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)