Non-celiac gluten intolerance and celiac disease are becoming more common. Celiac disease is a chronic autoimmune disorder caused by a genetic intolerance to gluten. Non-celiac gluten intolerance is diagnosed in people who do not have celiac disease, but have intestinal or extra-intestinal symptoms related to ingestion of gluten-containing grains.
Both conditions are treated by avoiding gluten containing foods. Finding ‘gluten free’ nutrition is becoming easier to do, but eliminating gluten from one’s diet can be a complex and time-consuming process.
Gluten is the protein component of wheat (e.g., including spelt, kamut, semolina, and triticale), barley (e.g., including malt), and rye. When a person with celiac disease or non-celiac intolerance ingests gluten, specifically the antigenic gluten constituent called gliadin, it can cause intestinal inflammation, diarrhea, abdominal pain, bloating, weight loss, fatigue, and iron deficiency anemia. Food malabsorption and nutritional deficiencies result.
Over time, these conditions can cause liver disease, defective gallbladder emptying, and osteoporosis. Celiac disease may be a reversible cause of osteoporosis. Adherence to a gluten-free diet is one way to help suffers minimize overall symptoms and to maintain maximal bone mineral density.
For perspective, oats are considered a type of gluten grain, but do not have the antigen that other gluten grains above do. Thus, oats do not induce an immune reaction in the small intestine of people with celiac disease. However, many commercial oat products are contaminated with wheat, barley, or rye and it’s important to carefully read their labels. Look for products that are certified to contain less than 20 ppm of gluten (FDA’s ‘gluten free’ definition).
Consumption of as little as 10 mg-50 mg gluten daily can lead to a clinical relapse in people with these conditions. Celiac disease may increase the risk of developing some types of cancer (e.g., T cell lymphoma and intestinal adenocarcinoma) if gluten restrictions are not maintained or gluten intake is only partly restricted.
It is important to find out where gluten resides in foods. This means not only reading food labels on products you purchase for home but also on foods you consume from fast food establishments and restaurant dining. Soups, sausages, and ice cream may contain hidden amounts of gluten as fillers. Talk with your grocer and restaurant owners before you consume questionable food items.
Watch out for the gluten content in herbs, other dietary supplements, and medications.
Consuming foods certified to be ‘gluten free’ will help keep the daily gluten total to under 50 mg and not cause symptoms for most people with celiac disease. Gluten-free grains include rice, millet, corn, quinoa, sorghum, and buckwheat. For more information, visit http://glutenfreecooking.about.com/od/gettingstarted/a/hiddengluten.htm
Gluten-Free Herbs and Other Dietary Supplements
It would be impossible to find information about the gluten content in over 60,000 products on the worldwide market. One can contact dietary supplement manufacturers directly for more information on gluten content before taking any of these products, including vitamins.
Over-the-counter and prescription medications may contain gluten in the list of inactive ingredients. For example, sweeteners used in medications may be hidden sources of gluten. Some manufacturers cannot guarantee their medications are gluten-free because the suppliers of raw materials can not do so, making it even more difficult for consumers to figure out what is safe to take and what is not.
A great resource for determining the overall ingredient content in medications, including whether or not gluten is present, can be found online at www.glutenfreedrugs.com .
Another online medication reference comes from the National Institutes of Health at www.dailymed.nlm.nih.gov. Go to the site, type in the generic name of the medication you want to review, then scroll down to the name of the manufacturer of that particular product, then click on ‘description.’ Scroll down to the inactive ingredients and look for gluten.
A third way to find more information about your medication’s gluten content is to call the medication manufacturer directly. Be sure to have the medication’s lot number available when you call.
Finally, click on https://www.ncbi.nlm.nih.gov/pubmed/?term=Gluten+content+of+the+top+200+medications+of+2009%3A+a+follow+up+to+the+influence+of+gluten+on+a+patient%E2%80%99s+medication+choices for “Gluten content of the top 200 medications: follow up to the influence of gluten on a patient’s medication choices” by AR King in Hosp Pharm 2013:48:736-43.
By Cathy Rosenbaum PharmD MBA RPh CHC
Certain prescription and/or OTC medications and dietary supplements may negatively interact with grapefruit juice, grapefruit, Seville oranges, pomelos, and tangelos due to chemicals in the fruits.
Fruit chemicals are thought to block enzymes in the body that metabolize medication in the small intestine, thereby causing the medication to hang around longer than expected. Interestingly, these fruits may also interfere with transporters in the body, causing medication to be less well absorbed into the bloodstream, and may reduce medication or supplement effects. Sound confusing? It’s complicated.
Product classes involved in unwanted interactions include, but are not limited to:
-Antihistamines (e.g., Allegra)
-Corticosteroids for Crohn’s disease and ulcerative colitis
Only some of the medications and supplements in each of the categories can be affected by the fruit/juices. Every person may react differently based on the amount of fruit they consume, the medication or supplement type/dose taken, and the individual’s natural ‘enzyme levels.’
Don’t worry, but do get educated about how and when to properly take your medications and supplements to be safe. Enjoy healthy nutrition. Talk with your pharmacist about what’s best for you!
