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Celiac.com 01/27/2024 - We've done many articles that cover nutrient deficiencies that are associated with untreated celiac disease, but many people do not realize that celiac disease can also lead to malabsorption of medications and supplements. Celiac disease damages the lining of the small intestine, where both nutrient and certain medication absorption takes place. This damage can result in decreased absorption of various substances, including both over the counter and prescription medications, and supplements. Medications that are taken orally and absorbed in the small intestine may be affected by malabsorption in individuals with untreated celiac disease. As a result, the effectiveness of these medications might be compromised. It's essential for individuals with celiac disease to maintain a strict gluten-free diet to allow the small intestine to heal and improve nutrient absorption, including medications. Common Medications Affected by Celiac Disease Malabsorption Here are some common medications that may be affected by celiac disease-related malabsorption, but many more medications might also be affected: Thyroid Medications: Medications used to treat thyroid disorders, such as levothyroxine, may have reduced absorption in individuals with untreated celiac disease. Certain Antibiotics: Some antibiotics, including tetracycline and doxycycline, are absorbed in the small intestine. Malabsorption issues may affect their effectiveness. Anti-Inflammatory Drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, commonly used for pain and inflammation, may have altered absorption in individuals with celiac disease. Certain Anticonvulsants: Medications used to treat seizures, such as phenytoin, might be impacted by malabsorption in untreated celiac disease. Oral Contraceptives: Birth control pills, which are taken orally, may be affected by malabsorption in individuals with celiac disease. Blood Pressure Medications: Calcium Channel Blockers: Medications like amlodipine, which are calcium channel blockers used to treat high blood pressure, may be affected by impaired calcium absorption. Beta-Blockers: Some beta-blockers, such as metoprolol, may have altered absorption due to malabsorption issues. Cholesterol-Lowering Medications: Statins: Medications like atorvastatin and simvastatin, commonly prescribed for managing cholesterol levels, might be impacted by malabsorption in the small intestine. Pain Medications: Opioids: Medications containing opioids, such as codeine or oxycodone, may have absorption challenges in individuals with untreated celiac disease. Diabetes Medications: Metformin: This common medication for managing diabetes may be affected by impaired absorption in individuals with celiac disease. It's important to note that individual responses to medication can vary, and the severity of malabsorption can differ among those with celiac disease. Therefore, open communication with healthcare providers is crucial to monitor medication effectiveness, adjust dosages when needed, and explore alternative treatments if necessary. Common Supplements Affected by Celiac Disease Malabsorption Here are some common supplements that may be affected by celiac disease-related malabsorption, but many more supplements might also be affected: Calcium Supplements: Calcium carbonate or citrate: Individuals with celiac disease may experience difficulty absorbing calcium, impacting bone health. Supplementing with calcium is common to address potential deficiencies. Iron Supplements: Iron sulfate or ferrous fumarate: Celiac disease can lead to iron deficiency anemia due to impaired iron absorption. Iron supplements are often recommended to address low iron levels. Vitamin D Supplements: Cholecalciferol (Vitamin D3): Malabsorption of fat-soluble vitamins, including vitamin D, can occur in celiac disease. Supplementation is often necessary to maintain adequate vitamin D levels. B Vitamins: B12 (Methylcobalamin): Deficiencies in B vitamins, particularly B12, may occur in individuals with celiac disease due to malabsorption. B12 supplements can be prescribed to address deficiencies. Folate (Folic Acid or Methylfolate): Methylfolate: Similar to B12, folic acid absorption may be compromised. Supplementing with methylfolate can be considered. Zinc Supplements: Zinc citrate or picolinate: Zinc absorption may be reduced in celiac disease. Zinc supplementation is recommended for those with zinc deficiencies. Magnesium Supplements: Magnesium citrate or glycinate: Malabsorption issues can affect magnesium levels. Supplementing with magnesium is common to address deficiencies. Omega-3 Fatty Acids: Fish Oil (EPA and DHA): Essential fatty acids may be poorly absorbed. Omega-3 supplements can help maintain a balance of these crucial fats. Summary Individuals with untreated celiac disease may experience malabsorption of various medications and supplements due to damage to the small intestine's lining. This can impact the absorption and effectiveness of certain drugs and supplements that are commonly taken or prescribed for various conditions. It's essential for individuals with celiac disease to be aware of potential interactions and work closely with their healthcare providers, including pharmacists, to ensure appropriate adjustments in medication dosage or explore alternative forms of administration when necessary.
