coatings on vitamins a problem?

[mia]

I'm wondering if the capsules that my vitamins are in are a problem. They are 'gelatin' type capsules - but sometimes I wonder if they are causing reactions. What do you all take for supplements? One of the things I worry about with this CC is that I'm not getting enough nutrients and vitamins; if these capsules are a problem- what would I do to address this I wonder.

I'm going to make an appt with my doctor; I'll ask for a referral to a gastro and to an allergist ( I have to fly to see specialists though, as I'm in Northern BC, Canada- a big deterrant to seeing specialists!) I think I'm going to ask for Asacol ( as I've just read that it controls inflammation, but it's not a steroid).

I still REALLY don't want a colonoscopy. They worry me because of the higher incidence of the colon 'splitting' when the air is pushed through ahead of the 'scope' thing - I think Dr Fine said the higher incidence of this splitting was because the colon is compromised by that extra collagen layer. Maybe someone can correct me on this.

[tex]

Mia,

Gelatin is made from, (believe it or not), collagen, so it is a natural material, and yes, it is the same type of material found in those collagen bands, in our intestines, and many other parts of the body. As far as I am aware, ingesting it has never been a problem for any of us. If you want to use vitamins that you can be sure are safe, Polly recommends Freeda vitamins, and she uses them herself:

http://www.freedavitamins.com/

I have problems with peripheral neuropathy, (presumably due to years of gluten damage) so in addition to a multivitamin, I take vitamin D3, (4,000 IU from November through April, 2,000 IU the rest the year), a product called Metanyx, which consists of megadoses of vitamins B-12, B-9, and B-6, (available by prescription only), glucosamine sulphate with condroitin, (1,500 mg glucosamine sulphate, 1,200 mg condroitin), 1,200 mg flax seed oil, and 1,200 mg fish oil. I also take lutein, since I have had an eye condition known as Drusen, (a form of macular degeneration), for over 30 years. Of course you would need much more D3, in British Columbia, than I need here in Texas.

Some members react adversely to Asacol, because it contains lactose. If I remember correctly, the other brands of mesalamine do not contain lactose.

If the endoscopy exam is just for the purpose of collecting biopsy samples, to verify whether or not you still have CC, the GI doctor can use a sigmoidoscope, instead of a colonoscope. As you are probably aware, Dr. Fine specifically recommends it, in order to avoid the splitting risk that you mentioned.

So far, no one here has mentioned any complications, (such as splitting), following a colonoscopy, but of course, one would not be aware that it had happened, unless a followup exam, (or x-rays, for example), were done. This is because the splits usually do not go completely through the wall of the colon, so that the serosa, (the outer wall of the colon, usually remains intact. If the splits were to completely penetrate the wall of the colon, then obviously a perforation would result in a severe and painful infection, requiring emergency surgery.

IOW, compressed air is used to inflate the colon, to improve visibility, with a colonoscopy, but it's not used, (as far as I am aware), with a sigmoidoscopy exam.

Tex

[mia]

Thanks Tex! It really does help to get input when trying to sort things out. I keep going over and over it all. Part of my trouble is that I don't really feel like my doctors are knowledgeable- and because they are -all of them- so into the 'medical community party line' and won't consider anything unless approved by the medical establishment and pharmaceuticals- I feel always like I can't trust them. Sometimes I think they just have a recipe book- 'CC- then prescribe these meds". Sigh.

[teagirl]

Hi Mia, I am Canadian too and take Pentasa, another form of the drug that is also supplied as Asacol. Pentasa is gf and drug plans, if you have one, cover it.

If you end up with Pentasa tablets, it's likely to be the 500mg flecked tablets. I began on 8 a day but am now on 4 a day (over one year). The one thing I find bad about them is that they don't go down well with water - they seem to get stuck in the gullet. I take mine with rice milk (I am df as well) and they go down fine.

[ant]

Tex said

So far, no one here has mentioned any complications, (such as splitting), following a colonoscopy

Wow, I had not really thought about this until reading this thread. Does anyone know if, over time, such splitting would heal naturally?

