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      Frequently Asked Questions About Celiac Disease   09/30/2015

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease? - list blood tests, endo with biopsy, genetic test and enterolab (not diagnostic) Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes

What else can cause villi blunting; Has any body had expereince with Losartan and Villi Blunting
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Forum Members,

This is a follow up question to a link posted in this thread

I have read the Patient Celiac site before but she noted the possible use of Losartan (Potassium) contributing to Villi Blunting?

This concerns me because I am now taking Losartan for blood pressure.

Can any one describe their experience with Losartan and/or provide the link that states Losartan's could be a contributing factor in Villi Blunting.

The Patient Celiac did not site her source and I couldn't find it.  Any help as to the source would be helpful because I would like to read it for myself.

Also what other blood pressure medicine's do others on this forum take instead of Losartan.

My BP seems to be under control now that I have been taking Folic Acid but don't won't to stop cold turkey until I have another BP medicine I can take in it's place that

won't contribute to possible Villi Blunting.

I recently had to "catch up" on Vitamin D for my prediabetes so I know absorption is still a problem and thought it  was curious because years ago after my celiac diagnosis I

had caught up on Vitamin D once before so I was surprised to find I was again low in it again.

The Losartan and Villi blunting (if indeed they are linked) could explain why I am still low (again) in Vitamin D.

I knew NSAIDS could cause and why I don't take them generally unless I am in unbearable pain but wasn't aware common BP medicines other than Benicar (olmesartan) could cause similar villi blunting.

Here is the link on the NSAIDs study.

http://www.thedailybeast.com/research-shows-link-between-nsaid-use-and-gut-disease

but the cureceliac.org site does not mention Losartan as other causes of Villi Blunting.

http://www.cureceliacdisease.org/faq/what-else-can-cause-damage-to-the-small-intestine-other-than-celiac-disease/

So does any body know if Losartan has also been linked to Villi blunting.

If it has I need to get off of it for good and find another BP medicine without this severe side effect.

Thanks in Advance. 

posterboy,

 

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Why not just ask her?  She is a very nice doctor .  You should be able to find her 

 

i mean Jess- the patient Celiac

Edited by kareng

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kareng,

the thought occurred to me but she noted it might be two weeks before she might could answer back and I thought the forum might have an answer where the research was quicker.

I will do that if someone doesn't already know where it is.

I didn't put 2+2 together about olmesartan and losartan being the same class of medicine I guess . ...

I actually changed to that form from a diuretic because I thought I might be loosing too many electrolytes like Magnesium.

who knew I could be making my GI problems worse in the process.

posterboy,

 

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3 hours ago, Posterboy said:

kareng,

the thought occurred to me but she noted it might be two weeks before she might could answer back and I thought the forum might have an answer where the research was quicker.

I will do that if someone doesn't already know where it is.

I didn't put 2+2 together about olmesartan and losartan being the same class of medicine I guess . ...

I actually changed to that form from a diuretic because I thought I might be loosing too many electrolytes like Magnesium.

who knew I could be making my GI problems worse in the process.

posterboy,

 

Poster boy, 

I found this article.  I don't know if it's the source of the Patient Celiac's information, but it may have the information you're looking for.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956379/

There's some evidence that vitamin D deficiency contributes to high blood pressure.  

https://www.vitamindcouncil.org/health-conditions/hypertension/

Vitamin D does so many things!  Getting my vitamin D up made me feel so much better!  I supplement every day to ensure I keep my level up about 80.  I don't do dairy and I don't get enough sun, so supplementing is the way to go for me.  And I have been able to get off my high blood pressure medications, but correcting a lot of different things (vitamin and mineral deficiencies) made that possible.  Make sure you check with your doctor before stopping any medications like high blood pressure medications.

Hope this helps!

Kitty 😸 

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Lol funny thing me and my dietician were talking about things that could also cause villi blunting years ago. He brought up a interesting one, he had a case where someone was taking massive amounts of Metamucil several times a day, He said it was like 2-4 tsp 3 times a day and making into hot gel drinks for weight loss to feel full. Anyway what this had done "scrubbed" his intestines so much with the abrasive fiber it had actually damaged the walls and blunted the villi.  He compared it roughly scrubbing with a loofah several times a day and it had like a fine sandpaper slowly eroded the insides of his intestines faster then it could heal.  He says because of that he would never suggest anyone to take the full dose of psyllium husk for longer then a week straight before rotating off of it.
 

Not medical advice posterboy and this is a dangerous things to play with I know, but with your BP perhaps try to help regulate it with cinnamon oil, and watching and playing with your salt intakes of potassium and sodium. These tend to effect my blood flow and how I feel often. I am unsure if BP related, mine always checks great when I do check it. But Cinnamon is one thing I can not live without, I take several tbsp a day of it or a few drops of the EO. I have been doing this for over a decade, before that and when I do not, I start feeling cold, not wanting to move, and just want to curl up in blankets...no clue why if it is health, blood, neurological, or termogenic.