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Gluten-Free Prescription Medications and Dietary Supplements
Sarah Curcio posted an article in Autumn 2021 Issue
Celiac.com 11/30/2021 - We all know symptoms of celiac disease are activated by the consumption of gluten, which can be found in wheat, barley, rye, and even oats that aren’t certified gluten-free. Most individuals who go on a gluten-free diet will think about food only, not necessarily medications. However, the truth of the matter is you need to be careful with both nutritional supplements, and over-the-counter and prescription medications, as they could contain gluten. More often than not, excipients, which are binding agents or inactive ingredients in pills, tend to contain wheat, potato, corn, or rice. Additionally, even if a brand name drug is gluten-free, this does not mean that its generic version is. Nutritional supplements tend to be easier because a lot of companies now label their bottles "gluten-free", or list all ingredients used in them on the packaging. For supplements that are not clearly labelled, checking the product on their company Web site is the best way to be sure, and sometimes you may need to call the manufacturer directly. Currently, however, prescriptions don't include "gluten-free" on their labels, and, unlike foods, are also not required to list any of the top eight common food allergens that they might contain. If you know your pharmacist well, they might be able to assist you, or you could reach out directly to the manufacturer. Another option is the Dailymed Web site which allows you to search for most prescription medications, including their generic equivalents, to find out what inactive ingredients are used to make them. Search for inactive ingredients and allergens contained in prescription medications: https://dailymed.nlm.nih.gov/dailymed/ Below are some potential suspect inactive ingredients that could contain gluten if their source is not specified: Modified starch Pregelatinized starch Pregelatinized modified starch Dextrates Dextrin Dextrimaltose Caramel coloring So, the next time you have to refill a prescription keep this information handy. That way, you protect your villi from further damage. Reference: beyondceliac.org- 6 comments
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Celiac.com 06/21/2021 - In a move that could help to protect people with celiac disease who purchase oral drugs, a senator in the Illinois State Legislature has sponsored a measure to require oral drugs to carry proper warning labels to alert users to the presence of gluten or other allergens. “Restaurants and grocery stores have increased their gluten-free offerings and have become far better equipped to properly label and handle items for people with dietary restrictions,” Morrison said. “People with Celiac and other gluten intolerances should feel just as protected when visiting a pharmacy.” Under the recently passed legislation, any prescription or over-the-counter drug that contains gluten that is not labeled would be considered misbranded. The fact is that most oral drugs do not contain gluten, so many consumers assume that all are gluten-free, unless otherwise specified. However, that is not true. Currently, many oral drugs do contain gluten ingredients that are not labeled and not required to be labeled by law. Inadvertently consuming gluten can be harmful to with celiac disease or other gluten intolerance, and may interfere with the action of some medications. “The measure will make it easier and safer for people with Celiac disease or gluten sensitivity to make informed purchases of necessary medications,” Morrison said. “We expect the food we purchase to be properly labeled, so why shouldn’t we expect the same from the medications we take?” Illinois House Bill 279 has now passed both chambers, and now goes to the Governor for approval. Read more at illinoissenatedemocrats.com.