Expiration dates on OTC & prescription medications and dietary supplements typically fall between 12 – 60 months after product production. Pharmaceutical manufacturers are required by law to establish these dates but do not have to study product stability and potency beyond those dates.
A recent study published in JAMA Internal Medicine using eight medications containing 15 active ingredients demonstrated product potency for decades beyond the original expiration dates. Another study in the military concluded the same results for 100 medications after 15 years.
The U. S. government has a Shelf Life Extension Program to extend dates on federal stockpiles for the military. But this is the exception to the rule in a special population to save the government money in repurchasing.
The bottom line for consumers is this – > follow the product manufacturer’s established expiration date stamped on the OTC bottle or prescription vial. Follow these same guidelines for your dietary supplements as well.
Keep all of these products in a cool, dry, dark place in your home.
Polypharmacy Is Not Jolly! By Cathy Rosenbaum PharmD MBA RPh CHC
Hallelujah. The healing paradigm is finally shifting in the U.S. The time is ripe for doctors to rethink how they prescribe medications. Less is more. As a fellow health care professional, I believe medical students should be taught to utilize drugs sparingly, as only one of many, customizable tools in their future healing quivers.
Envision a country where you as the patient could be asked by your doctor to select from a menu of non-invasive, evidence-based holistic healing regimens when needed. That’s right, you would choose! Aromatherapy, guided imagery, spiritual retreats, Yoga, Tai Chi, personality testing, and acupuncture would be covered by insurance or included as part of your total office visit fee. Doctors would collaborate with evidence-based non-traditional medicine practitioners for your good.
Seniors over age 65 years represent 12% of the U.S. population and consume 32% of prescription medications. Many take five or more prescription medications, intentionally combining them with other over-the-counter medications and multi-ingredient dietary supplements. Boomers, we need to collectively push back against that machine.
Everything changes. Our body’s physiologic clock resets as we mature in the life journey. We become more sensitive to the effects of medications. Talk with your doctor about this list of possible options the next time you go to the office.
• Sleep Restoration – drink a cup of chamomile tea, lavender tea, or decaffeinated green tea before bedtime; try a few minutes of slow, deep breathing as you retire to inhale life-giving oxygen and calm you down from the day’s challenges
• Stress/Anxiety – repeat affirming statements about your life blessings (we all have them); read up on the benefits of acupressure
• Weight Loss – eat apples and drink water for snacks; walk around the dining room table and up/down home stairs for ½ hour a day (yes, and let your neighbors see you through the window)
• Arthritis Pain/Inflammation – talk with your doctor about the appropriateness of glucosamine HCL or turmeric dietary supplements instead of a years worth of NSAIDs like Naprosyn and Motrin that can damage the kidney, heart, and stomach
• Viral Colds – eat chicken noodle soap; try zinc lozenges, as directed on the package label, at the first sign of symptoms
• General Health – exude a positive attitude; teach your family to grow, cook, and eat from the Mediterranean diet (e.g., olive oil, colorful fruits and vegetables, moderate wine consumption, nuts); prefer whole (not processed) foods for your nutrition regimen, locally grown in your own organic garden or community supported agriculture farm
New Year’s Resolutions
• Let your feet do the shopping. Choose a primary care physician that thinks out of the box and is open to integrative health principles & practices (see the Academy for Integrative Health and Medicine @ www.aihm.org )
• Don’t expect to get a prescription medication every time you leave the doctor’s office
• Incorporate medicinal herbal spices and teas into your nutritional regimen for health and taste
• Take charge of holistic you in your body mind and spirit
• Get educated on the exciting integrative health and healing paradigm (visit www.NIHseniorhealth.gov, www.babyboomers.com, www.lifereimagined.com)
• Be aware of all medications and dietary supplements your patients are taking; supplements act like drugs and have interactions and side effects that you must acknowledge and manage
• Treat your patient as an equal partner in the decision-making process and consider his/her point of view before prescribing any medication
• Try prescription drug reduction strategies (one medication as opposed to several, lowest dose possible)
• Try drug holidays (e.g., FLEX study with Fosamax for osteoporosis)
• Try evidence-based, alternate drug regimens (e.g., every other day Zocor for high cholesterol)
• Promote healthy nutrition to your patients at every office visit; discuss connection to eating whole foods and a healthy immune system
• Explain to your patients the importance of shopping at one pharmacy for all prescription medications
• Get educated on nutrition and dietary supplements,
• Recommend medicinal herbal teas instead of OTC medications whenever appropriate
• Talk consumers out of taking antibiotics for viral infections
Integrative health and medicine is here to stay. Take a lifelong learning class in your local community. Teach your grandchildren about it as your contribution to the family legacy. Be a part of the health evolution revolution. Happy New Year!
Dr. Rosenbaum has authored and just published, Don’t Sweep It Under the Drug! Integrating Evidence-Based Body Mind & Spiritual Practices into Your Health & Wellness Tool Kit, available on www.Amazon.com. Her book is the Xulon Press Fall 2015 Second Place Winner of the Christian Authors Award, Category: Health.