Dear Pharmacist,

In a previous column on apple cider vinegar (ACV), you stated that “heartburn and reflux can sometimes be related to insufficient levels of stomach acid, not high levels like many of you who take acid blockers assume.”  Really Suzy?  I’ve been on Omeprazole for years for heartburn.  My doctor says you’re nuts and got angry when I questioned him.

–T.B. Ft. Lauderdale, Florida

Answer: Doctors who thoroughly understand gastrointestinal function know this basic principle of physiology. A simple blood test evaluates stomach acid levels. Most physicians don’t test your “gastrin” level, they just hand you a prescription for medication. This bothers me.

Judging from the millions of pills that are dispensed from American pharmacies on a daily basis, the business of convincing you that “stomach acid is bad”  is working. Don’t misunderstand, acid blocking drugs are effective and necessary for certain individuals, but they are way overprescribed. As a nation, we should spend more money educating the public on how to eat healthier, rather than drugging people up each day, and advertising double-bacon triple-bypass cheeseburgers. I’m just saying…

Anyway, the signs of low acid (termed hypochlorhydria) may be heartburn, irritable bowel syndrome, burping, cramps, food sensitivities and a higher risk for autoimmune disorders, gallbladder disease, pancreatitis and cancer. Hypochlorhydria is a huge problem in this country and it’s getting more widespread, especially since the advent of acid blocking meds. Insufficient acid (whether it is drug-induced or not) can also cause:

Hashimoto’s thyroiditis

Osteoporosis

Elevated homocysteine

Rosacea and acne

Rheumatoid arthritis

Eczema and psoriasis

Yeast infections

Adrenal exhaustion

Vitiligo

Why does acid help? Many reasons, and one of them is that it keeps the tiny trap door shut between your stomach and esophagus. This sphincter is pH sensitive and in a healthy person, it stays shut because of the natural stomach acid. With acid deficiency, the stomach pH increases and this may cause the trap door to swing open, causing that familiar burn. Many people swear by the vinegar trick because it provides various acids including “acetic” acid, but gulping ACV forever is not my preference because it may be too caustic.

Digestive acids are sold at health food stores by names such as “betaine hydrochloride,” “betaine with pepsin” or “trimethylglycine.” Begin supplementation slowly and increase your dosage upward based on symptom relief. Take acid supplements at the end of each meal, not the beginning.  Ask a knowledgeable physician if acid supplements are appropriate for you, especially if you take medications of any sort.  Acid supplements aren’t right for everyone and should be approached with caution.

Betaine supplements work best when you eat healthy foods; you may also need to be gluten and casein free. Depending on your condition, you could also greatly benefit from probiotics, digestive enzymes, ginger, cayenne pepper, glutamine, bile salts and/or DGL (deglycyrrhizinated licorice).

Did You Know?

A new study concludes that bisphenol-containing plastics (some water bottles) make men four times more likely to have erectile dysfunction.

Dear Pharmacist,

I read your Facebook post about vitamin D and how it works better than diabetic medications.  I have diabetes, and no one has ever told me this. Would you share more information?  –L.N.  Denver, Colorado

Answer: Diabetes is an inflammatory condition, it is not just about high blood sugar like most people think. If left to run it’s devastating course, diabetes could steal your vision, destroy your kidneys, cause nerve pain, heart attack, stroke or amputation. So we have to take diabetes seriously, and do all that we can to reduce blood sugar (glucose) and make our cells happier to see insulin (improve insulin sensitivity).

Doctors have many medications at their disposal to reduce blood glucose. I think natural vitamin D can help too, so I posted that comment on Facebook and Twitter. I was trying to help people with diabetes because they may not know that it’s an inexpensive, over-the-counter dietary supplement. My comment was based in clinical science. More specifically, on a 2004 study published in the American Journal of Clinical Nutrition which found that raising a person’s blood levels of vitamin D (from 25 to 75 nmol/l) could improve insulin sensitivity by a whopping 60 percent. Compare that to metformin, one of our pharmaceutical gold-standards, which can dispose of blood sugar by a meager 13 percent according to the New England Journal of Medicine.

Guess what else? Back in 2001, The Lancet found that infants who took 2,000 IU daily, enjoyed a lowered risk of developing type 1 diabetes. Researchers have also found it may slash a person’s risk of developing pancreatic cancer in half.  Just amazing!

Before vitamin D can work inside your cells as a hormone, it has to undergo some biochemical changes in your liver and kidneys. People with diabetes have difficulty activating vitamin D to the body-ready form.

It annoys me that conventional medicine’s answer to controlling blood sugar centers primarily around medications which often has side effects. Many studies have concluded that D is good for people, especially those who have high insulin, prediabetes, diabetes, metabolic syndrome,  pancreatitis, breast or prostate cancer and heart disease.

If for some reason your physician snubs his/her nose at this dietary supplement, then get tested. There are home test kits, or you can ask your physician to order one at the local lab. Then there will be no question.

Low vitamin D is associated with depression, fatigue, osteoporosis, heart disease, hypertension, autoimmune disease, cancers and chronic pain. Dosages vary.  I suggest you ask your doctor if he minds you supplementing with about 5,000 IU “cholecalciferol” or vitamin D3 every morning.  The most usable form of vitamin D is D3 (not D2) so read your label carefully. For more information, visit www.vitamindcouncil.org

Did You Know?

Papaya extract (and fresh papayas) “papain” enzyme which helps you digest your food, especially protein.

