© Lindsey Elmore, Pharmd, BCPS Celiac Disease Celiac Disease Is A

Celiac Disease

Celiac disease is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications.

Gluten-free Diet

All people with celiac should avoid gluten as much as possible. Many people do not get a resolution in celiac symptoms without also removing milk products.

Chinese Medicine

Celiac is a weakened spleen-pancreas and complex carbohydrates are recommended. Well cooked rice, oats, sweet rice, and mochi are highly beneficial. Carbohydrate rich vegetables (winter squash, carrot, rutabaga, parsnip, etc), pungent vegetables and spices (onion, leek, black pepper, ginger, cinnamon, fennel), and small amounts of rice syrup, barley malkt, molasses, cherry, and dates. If the deficiency is severe small amounts of meat may be included in a soup or congee.

Papain Supplements

The toxic action of wheat gluten on two patients was eliminated after predigestion of gluten by crude papain. This change is thought to be due to an enzyme which liberates ammonia from gluten. It is not thought that this particular mechanism operates in the normal intestinal cell but it is envisaged that one of the peptide bonds of the coeliac active constituent (possibly a N-glutaminyl peptide) is normally split by a specific intestinal peptidase which is defective in coeliac patients.

Omega-3 Fatty Acids

People with celiac are more likely to have cardiovascular disease, and omega-3 fatty acids are critical in reducing heart disease risk.

Probiotics

Lactobacilli break gluten peptides and decrease immunotoxicity of fermented sourdough bread in people with celiac disease. A combination of Bifidobacterium

© Lindsey Elmore, PharmD, BCPS longum, infantis, and breve, lactobacillus acidophilus, casei, delbrueckii, bulgaricus and planarum, and streptococcus salivarius Thermophiles hydrolyzes gliadin peptides in pre-treated flour and when fed to people with celiac had a less pronounced effect on intestinal mucosa permeability.

Vitamin and Mineral Supplements

Anemia and malnutrition is common in celiac disease. Reduced levels of iron, folate, vitamin B12, vitamin D, zinc, and magnesium are common in untreated celiac disease (CD) patients probably due to loss of brush border proteins and enzymes needed for the absorption of these nutrients. In the majority of patients, removal of gluten from the diet leads to histological recovery and normalization of iron, vitamin, and mineral levels. Iron deficiency anemia is the most common extraintestinal sign of CD and usually resolves with adherence to a gluten-free diet. However, deficiencies of both folate and vitamin B12 may persist in some patients on a gluten-free diet, thus requiring vitamin supplementation to improve subjective health status. Similarly, exclusion of gluten from the diet does not always normalize bone mineral density; in these cases, supplementation of vitamin D and calcium is recommended. Resolution of mucosal inflammation may not be sufficient to abrogate magnesium deficiency. Since gluten-free cereal products have a lower magnesium content as compared with gluten-containing counterparts, a magnesium-enriched diet should be encouraged in CD patients.

Glutamine

Glutamine improves mucosal regeneration and absorption. Glutathione is a critical antioxidant synthesized from cystine. Both cystine and glutamine are lower in children with celiac and supplementation may be tried.

Herbal Treatments

Golden seal and echinacea may speed up healing of intestinal inflammation. Goldenseal also inhibits H. pylori meaning that it may also help with gastric ulcers.

Burdock root, slippery elm, sheep sorrel, and Turkish rhubarb also help reduce inflammation.

Avoid Glyphosate

© Lindsey Elmore, PharmD, BCPS Celiac disease is associated with imbalances in gut bacteria that can be fully explained by the known effects of glyphosate on gut bacteria. Characteristics of celiac disease point to impairment in many cytochrome P450 enzymes, which are involved with detoxifying environmental toxins, activating vitamin D3, catabolizing vitamin A, and maintaining bile acid production and sulfate supplies to the gut. Glyphosate is known to inhibit cytochrome P450 enzymes. Deficiencies in iron, cobalt, molybdenum, copper and other rare metals associated with celiac disease can be attributed to glyphosate's strong ability to chelate these elements. Deficiencies in tryptophan, tyrosine, methionine and selenomethionine associated with celiac disease match glyphosate's known depletion of these amino acids. Celiac disease patients have an increased risk to non-Hodgkin's lymphoma, which has also been implicated in glyphosate exposure.

