0
vovfisk

Citric Acid Problems

Rate this topic

Recommended Posts

Hey, I think that I have Citric Acid intolerance along with my gluten intolerance. Atleast every time I eat something with Citric Acid in it my body goes bananas. My vision get blurred, eyes go dry, loose stools, incomplete bowel emtying, stomac pain, Interstitial Cystitis and my feets are killing me. It's like my body cannabalise my feets treat pads. Also my memory is very foggy, though I'm not sure if it's caursed by Citric Acid or something else.

Does anyone have a complete list of food with citric acid in it and/or a list with Citric Acid free food? What about a list with what procced foods contain Citric Acid? I read somewhere on thies borads that baby carrots is wassed in Citric Acid.

I inted to on a salad+meat diet adn see what happens.

I really need a good list as my ability to put a list together myself fromwhat I find on the net is next to zero. Stupid disease =(

Thank you in advance

..eh I should proberbly mention that I'm a almost 29 year old male and I'm kinda picky with what I eat

Share this post


Link to post
Share on other sites
Ads by Google:
Ads by Google:


I think you will need to learn to cook. Citric acid is really common in processed foods. This might help you. It's some info compiled by another citric acid intolerant person.

http://www.chiark.greenend.org.uk/~vclarke/citric.html

Some info on this message board as well.

http://www.foodreactions.org/forum/viewtopic.php?t=2346

  • Upvote 1

Share this post


Link to post
Share on other sites

I can't have citric acid at all. Soda like Sierra Mist kills me. I have to avoid it in all forms. I have the same symptoms as you when I consume it. It feels just like a glutening. Tomato paste and sauce have citric acid and like Skylark said, most processed foods. Watch juices too. Every single juice in a bottle is full of citric acid. Synthetic vitamin C = citric acid. Those are the big ones for me.

Share this post


Link to post
Share on other sites

@Skylark: Thanks for the link. I also found this link http://www.foodstandards.gov.au/consumerinformation/nuttab2010/nuttab2010onlinesearchabledatabase/onlineversion.cfm?&action=nutrientFoods&category=Organic%20Acids&nutrientID=CITRIC

Apperently peas contain Citric Acid ...DUH. Oh well, atleast it makes sence now.

@GFreeMO: I see, so I'm most likely correct about being Citric Acid intolerant.

What kind of spice do you use for coocking? The food I've made so far is kinda dull =D

I was thinking about making some dessing based on olive oil or plain youghurt for my salat. Do you have some good recipies?

Can you tell me a bit about what you generelly eat?

Some other questions.

Does corn starch contain Citric Acid?

Does regular corn contain Citric Acid? The link I posted say that sweet corn does.

What should I eat to get C vitamins? Seems that it'll be hard to get C vitamin with out eating Citric Acid also.

Many thanks for the help. I really appriciate it.

Share this post


Link to post
Share on other sites

A true intolerance to citric acid is extremely rare (although it absolutely does exist, so you could be right on the money.). More common seems to be a reaction to what the citric acid is contaminated with or what it was sourced from. The link Skylark gave listed sugarcane as the main food source for the fungus used to make citric acid, but in my experience, corn syrup seems more common at this point, at least in the USA. Many sensitive corn allergic folks avoid all citric acid, because corn is so commonly used.

Another issue with citric acid can be sulfites (I found out I have this one). The vast majority of processed corn things, like citric acid and cornstarch both, pick up some sulfites from the processing. I'm not familiar with Interstitial Cystitis, but all the other symptoms you named are ones I've heard those with sulfite issues also describe. Many of them are what I get, too.

If you react to citric acid no matter what the source (corn, cane sugar, citrus), especially if it also includes natural sources, that's a good clue that it's a true citric acid intolerance rather than a reaction to something introduced from the source or during processing.