All of the following medications are gluten free unless otherwise noted

ANALGESICS/NONSTEROIDAL

Acetaminophen w Codeine (Teva)

Advil

Aleve

Alka Seltzer Gold

Anaprox

Anaprox DS

Arthrotec

Aspirin Enteric Coated 325mg (Leiner,code #44/227, Watson)

Aspirin 81mg chewable (Watson)

Avinza

Baby aspirin (Walgreens, Perrigo)

Bancaps HC

Bufferin-all products EXCEPT

Bufferin regular 325mg tablet

which does contain some gluten

Butazolidin

Carisoprodol (Watson, West-Ward)

Cataflam

Celebrex

Clinoril

Cyclobenzaprine (Mylan, Schein, Watson)

Daypro

Demerol

Durabac

Ecotrin (all strengths)

Endocet

Endodan

Esgic (all forms)

Excedrin Extra Strength

Feldene-contains gluten

Fioricet / with Codeine

Fiorinal

Fiorinal caps-generic (West-Ward)

Fiorinal tabs-generic (West-Ward)

Fiorinal with Codeine

Flexeril

Flubriprofen (Novapharm)

Hydrocodone/APAP all strengths (Mallinckrodt, Watson)

Ibuprofen (Pharm. Formulations)

Indocin

Indomethacin (Novapharm)

Ketoprofen XR (Andrx)

Lodine (tabs/caps/XL)

Lorcet 10/650

Lorcet Plus

Lortab

Motrin Childrens DF Conc. Drops

Mobic

Morphine IR tabs (Roxane)

Morphine Sulfate Ext Release Tab (Endo)

Motrin (Children’s) oral susp

Motrin Cold DF Berry

Motrin DF Oral Susp Berry

Motrin IB caplets

Motrin IB tabs

Naprelan

Naprosyn

Naproxen (Novapharm)

Nuprin

Parafon (generic from Lemmon Pharm)

Parafon DSC

Percocet

Percodan

Piroxicam (Novapharm)

Propoxyphene Napsylate (Mallinckrodt)

Relafen

Robaxin

Salsalate (Caraco)

Soma

Tizanidine (Purepac)

Tolectin (all strengths)

Tolmetin (Novapharm)

Tylenol Arthritis Pain Extended Relief Caplets

Tylenol cherry suspension infants drops

Tylenol chewable fruit burst flavor tabs

Tylenol Childrens Susp Grape Liquid

Tylenol Cold Plus Cough Chew Tab

Tylenol extended relief caplets

Tylenol extra strength caplets

Tylenol extra strength liquid

Tylenol extra strength PM gelcaps

Tylenol tabs

Tylenol ultratab

Tylenol with Codeine

Tylox

Ultracet

Ultram

Vicodin

Vioxx

Voltaren / XR

Zanaflex

Zydone

ANTIBIOTICS/ANTI-INFECTIVES

Acyclovir (Teva, Roxane,Schein, Novapharm)

Amoxicillin (Apothecon,Novapharm,Sandoz,Teva)

Amoxicillin chewable (Novapharm,Teva)

Amox/Clavulanic Acid (Prasco)

Amoxil

Augmentin tabs and liquids

Azithromycin (Greenstone,Teva, Pleva, Wockhardt)

Bactrim (tabs & liq)

Biaxin (tabs/liquid)

Bicillin

Ceclor

Cefaclor (Novapharm)

Cefadroxil tabs & caps (Ranbaxy)

Cefpodoxime 100 mg (Aurobindo)

Ceftin

Cefzil

Cefuroxime (Ranbaxy)

Cephalexin (Teva, Novopharm)

Cinobac

Cipro

Cleocin

Cleocin

Clindamycin (Greenstone)

Coly-Mycin M Inj

Cortisporin Cream & Oint

Dicloxacillin (Bristol-Myers-Squibb)

Diflucan tabs

Doxycycline (Zenith/Goldline)

Duricef

Erythromycin tabs (Abbott labs)

Flagyl tabs

Floxin

Fluconazole (Apotex, Barr, Greenstone)

Furoxone (tabs & liquid)

Isoniazid 100 & 300 mg (West-Ward labs)

Keflex

Levaquin (all strengths)

Lorabid

Macrobid

Minocycline caps (Ranbaxy,Schein)

Neosporin (all forms)

Noroxin

PCE

Priftin

Procaine Pen G (Monarch)

Proloprim (status unsure)

Retrovir

Rifadin

Rifamate

Rifater

Septra (tabs & liq)

Silvadene

SMZ-TMP (generic Bactrim-Lemmon Pharm)

Suprax susp

Suprax tabs

Tequin

Trimox

Trovan (all strengths)

Vantin

Vfend

Vibramycin (tabs & caps)

Vibratabs

Viracept

Zithromax (caps & suspension)

Zmax

Zovirax tabs and caps

Zyvox

ANTIDIARRHEALS

Bentyl (all forms)

Cantil

Dicyclomine (Lakeside, Mylan, Rugby, West-Ward)

Diphenoxylate/Atropine (Mylan, Sandoz)

Imodium

Imodium AD Caplets

Kaopectate

Lomotil

Loperamide tabs & caps (Novapharm)

Motesan

Pepto Bismol

ANTIHISTAMINE/DECONGESTANTS/COUGH/COLD

Actifed

Alavert (all forms)

Allegra

Allegra D

Atarax

Benadryl-all products

Benzonatate (Pleva)

