Gluten In Medications: A Hot Topic
How can you successfully manage celiac disease if medications you need contain gluten?
Gluten-free claims on packaged foods and supplements are regulated by the US Food and Drug Administration and standards are in place requiring manufacturers to call out certain common allergens if they are included in a packaged food. Unfortunately, similar laws are not in place for labeling gluten in medications, although a proposed bill was reintroduced to Congress in September 2015.
On April 3, 2019, Representative Tim Ryan introduced H.R. 2074, the Gluten in Medicine Disclosure Act of 2019 to the House of Energy and Commerce Committees Subcommittee on Health. If passed, the bill would amend the Federal Food, Drug, and Cosmetic Act to require gluten be labeled in all medications.
On December 11, 2019, Senator Richard Blumenthal introduced S.3021, to the Senate, Health, Education, Labor and Pensions Committee. This bill is meant to amend the Federal Food, Drug, and Cosmetic Act to require the label of a drug that is intended for human use and contains an ingredient that is derived directly or indirectly from a gluten-containing grain to identify each such ingredient, and for other purposes. It will also be known as the Gluten in Medicine Disclosure Act of 2019 and uses the same language as H.R. 2074, the bill Representative Tim Ryan introduced to the House in April.
There are risks for the celiac disease community when gluten is left off a medication label:
Q: What Should I Do If I Think Im Getting Glutened By My Medicine
A: Your first step should be to call your physician to let them know that youre experiencing symptoms. 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. Similarly, sugar alcohols in medications can cause significant stomach discomfort that could be easily confused with symptoms of gluten exposure. Beyond Celiac strongly recommends that you share your concerns and any symptoms with your doctor as soon as possible. Call the manufacturer to ask about the sources of their inactive ingredients as well as their production processes and any steps taken to prevent gluten exposure.
Where Do I Start
This was my biggest question and the one that caused me the most angst. Once I got started though, it became easier and almost second nature to cook within the parameters of these new food omissions. So, for starters, lets focus on gluten first. Over the next few months, I plan to post more on food allergies and intolerances, specifically gluten and dairy, so please stay tuned.
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Information For Using Wheat Substitutes
One cup of wheat flour equals:
- 1 cup rye meal
- 1 to 1 1/4 cups rye flour
- 1 cup potato flour
- 1 1/3 cups rolled oats or oat flour
- 1/2 cup potato four plus 1/2 cup rye flour
- 5/8 cup potato starch
Some foods and products are not covered by the FALCPA. These include:
- Foods that are not regulated by the FDA
- Cosmetics and personal care items
- Prescription and over-the-counter medicines and supplements
- Toys, crafts , and pet foods
Caution These Ingredients Contain Gluten Too
Consumers should look out for the following ingredients on the label and avoid any foods, supplements, or vitamins containing the following unless the label indicates they are from a non-gluten source:
- Hydrolyzed vegetable protein
- Vegetable starch or vegetable protein
- Gelatinized starch or pregelatinized starch
- Natural flavorings
Foods Where Gluten May Be Hidden
If youre new to eating gluten-free, youve been told to avoid wheat, barley, and rye, but you may not be aware that some processed foods may not sound like a problem but could be made using gluten-containing grains. An example of this is malt, which is germinated dried barley.
How is it possible to consume gluten when youre being so careful about what you eat? You may have ingested, or otherwise taken in, hidden gluten.
Hidden gluten refers to the gluten that is either not mentioned on a product label in a way that is obvious or is in products that may not seem likely to contain gluten but do. Gluten isnt really hiding, but you have to check ingredients carefully or contact the manufacturer to identify it.
How Will I Need To Change My Diet If I Have Celiac Disease
If you have celiac disease, you will need to remove foods and drinks that contain gluten from your diet. Following a gluten-free diet can relieve celiac disease symptoms and heal damage to the small intestine. People with celiac disease need to follow a gluten-free diet for life to prevent symptoms and intestinal damage from coming back. Your doctor or a registered dietitian can guide you on what to eat and drink to maintain a balanced diet.
If you or your child has been diagnosed with celiac disease, you may find support groups helpful as you learn about and adjust to a gluten-free lifestyle. Your doctor or a registered dietitian may be able to recommend support groups and other reliable sources of information.
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What Are The Causes Of Gluten Allergy
As mentioned above, gluten allergy is the outcome of the bodys inability to digest gluten on the consumption of wheat or its products. It begins to show allergic signs and symptoms which may appear within a few hours of wheat consumption.
Let us take a look at the signs and symptoms of Gluten Allergy.
What Foods And Drinks Contain Gluten
Gluten occurs naturally in certain grains, including
- wheat and types of wheat, such as durum, emmer, semolina, and spelt
- barley, which may be found in malt, malt extract, malt vinegar, and brewers yeast
- triticale, a cross between wheat and rye
Gluten is found in foods that contain ingredients made from these grains, including baked goods, baking mixes, breads, cereals, and pastas. Drinks such as beer, lagers, ale, flavored liquors, and malt beverages may also contain gluten.
