Friday, May 5, 2017

2 Reasons Why Celiac Disease Impairs Drug Therapy in Those Who Take Drugs?

If you have celiac disease you may have poor absorption of any drug prescribed for you or you may have more adverse affects. Poor drug absorption and impaired liver metabolism are two conditions found to effect drug therapy. 

As a pharmacist he advises increased monitoring for efficacy and adverse effects when starting a new medication regimen in patients with celiac disease.

Celiac disease is an autoimmune disorder that renders those affected with an intolerance to gluten, a protein found in many common grains. It occurs in approximately 1% of the population of the United States and Europe.1

People with celiac disease that ingest gluten generally experience an inflammatory reaction, manifested as gastrointestinal upset, diarrhea, and abdominal distension. Celiac disease is also associated with other chronic conditions, such as anemias and malabsorption of some critical vitamins. Alterations of the gastrointestinal tract, rates of gastric emptying, and gastric pH are responsible for altered vitamin and mineral absorption.2, 3 Intestinal CYP3A4 levels may also be disrupted, which may have implications in first-pass metabolism for some drugs that are substrates for this drug metabolizing enzyme.4 This has led some to investigate the potential impact of celiac disease on drug absorption. This would be of interest to pharmacists since altered drug absorption can have pharmacokinetic consequences and has the potential to impact overall drug therapy.

A comprehensive review on this topic was published in 2013 by Tran et al.The review considered absorption studies in subjects with celiac disease, and the authors summarized the literature available on a handful of drugs, including acetaminophen, aspirin, propranolol, levothyroxine, methyldopa, and some antibiotics.They reported that many studies had conflicting results. Some reports show an altered gastrointestinal environment and a significant difference in drug absorption in patients with celiac disease. Other reports did not show any absorption differences between those with and without the disease. It was noted that many of the studies considered for their analysis had small sample sizes and were not well powered. The authors concluded that there is the potential for altered drug absorption and that healthcare professionals should be cautious when initiating drug therapy.5

Another review on the topic of celiac disease and the potential impact on cardiovascular drug absorption was published in 2014. This review considered many of the same medications previously explored by Tran et al, with a focus on cardiovascular agents. The authors also expressed concern that many cardiovascular drugs may have altered absorption in celiac disease, but there are few published studies that are convincing enough for concrete clinical decision making. The authors also stressed the need for more studies that consider patients with celiac disease, as well as caution when initiating cardiovascular pharmacotherapeutic regimens.6

Based on the research available, it is clear that patients with celiac disease can exhibit altered absorption of many different substrates. Unfortunately, altered drug absorption and disposition are not well studied in this population. It is likely that future studies will elucidate any impact celiac disease has on drug disposition, as this disorder has been getting more attention in recent years. There is some preliminary evidence suggesting that celiac disease may alter drug absorption, but the degree and prevalence of this has yet to be confirmed with large prospective studies. Pharmacists should be cautious when making therapeutic recommendations for patients with celiac disease and consult the available literature when possible.

Increased monitoring for efficacy and adverse effects is advisable when starting a new medication regimen in patients with celiac disease.

References
1. Catassi C, Gatti S, Fasano A. The new epidemiology of celiac disease. J Pediatr Gastro Nutrition. 2014;S7-S9.
2. Perri F, Pastore M, Zicolella A, Annese V, Quitadamo M, Andriulli A. Gastric emptying of solids is delayed in celiac disease and normalizes after gluten withdrawal. Acta Paediatrica. 2000;8:921-25.
3. Caruso R, Pallone F, Stasi E, Romeo S, Monteleone G. Appropriate nutrient supplementation in celiac disease. Ann Intern Medicine. 2013;8:522-31.
4. Lang CC, Brown RM, Kinirons MT, et al. Decreased intestinal CYP3A in celiac disease: Reversal after successful gluten?free diet: A potential source of interindividual variability in first?pass drug metabolism. Clin Pharm Ther. 1996;1:41-46.
5. Tran TH, Smith C, Mangione RA. Drug absorption in celiac disease. Amer J Health-System Pharm. 2013;24.
6. Wang I, Hopper I. Celiac Disease and Drug Absorption: Implications for Cardiovascular Therapeutics. Cardio Ther. 2014;6:253-56.