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Celiac.com 01/29/2020 - After a long time in the making, and much effort, a bill that will require drug makers to label gluten in drugs is now officially in the lap the United States Senate. Senator Richard Blumenthal (D-CT) recently introduced S.3021: Gluten in Medicine Disclosure Act of 2019 to the Senate. The proposed law makes it easier to identify gluten in prescription drugs. We've written over the years about gluten in prescription drugs, and how to find out if your drugs or medicines contains gluten. Under the Proposed Law Drug manufacturers would be required to label medications intended for human use with the list of ingredients, their source, and whether gluten is present. Sorry, but there is no coverage for pet medicines just yet. A gluten-containing drug that does not meet these requirements would be misbranded under Section 502 of the Federal Food, Drug, and Cosmetic Act. This new labeling will help consumers to know, for example, if the starch in their prescription drug comes from wheat or corn, a small but important distinction. Currently, it is nearly impossible to know if there's any gluten in prescription medicine. Current FDA Law Current FDA rules require that packaged foods label wheat and 7 other allergens, but unfortunately rye and barley are not included. More alarmingly, medications are not covered, so there's no good way to figure out if prescriptions might contain gluten. Celiac disease is a serious autoimmune condition, and accidental ingestion of gluten triggers an immune response that could interfere with absorption of the medication. In many cases people must take drugs every day. People with gluten sensitivity due to celiac disease or other medical issues need to know that their medicines contain safe ingredients. Get Involved Celiac Disease Foundation CEO Marilyn G. Geller and the Celiac Disease Foundation have been major supporters of efforts to advance what became House version, HR 2074: Gluten in Medicine Disclosure Act of 2019, which garnered 47 cosponsors. Thanks are due to the CDF, the numerous supporters in the celiac community, and to Senator Blumenthal (D-CT), Congressman Tim Ryan (D-OH), and Congressman Tom Cole (R-OK). The foundation will now turn to securing cosponsors for the Senate version of this important legislation that will "make it easier and safer for individuals with celiac disease or gluten sensitivity to make informed purchases of needed medications." Get involved by going to celiac.org, and using the link to email your Senators to urge them to become a cosponsor, and to ask that you email your Representatives to continue to rally House support. The Foundation makes it easy. Their software handles everything, including a pre-populated message with the ability for you to personalize it, and email delivery to your Senators and Representatives.
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Celiac.com 03/28/2020 - Were you thinking that there wasn't much gluten in your medicine? Had you read that less than 1% of drugs were made with it? Think again, because while pharmaceutical manufacturers don't actually add gluten to drugs in most instances, they very frequently cannot say that their products are gluten free. That's because before some ingredients get into a manufacturing facility, they are purchased from suppliers that are not controlled by the drug maker. Let me explain. When you take a drug, most of what you are swallowing is filler. This is called an excipient in the trade. Excipients are inert stuff that the actual drug is mixed with, and it influences the rate the drug enters your blood. For people with celiac disease, the problem is that the excipient is often made from starches derived from corn, rice, tapioca, etc. If you're reading this, you probably just recognized how gluten could be getting into your medicine even when a drug maker did not intentionally use gluten as the excipient. Drug companies affirm that even when they have not added gluten to a particular drug, there could be gluten in that drug, and they won't say the drug is gluten free. Here is where Sister Jeanne Patricia Crowe Pharm.D. (no relation to the actor) comes into the picture. About ten years ago Sister Jeanne Patricia did a study which established just how much trouble drug makers had even knowing when there was gluten in their products. Working with her research partner Nancy Patin Falini M.A., R.D., Crowe sent out questionnaires to about 170 drug makers asking each what the gluten content of their medicine was. Their results were published in the American Journal of Health-System Pharmacy in 2001 (1). In their peer reviewed article titled Gluten in Pharmaceutical Products, the two researchers were able to conclude the following: Only 5 of 100 pharmaceutical companies that responded to a survey reported having a policy of producing gluten-free products. Many companies believed their products were gluten-free but could not guarantee it. But what Crowe and Falini's results also showed was that drug makers themselves had a hard time making sure that when