Chlortrimeton 4 mg tabs

Chlortrimeton 8mg and 12 mg extend tabs

Chlortrimeton liquid

Clarinex

Clarinex D

Clarinex Reditabs-company does not know source of starch

Claritin

Claritin D

Claritin D-24

Claritin liquid

Codiclear DH (sugar and dye free)

Comtrex (tabs/caplets/liquid)

Comtrex Deep Chest Cold

Comtrex Non Drowsy

CoPyronil

Creomulsion

Dayquil

Deconamine caps

Deconamine SR

Deconsal

Dimetane tabs-contains gluten

Dimetapp elixir

Dimetapp tabs-contain gluten

Drixoral

Duraflu

Durahist D caplets

Duraphen 100 caplets

Duraphen DM

Duraphen Forte

DuraTan DM susp

DuraTan Forte susp

Endafed

Entex

Entex LA

Entuss D

Eudal SR

Extendryl syrup, JR and SR caps

Fenofexadine (Teva)

Guaifenesin LA 600 mg (URL/Mutual)

Hycomine

Hycodan

Mucinex (all forms)

Mytussin AC

Mytussin DAC

Naldecon (tabs/syrup)

Naldecon DX Children’s syrup

Naldecon DX ped drops-may contain gluten

Naldecon generic (Rugby)

Niquil

Nucofed (all forms)

Periactin

Phenergan w/ Codeine syrup

Phen-Guai 25/900 (Prasco)

Promethazine w. Codeine Syrup (Hi-Tech Pharmacal)

Robitussin Cold & Congestion Caplet

Robitussin Cold & Cough Liqui-Gels

Robitussin Cold Severe Congestion liqui-gels

Robitussin Cold, Cough & Flu Liqui-Gels

Robitussin line

Robitussin Multi Symptom Cold & Flu Caplets

Robitussin Night Time liqui-gels

Ryna C

Ryna D

Rynatan

Safetussin 30

Scot-Tussin DM

Seldane

Seldane D

Sudafed

Sudafed Cold & Sinus Liquid Caps

Sudafed Plus

Tavist

Tavist D

TheraFlu Cough and Cold

Triaminic AM

Tuss DM

Tussend

Tussigon

Tussin 30

Tylenol allergy sinus caplets, maximum strength

Tylenol cold multi-symptom plus cough chewable tab

Vanex

Zyrtec (tabs & liquid)

Zyrtec D

ANTIFUNGALS

Diflucan

Grifulvin 5- “weak” gluten content

Lamisil

Nizoral

Sporonox

ASTHMA/RESPIRATORY

Accolate

Advair

Aerobid

Albuterol tabs (Novapharm)

Alupent (tabs/syrup)

Alupent inhaler

Aminophyllin tabs (West-Ward)

Atrovent

Azmacort

Beclovent

Combivent

Flovent

Flovent Rotadisk

Foradil Aerolizer

Guaifenesin (URL)

Intal inhalations

Maxair

Proventil (tabs/syrup)

Proventil HFA

Proventil inhalation

Proventil solution

Pulmicort

Quibron

Serevent Diskus

Serevnt Inhaler

Singulair (all stregnths)

Slobid (all strengths)

Tilade

Vanceril

Ventolin (tabs/syrup)

Ventolin inhaler

Ventolin solution

Xopenex

ENZYMES

Creon

Pancrease

Pancrease MT 10

Pancrease MT 16

Pancrease MT 20

Pancrease MT 4

Pangestine CN20

Viokase

EYE AND EAR PREPARATIONS

Acular

AK Mycin

Alamast

Alocril

Alomide

Azopt

Betoptic

Chibroxin

Ciloxin

Coly-Mycin S Otic

Cortisporin Ophth

Cortisporin Otic Solution

Cosopt

Cromolyn (Teva)

Dexacidin

Emadine

Floxin

FML

FML Forte

GenTeal eye drops

GenTeal eye gel

Gonisol

Herplex

Lacrisert

Livostin

Lotemax

Naphcon

Naphcon A

Ocufen

Ocuflox

Ocuhist

Otocain Drops

Patanol

Polysporin

Polytrim

Pred Forte

Pred G

RESCULA

Spersallerg

Sulamyd

Sulf-10

Tetracaine

Timoptic

Timoptic XE

Tobradex

Tobrex

Trusopt

Vasocidin

Vasocon

Vasocon A

Vasosulf

Vexol

Vira A

Viroptic

Visine

Visine A

Voltaren

Xalatan

Zaditor

MISCELLANEOUS

Abilify

Accupril

Aci-Jel

Aciphex

Actonel

Adalat

Adderal (all strengths)

Adrenalin inj

Aggrenox

Aldactazide

Aldactone

Aldoclor

Aldomet

Aldoril

Alkeran

Almora

Allopurinol (Mylan)

Alprazolam (Greenstone, Novapharm)

Alprazolam XR (Greenstone)

Altace

Ambien

Amerge

Amicar (tabs,syrup)

Amitriptyline (Geneva)

Amitiza

Amlodipine/Benazepril (Greenstone, Teva)

Anafranil

Angiscein

Antivert

Anturan

Anusol HC Cream

Anusol HC Supp

Anzemet

Apligraf

Apresoline

AquaSite

Arava

Aredia

Aricept

Aricept ODT

Arimidex

Armour Thyroid

Asacol

Atacand

Atacand HCT

Atenolol (Novapharm)

Ativan (all strengths)