To Your Health

Dr. Barbara (TM)

Celiacbrain.blog.spot.com (TM)

Tuesday, March 21, 2017

Welcome to Celiac Brain: 400% Increased Risk of Death if Undiagnosed

I have been studying Celiac disease and its other 
manifestation, gluten sensitivity since 1995. I have become aware of its hidden and virtually unknown consequences. And it is very common. I am a physician, practicing since 1977, and have seen the devastating effects of celiac/gluten sensitivity first hand. I have seen remarkable turnarounds of very seriously ill persons when they have been on a diet free of gluten.


This site is to spread the word of its serious and dangerous nature to those interested, whether you are a physician, other health care professional, or a person in need of more information.


I propose to bring to you the newest in scientific research, links to other reputable celiac disease/gluten sensitivity websites, and other helpful articles or news items.


The most important finding I would like to impress upon all people comes from Dr. Joseph Murray from the Mayo clinic and that is the 400% increased risk of death by age 65 in undiagnosed persons with celiac disease or gluten sensitivity. This information highlights the need to get a diagnosis as early as possible to allow you to reverse the damage, if possible.


And to relax, if you don't have genetics.


I push for ALL to get tested and as early in life as possible. With proper diet and treatment, one can "buy back your time!" and extend ones healthy life span by decades. See Dr. Murray's video.



400% increased risk of death by age 65 in undiagnosed celiacs
Dr.Joseph Murray and his team from the Mayo clinic reported on a small but significant study they published in 2009. Not only was there an astronomically elevated death rate, but they noticed that there has been a 400% increase in the incidence of celiac disease since 1948.

Listen to Dr. Murray::


So get tested and find out if you are one of the 40% of people that are susceptible. The best testing, in my opinion, is a genetic test found at www.enterolab.comI don't have any financial benefit from recommending the company. I have found this testing has revolutionized my practice and my ability to help people.

If you find yourself with gluten sensitivity, go on a gluten free diet, or better yet, the Gut and Psychology Syndrome diet. This diet includes healing foods and nutrients that positively affect the main problems: the damaged bowel and the wrong microbiota, "bugs living in the bowel", malnutrition, poor immune system. 


Untreated celiac or gluten sensitivity leads to increased infections, food allergies of all kinds, epilepsy, rashes, depression, 4 times the rate cancer, inflamed intestines, and 12 times risk of autoimmune diseases like type 1 Diabetes.

To Your Health
Dr. Barbara (TM)
CeliacBrain (TM) is the trademark and copyright of Dr. Barbara Powell. The right of Dr. Barbara Powell to be identified as the author of this work has been asserted by her in accordance with the Copyright, Patent and Designs Act 1988.
Note that all information on these pages is accurate to the best of our knowledge. Information from secondary sources should be double checked before being cited. Information is not meant to be medical advice. Please see your family doctor if you have concerns.

Screening for Celiac Disease: the use of HLA First?

The arguments for a step wise genetic screening for celiac disease made by a group of rheumatologists who wrote the following article are solid. If the risk of getting or having celiac disease is virtually zero in someone without the genetics of HLA DQ 2.5 or HLA DQ8 then the person with a medical problem associated with celiac disease (like an autoimmune disease) without these genetic markers doesn't need a small bowel biopsy. 

As the genetics tests become more economical than celiac blood tests, and are more accurate than celiac blood tests, then it makes sense to start with genetic HLA testing.


Read the full article here from International Journal of Celiac Disease, 2017.

Here is an excerpt: My Bold


3. A Step Wise Serology/Genetic Approach

CD patients negative for any of these HLA alleles are very rare. Therefore, the absence of both HLA-DQ2 and HLA-DQ8 heterodimer makes diagnosis of celiac disease very unlikely (sensitivity >96 %). HLA typing of patients has been included as a useful test to exclude celiac disease in the ESPGHAN guidelines for CD diagnosis. [8, 9] HLA typing confers a high negative predictive value: patients with a negative HLA (i.e. neither DQ2 nor DQ8) will not develop CD; and a suggested strategy to avoid repeated CD screening would be to first perform an HLA test. [10]

Targeting the HLA risk first, rather than tracking positive serology, would be a reasonable step-up approach, probably cost effective and time saving: in the past, HLA typing has been expensive and time-consuming, but new single nucleotide polymorphisms techniques [11] and other combined home-made procedures [12] have recently been reported as very cost-effective and work-time saving for HLA-DQ2 and DQ8 genotyping in CD screening................