they bought an ingredient from an outside supplier, that they were not letting gluten get into their manufacturing facility. Two other studies support the Crowe and Falini findings, so they are pretty convincing. Simply put, gluten can be making its way into your drugs, and you can't find out about it because the drug manufacturer also doesn't know it's there. And if the drug maker doesn't know, then when your pharmacist helps you to read the package insert, it really won't matter much what it says on the label. This chaotic situation is not acceptable for the manufacture of medication. At the least, a company that makes drugs needs to determine whether they are making their product with an excipient like corn starch, and whether that the corn starch is gluten-free. Either the excipient is gluten-free or it isn't. Even when a consumer goes to buy a gluten-free food like Cheese Curls, the manufacturer at least has a letter from its raw ingredient suppliers, stating that the ingredients are gluten-free. Some food makers will even test every batch of raw ingredient before it enters their own facility. It isn't too much to ask that drug makers learn what's in their products. The FDA is currently looking at how to address the issue of gluten in medications. One approach is to require that drug makers disclose when a particular drug is gluten-free. At the other extreme, as a petitioner, I have argued that because gluten is toxic, the law of the United States should be satisfied, and gluten should be taken off the list of allowed excipients. But the work of Sister Crowe and Nancy Falini has demonstrated just why the FDA must take a step back and first require drug makers themselves to know exactly what's inside that pill or capsule. I hope that I've gotten at least a few of you wound up. I'm a bit surprised that drug makers would put themselves in a position where they sometimes don't know what's in any given pill they make. Don't they see the liability issues? Where are their lawyers, anyway? In the first article I wrote for celiac.com, I asked readers to let the FDA know that they wanted to get gluten out of drugs, and many people did exactly that. And those comments do get read. Now I am going to make sure that the FDA takes into account the work of Sister Crowe and Nancy Falini. Tell the FDA what you think. Maybe next time you fill a prescription for whatever ails you, it will be possible for you and your pharmacist to determine whether gluten is present in your medication. Michael Weber lives in New York and can still remember what pizza tastes like. References: 1. Crowe, JP, Falini, NP Gluten in pharmaceutical products Am J Health Syst Pharm 2001 58: 396-401
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I'm not sure which forum/board I should ask this question in! Thanks :)
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So, where to begin... I was officially diagnosed with Celiac Disease about 2.5 years ago and have been trying to fully heal since then. I knew prior that I had celiac disease but didn't know how serious being gluten free needed to be if you have it. My intestines got so damaged that I had no energy (needed about 12 hours of sleep a day when I normally would sleep 8) and could barely function. I ended up having to quit my job because of how much time I had missed (had used all FMLA, vacation, etc) and spent about 5-6 months recovering till I had enough energy to work a 32 hour/week job but even then was calling out because of gluten exposure. The biggest problem for me has been Rx medication. Food has been hardly an issue at all, at least in comparison. I currently take 2 types of prescriptions and have had problems with both over the past 2.5 years; Hypothyroid medication (T3/T4) & SSRI for depression/energy. I used to go between Paxil and Cymbalta. I would be on one for about 9 months, switch to the other, and repeat (because of the immune system's "short term memory"). I've had a lot of trouble with generic brands and more recently have been using only name brands because they are the only ones now that are listed as Gluten Free on glutenfreedrugs.com, but, now I seem to be having problems with them as well. My doctor has told me that I'm very sensitive to gluten (I think she said I've ranged from an 8-12?). I'm not sure what scale she was referring to, but I know I'm very sensitive based on how my body's reacted to the smallest amount of gluten. When I ingest gluten, my body seems to react by my gallbladder producing a lot more bile (this is most noticeable about 8 hours after I consume gluten), which causes me to have severe diarrhea for about a week (it's basically all liquid). I take my Rx medications everyday, so it's non-stop diarrhea, which makes it hard to stay hydrated. The more water I drink, the more I just end up ****ing it out. I've been taking Benadryl at night because I heard it can help with upset stomach for people with celiac disease. Before I started taking the Benadryl at night I was waking up after about 6 hours of sleeping with extreme stomach pain (too much bile in my stomach?) and having to rush