Attenuvax

Avalide

Avapro

Avelox

Axert

Azulfidine (all forms)

Banzel 200 mg and 400 mg

Baycol (now questionable)

Bellaspas

Benicar

Betapace

Betaseron

Bextra

Biavax

Boniva

Brevital Inj

Bupropion Sustain Release (Purepac)

Buspar

Cabergoline

Caduet

Cafergot

Captopril (Novapharm)

Carafate (tabs & suspension)

Carbamazepine (Teva)

Carbatrol

Carbidopa/Levodopa tabs (Endo)

Cardizem SR

Cardura XL

Cartia XT (all strengths)

Casodex

Catapres patch

Catapres tablets

Celexa

Celontin

Chantix

Cibacalcin

Cimetidine (Novapharm)

Citrucel

Clofibrate (Novapharm)

Clomid

Clomiphene (Par, Teva, Watson)

Clomipramate (Novapharm)

Clonazepam (Apote, Caraco, Mylan, Sandoz, Watson)

Clorazepate (Watson)

Clorpres

Clozaril

Cognex

Colace

Colchicine (West-Ward)

Colested

Colestipol (Greenstone)

Combipatch

Combipres

Comtan

Comvax

Coreg

Corgard

Corizide (NOT GF)

Cortef

Cortenema

Cortisone (West-Ward)

Cortone

Coumadin (all strengths)

Covera

Cozaar

Crestor-contains no starch but company won’t verify

that product is GF

Cylert chewable

Cymbalta (all strengths)

Cystospaz

Cystospaz M

Cytadren

Cytomel

Cytomel

Danazol (Barr)

Dapsone

DDAVP

Decadron

Denavir

Depakote (all forms)

Desferal

Desyrel

Detrol

Detrol LA

Dexamethasone (Taro)

Dexedrine (Smith-Kline-Beecham)

Dexone

Diastat

Didronel

Digel liquid & tabs

Digitek

Dihydergo

Dilantin

Diovan / Diovan HCT

Ditropan

Ditropan XL

Diuril

Divalproex Sodium (ApotexMylan, Dr Reddy’s, Sandoz, Teva)

Dolobid

Dostinex

Duphalac

Dyazide

Edecrin

Effexor (all strengths)

Elavil

Elidel

Elspar

Enablex

Endagen-D

Enjuvia

Entocort EC

Eplerenone tabs (Greenstone)

Esidrex

Eskalith

Eskalith CR

Estrace

Estraderm

Estratab-possible gluten in active ingredient

Estratest-possible gluten in active ingredient

Estring

Estrostep

Etodolac (Taro)

Evista

Exelon

Famvir (all strengths)

Femara

Fenesin

Fenesin DM

Fentora

FiberCon

Fiberlax

Flomax

Florinef

Fluoxetine-all strengths/forms (Barr, Par, Sandoz)

Flurazepam (West-Ward)

Flumadine

Focalin

Fosamax

Fosrenal

Frova

Furosemide (Watson-doesn’t test but uses corn starch)

Furosemide (Ivax,Sandoz)

Gabapentin (Apotex, Greenstone)

Gabitril (all strengths)

Gas-X

Gaviscon

Geodon

Gleevec

Glivec

Glycopyrrolate (URL, Mikart)

Halcion

Haldol (tabs, concentrate)

Humatin

Hydergine

Hydrochlorothiazide (Qualitest)

Hydrocortone

HydroDiuril

Hygroton

Hyoscyamine 0.375mg (Amide)

Hyzaar

Imitrex

Inapamide (Novapharm)

Inspra

Isosorbide Dinitrate (West-Ward)

Kapidex

Kayaxelate

Kemadrin

Keppra (all strengths)

Ketek

Klor-Con

Lactaid liquid drops

Lactaid original strength caplets

Lactaid ultra caplets

Lamictal

Lamprene

Lanoxin

Lasix

Leflunomide (Apotex, Sandoz)

Lescol / XL

Leucovorin

Leurkeran-contains gluten

Levothroid

Levothyroxine (Mova)

Levoxyl

Levsin

Levsinex

Lexapro

Lexxel

Lioresal

Lioresal Intrathecal

Lipitor

Liqui-Char

Lisinopril (Apotex, Mylan, Teva, Watson, West-Ward; Ranbaxy is unsure of this specific product)

Lisinopril/HCTZ (West-Ward; Ranbaxy is GF)

Lithobid

Lithonate

Lithotabs

Logroton Retard

Lomir / SRO

Lopid

Lopressor / HCT

Lorazepam (Geneva contains gluten)

Lorazepam (Mylan, Ranbaxy, Watson are GF)

Lotensin

Lotensin HCT

Lotrel

Lozol (1.25 & 2.5)

Ludiomil

Lunesta (all strengths)

Luvox

Lyrica

Mag-Ox

Maxalt

Maxalt-MLT

Maxibar-may contain gluten

Maxzide

Mebaral-contains gluten

Medrol

Melleril

Menest (NOT GF)

Mephyton

Metamucil

Methergin

Methimazole (Monarch)

Methylprednisolone (Greenstone)

Metoclopramide (Qualitest)

Metopirone

Metoprolol (Watson-doesn’t test but uses potato starch)

Metoprolol (Apothecon, Novapharm)

Mevacor

Mexiletine (Novapharm)