In general population, the preferred test to screen for CD is the measurement of IgA TTG [Link here to a critique of the IgA TTG test]along with total serum IgA to avoid false-negative results due to selective IgA deficiency. Positive serology would lead to endoscopic small intestinal biopsies [14]. These serological tests, based on TTG associated to endomysial and deamidated gliadin peptides antibodies are recognized as performant screening tools. [15]

However, in asymptomatic members of a high-risk group, like those presenting RA, it seems reasonable to test first for negative result of HLA-DQ2/DQ8 in order to exclude CD, so that further serologic testing would be unnecessary [16]. Performing HLA genetic typing seems cost effective and could avoid subsequent fiberoscopies and biopsies [17].................recent studies emerging from the South Hemisphere confer solid arguments to such strategies [18] as CD is reported to be strongly associated with HLA-DQ2 in these regions [19].

It is my opinion and the opinion of these authors that the genetic tests for HLA provides a flexible, cost-effective methodology that could be applied to protocols to diagnose celiac disease and to obtain accurate estimates of the prevalence of CD in large cohort studies. The ESPGHAN guidelines for CD diagnosis are worth a look if you are interested in clinical matters.

To Your Health
Dr. Barbara (TM)
CeliacBrain (TM)

Monday, January 30, 2017

Processed Foods Have Contaminants That Have Undesired Side Effects



Watch this informative video, which is less than four minutes, and which explains how some of the predictable contaminants get into processed foods, including gluten free foods. You want to avoid toxic products. One way is to avoid processed foods. Another is to not cook foods for a long period of time above 120 degrees Celsius (248 F). And to avoid regular eating of "burnt"food such as french fries or toast, charred meat, fish, or vegetables. This info is good for all persons, gluten sensitive or not.

Source: https://www.youtube.com/watch?v=yedloySByx4  

To Your Health
Dr. Barbara (TM)
Celliacbrain.blog.spot.com (TM)



















Monday, November 21, 2016

Food Fraud and the Mediterranean Diet: What You Can Do About It!


Have you been asked to eat a Mediterranean diet? Well, you can't eat a real Mediterranean diet unless you eat authentic olive oil as part of that diet. Olive oil has many health properties. It is high for example in phenolic substances which are highly anti-inflammatory in nature and likely the reason why studies of the Mediterranean Diet, high in olive oil, have indicated a decrease in heart disease, among other conditions. 

And to source and buy the real olive oil, for that you need to know about food fraud. And the best article I have seen about fake food is at Dr. Mercola's where he interviews Larry Olmsted, the author of the book "Real Food/Fake Food: Why You Don't Know What You're Eating and What You Can Do About It". 

The whole interview is gripping. It covers fake seafood and this subject will sadden most people. It did me and motivated me to do more research on the seafood I buy and eat. And it covers Parmesan and the legal cover up of inferior foods with "brand" names to entice you into thinking you are getting the real thing.

I've written about the olive oil fraud and how to find authentic olive oil. We all think of Italy and those pastoral hills dotted with olive trees when we cook with olive oil, but the truth is an Italian olive oil has a good chance of being an inferior seed oil. You get what you pay for. Real olive oil can be pricey with a few exceptions, like Costco's extra virgin olive oil which has been consistently found in testing to be authentic.

To maintain the health benefits of olive oil, one should not cook with it, but put it on cold or room temperature dishes. For high heat cooking such as stir fry or sauteing use a temperature resistant fat such as avocado oil, animal fats like chicken fat and lard from pastured animals, organic red palm oil or coconut oil.


Here is an excerpt from Dr. Mercola's interview with Larry Olmsted:


Olive Oil Fraud


Olive oil is a $16 billion-a-year industry fraught with fraud. Tests reveal anywhere from 60 to 90 percent of the olive oils you find in grocery stores and restaurants are adulterated with cheap, oxidized, omega-6 vegetable oils, such as sunflower oil or peanut oil, that are pernicious to health in a number of ways.


   "Italy makes some delicious extra-virgin olive oil and they make some very good real extra-virgin       olive oil. The problem is a lot of what is exported from Italy is not their best product," Olmsted           says. "People associate olive oil with Italy … The thing that they look for most is that the oil               comes from Italy. But coming from Italy is not the same as being made in Italy.


    Italy is the world's largest exporter of olive oil, but they're also the world's largest importer of olive     oil. They buy up oil from all over the Mediterranean basin — from Tunisia, Syria, Morocco, Spain     — blend it, bottle it. Often it's labeled "bottled in Italy," which is technically true. It was shipped to     Italy and put into bottles, but it's not Italian olive oil. When people buy that, they're relying on            some sort of myth of Italian quality.