However, it can be tricky to test this, because it's a challenge to find out if you are getting totally clean produce that hasn't had contact with citric acid. Both conventional and organic farmers can use chemicals, pesticides, or other substances that contain citric acid, so that can muddy the issue. Even the soap we use to wash off our fruits and veggies frequently contains citric acid. <_<

According to the EPA:

...Citric acid is an active ingredient in pesticide products registered for residential and commercial use as disinfectants, sanitizers and fungicides. These products, containing citric acid in combination with other active ingredients, are used to kill odor-causing bacteria, mildew, pathogenic fungi, certain bacteria and some viruses; and to remove dirt, soap scum, rust, slime and calcium deposits. Citric acid products are used in bathrooms, and in/on dairy and food processing equipment. (Prevention, Pesticides, and Toxic Substances, 1992, EPA)

So in other words, it may need some detective work to figure out exactly what you react to. If you have any friends or relatives that might have totally clean produce in their gardens, that may be a useful resource for your food detective work, as it were.

If you are very sensitive to citric acid or something in it, here's some more food risks you'll want to be aware of.

- Those little plasticky-paper pads underneath raw beef and chicken, inside the styrofoam trays - that's got citric acid in it to help keep down on bacterial growth.

- Meats in the USA have certain cleaning practices that they have to go through after slaughtering but before being packaged. An antibacterial wash is one of these, and some meats are washed with either citric or lactic acid, as well as a diluted bleach wash. This is most common with beef and seldom seen with poultry. I'm unsure about how common it is with lamb or pork.

- Fish can also come into contact with citric acid during cleaning. In fact, some fishing boats now that have ice on the boat, to put the fish on right after being caught, are now making the ice from part water, part citric acid. The citric acid penetrates the first few layers of skin, so it can't be washed off.

- Medications. Pills and vitamins can contain citric acid, and you'll want to examine the ingredient lists of any injections you get, too. I just got zapped a while back with numbing shot that contained citric acid. :-/

Because so many corn sensitive folks have to avoid citric acid, corn-free sites can be a good source of information on where it can be hiding, actually.

Sources of vitamin C - Fortunately, produce will take care of this. A lot of vegetables are surprisingly high in vitamin C. Broccoli has almost as much vitamin C per cup as lemon does - 1 cup of raw, chopped broccoli is 135% of your daily vitamin C. Red bell pepper has even more - 1 cup chopped, raw red bell pepper is about 317% of your daily vitamin C needs. The main thing to remember is that heat and contact with the air slowly destroys vitamin C, so eating produce that is fresh and has little to no cooking will net you more vitamin C.

If you're looking for other sources, the following site is a good one for telling you the nutritional information on various foods - you just enter a food into the search box and it'll give you options that may match. :-)

http://nutritiondata.self.com/

Re: foods to eat

I've pretty much been making everything from scratch. Sauces, salad dressings, etc... One of the best things that's helped me get some better flavor is to start up an herb garden. It took me a good year to get a really nice one, but now, my food is SO much tastier when I can add all these fresh herbs!

Without them, it's been much harder to have a nice flavor.

A cooking site you might like is called 101cookbooks:

http://www.101cookbooks.com/

She does recipes from whole food ingredients rather than a lot of added sauces, primarily. She has a gluten free section, but the part I really like, that may be of use to you as well, is her 'Basic Techniques' section, where she talks about making, say, your own celery salt or homemade bouillon.

If you'd like any more information about sulfite possibilities, just let me know. Some of the information on the web can be challenging to wade through, because there are varying sensitivity levels and a couple other oddities which make the safe/unsafe food lists not universally applicable.

Wishing you good luck on figuring this all out!

Share this post


Link to post
Share on other sites
Ads by Google:


MIne is def. corn and sals related. Read about salicylate sensitivity. A lot of us here can't handle them. Also, many here have problems with corn causing gluten like reactions.

Manufactured citric acid comes from corn. The citric acid in plain old oranges is natural. If you are ok with eating an orange than it is probably corn and or sals.

Share this post


Link to post
Share on other sites

I just remembered that I'm also intolerant to acetylsalicylic acid.

