Celiac disease can be BRUTAL on your GI System. I mean, I'm sure you've experienced some of the negativities yourself!
And, while I already knew my GI System was important, I had never before thought about how inflamed intestinal mucosa could change the way conventional pharmaceutical drugs would behave in my body.
After doing some additional research, I found some information on how Celiac Disease changes the absorption rate of oral medications and decided to bring that information here to share with all of you!
How Orally Administered Medication's Work
When you take a drug, whether prescription or just a Tylenol extra strength on Sunday morning, they often follow the exact same path once inside your body.
In the case of an orally administered drug, the drug must cross several semi-permeable cell membranes before reaching your blood vessels and entering the systemic circulation.
Drugs can cross these cell membranes in a variety of ways, with the most common being Passive Diffusion.
Passive Diffusion is the movement of a molecule from a high concentration gradient to a lower concentration gradient. In the case of orally administered medication, the high concentration gradient is the GI Fluid found in the small intestine and the low concentration gradient is your blood.
Passive diffusion allows for molecular movement across the cell membrane until both sides of the membrane (GI Fluid and Blood) have equal concentrations of the drugs.
What The Research Says
A comprehensive review of research on drug absorption in Celiac subjects was published in 2013. This review addressed absorption rates of a variety of drugs including acetaminophen, aspirin, propranolol, levothyroxine, methyldopa and a few antibiotics.
While some research reported conflicting results, the author's concluded that "there is the potential for altered drug absorption and that health care professionals should be cautious when initiating drug therapy". 1
Another review published in 2014 focused specifically on cardiovascular drugs. In the review, the authors made clear that there is a serious concern regarding altered absorption in Celiac patients, but more research needs to be done with consideration to Celiac patients. (2)
Why Exactly Celiac Disease Alters Absorption
Celiac Disease is an auto-immune disease that is exacerbated by the consumption of gluten. When gluten is consumed, the intestinal mucosa becomes inflamed.
When the intestinal mucosa becomes inflamed, small finger-like projection called microvilli begin to retract into the intestinal epithelial. These microvilli play a crucial role in micronutrient absorption within the small intestine.
The retraction of these microvilli can also play a role in the rate of absorption of pharmaceuticals as they travel through the small intestine.
In addition to the epithelial and microvilli tissue damage, intestinal transit time can play a role in the absorption rate of pharmaceuticals.
An article published in the Journal of Clinical Gastroenterology in 2004 found that up to 60% of celiac patients showed symptoms suggestive a gastrointestinal motility disorder.
This deviation from the average intestinal transit time could certainly alter the drug volume that is absorbed into the body.
So What Can You Do
Well, the first step is to talk to your doctor.
There are a variety of tests you can take that can determine the extent of potential intestinal damage as well as the changes in your intestinal transit time.
The second step is to just remain aware. If you are on a medication and are experiencing severe side effects, talk to your doctor and see if the dosage is appropriate for you specifically.
If you feel a medication isn't working at all, again speak to your doctor.
I hope you all have a great weekend and I'll talk to you soon.
(2) : Wang I, Hopper I. Celiac Disease and Drug Absorption: Implications for Cardiovascular Therapeutics. Cardio Ther. 2014;6:253-56.