Do Prescription Medicines & Over the Counter Medicines contain GLUTEN?

Gluten in medications is a hot topic within the coeliac disease community, because how can you successfully manage coeliac disease if medications you need contain gluten?  Having said that, almost all prescription medications are gluten-free.  If you are in doubt always ask your pharmacist.

The Coeliac Society of Ireland has compiled a Food List of gluten free foods that includes some of the main over-the-counter (OTC) medications. On this list is a declaration that Nurofen for Children Orange Flavour only, and Nurofen Six Plus Orange Flavour only, are NOT suitable for children with coeliac disease. This is because it contains wheat and that is listed in the ingredients. All Strawberry flavoured Nurofen are suitable.

Manufacturers use excipients, which bind pills together and help deliver the medication to the patient. There are several types of excipients, and some of them may contain gluten.

The following inactive ingredients may be sourced from wheat, barley or rye. Always check with your pharmacist if you are in doubt:

  • Wheat
  • Modified starch (if source is not specified)
  • Dextrimaltose (when barley malt is used)
  • Caramel coloring (when barley malt is used)

Contact your Doctor if you think, or if you know, that your prescription medicine contains gluten

Let your Doctor know that you have discovered that the medication has gluten, or if you’re experiencing symptoms and think it may contain gluten. Do not stop taking prescription medicine without talking to your doctor first. There may be reasons aside from gluten exposure that you are experiencing symptoms, such as side effects of the prescribed medication. It is important to understand that some common side effects of medicines overlap with gluten exposure.  You could also call the manufacturer to ask about their ingredients and production process.

When talking to the manufacturer, you could ask them:

  • If their medications are made on shared equipment with gluten-containing medications
  • Whether they test their products for gluten
  • If they speak to the manufacturers of their sourced ingredients about possible gluten in their raw materials.

What exactly is Coeliac Disease?

When someone with coeliac disease eats food containing gluten, their body overreacts to the gluten by producing antibodies that damage their villi, which are very small finger-like projections found along the wall of the small intestine.  In people who were not diagnosed early on, this damage can be irreversible.

 

Gluten is a protein found in wheat, barley, rye, and other grains. Gluten makes dough elastic and gives bread its chewy texture.

Villi

In a healthy small intestine, the surface of the gut lining is covered with millions of these tiny finger like  villi.  The villi increase the surface area of the gut and allow the body to absorb nutrients from food across to the blood more effectively.

However, in coeliac disease, the damage and inflammation to the lining of the gut over time flattens the villi, reducing their ability to help with digestion.  As a result, your gut is no longer able to absorb all the available nutrients.

What are the symptoms of Coeliac disease?

Symptoms vary from person to person, they can include:
– severe or occasional diarrhoea, excessive wind and/or constipation
– persistent unexplained gastrointestinal symptoms such as nausea and vomiting
– stomach pain, cramping or bloating
– mouth ulcers
– tiredness
– sudden or unexpected weight loss (not in all cases)
– anaemia
– deficiency in iron, calcium, vitamin D and folate

The way the body’s immune system reacts to gluten can affect other parts of the body as well. For example, the skin rash called dermatitis herpetiformis may develop.  Dermatitis herpetiformis is the skin manifestation of coeliac disease, this rash commonly occurs on the elbows, knees, shoulders, buttocks, and face, with red, raised patches often with blisters. It affects around one in 3,300 people.

How common is the coeliac disease?

It is estimated that 1 in 100 people have the condition in Ireland and the UK.  There is a genetic link to the disease, therefore having a first-degree relative with the condition increases a child’s risk of developing the disease to 1 in 10.

Research has shown that introducing gluten during the first 3 months of life in groups of at risk children increased the risk by 5 times compared to when gluten was introduced at 4-6 months.  There was no benefit found in delaying introduction until after 6 months.  Therefore it’s generally recommended that gluten should not be introduced before 6 months, regardless of whether the child has a relative with the condition or not.

What are the long-term consequences?

Osteoporosis

Coeliac disease is a strong risk factor for osteoporosis with many studies reporting decreased levels of bone mineral density in newly diagnosed patients by up to ¼ when compared to healthy counterparts.  This reduction in density is thought to be due to the chronic malabsorption of calcium prior to diagnosis.

This malabsorption causes calcium to be drawn from the bones to meet the body’s requirements.   There is also reduced calcium intake following diagnosis as the gluten free diet will involve avoidance of bread and cereals which normally contribute around 30% of daily calcium intake in the Irish & UK diet.

Therefore it is recommended that the target calcium intake for prevention and treatment of osteoporosis in adult coeliac patients is 1500mg per day.

Malabsorption

As the body does not fully absorb nutrients from the food you eat due to the inflammation, over time this can lead to a deficiency of certain vitamins and minerals and in turn, other complications can develop such as osteoporosis (see above), or anaemia, caused by either lack of iron, B12 or folate in the body.

Cancer

There is research to suggest that coeliac disease is related to an increased risk of developing certain cancers including bowel cancer and lymphoma.  It’s estimated that coeliac patients are twice as likely to develop bowel cancer than the general population. However this is still a very small increase in risk with only 1 in every 200 people with coeliac disease developing bowel cancer in the first 10 years after diagnosis.  The risk drops as the gluten free diet takes effect.

Coeliac patient or not, if you have symptoms such as blood in stools, unexplained weight loss and changes to normal bowel habit that last over 4 weeks, you should see your GP.

What is the treatment for coeliac disease?

Once diagnosed, the only treatment for coeliac disease is a gluten-free diet.   Therefore complete avoidance of foods containing wheat, rye and barley .  Some people with the condition may also be sensitive to oats.   Including oats in the diet is a valuable source of soluble fibre however this should be considered on an individual basis depending on sensitivity.

Some gastrointestinal symptoms such as diarrhoea will improve within a few weeks of commencing a gluten free diet but it can often take over 12 months for the mucosal damage to the small bowel to repair and the villi return to normal.  So some other symptoms related to nutrient absorption may take longer to improve.

Practical advice to avoid contamination at home:

Use a separate toaster for gluten free breads or a toaster bag

Ensure chopping boards & utensils are thoroughly cleaned or use a separate set

Wipe down surfaces after preparing food

Separate containers for butter, jams etc.

Revive Active, producers of a range of gluten free supplements, have been awarded the Best Vitamins, Minerals and Supplements Product in the Irish Pharmacy Over the Counter Awards, 2017. Revive Active Health Supplement is a unique and powerful blend of 26 active ingredient in a single daily sachet. Suitable for vegetarians, vegans and gluten free

 

References:

Food Safety Authority of Ireland – https://www.fsai.ie/faq/gluten_free_declarations.html

Coeliac Society of Ireland – https://www.coeliac.ie/

JT Physiotherapy – http://www.jtphysio.com/coeliac-disease/

Villi and Absorption – https://www.slideshare.net/praveenakt/villi-and-absorption