Many food ingredients and additivessuch as colorings, flavorings, starches, and thickenersare made from grains that contain gluten. These ingredients are added to many processed foods, including foods that are boxed, canned, frozen, packaged, or prepared. Therefore, gluten may be found in a variety of foods, including candy, condiments, hot dogs and sausages, ice cream, salad dressing, and soups.
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Burmese Tofu With Cilantro Lime Stir
Sneak more protein into your diet with this entirely gluten free dish. This mouthwatering Burmese Tofu with Cilantro Lime Stir-Fried Vegetables is a plate thats loaded with nutrients. A combination of great-for-you foods, the tofu in this dish is made with garbanzo bean flour and is entirely gluten and soy-free. When paired with a side of veggies, its a nutrient-rich meal that youll want to dive into immediately.
Foods That May Contain Gluten
These foods must be verified by reading the label or checking with the manufacturer/kitchen staff.
- Energy bars/granola bars some bars may contain wheat as an ingredient, and most use oats that are not gluten-free
- French fries be careful of batter containing wheat flour or cross-contact from fryers
- Potato chips some potato chip seasonings may contain malt vinegar or wheat starch
- Processed lunch meats
- Candy and candy bars
- Soup pay special attention to cream-based soups, which have flour as a thickener. Many soups also contain barley
- Multi-grain or artisan tortilla chips or tortillas that are not entirely corn-based may contain a wheat-based ingredient
- Salad dressings and marinades may contain malt vinegar, soy sauce, flour
- Starch or dextrin if found on a meat or poultry product could be from any grain, including wheat
- Brown rice syrup may be made with barley enzymes
- Meat substitutes made with seitan such as vegetarian burgers, vegetarian sausage, imitation bacon, imitation seafood
- Self-basting poultry
- Pre-seasoned meats
- Cheesecake filling some recipes include wheat flour
- Eggs served at restaurants some restaurants put pancake batter in their scrambled eggs and omelets, but on their own, eggs are naturally gluten-free
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What Additives Contain Gluten
There is more to going gluten-free than just cutting bread out of your diet. If you have celiac disease or a gluten sensitivity, you want to avoid all forms of gluten. Gluten is found in wheat, barley, rye and triticale, and many food additives are derived from these grains. Know what to look for on a food label to avoid these gluten-containing ingredients.
What Is A Fructan And Fructan Intolerance
Fructans are a type of short-chain carbohydrate often referred to as FODMAPs.
Fructans occur in large quantities in:
- wheat, barley and rye
Those who experience digestive problems after eating fructans very likely have a fructan intolerance. Its basically the same concept as those with a lactose intolerance who eat dairy, or those with a fructose intolerance who eat honey.
Summary: Fructans are a type of carbohydrate often referred to as FODMAPs. They are likely to cause strong digestive symptoms in those who are fructan intolerant. Rich sources of fructans include wheat, garlic, onion, chickpeas and more.
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Mashed Potatoes For Pizza Crust
Pizza baked on mashed potatoes? Wow! Thats a treat! Besides being gluten-free, of course, almost everyone loves mashed potatoes.
Potato flour is also a good substitute for gluten-free bread by combining it with other flours that are also gluten-free. People with celiac disease find this substitution appealing.
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Alternative Names For Gluten
Sometimes, gluten-containing ingredients are listed under their scientific names, which are in Latin. The following terms represent the most commonly used Latin terms for wheat, barley, and rye. If you see any of these, the product contains gluten:
- Triticum vulgare
- Pasta: Made from wheat unless otherwise indicated
- Seitan: Made from wheat gluten and commonly used in vegetarian meals
- Wheat or barley grass: Will be cross-contaminated
- Wheat germ oil or extract: Will be cross-contaminated
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Substitutes For Common Gluten Foods
There are many foods that contain gluten. Hence, it can get quite difficult to switch from it to a diet free of gluten.
But theres nothing to worry about as you can also try gluten-free substitutes for foods that are rich in gluten.
Here are a few substitutes for gluten-rich foods you can include in your platter:
- For beer, you can switch to wine or spirits
- In the case of burgers, you can go for gluten-free burgers
- Soba noodles can be replaced by noodles made of beans and lentils
- You can try going for tamari sauce instead of soy sauce
- There are medications rich in gluten too. In such cases, you can go ahead with certified gluten-free medicines.
- In the case of barley malt, try red wine, apple cider, or rice vinegar.
Will There Ever Be A Drug For Celiac Disease
Currently, drugs are not required to note that there may be gluten in the formula on the label. Sometimes even manufacturers dont know, says Bertiger. When patients ask if they can take a specific medication, the truthful answer is were not sure, he says.
If a medication is important for a patients health, Bertiger advises taking it doctors can then retest for antibodies to see if the particular medication may be aggravating any symptoms.
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How Is Gluten Intolerance Treated
Theres no cure for gluten intolerance. But most people find relief from symptoms by following a gluten-free diet. You should work with your healthcare provider and a dietitian to plan your diet.
You can also ask your healthcare provider about adding probiotics to your diet. Probiotics help increase the good bacteria in your gut. They may reduce symptoms of bloating, gas or constipation.
