My 21-year-old daughter has never been able to swallow pills. She says she gags on them and has tried to cut them into halves or even quarters, but she can’t get them down. I don’t recall any trauma in her childhood that would cause this problem. It is common? As a child, she took syrup for fever reducers and antibiotics. Now, as a young adult, she grinds pills – mostly aspirin – into a powder. But I wonder if crushing would change the effect of drugs, and what she will do if she urgently needs medication for a real illness. Is grinding up a pill safe, or does it change the efficacy of the drug? Do you have any advice to help her swallow a pill? – M.N., NetanyaHoward Rice, former chairman of the Israel Pharmacy Association and now a pharmaceutical consultant, responds: There are some people who have an aversion to swallowing tablets or capsules.On the surface, it seems strange, since these people often eat foods that are much larger than pills – but there are other factors involved.We can chew food, but medication tablets we often cannot. Food is moist, so we can swallow it easily after we have macerated it somewhat with saliva; tablets are dry – though capsules, when moistened, slide down more easily.Food is tasty; tablets at best have no taste, but can also be bitter if crunched.It’s important to drink plenty of water to get it down.So don’t be upset with your daughter.Give her an exercise of swallowing a few small grains of moistened rice, and then perhaps larger grains. This will let her feel that it can be done. There are many sizes of grains, so she can take larger ones as time goes on if she wants.Explain that there is really no difference between this and the tablet. She should understand why you are doing this – that if, God forbid, she were to require medication that could not be crushed, she would have to make the choice of having it in injection form or, if available, in suppository form.In the paper insert inside drug boxes, it is always written whether the medication can be crushed. Your pharmacist will also be able to advise. Generally speaking, sustained (slow-release) medication cannot be crushed (for example, Tegretol CR, Ritalin SR and Lopressor Divitabs) and a few tablets with special coating (enteric) that dissolve in the upper small intestine and not in the stomach (for example, Doxylin, Slow K, Cartia Aspirin). My list is far from complete. I hope my advice solves your problem.Judy Siegel-Itzkovich adds: A new Teleseker poll by a local pharmaceutical company, among a representative sample of 500 adults, found that one out of five adults has trouble swallowing pills. About 60 percent of those with the problem said it was due to the “large size” of the pill, 45% said the pill got stuck in their throats, and 22% said they couldn’t stand the taste.People aged 18 to 29 were more likely to be unable to swallow pills than those over 29. A quarter of women said they couldn’t get a pill down, compared to 14.4% of men, who were much less troubled by the size of the pills and the taste than women were.By the way, somebody once told me he learned how to swallow pills by practicing swallowing M&M’s chocolate candies, which taste good and wouldn’t do him any harm.I like canned tuna in water, while my children prefer that I buy tuna in vegetable oil, because they say the kind in water has “no taste.” Is there any significant difference in nutrition between the two? I read in a Hebrew newspaper just now that tuna in water is much more nutritious than that in oil because there is “too much” of Omega 6 fatty acids in tuna in vegetable oil and “not enough” Omega 3 fatty acids in it, while tuna in water has the “right proportion” of Omega 3 to Omega 6. What is correct? – B.C., Tivon Olga Raz, the chief clinical nutritionist at Tel Aviv Sourasky Medical Center, comments: There is no doubt that most people like tuna in vegetable oil more than tuna in water. There is more “tuna taste” to it. As for nutritional values of tuna itself, there is not much difference between these two kinds. Regarding vegetable oil, it is a part of any healthy diet, although most people strain the tuna and not much of the oil remains.The claim that tuna in water is much more nutritious than that in oil is not true at all. What’s important here is the source of the tuna. Most of the canned tuna sold in Israel comes from warm ocean water. Thus, there are apparently no Omega 3 fatty acids in tuna imported to Israel, as the fatty acids exist in fish that are caught in cold waters. There is no need to add Omega 6 at all because there is too much Omega 6 in the modern diet. So regarding Omega fatty acids in the diet, one should get more Omega 3 and less Omega 6. Thus the Hebrew newspaper report is nonsense.Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting.Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538- 9527, or email it to jsiegel@jpost.com, giving your initials, age and place of residence.