to the bathroom, and would be in there for about an hour. I'm very in tune to knowing when I'm getting gluten exposure for 2 reasons: 1) the slightest amount will cause my stool to get softer and I can smell a difference when I go to the bathroom (my guess is it's from the bile, which has a strong odor), and 2) the amount of long acting insulin required for me per day is less depending on how damaged my small intestines are (I have type 1 Diabetes). I started taking Cymbalta 60 mg about 2 weeks ago and notice severe gluten exposure. I was on it for about 5 days and stopped taking it for a day to see if the symptoms lessened and I couldn't see a difference from only a day. I tried to stop taking it for 2 days but the withdrawl symptoms were too severe (intense sadness/hopelessness, strong suicidal thoughts, etc) and I don't even remember if the gluten exposure symptoms lessened because I could barely function mentally. I'm pretty sure that's where the gluten is coming from because it was the biggest change at the time. I had actually switched from a generic Cymbalta (duloxetine by Mylan) slightly early from my 9 month usual switch because I was having gluten symptoms (at the time, glutenfreedrugs.com listed it on their list but soon changed it to "now questionable"). I'm currently trying Zoloft (been on it for about 3 days now) and the gluten symptoms seem to be slightly less but I won't know for at least another few days. Plus, I don't know if it's actually going to work for me (depression wise). I was going between Paxil & Cymbalta for about 15 years and they were working for me very well (as far as depression) up until recently (because of gluten). I know I've tried Celexa, Lexipro, & Wellbutrin in the past and cannot take them because they either make things worse or the negative side effects outweigh the benefits. I may have tried another type or two of SSRI but it's been so long that I can't remember for sure. I'm making this post to try and get some advice, or even just words of encouragement, on any generic Rx versions of Cymbalta (and Paxil as well, but I won't be taking it for a while so it's less relevant at this point) that people have recently had success with. I've searched online & this site but haven't been able to find anything recent about these medications (most of the posts I've found are from many years ago). I'm scared. Scared of all the times I want to kill myself in any given day because of not taking an SSRI to try and reduce the gluten exposure. Scared that things will get as bad as they've gotten before and I will have to quit my job again. Scared to cry because I'll become even more dehydrated and may not be able to keep fluid in me because of my body is currently not being able to absorb water the way I need it to. The past 3 years have been really tough and I don't really know where to turn at this point. Sorry if this post isn't the most organised. I'm currently an emotional wreck while typing this and at least trying to get out all the important info. Here is a list of new things I've been eating in case someone reads this and sees something they've had problems with that might (also?) be causing gluten issues: Schär Gluten Free Artisan Baker Multigrain Bread (to try and soak up some of the bile, but with constant gluten exposure this doesn't help much) Ensure Original Nutrition Shake (says Gluten Free on it) Pedialyte Advanced Care+ Benadryl
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Health Cuts in UK Doom Gluten-Free Food Prescriptions
Jefferson Adams posted an article in Additional Concerns
Celiac.com 12/18/2018 - Prescriptions for gluten-free food will no longer be part of the UK’s vaunted national health care program in all places, due in part to the widespread availability of gluten-free foods at regular markets, and the high costs of maintaining the program. Starting Monday, December 3rd, 2018, gluten-free food will no longer be routinely available on prescription from any GP practice in the "Greater Nottingham" region for patients with celiac disease or dermatitis herpetiformis: a skin condition linked to celiac disease. Patients with such prescriptions, including children, will be notified by mail of the pending changes, and will receive information, help and support for managing their gluten-free diets. Coming at a time of "severe financial pressures", the decision ostensibly concerns patients in Nottingham, Rushcliffe, Gedling, Broxtowe and Hucknall, where patients were eligible for a mix of bread and flour each month. In the city, patients could get a range of products like bread, pasta, mix and cereal. Explaining the decision, Dr Hugh Porter, chair of the Nottingham City Clinical Commissioning Group, said "The cost to the NHS of a loaf of gluten-free bread is much higher than those bought in a supermarket.” Dr. Porter also adds that the Commissioning Group is planning a detailed evaluation process “to assess the effects of these changes over the coming year."- 1 comment