Best, Ant

[tex]

In Dr. Fine's own words:

The latest finding I have become familiar with (although I have never experienced because I perform flexible sigmoidoscopies rather than the more risky colonoscopy) is a splitting of the surface of the colon resulting from air insufflation during the time of colonoscopy. This complication appears as a linear tear without surrounding inflammation characteristic of an ulcer. It is usually seen when there is collagen associated with the microscopic colitis (usually called collagenous colitis).

http://www.finerhealth.com/Educational_ ... c_Colitis/

Notice that he says "surface" of the colon, (referring to the luminal, or interior, surface). A linear tear would refer to a tear in the direction of the main axis of the colon, (a transverse tear would be the correct term for a tear in the circumferential direction, but apparently that is not a risk). Since those tears presumably should not propagate past the depth of the lamina propria, they would certainly be less severe than some of the lesions caused by Crohn's disease, and therefore should heal without intervention, unless infection becomes a problem. I'll bet some of us have experienced this, (especially those who have several days of significant pain, following a colonoscopy exam), but we were unaware of what had actually happened.

Tex

[ant]

Thanks Tex.

Ant

[natythingycolbery]

If you end up with Pentasa tablets, it's likely to be the 500mg flecked tablets. I began on 8 a day but am now on 4 a day (over one year). The one thing I find bad about them is that they don't go down well with water - they seem to get stuck in the gullet. I take mine with rice milk (I am df as well) and they go down fine.

I'm currently on 8 a day of the 500mg Pentasa and I have this problem too! I tried breaking the tablets up and it didn't work, putting the tablets in a small amount of water really didn't help matters at all. so i either end up just going for it with water and sucking a mint or eating something small immediatley afterwards to help it go down, or rather (i presume) unadvisably taking the tablets with a drink of cola as they don't get stuck

[tex]

Naty,

Pentasa has an enteric coating, so that it will not release the active ingredient, (mesalamine), until after it has passed through the stomach, into the intestines. IOW, it should be swallowed whole, because breaking up the pill may cause the drug to be released too early in the digestive tract. You can take it with a meal, or with a snack, if that helps.

Soaking it in water can cause it to dissolve too soon in the digestive tract, also. The directions say to take it with a full glass of water. Taking it with a glass of water will not cause it to activate, because as soon as it hits the stomach, the low pH level will prevent it from activating. As it emerges from the stomach, and enters the small intestine, the pancreas will release a buffering agent into the stream, which will raise the pH to above 6.5, at which point most enteric coatings will break down, and allow the pills to activate.

Tex

[natythingycolbery]

Naty,

Pentasa has an enteric coating, so that it will not release the active ingredient, (mesalamine), until after it has passed through the stomach, into the intestines. IOW, it should be swallowed whole, because breaking up the pill may cause the drug to be released too early in the digestive tract. You can take it with a meal, or with a snack, if that helps.

Soaking it in water can cause it to dissolve too soon in the digestive tract, also. The directions say to take it with a full glass of water. Taking it with a glass of water will not cause it to activate, because as soon as it hits the stomach, the low pH level will prevent it from activating. As it emerges from the stomach, and enters the small intestine, the pancreas will release a buffering agent into the stream, which will raise the pH to above 6.5, at which point most enteric coatings will break down, and allow the pills to activate.

Tex

Hey Tex, it actually says in the leaflet that comes with the medication that it can be added to 50ml of water and drunk immediatley or broken into 2. Also what is the enteric coating? I googled it and got confused

[natythingycolbery]

Just found the link to the leaflet in my pentasta... http://www.netdoctor.co.uk/medicines/100001423.html

It says half way down:

'Pentasa tablets must not be chewed or crushed. They should be swallowed with fluid, either whole or broken up. The tablets can also be dispersed in 50ml of cold water. Stir and drink immediately.'

[tex]

Naty,

When I advised against "soaking it in water", I meant leaving it to soak for a while, of course. If you drink it immediately, that's no different than swallowing the pill, and chasing it with water, so obviously that is OK to do.

Since you asked about the enteric coating, I looked it up, in an old post I had written, (a couple of years ago), and I've copied my post below, (and included a link to the thread where I originally posted it). Evidently, it is indeed safe to break up a Pentasa tablet, because of the unique encapsulation method used with it. Instead of encapsulating the entire pill, individual granules are microencapsulated. That way, it is still encapsulated, even after it is broken up into tiny pieces. My old post explains the details of the encapsulation process. I've emphasized the parts that refer to Pentasa, by having them print in red.