Mexitil

Miacalcin

Micardis

Midamor

Mirapex

M-M-R II

Moban

Moduretic

Monopril

M-R-VAX II

Mylicon Drops

Mysoline

Nasonex

Neoral

Nepresol

Neurontin

Nexium

Nifedipine cap (Novapharm)

Nifedipine ER (Mylan)

Nilandron

Nimotop

Nitroderm TTS

Nitrogard

Nitroquick

Nitrostat

NoDoze

Nolvadex

Norpramin

Norprolac

Norvasc

Nuvigil

Opana ER

Orasone

Osteo Bi-Flex

Palgic

Parlodel

Paroxetine (Apotex-now questionalble)

Paxil

Pedvax HIB

Pentasa

Pepcid

Pepcid RPD

Permax

Persantine

Phazyme

Phoslo

Pindolol (Novapharm)

Pitocin

Plaquenil

Plavix

Plendil

Pletal

Polibar Liquid-may contain gluten

Pneumovax 23

Ponstel

Potassium Chloride (Andrx)

Pravachol

Prazosin (Mylan)

Prednisone (Mutual, Roxane, West-Ward)

Premarin

Prevacid (all forms)

Prilosec-all forms

Prinivil

Prinzide

Pro-Banthine

Procanbid

Proctocort

Promethazine (Breckenridge)

Propecia

Propulcid

Proscar

Protonix

Provera

Provigil-The company states that the outer coating could come from a wheat source or

a non-wheat source so caution is advised when taking the product

Prozac

Purinethol

Questran/Questran Lite

Quinaglute

Quinapril (Greenstone)

Ramipril (Lupin)-all strengths are GF

Ranitidine (Geneva,Novapharm)

Ready-Cat-2 Vanilla Smoothie-may contain gluten

Ready-Cat-2-Smoothie-all other flavors are GF

Recombivax

Regitin

Reglan

Regranex Gel

Relpax

Remeron

Renagel

Requip

Restoril

Retrovir

Revatio

Rilutek

Risperdal

Ritalin (all strengths)

Ritalin LA

Ritalin SR

Rolaids

Rowasa

Saluron

Salutensin

Sandimmune

Sandoglobulin

Sandostatin

Sansert

Selegiline (Novapharm)

Selzentry

Ser-Ap-Es

Serentil

Seroquel

Sertraline (Greenstone)

Serzone

Silvadene

Simulect

Simvastatin (Ranbaxy, Teva)

Sinemet

Sinemet CR

Skelaxin

Slow-Mag

Sonata

Sorbitrate

Spironolactone (Greenstone)

Spironolactone.Hydrochlorothiazide (Greenstone)

Strattera (all strengths)

Sular

Sulfasalzine (Greenstone)

Sulfasalzine Delayed Release (Greenstone)

Sumatriptan (Dr Reddy’s)

Symmetrel

Synercid

Synthroid (all strengths)-can no longer guarantee GF status

Syntocinon

Tambacor

Tamiflu

Tamoxifen (Barr pharmaceuticals)

Tapazole

Tegretol (tabs/chew tabs/suspension/XR tabs)

Tegretol / XR

Tenoretic

Tenormin

Tenuate

Terazol (all forms)

Testosterone 2% cream

Thalitone

Thalomid (all strengths)

Thrombin Inj

Thyrolar

Tiazac

Tigan (all forms)

Tigan (caps & suppositories)

Tikosyn

Timolide

Timolol tabs (Novapharm)

Tofranil

Topamax (all strengths)

Toprol XL

Tracleer

Trandate

Trazadone (Schein, Sidmak, Teva)

Trental

Triamterene/Hydrochlorothiazide cap (Barr,Duramed,Novartis,Watson)

Triazolam (Greenstone)

Tricor-contains gluten on the coating

Trileptal

Trilipix

Triostat Inj

Tums-all are GF except as noted below

Tums Smoothies-contain gluten

Unitrhoid

Urised

Uro-Mag

Valium-all strengths

Vanish Gel

Varivax

Vascor (all strengths)

Vaseretic

Vasotec

Venlafaxine (Teva)

Verapamil (Mylan, Watson)

Vesicare

Viagra

Visken

Vitravene

Vivactil

Vivelle

Vivelle Dot

Vytorin-all strengths

Warfarin (Barr-all strengths)

Welbutrin

Welchol

Xanax (all forms)

Xylociane Flavored Oint

Zaditen

Zantac (tabs/caps/liq/granules)

Zarontin

Zelnorm

Zemplar

Zestoretic

Zestril

Zetia

Ziac

Zocor

Zofran (all forms)

Zoladex

Zoloft

Zometa

Zomig

Zomig-ZMT

Zonegran

Zovirax

Zyloprim

Zyprexia

NASAL SPRAYS

Afrin

Beconase

Beconase AQ

Flonase

Nasacort

Nasacort AQ

Nasalcrom

Nasalide

Rhinocort

Rhinocort AQ

Vancenase

Vancenase AQ

ORAL CONTRACEPTIVES

Alesse

Apri-28

Aranelle

Aviane-28

Camila

Cryselle

Desogen

Enpresse-28

Errin

Junel (all strengths)

Kariva-28

Lessina-28

Levlin

Levora

Loestrin

LoOvra

Low Ogestrel

Lutera

Microgestin

Micronor

Mircette

Modicon

Necon

Nordette

NorQD

Nortrel (all strengths)

Ogestrel

Ortho Cept

Ortho Cyclen

Ortho Est

Ortho Novum (entire line)

