Celiac disease is a serious condition which needs constant vigilance in the part of the patient, the doctor and the pharmacist. One needs to watch carefully everything they ingest. This not only means the food they eat, but the supplements, vitamins and medication they take.
Finding a Cure
Western medicine prides itself for finding cures to illnesses using precise methods and following the scientific method of inquiry. Doctors and Pharmacists gained the trust of their patients through the centuries by promising prescribed drugs would work on patients through religious application, constant follow-up, and conscientious adherence medical procedures. For the most part, these medications offer at least temporary relief of symptoms when applied correctly after the correct diagnosis.
Medication should be offered to patients after medical practitioners have discussed all options, side-effects and the pathology of their current disease. Most medications cannot treat the main source of the disease, but can only alleviate the symptoms or slow the progression. It is important to inform the patients their complete situation and not promise their patients that after taking the medication, they’ll be instantly cured of all illnesses. Patients should be aware that the medicine offered to them do not produce the same effects in all individuals. Idiosyncratic action means some patients may be cured, but other patients may still feel ill after treatment. More importantly, side-effects vary and may lead to grave complications depending on the patient and the situation. Patients may get something as light as nausea from taking the medication while others may go through complete anaphylactic shock.1
Patients should be well-informed prior to making a choice. Doctors should be able to tell you the action of the drug given to you and why giving it to you is a better alternative to not giving you anything for your illness. It is important to inform patients of all the different side-effects the drug can produce, prior to prescription.
Possibility of Gluten in your Medication
Patients suffering from gluten sensitivity and celiac disease need to be mindful of the food they eat. Every aspect of their life and diet has to be carefully monitored because the consequences are deleterious. However, one must be mindful of more than just the food they eat. They need to monitor vitamins, food supplements and medication they take. It’s possible that food supplements may contain gluten. At the same time, people should be mindful of the effects of these drugs in our body and how they interact with our immune cells and those of the intestinal lining. A drug may not have gluten but it may harm the patient’s immunocompromised system. Some drugs may make the situation worse through the interaction they have with the patient’s body. While most medication is gluten free; it is the additive that may present a problem.2
Additives that are safe for consumption
Xylitol and Mannitol are sugar alcohols. Though some may be refined from wheat and intuitively risky, they are generally safe for consumption if you have gluten sensitivity. Sugar alcohols are considered safe along with dextrin, lactose, gelatine, mag stearate and titanium dioxide. These sugar alcohols are considered safe additive to drugs.
Drug companies place additives in medication to ensure that the active ingredient stays potent and safe for consumption. This is similar to the introduction of preservatives to keep natural food from spoiling immediately.
An example of these additives would be starches. Starches are used to absorb the moisture or water in the medication or pill so it does not disintegrate immediately and thereby prolong its shelf life. Maltodextrin is a starch hydrolysate used as an additive to these drugs. This is obtained from corn and can also be extracted from wheat, rice or potato as well. For celiacs, this knowledge should raise warning flags. Dextri-maltose is another additive which can be obtained from barley malt. This is a pregelatinized starch which could present a problem for gluten-sensitive individuals.
It is important for every gluten-sensitive patient to monitor the contents of their medication. If they see that there is “starch” in the list of ingredients, they better be proactive enough to ask the pharmaceutical company where this starch came from or what is the plant source of the starch content. The list of ingredients can be seen in the patient package insert found in medicine bottles. One can also look up the list of ingredients online. The pharmaceutical companies usually provide this information owing to disclosure rules of agencies like the Food and Drug Administration.
Be wary of generic products that claim the same active ingredients but affect patients differently. The branded medication may prove to be gluten-free but the generic medication might use starch which can prove harmful to patients with gluten sensitivity. This is because the only similarity between generic and branded medicine is their active ingredient. Thus, it is important to check on a medication when you switch brands, even if it is touted as the generic equivalent of the drug. This is one case where your physician resists generics for a very good reason.
Antacids and Their Effects on Gluten-Sensitive and Celiac Disease Patients
The main purpose of taking antacids is to prevent gastric acid reflux and stomach and duodenal ulcers. Excess production of acid leads to an increased likelihood of developing ulcers which can severely affect the physiology and integrity of the gastrointestinal tract. The first line of treatment for excessive gastric acid production is using antacids such as Maalox. Advanced treatment includes introduction of H2-receptor antagonists. Examples of these include Zantac and Tagamet. Some patients require long-term anti-acid treatment. In these cases, doctors usually prescribe long acting gastric acid suppressors. These are Proton Pump Inhibitors such as Omeprazole.3
The main function of proton pump inhibitors is to raise the pH of the stomach to prevent the onset of ulcers. Aside from this, inhibitors produce a pronounced reduction in acid production, as the name implies. In doing so, however, proton pump inhibitors may have a detrimental contribution to celiac disease and its pathology.
One of the main issues in gluten sensitivity and celiac disease is the presentation of symptoms which are caused by malabsorption of the essential vitamins and minerals. This is because the absorption surface of the small intestines is decreased due to the damage caused by celiac disease. Taking proton pump inhibitors makes the condition worse. This is because proton pump inhibitors decrease the gastric acid which was supposed to digest the food we eat. If the food is not properly digested, the vitamins and minerals present in the food cannot be absorbed by the small intestine which is already having a hard time absorbing nutrients in the first place. This increases the likelihood of malabsorption symptoms.
Studies show that increase exposure to proton pump inhibitors lead to an increase risk in developing celiac disease.4 Ingesting anti-secretory medication such as Omeprazole was found to lead to a subsequent diagnosis of celiac disease. It was found that there was a causal relationship between the occurrences of celiac diagnosis only after the prescription was taken.
- The Health Strategies Consultancy LLC (2005). Follow The Pill: Understanding the U.S. Commercial Pharmaceutical Supply Chain. The Kaiser Family Foundation. ↩
- Cohen, S. (2013). Hidden sources of gluten in your vitamins and medication. Retrieved from theglutensummit.com ↩
- Sachs, G. Shin, J. M. & Howden, C.W. (2006). Review article: The clinical pharmacology of proton pump inhibitors. Alimentary Pharmacology and Therapeutics 23: 2–8. ↩
- Lebwohl, B., Spechler, S.J., Wang, T.C., Green, P.H. & Ludvigsson, J.F. (2014). Use of proton pump inhibitors and subsequent risk of celiac disease. Digestion and Liver Disorder, 46 (1): 36-40. ↩