My nose tend to run in the morning. It is not as bad currently as it was when I didn't know I was Gluten intolerent. (I lost like 41-42 pounds over 9-10 months) It run mostly in the morning.

I also had this weird sneezing thing going. I would Sneeze 7-10 times in a row with some very powerfull snezes. Still do 3-4 ish powerfull sneezes a day though.

I get a headache/migraine from time to time and there's often a lot of tention around my eyes. (I rearly take painkillers)

I do have some itcing around my eyes 1-3 times a day in relation to eating. But it's no where near to when I eat gluten.

Sometimes when I eat, I get really sleepy. I though it was my bloodsukker going out of wack.

I tend to get depressed easily, but that's proberbly not so weird with all that is going on right now.

My stool is kinda oliy, which is what make wiping hard.

As for hyperactivity hmm... mayby, I think that it is akathisia I got and now I'm doubting that. I kinda have a hard time starting and staying with a task. I should mention that I have been schitzofrenic, but that when away when I got of gluten *wild scream of pure joy* I only got the dysfunctial memory and akathisia/hyperactivity left.

So this salicylate sensitivity is also a good candidate.

So buying a lokal danish organic thing with Citric Acid and no salicylate in it and vice versa, would be the best way to find out.

@T.H.: Broccoli have 0.3G per 100G Citric Acid accoarding the the link I posted.

I would love to know more about sulfites intolerance.

A thing I have noticed is that the same type of food doesn't always tricker a reaction. If i drink a certain danish chocolate milk my body reacts. But if I eat a chocolate frog with sugger/caramel cream inside my body doesn't react. I once eat some with cabbage with out a problem and a little week latter I tried again and my body reacted. It was a different recipe. I also drank some fresh pressed orange jouice a some point without a problem. My dad, who have the same problem as I, couldn't eat the oranges. My dad doesn't necessary have the same intolerances as I though.

@GFreeMO: Guess I should try an organic orange

Again, thanks for the help. i appreciate it a lot.

Share this post


Link to post
Share on other sites

I believe the vitamin C in an orange is ascorbic acid, not citric acid. fwiw.

Share this post


Link to post
Share on other sites

@ciamarie: I see,byt the link I posted say 0.6g per 100g and the site is run by the Australian goverment.

Anyway, after some experimentation, I'm now pretty sure that it's corn/maize I'm intolerant too. Corn is like everywhere too ...grr

Thanks for the help all. I appreciate the help.

I'll come back if new problem pop up =D

Share this post


Link to post
Share on other sites

Greetings everyone!

@Skylark- apologies for voting your post down, please let me know it this affects your standing/ability to post things etc. and I will undo it. I just did that because the website you posted, though I'm sure well-intentioned, is dangerously inaccurate. :blink:

@T.H. That's a lot of great information! Just a warning, though, that *all* fruits and vegetables contain citric acid to some degree. Some people can tolerate low-CA veggies like carrots and lettuce- I personally cannot.

Wishing you a safe and lemon/gluten free day!

Share this post


Link to post
Share on other sites


Ads by Google:


If you want a Vitamin C supplement that is NOT corn based, there is one out there made from palm trees. Its The only one I have not reacted to.

Share this post


Link to post
Share on other sites

Umm, as has been said, I thought citric acid is naturally found in, well, all fruits and probably most vegetables? Do you have a problem with fruits? Is it worse with citrus fruit? ALTHOUGH, from what I've read, most citrus fruit is waxed with a wax that is likely corn derived, so that's also hard to tell...it's never easy is it :-(

If you think you have a corn sensitivity, then any processed food listing citric acid is suspect, but that would be due to corn potentially being in the citric acid they add.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
0

  • Who's Online   7 Members, 0 Anonymous, 1,052 Guests (See full list)