This topic, (about the Asacol capsules passing through the GI tract and remaining intact, sometimes), comes up on this board every once in a while, so here's the "poop" on that phenomenon:

In order to insure delivery of the active 5-ASA compounds to the ileum and the colon, (without becoming activated in the stomach, or upper small intestine), the ingredients are encapsulated in a "shell" made of acid-resistant acrylic resin, used in combination with sodium bicarbonate/glycine buffering. Two different types of commercial resins are used for the various 5-ASA products, (which include Asacol, Pentasa, Rowasa, Colazal, etc.). The resin used for Asacol is known in the trade as Eudragit S, and the one used for the others is Eudragit L. Eudragit S disintegrates at pH>7, (IOW, a pH value greater than 7, which would be a slightly alkaline level), whereas Eudragit L disintegrates at approximately a pH value of 6, (which would be a slightly acid level). Obviously, a pH value of 6 would be reached sooner than a pH value of 7, as the capsules travel down the GI tract. The pH of the stomach should be somewhere in the 2 to 3 range, (assuming the stomach is producing sufficient acid for proper digestion), and as the chime leaves the stomach, the pancreas dumps bicarbonate into the small intestine, (at the upper duodenum), in order to raise the pH level of the chime as it passes through the intestines.

Therefore, I would surmise that if the pH of your ileum and colon are acidic, (that is, pH below 7), the Asacol capsules will not disintegrate, and should pass through the entire system, in their original form.

If the capsules disintegrate, (IOW, if the pH is greater than 7), then the sulfasalazine parent ingredient will be reduced by the bacterial enzyme azoreductase, to the active ingredients, sulfapyridine, (which is effective to treat rheumatoid arthritis), and 5-ASA, (which is effective to treat colitis). IOW, coliform bacteria are necessary to reduce the relatively inactive parent drug to its active derivatives.

I would further surmise that in the absence of adequate coliform bacteria, (IOW, an inadequate supply of the bacterial enzyme azoreductase), then the conversion will not take place, (the components will not be split and activated), and no benefit will be derived from the drug, even though the capsule might have disintegrated correctly.

Pentasa uses a different technology - it is microencapsulated in a semipermeable ethylcellulose membrane, which is acid stable, and active 5-ASA diffuses through the membrane at a rate that is dependent on the ambient pH. With this system, the time to 50% release at a pH of 2 is 15 hours, whereas at a pH of 7, the time is 4 to 5 hours. IOW, not much will be released in the stomach, and the rate of release will increase as the med travels farther down the GI tract.

Colazal uses a completely different mechanism - it uses one 5-ASA molecule linked to an inert unabsorbed carrier molecule. Colazal is sometimes effective for patients who get no benefit from the other 5-ASA drugs. It still requires the presence of colonic bacteria, however, in order to activate the 5-ASA. Therefore, I would assume that if a patients gut bacteria are in disarray, then the 5-ASA meds may be ineffective.

It's no wonder then, that Asacol does not work for everyone, since the pH of the intestines needs to be in the proper range for the encapsulation to disintegrate, and the colonic bacteria need to be producing the enzyme azoreductase, in order for the 5-ASA to become activated. It would appear that this family of meds would work properly on someone with a normal digestive system, (which none of us have), but it may be ineffective for those of us with the noted digestive system problems. At least that's the way I see it.

Tex

http://www.perskyfarms.com/phpBB2/viewt ... n&start=30

Sorry for the confusion.

Tex

[natythingycolbery]

No worries Tex, it's nice to know i'm not making things worss by doing strange things!

[mfwsunshine]

I was diagnosed with collagenous colitis about two years ago. The Dr. gave me no clues as to what - in my diet -might affect my system. He prescribed Asacol which seemed to be doing some good for a few days. Then, the symptons kept getting worse and worse. The Dr. then doubled my dose which of course made it ten times worse. My question is this: I am highly allergic to sulfa drugs. You mentioned sulfasalazine as an ingredient in Asacol. Could that be the reason it made my symptons worse?

[tex]

Hi,

Welcome to the board.

Yes, there can definitely be a cross-reaction.

Sulfasalazine and sulfa allergies — People who are allergic to sulfa drugs may have a cross reaction to sulfasalazine and should therefore not take it.

From:

http://www.uptodate.com/patients/conten ... PRd8_TGd.L

Your doctor should have known better, if he or she was aware that you are allergic to sulfa drugs.

Please feel free to ask anything.

Tex