Inflammatory Bowel Disease: Crohn’s Disease and Ulcerative Colitis

Crohn’s disease (CD) is a type of inflammatory bowel disease and is a recurrent systemic inflammatory disease that mainly affects the gastrointestinal tract, with extraintestinal manifestations and related immune diseases.

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.

Fish Oil

While there has been one study showing benefit of fish oil in managing remission in Crohn’s disease, overall there is insufficient evidence to promote the use of fish oil to management remission of Crohn’s disease.

Acupuncture

Patients who received three treatment sessions per week for 12 weeks had increased quality of life, higher hemoglobin levels, and decreased C-reactive protein. Symptom improvement persisted for 24 weeks.

Cannabis

© Lindsey Elmore, PharmD, BCPS Up to 50% of patients with Crohn’s disease report using cannabis to relieve disease symptoms. Both the CB1 and CB2 receptor are found to be upregulated in Celiac disease. In animal models, THC reduced trinitrobenzene sulfonic acid-induced colitis. CBD has protective effects in murine colitis with less colon injury, reactive oxygen species, tumor necrosis factor.

Cannabis consumption also significantly reduce Harvey Bradshaw Indices which is a composite measure fo well=being, abdominal pain, number of stools, abdominal mass, and complications such as joint pain, anal fissures, or abscess.

Herbal Treatments

For Crohn’s disease, mastic gum, wormwood, and thunder god vine are superior to placebo in inducing remission and preventing post-operative recurrence of disease, respectively.

In ulcerative colitis, aloe vera gel, wheat, green chireta, xilei san were superior to placebo in inducing remission. Curcumin maintains remission. Boswellia serrata gum resin is as effective as mesalazine at controlling symptoms of ulcerative colitis.

Probiotics

A wide variety of probiotics decrease colonic inflammation, and decrease pro- inflammatory cells including interleukins, tumor necrosis factor, NF-κB, and interferons.

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© Lindsey Elmore, PharmD, BCPS 4. Mesnage R, Antoniou MN. Facts and Fallacies in the Debate on Glyphosate Toxicity. Front Public Health. 2017;5:316. Published 2017 Nov 24. doi:10.3389/fpubh.2017.00316 5. Turner D, Zlotkin SH, Shah PS, Griffiths AM. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006320. doi: 10.1002/14651858.CD006320.pub3. 6. Belluzzi A, Bringnola C, Campieri M, Pera A, et al. Effect of an Enteric-Coated Fish-Oil Preparation on Relapses in Crohn's Disease N Engl J Med. 1996; 334:1557-1560. DOI: 10.1056/NEJM19960613334240 7. Bao CH, Zhao JM, Liu HR, et al. Randomized controlled trial: moxibustion and acupuncture for the treatment of Crohn's disease. World J Gastroenterol. 2014;20(31):11000–11011. doi:10.3748/wjg.v20.i31.11000 8. Baumgart DC, Sandborn WJ. Crohn's disease. Lancet. 2012; 380(9853):1590- 605. 9. Di Sabatino A, Battista N, Biancheri P, Rapino C, et al. The endogenous cannabinoid system in the gut of patients with inflammatory bowel disease. Mucosal Immunol. 2011 Sep; 4(5):574-83. 10. Triantafyllidi A, Xanthos T, Papalois A, Triantafillidis JK. Herbal and plant therapy in patients with inflammatory bowel disease. Ann Gastroenterol. 2015;28(2):210–220. 11. Round JL, Mazmanian SK. The gut microbiota shapes intestinal immune responses during health and disease [published correction appears in Nat Rev Immunol. 2009 Aug;9(8):600]. Nat Rev Immunol. 2009;9(5):313–323. doi:10.1038/nri2515