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Celiac.com 06/25/2018 - The latest studies show that celiac disease now affects 1.2% of the population. That’s millions, even tens of millions of people with celiac disease worldwide. The vast majority of these people remain undiagnosed. Many of these people have no clear symptoms. Moreover, even when they do have symptoms, very often those symptoms are atypical, vague, and hard to pin on celiac disease. Here are three ways that you can help your healthcare professionals spot celiac disease, and help to keep celiacs gluten-free: 1) Your regular doctor can help spot celiac disease, even if the symptoms are vague and atypical. Does your doctor know that anemia is one of the most common features of celiac disease? How about neuropathy, another common feature in celiac disease? Do they know that most people diagnosed with celiac disease these days have either no symptoms, or present atypical symptoms that can make diagnosis that much harder? Do they know that a simple blood test or two can provide strong evidence for celiac disease? People who are newly diagnosed with celiac disease are often deficient in calcium, fiber, folate, iron, magnesium, niacin, riboflavin, vitamin B12, vitamin D, and zinc. Deficiencies in copper and vitamin B6 are less common, but still possible. Also, celiac disease is a strong suspect in many patients with unexplained nutritional anemia. Being aware of these vague, confusing symptoms of celiac disease can help people get bette advice, and hopefully speed up a diagnosis. 2) Your dentist can help spot celiac disease Does your dentist realize that dental enamel defects could point to celiac disease? Studies show that dental enamel defects can be a strong indicator of adult celiac disease, even in the absence of physical symptoms. By pointing out dental enamel defects that indicate celiac disease, dentists can play an important role in diagnosing celiac disease. 3) Your pharmacist can help keep you gluten-free Does your pharmacist know which medicines and drugs are gluten-free, and which might contain traces of gluten? Pharmacists can be powerful advocates for patients with celiac disease. They can check ingredients on prescription medications, educate patients to help them make safer choices, and even speak with drug manufacturers on patients’ behalf. Pharmacists can also help with information on the ingredients used to manufacture various vitamins and supplements that might contain wheat. Understanding the many vague, confusing symptoms of celiac disease, and the ways in which various types of health professionals can help, is a powerful tool for helping to diagnose celiac disease, and for managing it in the future. If you are suffering from one or more of these symptoms, and suspect celiac disease, be sure to gather as much information as you can, and to check in with your health professionals as quickly as possible.
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Could Your Pharmacist Help Keep You Gluten-Free?
Jefferson Adams posted an article in Additional Concerns
Celiac.com 06/11/2018 - Untreated celiac disease causes damage to the small intestine, which can interfere with proper nutrient absorption. Most patients can recover proper nutritional absorption via vitamins and mineral therapy, according to the CDF. Avoiding gluten is key. However, many people with celiac disease may not know that their pharmacist might just be one of their best allies in the fight to avoid gluten. Currently, there are no rules that require drug manufacturers to disclose the source of medication ingredients. Consumers can contact the manufacturer directly with questions, and some drug companies strive for clear, helpful answers, but getting correct information can be challenging. Many times though, an answer won't address possible cross contamination during the manufacturing process. This is where pharmacists can be a strong ally for patients with celiac disease. Here are a few way that pharmacists can help people with celiac disease to avoid hidden gluten in their prescriptions and over-the-counter drugs. The first thing pharmacists can do is to check ingredients on prescription medications these patients are taking. They can also share related information to help educate patients, and to improve their choices, and speak with drug manufacturers on patients’ behalf. In addition to assisting with prescription medicines, pharmacists can offer recommendations on vitamins and supplements. As with prescription drugs, both doctors and patients should do their best to review the ingredients used to manufacture vitamins and supplements, and to share this information with celiac patients. So, if you have celiac disease, definitely consider enlisting your pharmacist in an effort to get complete drug and supplement information. This simple tactic can help you to remain gluten-free during your course of drug treatment, however long that may last? Do you have a story about gluten in prescription drugs or supplements? Do you use your pharmacist to help you better understand your gluten-free drug and supplement options? Share your story with us. Source: medscape.com- 4 comments
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