Ortho Prefest

Ortho TriCyclen

Ovcon 35

Ovral

Portia

Sprintec

Trilevlin

TriPhasil

Tri-Sprintec

Velivet

Xifaxan

Yasmin

Yaz

Zovia

ORAL HYPOGLYCEMICS

Actos

Amaryl

Avandia

Diabeta

Glipizide (Novapharm)

Glipizide XL (Greenstone)

Glucophage

Glucotrol

Glucotrol XL

Glucovance (all strenghts)

Glyburide (Greenstone, Novapharm)

Glynase

Glyset

Metformin (Teva)

Micronase

Prandin

Precose

Rezulin

Starlix

Triglide (all strengths)

VITAMINS AND IRON

Albee w C

Aquasol A

Aquasol E

Basic vitamins

Bugs Bunny Chewables

Cal-Quick

Caltrate

Centrum

Centrum Chewable (all)

Centrum Jr-possibly contains gluten

Centrum Performance

Centrum Liquid

Centrum Silver

Chromagen Forte

Chromagen Forte

Citracal (all forms)

Disney Princess Gummies Vitamins

Feosol-traces of gluten

Feostat

FerInSol

Ferrous Gluconate (Paddock)

Ferrous Sulfate (Goldline)

Folgard

Folgard RX

Folic Acid (Schein, West-Ward)

Freeda’s Vitamins

Kirkman (all products are GF)

L’il Critters Gummy Bear Vitamins

Maginex

Melaleuca Vitabears

MultiTech Formula Isotonix

Natalcare Advance

Natalins

Natalins RX

Nature Made brand multivits

Natures Plus Animal Parade

Nephro-Fer

Nestabs FA

New Chapter Vitamins

Niferex 150

Nordic Naturals

Nutrilite Corps Double X

One A Day (entire line)

OsCal Plus D

Poly Vi Flor

Poly Vi Flor w Iron

Poly Vi Sol

Prenatal Advance

Repliva 21/7 Red

Sesame Street Complete Vitamins & Minerals

Slo-Mag

Slow Fe

Solgar

Sunkist Multivit Complete

Theragran

Theragran Heart Right

Theragran M

Theragran M Advance

Tr iVi Sol

Tri Vi Flor

Twin Lab Animal Friends Multivit wafers

Twin Lab Animal Parade Cherry

Ultramega Gold (GNC)

Viactive

Vitamin D (Pliva)- the company and their excipient manufacturers state that no gluten is

used in the manufacturing of the product however at least one celiac

has expressed to me that she experienced celiac like symptoms after

taking the product (7/6/09)

VitaminShoppe brand all GF

Zemplar

Zenate Advanced Formula

]]> http://dearpharmacist.com/?feed=rss2&p=755 1 http://dearpharmacist.com/?p=751 http://dearpharmacist.com/?p=751#comments Thu, 29 Oct 2009 16:51:02 +0000 suzy http://dearpharmacist.com/?p=751

Dear Pharmacist,

My neighbor swears by apple cider vinegar and every time I complain about my health, she rants about the vinegar.  I haven’t tried it, but I have to say she looks fairly healthy and never gets sick.  Do you think there’s something to it?

–P.B.,  Lodi, California

Answer:  Vinegar has been used for centuries for many purposes including cleaning, killing weeds and pickling.  Apple cider vinegar (ACV) is sold as both a bottled vinegar, and a dietary supplement in the United States.  It is a popular folk remedy.  I don’t think that ACV cures everything, but I do find some studies intriguing.  I use ACV almost daily in my kitchen.

Apple cider vinegar is a fermentation product of pulverized apples.  It’s primary active ingredient is “acetic acid” and many holistic practitioners believe that a little acid can relieve symptoms of reflux disease and heartburn.  Sounds strange to you doesn’t it, but the bitter truth is that  symptoms of heartburn and reflux can sometimes be related to insufficient levels of stomach acid (termed hypochlorhydria) not high levels like many of you who take acid blockers assume.  So the acetic acid in ACV sometimes brings relief to people with certain digestive disorders. Nevertheless, I wouldn’t take ACV without your doctor’s approval because it could damage the delicate lining of your digestive tract.

Here are some other sweet uses for the vinegar:

High Cholesterol- An animal study published in the British Journal of Nutrition (2006) showed evidence that vinegar could lower cholesterol.  The scientists gave rats some acetic acid, and their cholesterol ratio improved. But they had permanent puckers on their face afterwards, go figure.

Weight Loss- A small study conducted in 2005 found that people who consume vinegar with meals feel fuller faster!   ACV also contains chromium which helps balance blood sugar and suppresses cravings for carbs.  Compounds in ACV appear to help a person break down fats easier too.

Arthritis- ACV is derived from apples which give us “malic acid.” This substance helps fight infections and also relieves pain. Malic acid may ease joint pain, fibromyalgia and gouty arthritis by dissolving uric acid deposits that form around joints.

Diabetes- This is ACV’s most promising effect.  Several studies have concluded that it may help control blood glucose.  A 2007 study published in Diabetes Care concluded that people with type 2 diabetes experienced about a 5 percent reduction in morning blood glucose levels.

Apple cider vinegar contains a lot of enzymes too, as well as minerals and vitamins.  The naturally-occurring compounds could theoretically interact with diuretics, laxatives, blood-thinners and medications often used to treat diabetes and heart diseases so run this by your physician before use.

To use ACV, just add 2 teaspoons to water each day and drink it or use it as salad dressing.  Look for organic, I prefer “raw and unfiltered.”