    Italy doesn't even produce enough extra-virgin olive oil to meet its own domestic demand. While         you can get very good olive oil from Italy, it's trickier than from some other countries … What           people need to understand about olive oil is that it's essentially closer to fresh-squeezed fruit juice       than it is to most of the other oils we're familiar with … As a result, olive oil has a fairly short shelf     life compared to other oils."


How to Identify High Quality Olive Oil


Part of the problem is that olive oil is shipped by boat, which takes a long time. Then it's stored and distributed to grocery stores, where the oil may sit on the shelf for another several months. Moreover, the "use by" or "sell by" date on the bottle really does not mean a whole lot, as there's no regulation assuring that the oil will remain of high quality until that date.

The date you really want to know is the "pressed on" date or "harvest" date, which are essentially the same thing because olives go bad almost immediately after being picked. They're pressed into olive oil basically the same day they're harvested. High quality olive oil is pressed within a couple of hours of picking. Poorer quality olive oils may be pressed 10 hours after the olives are picked.

Ideally the oil, based on the "pressed" or "harvest" date, should be less than 6 months old when you use it. Unfortunately, few olive oils actually provide a harvest date.


As for olive oil in restaurants, more often than not, the olive oil served for bread dipping is typically of very poor quality and is best avoided. For more information about olive oil — how it's made and what constitutes extra-virgin olive oil, please listen to the full interview, or read through the transcript, where Olmsted goes into more details about pressing, grading and testing............

Where to Find the Best Olive Oil

Surprisingly, the big box stores actually do a better job with their supply chain of most foods, including olive oil and seafood.

"Let food be thy medicine", so Hippocrates famously said. With the ever more increasing pressures of finding the real food, it may be best to cook at home more. Be more careful when choosing a restaurant and what you choose to eat in the restaurant. I suggest asking more questions but be sure to do this only when the restaurant is not busy.

When it comes to sourcing out your food, it is a good idea to get to know your local fish monger, and your local farmers. And starting a small balcony or patio garden is not a bad idea too.

To Your Health
Dr. Barbara (TM)
CeliacBrain (TM) is the trademark and copyright of Dr. Barbara Powell. The right of Dr. Barbara Powell to be identified as the author of this work has been asserted by her in accordance with the Copyright, Patent and Designs Act 1988.

Monday, November 7, 2016

ATI: The New "Gluten": Part 2, Dr. Richard Nahas of the Seeker's Centre Shares

Over at the Seeker's Pain Centre Dr. Richard Nahas writes about his approach. 

Is wheat affecting your brain?

We have supervised hundreds of patients during a trial of a gluten-free diet. What we have seen has been nothing short of amazing. About half of patients report dramatic improvements. This does not just include GI problems like bloating, gas, heartburn, constipation, stomach pain and diarrhea. We see improvement in fatigue, muscle aches and joint pain. Less depression and anxiety. Better sleep. Swelling and edema, blood pressure and blood sugar, and many other problems improve.


In medical school, we are taught that gluten allergy is called celiac disease, and that it affects about 1% of people. Recent studies, and the experiences of millions of ordinary people, point to another problem with wheat and other gluten-containing foods. It is called Non-Celiac Gluten Sensitivity (NCGS), and it appears to be a silent epidemic. No one knows exactly how many people suffer from NCGS, but it is one of the most common reasons why some people who suffer a minor injury are not able to ‘bounce back’.


When we suspect NCGS, we recommend a strict, 100% gluten-free diet for three months. This means no wheat, rye, barley, spelt or kamut. This means no bread or beer, pizza or pasta, cookies, pies, cakes, donuts or muffins. It means reading ingredients, talking to servers in restaurants, and sometimes saying ’no thank you’ at social gatherings. But for people with NCGS, these small sacrifices pay huge dividends.


We have blamed all of this on gluten, but this new study points to a new possible cause. Researchers have reported that amylase-trypsin inhibitors can trigger inflammation in tissues. This may help explain why a gluten-free diet can improve symptoms throughout the body. Inflammation is at the root of Alzheimer’s, diabetes, depression and dozens of other chronic diseases. While we know that gluten can disturb the immune system, this new finding suggests that ATIs may cause additional problems, leading to a one-two punch.


If you have any health problems at all, you should definitely consider a trial of a gluten-free diet. If it does not help, then you can try other dietary approaches to see if they make a difference. Avoiding nightshades, going vegetarian, occasional fasting, raw food diets and low-carb ‘Paleo’ diets have also helped many of our patients.