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Hello,

Often drugs that end in –artan are ARBs, and they work by blocking the angiotensin receptors. I’m not sure what the exact difference is between the two medications you mention, though. Have you called the manufacturer of losartan to see if any of the fillers contain gluten? It might be a good idea to know what those fillers are.

In my drug book “dyspepsia” and “gastritis” are mentioned as side effects, but they did not drill down to the specificity of villous blunting. I did some googling, and in addition to what Knitty found, I came across this:

Small Bowel Histopathologic Findings Suggestive of Celiac Disease in an Asymptomatic Patient Receiving Olmesartan

“Although Rubio-Tapia et al are careful to avoid claiming a proven causal relationship between olmesartan therapy and the observed spruelike enteropathy, the data are highly suggestive of more than just a coincidental association.

“They further suggest that a potential mechanism for the enteropathy could relate to inhibitory effects of angiotensin II receptor antagonists on transforming growth factor β action because transforming growth factor β is important in gut immune homeostasis.

“Although anecdotal, these observations lead to the hypothesis that olmesartan, and perhaps other angiotensin II receptor antagonists, could be a cause of intraepithelial lymphocytosis in architecturally preserved proximal small intestinal mucosa.”

(One of the patients in question was offered the opportunity to do a gluten-free diet, but he/she declined.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547582/

So, it looks like you are definitely on to something, and if this turns out to be a “thing,” would probably warrant dissemination on a wider scale.

You didn't mention what your BP is with the medication or was without it, but please let your health care provider know if you do decide to discontinue your blood pressure medication. It's often recommended not to DQ suddenly, which can cause the BP to spike in some cases.

Plumbago

 

ETA: Just because a drug can cause a particular side effect does not mean it does in your case. I just thought I'd add that, but nevertheless totally and completely understand the cause of concern in any case.

 

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In my brief research, I did not find any public papers indicating villi blunting for Losartan specifically.   There was research and a law suit on olmesartan (other celiac.com members have pointed out).  Dr. Hart may have been making clinical observations or has access to medical research that is not public (or free).  He is/was located at the University of Chicago.  

Are you still having GI symptoms despite the gluten free diet and your supplements?  

If not, this BP drug may not be affecting you.  I understand your concern, so you might talk with your doctor or pharmacist about an alternative drug or re-visit the need to take this drug.  Make sure they know all the supplements you are taking in addition to other prescription drugs.  

Talk also with your GI about your suspected or continued malabsorption issues.   Have you had follow-up biopsies?  

I understand your concern.  I hope you find a solution that satisfies you and your doctor.  

 

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13 hours ago, plumbago said:

Hello,

Often drugs that end in –artan are ARBs, and they work by blocking the angiotensin receptors. I’m not sure what the exact difference is between the two medications you mention, though. Have you called the manufacturer of losartan to see if any of the fillers contain gluten? It might be a good idea to know what those fillers are.

In my drug book “dyspepsia” and “gastritis” are mentioned as side effects, but they did not drill down to the specificity of villous blunting. I did some googling, and in addition to what Knitty found, I came across this:

Small Bowel Histopathologic Findings Suggestive of Celiac Disease in an Asymptomatic Patient Receiving Olmesartan

“Although Rubio-Tapia et al are careful to avoid claiming a proven causal relationship between olmesartan therapy and the observed spruelike enteropathy, the data are highly suggestive of more than just a coincidental association.

“They further suggest that a potential mechanism for the enteropathy could relate to inhibitory effects of angiotensin II receptor antagonists on transforming growth factor β action because transforming growth factor β is important in gut immune homeostasis.

“Although anecdotal, these observations lead to the hypothesis that olmesartan, and perhaps other angiotensin II receptor antagonists, could be a cause of intraepithelial lymphocytosis in architecturally preserved proximal small intestinal mucosa.”

(One of the patients in question was offered the opportunity to do a gluten-free diet, but he/she declined.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547582/

So, it looks like you are definitely on to something, and if this turns out to be a “thing,” would probably warrant dissemination on a wider scale.

You didn't mention what your BP is with the medication or was without it, but please let your health care provider know if you do decide to discontinue your blood pressure medication. It's often recommended not to DQ suddenly, which can cause the BP to spike in some cases.

Plumbago

 

ETA: Just because a drug can cause a particular side effect does not mean it does in your case. I just thought I'd add that, but nevertheless totally and completely understand the cause of concern in any case.

 

Plumbago et al,

Thanks for letting me know  about the "artan" drugs being ARBs.

I think Cyclinglady was right the Losartan research is not free and thus not public.

I saw the link with no abstract but wanted to read it to confirm as you noted in your ETA that it was another "Artan" drug Losartan causing the problem.