Some research suggests that taking certain enzymes may help you digest gluten. But experts are still investigating this treatment. Talk to your healthcare provider before taking any enzymes.
How Can I Identify And Avoid Foods And Drinks That Contain Gluten
A registered dietitian can help you learn to identify and avoid foods and drinks that contain gluten when you shop, prepare foods at home, or eat out.
For example, when you shop and eat at home
- carefully read food labels to check for grains that contain glutensuch as wheat, barley, and ryeand ingredients or additives made from those grains.
- check for gluten-free food labeling.
- don’t eat foods if you arent sure whether they contain gluten. If possible, contact the company that makes the food or visit the companys website for more information.
- store and prepare your gluten-free foods separately from other family members foods that contain gluten to prevent cross-contact.
When you eat out at restaurants or social gatherings
- before you go out to eat, search online for restaurants that offer a gluten-free menu.
- review restaurant menus online or call ahead to make sure a restaurant can accommodate you safely.
- at the restaurant, let the server know that you have celiac disease. Ask about food ingredients, how food is prepared, and whether a gluten-free menu is available. Ask to talk with the chef if you would like more details about the menu.
- when attending social gatherings, let the host know you have celiac disease and find out if gluten-free foods will be available. If not, or if you are unsure, bring gluten-free foods that are safe for you to eat.
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Gluten A Group Of Proteins That People With Gluten
ISBN: 978-0-660-35157-5Pub.: 200075
Gluten is the common term for a group of related proteins known as prolamins and glutenins found in wheat, rye and barley. Gluten is harmful for patients with gluten-related disorders , which includes celiac disease, wheat allergy, as well as non-celiac gluten sensitivity, dermatitis herpetiformis and gluten ataxia.
For people with celiac disease, the prolamins found in wheat , rye and barley are considered to be of most concern.
For people with wheat allergy, gluten and some other proteins from wheat can trigger allergic reactions, but gluten from rye and barley does not.
For people without celiac disease, wheat allergy or other gluten-related disorders, gluten is safe to eat.
What Is Wheat Allergy
Wheat allergy is most often reported in young children and may affect up to 1% of children in the U.S. One study found that two-thirds of children with a wheat allergy outgrow it by age 12.1 However, some individuals remain allergic to wheat throughout their lives.
When a person with a wheat allergy is exposed to wheat, proteins in the wheat bind to specific IgE antibodies made by the persons immune system. This binding triggers the persons immune defenses, leading to reaction symptoms that can be mild or very severe.
Wheat allergy and celiac disease are both adverse food reactions, but their underlying causes are very different. Wheat allergy results from an adverse immunologic reaction to proteins in wheat and reactions can cause typical allergy symptoms involving the skin, gastrointestinal tract, respiratory system, and anaphylaxis in some individuals.1
Celiac disease is an autoimmune disease. Antibodies are produced in response to the presence of gluten resulting in inflammation and damage to the lining of the small intestine. Many symptoms involve the gastrointestinal tract . Other symptoms can include skin rashes and disorders that result from nutrient deficiencies. The estimated global prevalence of celiac disease is 1%, similar to wheat allergy.2
Its important to work with your physician to determine an accurate diagnosis to prevent short- and long-term complications.
Wheat is sometimes found in the following:
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What Does May Contain Mean
Basically, it means that an allergen MAY be present in this product. The manufacturer cant guarantee that it isnt present, even though the allergen is not listed in the ingredients. The manufacturer wants to voluntarily let the consumer know that they do not have a dedicated gluten-free facility for producing the product. Thus, may contain labels boils down to cross-contamination potential. The product was either made in a facility that also makes products containing wheat, or that equipment and/or employees are used to produce both wheat and gluten-free products.
It is a warning that there could be trace amounts of that allergen present in the product and it is probably more than 20ppm. An example could be a bag of rice that says may contain wheat on the label. Now, rice is inherently gluten-free, but depending on how and where it is produced, there is a possibility for cross-contamination. This could be true of any product from frozen fruit/vegetables to beans or corn meal. This is why you must always read the labels, on almost every product.
Gluten-Free Tip:You can always call the manufacturer and ask about the product, to find out why it would contain wheat/gluten. Sometimes knowing what the risk of cross-contamination is, can help you make an informed decision.
Should I Start A Gluten
No. If you think you might have celiac disease, you should talk with your doctor about testing to diagnose celiac disease before you begin a gluten-free diet. If you avoid gluten before you have testing, the test results may not be accurate.
Also, if you start avoiding gluten without advice from a doctor or a registered dietitian, your diet may not provide enough of the nutrients you need, such as fiber, iron, and calcium. Some packaged gluten-free foods may be higher in fat and sugar than the same foods that contain gluten. If you are diagnosed with celiac disease, your doctor and dietitian can help you plan a healthy gluten-free diet.
If you dont have celiac disease or another health problem related to gluten, your doctor may not recommend a gluten-free diet. In recent years, more people without celiac disease have begun avoiding gluten, believing that a gluten-free diet is healthier or could help them lose weight. However, researchers have found no evidence that a gluten-free diet promotes better health or weight loss for the general population.8
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