In the words of Hippocrates, the great Greek physician, ‘let food be thy medicine’. And keep seeking.


Those of you who have been reading me faithfully know that I recommend a trial of gluten-free, dairy free, nightshade free, grain-free, sugar-free diet similar to Paleo, called GAPS (www.gaps.me) which has a step wise approach to ensure smooth sailing and success. Why because I have seen remarkable successes with this. 

Avoiding grains ( and more particularly the GAPS way) makes more and more sense as more scientific research comes in. Like the info on the Non Celiac Gluten Sensitivity being a new and different immune reaction than Celiac disease and now the Anti Trypsin Inhibitors found in wheat causing inflammation. 
There is more and more reason to go for a trial of GAPS ( or a GAPS/ Paleo version) 
 
To Your Health
Dr. Barbara (TM)
CeliacBrain (TM) is the trademark and copyright of Dr. Barbara Powell. The right of Dr. Barbara Powell to be identified as the author of this work has been asserted by her in accordance with the Copyright, Patent and Designs Act 1988.


Tuesday, November 1, 2016

Meet ATI, The New "Gluten". New Wheat Protein Found to Aggravate Chronic Health Issues, New Study!



Another wheat protein has been found that causes gastrointestinal problems and problems in other parts of the body like inflammation of the brain, lymph nodes, kidneys, spleen and other organs. It is called ATI or amylase trypsin inhibitor. ATIs make up no more that 4% of wheat proteins, but can trigger powerful immune reactions in the gut that can spread to other tissues in the body. The implications are massive.

Evidence suggests that ATIs can worsen the symptoms of rheumatoid arthritis, multiple sclerosis, asthma, lupus and non-alcoholic fatty liver disease, as well as inflammatory bowel disease.
That explains why some people eating wheat but don't have non celiac gluten sensitivity nor wheat allergy nor celiac are getting sick. 

This is another reason for the success of the GAPS or Paleo (without specific carbohydrates, legumes or chocolate) in resolving many health issues. 

More research has to be done to see if ATI is also found in other grains or cereals. According to Dr. Schuppan lead researcher of the study:

Wheat amylase-trypsin inhibitors (ATIs) have been identified as the most likely triggers of NCWS [Non Celiac Wheat Sensitivity]. They are highly protease resistant and activate the toll-like receptor 4 (TLR4) complex in monocytes, macrophages and dendritic cells of the intestinal mucosa. Non-gluten containing cereals or staples display no or little TLR4 stimulating activity. Wheat ATIs are a family of up to 17 similar proteins of molecular weights around 15 kD and represent 2-4% of the wheat protein. With oral ingestion they co-stimulate antigen presenting cells and promote T cell activation in celiac disease, but also in other immune-mediated diseases within and outside the GI tract.

Read the news report from WorldHealth.net  entitled -Wheat Protein Linked to Non-Celiac Gluten Sensitivity.  

Read the press release from United European Gastroenterology. from October 17th, 2016.



References:

1. Zevallos V, Weinmann-Menke J, Meineck M et al. Alpha-amylase/trypsin inhibitors (ATIs) accelerate murine systemic lupus erythematosus. Poster presentation at the 16th International Coeliac Disease Symposium, 21-24 June 2015, Prague, Czech Republic. Poster P168.

2. Zevallos V, Yogev N, Nikolaev A et al. Consumption of wheat alpha-amylase/trypsin inhibitors (ATIs) enhances experimental autoimmune encephalomyelitis in mice. Oral presentation at the 16th International Coeliac Disease Symposium, 21-24 June 2015, Prague, Czech Republic.

3. Junker Y, Zeissig S, Kim S-J et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J Exp Med 2012;209(13):2395-408.

4. Fasano A, Sapone A, Zevallos V et al. Nonceliac gluten and wheat sensitivity. Gastroenterology 2015;148(6):1195-204.

5.Schuppan D, Pickert G, Ashfaq-Khan M et al. Non-celiac wheat sensitivity: Differential diagnosis, triggers and implications. Best Pract Res Clin Gastroenterol 2015;29(3):469-76.

To Your Health
Dr. Barbara (TM)

CeliacBrain (TM) is the trademark and copyright of Dr. Barbara Powell. The right of Dr. Barbara Powell to be identified as the author of this work has been asserted by her in accordance with the Copyright, Patent and Designs Act 1988.