Did You Know?

Taking blood pressure pills at night rather than the morning can help offset side effects like dizziness, nausea and daytime fatigue.

Dear Pharmacist,

I’m 31 and the only medication I take is Camilla (birth control pills) and occasional ibuprofen for menstrual cramps.  Today, the doctor prescribed Synthroid (for my fatigue and low thyroid ) and Paxil because I cried when I told him how badly I felt.

–H.W. Miami, Florida

Answer:  Welcome to the medication merry go round, grab a prescription  and hold on for your life.  I’m going to let you in on a  little secret… many physicians today are still unaware that estrogen-containing drugs like birth control actually mug your body’s natural stash of B vitamins and minerals and the depletion can cause fatigue, hypothyroidism, heart disease and mood instability. It occurs because certain medications are drug muggers of nutrients that are essential in the body to manufacture healthy thyroid hormone and brain neurotransmitters.

As a pharmacist who dispenses these drugs, I have almost come to expect that women who routinely use oral contraceptives will eventually become fatigued,  overweight, depressed and uninterested in sex. When you replenish what the drug mugger steals, you might avoid getting ‘diagnosed’ with some new illness, and subsequently medicated. Here’s what I would take if I was prescribed a synthetic hormone like birth control or menopausal medication:

-B-complex be cause it contains some B6 and folic acid to help produce happy brain chemicals

-Iodine to help you build thyroid hormone

-Probiotics to replenish intestinal flora which protects your immune system

-Minerals because they are rich in magnesium to help you make brain chemicals and hormones.

-I3C or DIM which is a broccoli extract which appears to protect against breast cancer

There are thousands of drug muggers.  Statin cholesterol meds mug coenzyme Q10.  CoQ10 is needed to prevent weakness, fatigue, leg cramps, memory problems, and heart trouble.  Some diabetic drugs mug your stash of B vitamins, particularly B12 and a B 12 deficiency can cause nerve pain confusion, mouth/tongue sores and depression.  Antibiotics wipe out your beneficial intestinal flora leading to diarrhea, cramps, fatigue and lowered immunity.  It’s imperative that your healthcare team understand the simple principle that drugs can deplete vital nutrients from the human body.  This unique perspective is the basis for my second book, Drug Muggers:  How To Keep Your Medicine from Stealing the Life Out of You which is sold at my website and on Amazon.

Readers Alert:

The nice people at the Corn Refiners Association asked me to clarify a possible misperception in my October 3rd post about why you should cut way back on high fructose corn syrup (HFCS) in your diet.  I did not intend to imply that because too much HFCS can cause high insulin blood levels, and because there is a link between high insulin blood levels as a risk factor for pancreatic cancer, that therefore consumption of HFCS is itself a risk factor for pancreatic cancer.  There is absolutely no data in the scientific literature that makes that connection. I do stand by my statement that you should cut out as much HFCS from your diet as possible – because (just like sucrose) it promotes obesity– but not because it is a risk factor for pancreatic cancer.

Dear Pharmacist,

In a recent column, you stated that fennel tea is good for gas and bloating. I’ve seen it as a vegetable in my grocery store, but how do I make it into a tea, and what else is it good for?

–H.S., Crystal River, Florida

Answer: I believe that fennel can  ease gas, stomach cramping, spasms, bloating and other irritable bowel syndrome (IBS) symptoms, although eliminating food allergies may be the ultimate cure.  One reason fennel works so well is because it stimulates the production of bile which helps you digest food, particularly fats.

Fennel is nutritionally packed.  It contains calcium, iron, B vitamins and lots of vitamin C, folic acid and carotenes.  It should not surprise you with this type of make-up, fennel can do so much more than soothe your tummy.

A compound in fennel called “anethole” suppresses high levels of an inflammatory chemical  called “TNF alpha” and this means that it could relieve pain if consumed regularly;  Maybe it could help you with arthritis, fibromyalgia or any TNF-driven pain syndrome.

Caretonoids, anetholes, vitamin C and rutin are a few powerful antioxidans in fennel; these may support your immune system and reduce your risk of cancer and dangerous infections. Fennel may also reduce frequency of asthma attacks or allergic reactions.

Fennel contains some antioxidants including “caffeoyl quinic acids” which according to studies may prevent or reduce formation of atherosclerotic plaques.

The active compounds in fennel have a mild estrogen-like activity and it may promote milk production (lactation) or improve libido.  Do not use if pregnant.

Fennel has mild diuretic properties so it may be able to lower blood pressure; it is also a mild appetite suppressant.   That combo is a slam dunk if you want to lose a little weight.

Fennel is available in the produce section of most grocery stores.  Fennel belongs to the same class of vegetables as celery, and looks very similar with its big white bulb at the bottom and long green stalks. It imparts the flavor of anise, and is the basis for licorice.  Fennel herb is often added to soups and vegetable recipes.  You just chop it and use in your soup, or stir-fry. You can also buy ready-made tea bags of fennel, or steep your own.  To do that, buy fennel seeds and steep them in boiling water for about 5 minutes.  Strain and add honey if desired.  This is morning tea because it is makes you more alert and in many people, it acts as a mild diuretic.

Like many potent herbs (and medications) there are safety considerations.  Don’t supplement with excessive amounts of fennel because it may cause bizarre psychiatric problems (even hallucinations) and also, it can injure muscle tissue.  Fennel should be avoided in pregnancy because it can stimulate uterine contractions.