I believe it is.

I found a great (after more digging) review of all the "artans"/ARBs or most of them about whether they can contribute to sprue symptom's in addition to Benicar.

here on wiley as studied by the alimentary pharmacology and therapeutic journal (AP&T) for short.

http://onlinelibrary.wiley.com/doi/10.1111/apt.14176/full

I wish I knew how to post the able alone it is very informative.  Please scroll over the table to the end of it since it even tells how long to expect before your sprue symptom's/conditions improve IF the "artan" drug is causing your symptom's which I find the most helpful thing about the table.  They also note histological feature (degree of villi blunting) to expect on biopsy.

They note Losartan can cause "total atrophy of duodenal villi" by their reporting.

I also recently had an issue with my potassium levels so I feel sure it is the Losartan.

I remember reading a study about how losartan was better at the "chronic cough" I had developed using Lisinopril so I changed to Losartan a few years ago . . . now I find I could of been making my GI symptom's worse.

But to answer  your other question since I began taking Folic Acid a few months ago my BP numbers went down to a healthy level of 120/80 or less sometimes . . . but with medicine.

I had already been thinking I wanted to try get off the BP medicine (for good) so this is more motivation.

C0q10 worked well but it is too expensive for me to take all the time!

I called my doctor to have them put me back on Amlodipine/Norvasc and I can't remember why I changed off that medicine to begin with now.  I do remember needing two medicine's back then to control my BP so maybe we stopped the Norvasc instead of the Linsinopril.

But now that they have put me back on Norvasc I hope my potassium levels will correct themselves.

I just don't feel safe anymore taking Losartan after learning it could be making my GI symptom's worse or causing the to be unreliable.

I first thought my touch of D. was from an antibiotic round but when kefir didn't get me back on track I suspected something else when my Vitamin D levels showed up low too again!

Thanks everybody for ya'lls great suggestions and good research on my behalf.

I also recommend this verywell article if you are still having GI problems and you suspect an "artan" like ARBs BP medicine and looking for a medicine that might have less severe  or more manageable symptom's for your lifestyle because it comprehensively list's the medicine's by drug types.

https://www.verywell.com/hypertension-drugs-1745989

no medicine is without a side effect as (I) am learning but I never thought sprue would be one for my BP medicine and why I prefer Vitamins when I can find out which one too take.

Now that I have the Norvasc approved as a replacement for the Losartan I might see if my BP goes up again if I stop my medicine all together as I was hoping the Folic Acid might help me with it (without medicine) and it explains why I was low in Folic Acid to begin with again.

posterboy,

 

 

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Most physicians follow the joint commission’s guidelines on prescribing HTN medications which usually begin with a diuretic and calcium channel blocker (the amlodipine) - see below. Is it possible that your bp was still not controlled on the CCB (amlodipine)? So the ARB was added? Again, I’d just like to say that just bc a drug does have certain adverse effects does not mean you will have them, but I understand if you would not even want to take the chance, given a previous history of celiac disease.

http://www.aafp.org/afp/2014/1001/p503.html

“In the general nonblack population, including those with diabetes, initial anti-hypertensive treatment should include a thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, or angiotensin receptor blocker (ARB). In the general black population, including those with diabetes, initial treatment should include a thiazide diuretic or calcium channel blocker. If the target blood pressure is not reached within one month after initiating therapy, the dosage of the initial medication should be increased or a second medication should be added (thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB; do not combine an ACE inhibitor with an ARB). Blood pressure should be monitored and the treatment regimen adjusted until the target blood pressure is reached. A third drug should be added if necessary; however, if the target blood pressure cannot be achieved using only the drug classes listed above, antihypertensive drugs from other classes can be used (e.g., beta blockers, aldosterone antagonists). Referral to a physician with expertise in treating hypertension may be necessary for patients who do not reach the target blood pressure using these strategies.”

Drugs for BP in different classes work by different mechanisms. It may be worth it to print out those huge, long drug information sheets and go over them with a fine toothed comb. As for CoQ10, have you checked for coupons online? Can your doctor write you an Rx and get your insurance to pay? They might say it’s on OTC and you have to pay out of pocket, but it may be worth it to find a way around that - would a prior authorization do the trick? I don’t know, just bringing up the questions.

In the report you cited, these concluding words were to me, chilling:
“Therefore, we suggest the possibility of a class effect.” Losartan, olmeseartan - doesn’t matter. And I'll say it again, there must be a way to disseminate this information more widely as I had no idea about this adverse effect, and never heard any docs speaking about it either. It really warrants wider sharing.

Finally, one person who is often an overlooked resource is your pharmacist. They have just tons of knowledge and should be able to talk to you in some depth if asked, in an articulate, easy to understand way. They may even be able to do some digging and research for you.

Plumbago

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