  • Top Posters +

  • Recent Articles

    Jefferson Adams
    Celiac.com 06/18/2018 - Celiac disease has been mainly associated with Caucasian populations in Northern Europe, and their descendants in other countries, but new scientific evidence is beginning to challenge that view. Still, the exact global prevalence of celiac disease remains unknown.  To get better data on that issue, a team of researchers recently conducted a comprehensive review and meta-analysis to get a reasonably accurate estimate the global prevalence of celiac disease. 
    The research team included P Singh, A Arora, TA Strand, DA Leffler, C Catassi, PH Green, CP Kelly, V Ahuja, and GK Makharia. They are variously affiliated with the Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Lady Hardinge Medical College, New Delhi, India; Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Bergen, Norway; Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Gastroenterology Research and Development, Takeda Pharmaceuticals Inc, Cambridge, MA; Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy; Department of Medicine, Columbia University Medical Center, New York, New York; USA Celiac Disease Center, Columbia University Medical Center, New York, New York; and the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
    For their review, the team searched Medline, PubMed, and EMBASE for the keywords ‘celiac disease,’ ‘celiac,’ ‘tissue transglutaminase antibody,’ ‘anti-endomysium antibody,’ ‘endomysial antibody,’ and ‘prevalence’ for studies published from January 1991 through March 2016. 
    The team cross-referenced each article with the words ‘Asia,’ ‘Europe,’ ‘Africa,’ ‘South America,’ ‘North America,’ and ‘Australia.’ They defined celiac diagnosis based on European Society of Pediatric Gastroenterology, Hepatology, and Nutrition guidelines. The team used 96 articles of 3,843 articles in their final analysis.
    Overall global prevalence of celiac disease was 1.4% in 275,818 individuals, based on positive blood tests for anti-tissue transglutaminase and/or anti-endomysial antibodies. The pooled global prevalence of biopsy-confirmed celiac disease was 0.7% in 138,792 individuals. That means that numerous people with celiac disease potentially remain undiagnosed.
    Rates of celiac disease were 0.4% in South America, 0.5% in Africa and North America, 0.6% in Asia, and 0.8% in Europe and Oceania; the prevalence was 0.6% in female vs 0.4% males. Celiac disease was significantly more common in children than adults.
    This systematic review and meta-analysis showed celiac disease to be reported worldwide. Blood test data shows celiac disease rate of 1.4%, while biopsy data shows 0.7%. The prevalence of celiac disease varies with sex, age, and location. 
    This review demonstrates a need for more comprehensive population-based studies of celiac disease in numerous countries.  The 1.4% rate indicates that there are 91.2 million people worldwide with celiac disease, and 3.9 million are in the U.S.A.
    Source:
    Clin Gastroenterol Hepatol. 2018 Jun;16(6):823-836.e2. doi: 10.1016/j.cgh.2017.06.037.

    Jefferson Adams
    Celiac.com 06/16/2018 - Summer is the time for chips and salsa. This fresh salsa recipe relies on cabbage, yes, cabbage, as a secret ingredient. The cabbage brings a delicious flavor and helps the salsa hold together nicely for scooping with your favorite chips. The result is a fresh, tasty salsa that goes great with guacamole.
    Ingredients:
    3 cups ripe fresh tomatoes, diced 1 cup shredded green cabbage ½ cup diced yellow onion ¼ cup chopped fresh cilantro 1 jalapeno, seeded 1 Serrano pepper, seeded 2 tablespoons lemon juice 2 tablespoons red wine vinegar 2 garlic cloves, minced salt to taste black pepper, to taste Directions:
    Purée all ingredients together in a blender.
    Cover and refrigerate for at least 1 hour. 
    Adjust seasoning with salt and pepper, as desired. 
    Serve is a bowl with tortilla chips and guacamole.