Did You Know?

Supplements of vitamin K2 may be helpful if you have osteoporosis but ask your doctor because it affects your blood thinning capabilities.

Dear Pharmacist,

I’m very tired and weak without my thyroid medicine.  Now, I’m concerned about the thyroid shortage and worried that there will not be medication for me. What else can I do?   M.K., Gainesville, Florida

Answer:  There will always be thyroid medication, don’t worry. While this is all getting sorted out by the manufacturers and the FDA, let me assure you that it’s possible to create more thyroid hormone naturally.  You can also make your cells more sensitive to circulating thyroid hormone.

The active version of thyroid hormone is called T3 and it makes you feel “awake.”  The inactive hormone is called T4.  In order for you to feel well, have energy and burn carbs and fat, your body must be able to convert T4 to T3.  It’s pretty easy to do.  Low thyroid (T3) can cause depression, weight gain, brittle nails, cold sensations and thinning hair.

Low thyroid (T3) will trigger your brain to produce some TSH (Thyroid Stimulating Hormone) which shouts at your thyroid gland, “Make more T3, we don’t have enough!”  When the gland makes some more T3, the TSH hushes up. It’s a complex feedback loop, but that’s the gist.  With that in mind, here’s some more advice that can help you regain healthy thyroid levels:

Iron:  You need sufficient levels of iron to make thyroid hormone and to get it into your cells where it works.  Women with a heavy monthly flow often run short on iron. You can measure iron stores (called “ferritin”) with a simple blood test.

Trace Minerals:  They help you convert T4 to T3 and include zinc, selenium and chromium. These minerals double as antioxidants which means that they do good housekeeping on your cells and protect the thyroid gland from destructive free radicals.  It’s an inexpensive fix, take “chelated” minerals or drink green food supplements that contain marine-derived compounds.

Iodine:  Another trace mineral that is absolutely critical in making thyroid hormone and also in protecting against breast cancer. It’s shocking but white bread often contains bromine which can cause iodine deficiency and interferes with thyroid functioning. So iodine is helpful to your thyroid, bromine is not.

Ashwagandha:  In animal studies, this herb stimulates more T3 production.  Additionally, it nourishes tired, stressed adrenal glands. This causes your stress hormone cortisol to come down, and it may help you lose belly fat.

Guggul: You get a lot of bang for your buck with guggul because it helps you make more T3, it can lower cholesterol/triglycerides and it may relieve joint pain and osteoarthritis.

Insulin:  When serum insulin is high, thyroid hormone can’t work well.  You can bring insulin levels down by exercising and taking various supplements which I outlined for you in a prior column (now posted at my website, www.DearPharmacist.com).

Did You Know?

Essential oils should be avoided for ten days following chemotherapy administration.

Dear Pharmacist,

Sometimes after I take Viagra, my vision turns blueish-grey and it gets blurry. Is this this an expected side effect?  I can’t ask my doctor because he may stop prescribing it for me.

–C.G.,  Long Island, New York

Answer:  Viagra, and the two other FDA approved medications for erectile dysfunction, Cialis and Levitra are blockbuster drugs that are known to affect vision and many men fear they will go blind by using these drugs. But this doesn’t stop men from using these drugs, or buying fake versions over the Internet. Counterfeit impotence pills are big business for drug dealers.  For example, consider Viagra, affectionately dubbed the “blue diamond” pill.  According to Jim Thomson, founder of the European Alliance for Access to Safe Medicines, “The margin (for Viagra) is about 2,000 times more profitable than cocaine.”

Prescribed sex pills work by suppressing a chemical pathway (called PDE-5) which enhances the effects of a naturally-occurring chemical in your body called “nitric oxide.”  During arousal, this chemical relaxes smooth muscles surrounding the penis which facilitates blood flow down South.  That’s when the magic happens and an erection is obtained.

What does an erection have to do with blue vision and blindness?  Absolutely nothing but I thought it was interesting.  Anyway, sex enhancement pills happen to affect a second pathway (called PDE-6) and this increases a chemical called “cyclic GMP” which affects cells in your retina.  Through this mechanism, sex drugs can cause that infamous blue vision, vision loss, double vision or blurriness.   Men who take higher dosages of medication are affected more often.

There are many confirmed cases of visual disturbances such as double vision or blue vision. In a small clinical trial, researchers  found an unusually high percentage of visual disturbances.  More specifically, 6 of the 7 patients in the study experienced vision loss in one or both eyes within 24 hours after using Viagra (sildenafil).   Interestingly, these patients were also dealing with hypertension, diabetes, elevated cholesterol, or high cholesterol.  Regardless, the scientists concluded that “Sildenafil may provoke ‘non-arteritic ischemic optic neuropathy’ (NAION) in individuals with an arteriosclerotic risk profile.”  So yes, vision problems can occur.

But it’s not all bad news for the super sex pill. Recently, a study published in the September 2009 issue of The Journal of Stroke and Cerebrovascular Disease basically cleared the besmirched reputation of these drugs by testing them in a group of ill patients who had already suffered a stroke.  The scientists looked for worsening symptoms of stroke, heart attack, vision or hearing loss, and death from any cause for two weeks. They concluded that intake of Viagra 25 mg per day “appeared to be safe.”   What happens after two weeks? Who knows, but if you rely on sex pills, you may have underlying diabetes or heart disease.

Did You Know?

Mayo Clinic studies support the use of probiotic supplementation in order to prevent kidney stones.