RX For Readers: Know your pills

Ask your pharmacist to identify the contents of your medication if you think certain ingredients are problematic.

Asprin heart 521 (photo credit: MCT)
Asprin heart 521
(photo credit: MCT)
I am lactose intolerant. It took me four years to find out that I have to be very vigilant about which medicines I take. I don’t know the percentage, but I am willing to bet that at least 50 percent of medications have a large amount of lactose in them as a filler. Am I right? I found out that one medication I was prescribed had 950 grams of lactose in it. Before my revelation, I couldn’t figure out what was causing all the problems. Since then, I make the pharmacist tell how much lactose is in anything I take. If there is some, I don’t take it until I find a compatible substitute. Why aren’t pills made without lactose? Surely there is a substitute such as cellulose.

--K.M., Hatzor
Veteran pharmacist Howard Rice replies:
While I doubt if anyone knows what percentage of lactose is used as one of the “non-active” ingredients in medication, I am sure that it is very widely used. Lactose is a two-molecule sugar (a disaccharide) found in milk. The reasons for its inclusion in pharmaceuticals are it is inexpensive, easily compressible when formulating tablets, without flavor or smell, inert so that it will not react with the active pharmaceutical ingredient and acts as a stabilizer in the finished product. There are not many alternatives for lactose, which is inexpensive, but the pharmaceutical industry is working on it.
I hope that you made a typographical error when you said that there was 950 grams of lactose in your medicine – this is almost a kilo and if so, it would certainly create problems!
As indicated above, the choice of material for holding the pill together depends on the active compound and whether it will be stable with the active ingredients. There are preparations without lactose. As you have realized, you must ask your pharmacist to ensure that you are not taking excess amounts (if at all).
The recent problems encountered with the formula change of the thyroid function drug Eltroxin is a perfect example. The old formula contained lactose monohydrate, maize starch, acacia and magnesium stearate. The new formula contains microcrystalline cellulose, pre-gelatinized maize starch, purified talc, silicon dioxide (colloidal anhydrous silica) and magnesium stearate. This was done to stabilize the preparation and (it is hoped) remove the lactose because of people such as yourself who are lactose intolerant.
A friend of mine eats Greek yogurt and keeps suggesting that I buy it too, because it supposedly is better for your health than other yogurts. I eat plain bio yogurt every morning and am perfectly satisfied with it. Is there anything special to Greek yogurt related to health benefits, or is it just advertising?
--A.S., Ramat Gan
Dorit Adler, chief clinical dietitian at the Hadassah University Medical Center in Jerusalem’s Ein Kerem, answers:
I don’t know of any special proven health benefits of what is being marketed as Greek yogurt. All yogurt began in the Balkan region. Greek yogurt has a thicker, creamier texture than regular yogurts because much of the liquid is drained off. This means it has less lactose but also less calcium. The different kinds carry different beneficial microflora, of which only few kinds were studied for their benefits. I recommend low-fat (bio) yogurt of any type.
Is there such a thing as eating too little salt (sodium) in one’s diet and not just too much? I am 42, and as my father had hypertension (I don’t), I learned never to add salt to food. Is this wise, or is there a danger of having too little salt? Should I be tested?
--M.F., Ma’aleh Adumim
Dr. Olga Raz, chief clinical dietitian at Tel Aviv Sourasky Medical Center, comments:
There is plenty of salt in most foods, without adding more, so a healthy individual does not develop sodium deficiency under normal conditions. Only if you have diarrhea or increased perspiration or take water pills can you develop a deficiency. You can have a blood test for sodium (Na) to be on the safe side.
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 e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.