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 06/15/2018 - There seems to be widespread agreement in the published medical research reports that stuttering is driven by abnormalities in the brain. Sometimes these are the result of brain injuries resulting from a stroke. Other types of brain injuries can also result in stuttering. Patients with Parkinson’s disease who were treated with stimulation of the subthalamic nucleus, an area of the brain that regulates some motor functions, experienced a return or worsening of stuttering that improved when the stimulation was turned off (1). Similarly, stroke has also been reported in association with acquired stuttering (2). While there are some reports of psychological mechanisms underlying stuttering, a majority of reports seem to favor altered brain morphology and/or function as the root of stuttering (3). Reports of structural differences between the brain hemispheres that are absent in those who do not stutter are also common (4). About 5% of children stutter, beginning sometime around age 3, during the phase of speech acquisition. However, about 75% of these cases resolve without intervention, before reaching their teens (5). Some cases of aphasia, a loss of speech production or understanding, have been reported in association with damage or changes to one or more of the language centers of the brain (6). Stuttering may sometimes arise from changes or damage to these same language centers (7). Thus, many stutterers have abnormalities in the same regions of the brain similar to those seen in aphasia.
    So how, you may ask, is all this related to gluten? As a starting point, one report from the medical literature identifies a patient who developed aphasia after admission for severe diarrhea. By the time celiac disease was diagnosed, he had completely lost his faculty of speech. However, his speech and normal bowel function gradually returned after beginning a gluten free diet (8). This finding was so controversial at the time of publication (1988) that the authors chose to remain anonymous. Nonetheless, it is a valuable clue that suggests gluten as a factor in compromised speech production. At about the same time (late 1980’s) reports of connections between untreated celiac disease and seizures/epilepsy were emerging in the medical literature (9).
    With the advent of the Internet a whole new field of anecdotal information was emerging, connecting a variety of neurological symptoms to celiac disease. While many medical practitioners and researchers were casting aspersions on these assertions, a select few chose to explore such claims using scientific research designs and methods. While connections between stuttering and gluten consumption seem to have been overlooked by the medical research community, there is a rich literature on the Internet that cries out for more structured investigation of this connection. Conversely, perhaps a publication bias of the peer review process excludes work that explores this connection.
    Whatever the reason that stuttering has not been reported in the medical literature in association with gluten ingestion, a number of personal disclosures and comments suggesting a connection between gluten and stuttering can be found on the Internet. Abid Hussain, in an article about food allergy and stuttering said: “The most common food allergy prevalent in stutterers is that of gluten which has been found to aggravate the stutter” (10). Similarly, Craig Forsythe posted an article that includes five cases of self-reporting individuals who believe that their stuttering is or was connected to gluten, one of whom also experiences stuttering from foods containing yeast (11). The same site contains one report of a stutterer who has had no relief despite following a gluten free diet for 20 years (11). Another stutterer, Jay88, reports the complete disappearance of her/his stammer on a gluten free diet (12). Doubtless there are many more such anecdotes to be found on the Internet* but we have to question them, exercising more skepticism than we might when reading similar claims in a peer reviewed scientific or medical journal.
    There are many reports in such journals connecting brain and neurological ailments with gluten, so it is not much of a stretch, on that basis alone, to suspect that stuttering may be a symptom of the gluten syndrome. Rodney Ford has even characterized celiac disease as an ailment that may begin through gluten-induced neurological damage (13) and Marios Hadjivassiliou and his group of neurologists and neurological investigators have devoted considerable time and effort to research that reveals gluten as an important factor in a majority of neurological diseases of unknown origin (14) which, as I have pointed out previously, includes most neurological ailments.
    My own experience with stuttering is limited. I stuttered as a child when I became nervous, upset, or self-conscious. Although I have been gluten free for many years, I haven’t noticed any impact on my inclination to stutter when upset. I don’t know if they are related, but I have also had challenges with speaking when distressed and I have noticed a substantial improvement in this area since removing gluten from my diet. Nonetheless, I have long wondered if there is a connection between gluten consumption and stuttering. Having done the research for this article, I would now encourage stutterers to try a gluten free diet for six months to see if it will reduce or eliminate their stutter. Meanwhile, I hope that some investigator out there will research this matter, publish her findings, and start the ball rolling toward getting some definitive answers to this question.
    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics