from what were referred to as more common symptoms of the disease in the adult population.

Five years later, Ludvigsson and colleagues published a paper in the Journal of Pediatric Gastroenterology and Nutrition discussing the same topic with regard to Swedish children with celiac disease. This paper covered the signs and symptoms of celiac disease in a pediatric population that were part of a previous prospective cohort study that aimed to identify risk in the pediatric population of Sweden for immune system diseases, including celiac disease. …

“Biochemical individuality” — A phrase I state multiple times a day in appointment settings, speaking with the media, and colleagues alike. That phrase comes to mind again with regard to a proper understanding of the unique nutrient deficiencies that may plague the newly diagnosed celiac disease patient. I will discuss what is common in peer-reviewed literature, but that data should be a guide, not set-in stone examples of only what to test for in such a patient base.

Since celiac disease is a disease that attacks the nutrient absorption areas of the small intestine, nutrients that appear in peer-reviewed literature that are typically deficient include vitamins A (retinol), D, E, K, folic acid, B6, B12, and the minerals calcium, copper, magnesium, zinc, selenium and iron. Quoting Green and Cellier, “after the diagnosis of celiac disease has been established, the patient should be assessed for deficiencies of vitamins and minerals, including folic acid, B12, fat-soluble vitamins, iron, and calcium, and any such deficiencies should be treated”. That quote is from one of the most important peer-reviewed publications on celiac disease at the time in 2007, from the New England Journal of Medicine, simply titled Celiac Disease. I recall reading that paper and I was excited. In my mind, fleets of medical doctors were going to read this review of this important disease and increase their understanding of some of the complexities of this disease, including the aforementioned statement on the importance of testing nutrient status, as opposed to simply asking what people eat and with what frequency. Never assume nutrient status. Unfortunately, of all the cases of celiac disease I have worked on, the only nutrients ever routinely tested have been iron, B12 and vitamin D, and certainly not in every case. …

A paper published last year by Simons and colleagues identified a direct link between celiac disease and pneumococcal infection. While the incidence was higher in hospitalized patients versus the general population, the data has been building for years in the general population. The main cause of action for this increased risk involves the spleen.

The Spleen

In the most basic terms, the spleen is an organ in the lymphatic system that helps maintain fluid balance in the body and fight off infection. It is located on the left side of the body, under the ribs and above the stomach. It is about the size of a human fist. …

As a celiac disease expert, one question I am asked most often is “what if you have celiac disease and are exposed to gluten?” Unfortunately there are no magic bullets. There is no cure for this disease. Sadly, many celiac disease organizations estimate over 75% of celiac disease patients confirm exposure to gluten over a short period of time. It is important to state what I hope is obvious, but it is critical to communicate that you have celiac disease to whomever is preparing your food. Regardless, sometimes things do not go as planned. If you, like me, have celiac disease, you may have experienced that dining out doesn’t always go as planned regardless of how much planning you do, or orate the seriousness of the disease. …

Receiving continuing proper medical care after the diagnosis of celiac disease is critical. I call the process of medical follow up for the celiac disease patient the 3 or 6 and 12 month post diagnosis process (just remember 3 or 6 and 12).

Around 3 to 6 months after your diagnosis see your physician for a follow up appointment. I prefer 3 months, but there is one test that actually requires 6 months to become normal on a strict GF diet, I’ll explain in a moment. The reason I prefer a medical follow up at 3 months post diagnosis versus 6 is to follow up on or discover any nutritional deficiencies that are linked to celiac disease. Quoting Green and Cellier as I did in a previous blog post , “after the diagnosis of celiac disease has been established, the patient should be assessed for deficiencies of vitamins and minerals, including folic acid, B12, fat-soluble vitamins, iron, and calcium, and any such deficiencies should be treated. It is important to identify deficiencies and track the normalization of any essential nutrient. …

Lactose intolerance is not the same as an allergy to milk. Lactose intolerance differs from a milk allergy in that a milk allergy is an immune system reaction and true lactose intolerance is due to a deficiency of the enzyme lactase that digests the milk sugar lactose that does not cause an immune system reaction. Lack of this enzyme can cause some disturbing symptoms including but not limited to bloating, gas and diarrhea.

It is estimated that 68% of the world’s population have lactose intolerance, which is also referred to as lactose malabsorption. The 68% of the population with lactose intolerance also has a majority demographic in Africa and Asia, while in northern Europe, some people carry a gene where the C allele indicates lactase nonpersistence (they do not produce the enzyme lactase) and the T allele indicates lactase persistence (they do produce the enzyme lactase). …

Should you just immediately go gluten free and skip any diagnosis? No, and I’ll explain in a bit. The goal is to find out if you have this lifelong disease. Do not stop eating gluten and schedule an appointment with your doctor. All the testing I’m about to recommend (except for genetic testing) requires gluten being in your diet.

It may help to bring this article to your doctor. I’m going to do my best to simplify this process, but please note things can get a bit complicated.

Start with a request for a total serum IgA and a tissue transglutaminase IgA. Many doctors prefer to get both tests done at the same time once you provide the reasoning. As mentioned above, there is a risk for a total IgA insufficiency and that could render any IgA test moot. If your total IgA is low, ask your doctor to order a tissue transglutaminase IgG and Gliadin (deaminated) IgG serum blood test. If any of those results are positive, proceed to a biopsy. …