CeliacDisease? What is Celiac disease is an autoimmune digestive disease that damages the villi of the small intestine and interferes with absorption of nutrients from food. Celiac disease is triggered by consumption of the protein called gluten, which is found in wheat, barley and rye. While this genetic disorder can sometimes emerge in childhood, celiac disease can also be triggered by events such as surgery, pregnancy, childbirth, viral infection, or severe emotional stress. Roughly one out of every 133 Americans has celiac disease, but 97% remain undiagnosed. This means that almost three million Americans have celiac disease and only about 100,000 know they have it. Left untreated, people with celiac disease can develop further complications such as other autoimmune diseases, osteoporosis, thyroid disease, and cancer. Additionally, there are a number of medical problems that are associated with undiagnosed celiac disease including cancer, osteoporosis, diabetes Type 1, thyroid problems and reproductive health issues. What are the symptoms? Symptoms of celiac disease can affect any system in the body and may not necessarily occur in the digestive system. Some of the most common symptoms of celiac disease include: ¥ Bloating ¥ Tingling/Numbness ¥ Osteoporisis ¥ Gas ¥ Headache ¥ Infertility ¥ Diarrhea ¥ Canker Sores ¥ Depression ¥ Constipation ¥ Joint Pain ¥ Discolored Teeth ¥ Fatigue ¥ Delayed Growth ¥ Itchy Skin Rash ¥ Poor Weight Gain What is the treatment? The only treatment for celiac disease is a lifelong gluten-free diet. A gluten-free diet means avoiding all foods that contain wheat (including spelt, triticale, and kamut), rye, and barley. (over) For the Pharmacist Gluten in Medication Gluten is used in many medications as an excipient, so it is important for peoplewith celiac disease to check with the manufacturer to be sure that each medication they take is gluten-free. Some patients may ask their pharmacistÕs help in reading the listof ingredients or contacting the manufacturer. ItÕs also important for pharmacists to be aware that medications may not work as expected in peoplewith undiagnosed celiac disease, due to problems with malabsorption. The problem: ¥ There are currently N O requirements for labeling gluten or common allergens found in drug ingredients. ¥ There are N O specific precautions for individuals with celiac disease in labeling. ¥ Potential sources of gluten in medication excipients are NOT well-recognized by health professionals or patients. ¥ Botanical sourceof starch may not be specified. ¥ G eneric formulations may include different excipients than the brand-name drug. Starches found in medications: ¥ C orn (most common) ¥ Pregelatinized starch ¥ Pregelatinized ¥ Modified starch (source not specified) modified starch (source not specified) ¥ Wheat (source not specified) ¥ Potato ¥ Tapioca Starch derivatives: ¥ D extrates (source not specified) ¥ D extrin (source not specified butusually corn or potato) Other excipients: ¥ D extrimaltose (when barley malt is used) ¥ Caramel coloring (when barley malt is used) Resourcesfor more information about gluten in medications 224 South Maple Street, 2nd Floor Ambler,PA 19002 www.celiaccentral.org 7272 Wisconsin Ave. Bethesda, MD 20814 301-657-3000 www.ashp.org Manufacturers Some drug manufacturers can advise a patient who contacts them about the gluten content of a particular medication. On the Web www.glutenfreedrugs.com (Maintained by a pharmacist at Nationwide ChildrenÕs Hospital, Columbus, Ohio) In Print A Guide through the Medicine Cabinet A book developed to give those who suffer with Celiac Disease the tools to choose medications and supplements that meet special dietary requirements. Literature Crowe, J. P., & Falini, N. P. (2001). Gluten in pharmaceutical products. American Jour nal of Health-System Pharmacists, 58, 396-401. Parrish, C. R. (2007). Medications and celiac disease: Tips from a pharmacist. Practical Gastroenterology. January, 58-64. Information provided by the National Foundation for Celiac Awareness and the American Society of Health-System Pharmacists.