More than half of probiotics contain traces of gluten, study finds

First author Dr. Samantha Nazareth, a gastroenterologist at Columbia University Medical Center (CUMC) in New York, NY, and colleagues recently presented their findings at the Digestive Disease Week 2015 meeting in Washington, DC.

When a person with celiac disease eats gluten – a protein found in wheat, barley and rye – their immune system attacks the villi of the small intestine. When the villi are damaged, the body has difficulty absorbing nutrients.

It is estimated that around 1% of the US population – the equivalent to around 1 in 133 Americans – have celiac disease. Around 83% of people with the condition, however, are believed to be undiagnosed or misdiagnosed with other illnesses.

Celiac disease can present more than 300 symptoms, making it tricky to diagnose. Some people may experience diarrhea and abdominal pain or bloating, while others may experience fatigue and weight loss, among other symptoms.

At present, the only treatment for celiac disease is to follow a gluten-free diet, though some people with the condition turn to dietary supplements – particularly probiotics – believing the products will help alleviate symptoms.

According to Dr. Nazareth and colleagues, previous research has found that patients with celiac disease who use dietary supplements tend to have more symptoms than those who do not use them. As such, they set out to determine whether probiotics on sale in the US may be contaminated with gluten.

Two probiotics labeled gluten-free contained gluten at levels exceeding FDA standards

Using a sensitive detection technique known as liquid chromatography-mass spectrometry, the team tested 22 popular probiotics for traces of gluten – more than half of which were labeled “gluten-free.”

The team found that 12 (55%) of the probiotics contained traces of gluten. While the majority of these probiotics contained the protein at levels less than 20 parts per million – a level considered to be gluten-free by the US Food and Drug Administration (FDA) – four (18%) of them exceeded this level.

What is more, two of the probiotics that contained gluten at levels higher than 20 parts per million – exceeding FDA standards for gluten-free products – were labeled gluten-free.

Dr. Peter Green, professor of medicine and director of the Celiac Disease Center at CUMC, believes the findings are worrisome for patients with celiac disease:

“We have been following reports in the scientific literature and news media on inaccurate labeling of nutritional supplements, and it appears that labels claiming a product is gluten-free are not to be trusted, at least when it comes to probiotics. This is a potential hazard for our patients, and we are concerned.”

Study co-author Dr. Benjamin Lebwohl, assistant professor of medicine and epidemiology at the Celiac Disease Center, stresses that it is unclear as to whether the gluten in these probiotics may pose harm for patients with celiac disease at the levels identified.

“We know that most patients with celiac disease only develop intestinal damage when consuming more than 10 milligrams of gluten daily, and it is unlikely that contaminated probiotics can lead to that amount unless patients are ingesting mega-doses,” he explains.

He adds, however, that their findings are still a cause for concern. “Why is there any gluten in these products? Why should the consumer pay any attention to gluten-free labeling on such products? And given the great consumer interest in probiotics, will regulatory bodies take action to protect the public?”


Last week, Medical News Today reported on a study published in JAMA Neurology, in which researchers found people with celiac disease may be at higher risk of nerve damage.

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Weekly Care Likely to Better Diabetic’s Health

Eli Lilly the world’s first insulin maker has been entitled by the


European Commission for marketing Trulicity (dulaglutide), a novel injectable treatment for adults with type 2 diabetes. The once-weekly Trulicity may affect the Novo Nordisk’s widely used blockbuster Victoza (liraglutide) as it has demonstrated clinical superiority however there are safety concerns based on pre-clinical lab data which may result in an uncertain sales outcome in view of upcoming approvals from other companies.
Trulicity is a once-weekly glucagon-like peptide-1 receptor agonist (GLP-1 RA) designed in an easy-to-use single-dose pen and can be taken any time of day, with or without meals. Studies reveal that Trulicity can help in lowering the A1C and blood sugar numbers and may even help to lose some weight. GLP-1 is a natural hormone, in prodding the body to release insulin when patients eat. Like other insulin products Trulicity can cause hypoglycemia, nausea, fainting and other symptoms and is contraindicated in thyroid patients.
Diabetes (type 1 and 2) is a chronic disease in which the body either does not properly produce, or use, the hormone insulin. It victimizes 29 million Americans and 382 million people around the globe with 90-95% occurrence of Type 2.
Launched in 2009, Victoza reached 2.3 million patients globally with a blockbuster sale of $418 million in 2010 and doubling to $1.04 billion in the first half of 2013. The analysts estimate the sales to quadruple to $4.07 billion in 2018. Tim Anderson, Bernstein analyst forecasts the sale of Trulicity to reach $1.3 billion by 2020. The current market of GLP-1 is around $3 billion.
Last year GlaxoSmithKline’s Tanzeum was approved by the FDA which is also a once-weekly GLP-1 agonist but unlike Trulicity Tanzeum failed to show superiority to Victoza. AstraZeneca after acquiring the Byetta from the dead alliance of the inventors Amylin and Eli Lilly launched Bydureon, which is another once-weekly treatment but it failed due to complicated delivery system, however approval for a new delivery system for Bydureon was received earlier this year.  Merck’s DPP-4 inhibitor Januvia, Sanofi’s Lyxumia (lixisenatide) and AstraZeneca’s once-a-month version in the pipeline is yet another reason for Trulicity to worry.
Although While Trulicity has been found as non-inferiorsuperior to blockbuster Victoza in head-to-head trials, its fate is dilemmatic with robust rivals anduncertain as there is a major concern of drug safety as per its black box warning regardingdue to increased risk for thyroid C-cell tumors based on pre-clinical studies. The stakes are high and the diabetes patient population is large so the outcome remains to be seen specially in view of the oncoming competition.

Author: Toshit

Stop Taking Antibiotics When You Feel Better?

Conventional wisdom: Antibiotic regimens should be taken in full, even after the patient feels healthy again. 

Contrarian view: Shorter courses are often just as effective and do a better job at preventing antibiotic resistance. 14200527505_7c25db2ce9_z

You know the drill: When you’re prescribed a typical seven- to 14-day antibiotic course, do not, repeat, do not forget to take all the drugs. This take-all-your-pills orthodoxy, championed since the discovery of antibiotics some 70 years ago, is based on eliminating all bacterial culprits as quickly as possible.

Doing so, in theory, reduces the odds that the bugs will develop random mutations or pick up drug-resistant genes from other bacteria. Plus, the sustained antibiotic onslaught supposedly ensures that any hardier, partially drug-resistant bacteria also succumb, and thus don’t pass on “stepping-stone” genes leading to full-blown resistance.

An emerging view, however, suggests that standard long antibiotic courses are wrong on both counts — they’re no better than shorter courses and actually promote antibiotic resistance.

“The science is clear,” says infectious disease specialist Brad Spellberg of the Los Angeles Biomedical Research Institute. “Every study that has been done comparing longer versus shorter antibiotic therapy has found shorter therapy just as effective.” A few days of taking antibiotics, it seems, should usually be enough to knock infections on their heels, allowing the patient’s immune system to come in and mop up.

Taking the full course of antibiotics unnecessarily wastes medicine, and more drugs translates to increased evolutionary pressure on the harmless bacteria in our bodies. These “good” bugs can develop drug-resistant genes, which can then transfer to bad bugs.

Furthermore, wiping out drug-susceptible bacteria in infections too quickly makes it easier for drug-resistant bacteria to compete over a host’s resources. Better access to nutrients lets the mutant bugs multiply far more rapidly, upping the odds that they’ll reach a so-called “transmissible density.” That means the resistant bacteria proliferate so much that they can escape and infect another person.

In essence, if you take all those extra antibiotics, you might be doing the worst bugs’ dirty work for them by removing a check on their growth.

Shorter antibiotic regimens, in contrast, intentionally allow some susceptible bacteria to survive in order to help suppress any resistant pathogens. A recent study showed just this: Mice infected with both drug-susceptible and drug-resistant malaria, when treated less aggressively, were 150 times less likely to pass on the resistant pathogens.

Multiple studies demonstrate how doctors might gauge when to end antibiotic therapy. (See “Less Is More? Selected Studies” below.) Thriving bacteria raise blood levels of the hormone precursor procalcitonin, for example; guiding treatment based on procalcitonin concentrations led to half as much antibiotic use across seven studies, with no drop in cure rates. More signs of improved health, such as fever alleviation, could also indicate antibiotics are no longer necessary.

Overall, the accumulating data lend support to the heretical notion of patients, in consultation with their doctors, stopping their pill-popping upon feeling better. “The issue of continuing therapy until all doses are done is an old wives’ tale,” Spellberg says. “There’s no data to support it. You can’t make a cured patient better.”

Less Is More? Selected Studies

  • Mild to moderate pneumonia:Three days is as effective as eight (el Moussaoui et al., 2006,British Medical Journal); four studies suggest three days is as effective as five in children (Haider et al., 2008, Cochrane Database of Systematic Reviews).
  • Hospital-acquired ventilator-associated pneumonia:Eight days is as effective as 15 (Chastre et al., 2003,Journal of the American Medical Association); eight studies suggest for certain pneumonias, seven- to eight-day courses have better outcomes than 10 to 15 (Pugh et al., 2011,Cochrane Database of Systematic Reviews).
  • Acute pyelonephritis (kidney infection):Seven days is as effective as 14 (Sandberg et al., 2012,The Lancet).
  • Septic arthritis (joint infection):Twenty days can cure most cases compared with the typical one to two months of antibiotics usually accompanied by surgery (Peltola et al., 2010,The Pediatric Infectious Diseases Journal).

By Adam Hadhazy


What do I need to know about my child’s medicines?

Your child’s doctor and your pharmacist can answer questions about prescription and over-the-counter (OTC) medicines. (OTC medicines are medicines that you can buy without a prescription from your doctor.)caring-for-a-sick-child

Here are some things you should know about each of the medicines that your child takes by mouth (oral medicines):

  • The name of the medicine
  • What the medicine is for
  • The dose (amount) of the medicine to give
  • What measuring device to use to give your child the medicine
  • The number of times a day the medicine should be given
  • The times of the day the medicine should be given
  • Whether the medicine can be given with food
  • The number of days the medicine should be given
  • How you will know the medicine is working
  • The most common and important side effects

What should I tell the doctor?

When your doctor prescribes a medicine, or when you ask about giving your child an OTC medicine, be sure to tell your doctor these things:

  • Other medicines that your child is taking (both prescription and OTC medicines)
  • Any drug allergies your child has
  • If the medicine costs too much for you to buy

What can I expect from my pharmacist?

The pharmacist should tell you when and how to give your child the medicine, and should answer any questions you have about the medicine. For liquid medicines, the pharmacist should give you a measuring device and show you the right way to use it.

What should I do if my child won’t take medicine?

There are many things you can do to make medicine taste better to your child. Put liquid medicines in the refrigerator before giving them to your child. If your child will not take a medicine because of the taste, it may be okay to mix the medicine with a small amount of liquid (like juice) or soft food (like pudding). Ask your doctor or pharmacist about your child’s medicine to see if this is okay. Some pharmacies have flavorings they can mix with liquid medicine before you take it home.

You should also explain to your child how medicine can help him or her stay healthy or feel better.

How can I safely store medicines?

Store all medicines up and away, out of reach and sight of young children. Keeping medicines in a cool, dry place will help prevent them from becoming less effective before their expiration dates. Do not store medicines in bathrooms or bathroom cabinets, which are often hot and humid.

Things to remember about giving medicine to your child:

  • When you get a new prescription, ask your doctor or pharmacist for a medicine information sheet. It will tell you about the medicine.
  • Be sure you only give the prescribed or recommended dose of each medicine. Sometimes people think, “If a little medicine is good, a lot is better (or will work quicker).” This is wrong. Giving too much medicine can be harmful.
  • Use a special measuring device for liquid medicine to get the correct dose. Ask your pharmacist for a spoon, cup, or syringe that lists both teaspoons (tsp) and milliliters (mL). An ordinary kitchen teaspoon will not hold the right amount of medicine. If you use a syringe to give liquid medicine to your child, first throw away the small cap of the syringe. Children can choke on these caps.
  • When the drug facts label on the medicine says to give it “every 6 hours,” that generally means the medicine is taken 4 times a day (for example, at breakfast, lunch, supper, and bedtime). It doesn’t usually mean you have to wake the child up in the night to take medicine. “Take every 8 hours” generally means the medicine should be taken 3 times a day.
  • Even when your child begins to feel better, continue to give as much medicine as the doctor prescribed. If you are giving your child an OTC medicine, it is usually okay to stop when your child feels better.
  • Ask your doctor to include on the prescription label what the medicine is for. This helps the pharmacist double-check the prescription.
  • Children should not be allowed to play with medicine bottles.
  • If your child has a bad reaction to a medicine or is allergic to a medicine, tell your doctor right away. This is important medical information. You should also keep a record of the following information at home: the name of the medicine, the dosage directions, why your child is taking the medicine; and any side effects the medicine caused.
  • If your child has any problems after taking a medicine, call your doctor or the pharmacist right away.


Funding and support for this material have been provided by the Consumer Healthcare Products Association.

OTC: Know Its Other Side

What risks are involved in taking an OTC medicine?

Over-the-counter (OTC) medicines are medicines you can buy without a prescription from your doctor5460674795_7bd1185aa9_n. OTC medicines can help you feel better by helping to treat or prevent health problems, such as allergies, constipation, cold and flu (influenza), and nausea. However, sometimes OTC medicines can cause unpleasant effects (also called adverse effects). These adverse effects include side effects, drug-drug interactions, food-drug interactions, and allergic reactions. It is best to be aware of the risks so you know how to avoid them.

Certain situations put you at higher risk for adverse effects. Because the possible adverse effects differ from 1 OTC medicine to another, it’s best to carefully read the drug facts label of any OTC medicine so you know what to expect.

What’s my risk for adverse effects?

OTC medicines have a low risk of adverse effects when used occasionally and properly by adults who are generally healthy. However, they can pose greater risks for some people, including very young children, older adults, and people taking more than 1 type of medicine. People who have the following conditions are also at a higher risk:

  • Asthma
  • Bleeding disorders
  • Blood clotting disorders
  • Breathing problems
  • Diabetes
  • Enlarged prostate gland
  • Epilepsy
  • Glaucoma
  • Gout
  • Heart disease
  • High blood pressure
  • Immune system problems
  • Kidney problems
  • Liver problems
  • Parkinson’s disease
  • Psychiatric problems
  • Thyroid problems

Even though these conditions put some people at greater risk, it is important to remember that anyone can experience an adverse effect from an OTC medicine.

How will I know if I’m experiencing an adverse effect?

When you take any type of medicine, it’s important to be aware of changes in your body and how you feel. It may be hard to know whether a certain symptom is caused by your illness or by an adverse effect from your medicine. Tell your family doctor when the symptom started and if it is different from other symptoms you have had.

Tips to help you avoid adverse effects

  • Try to limit how often you use OTC medicines. Don’t use them unless you really need them.
  • If you take any prescription medicines, ask your doctor before taking an OTC medicine.
  • Read the drug facts label on the medicine carefully. Make sure you know what ingredients the medicine contains and understand any warnings or possible adverse effects.
  • If you don’t understand something about the medicine, ask your doctor or pharmacist.
  • Take the medicine just as your doctor or the drug facts label instructs. Don’t take a higher dose of the medicine than recommended. Don’t take the medicine more frequently or for a longer period of time than recommended.
  • When giving medicine to children, use the correct measuring device (for example, a spoon made for measuring medicine, or a syringe or cup) to make sure they get the right amount.
  • Don’t stir medicine into your food or take capsules apart unless your doctor says it’s okay. This may change the way the medicine works.
  • Don’t take medicine with alcoholic drinks.
  • Don’t mix medicine into hot drinks unless the label tells you to. The heat may keep the medicine from working as it should.
  • Don’t take vitamin pills at the same time you take medicine. Vitamins and minerals can cause problems if taken with some medicines.
  • Keep track of any allergies and adverse reactions you have had to OTC medicines in the past so you can avoid medicines that contain the same ingredients.
  • Remember that even if you didn’t have a reaction to a medicine you took in the past, you could have a reaction when you take it now.
  • Check drug facts labels and avoid taking medicines that contain the same active ingredients at the same time. This can help you avoid taking too much of a certain medicine.

What is a side effect?

Side effects are effects that medicines have on your body that don’t help your symptoms. Most side effects are unpleasant. A few examples are nausea, dizziness, or bleeding in your gastrointestinal (GI) tract. Sometimes, side effects can be useful. For example, certain antihistamines can cause sleepiness. This might be bad for people who take antihistamines during the day to treat allergies. But if you’re taking an antihistamine at nighttime, this side effect might help you get the sleep you need. Side effects are not the same thing as true drug allergies, which are much less common.

What is a drug-drug interaction?

The body processes (metabolizes) every medicine differently. When medicines are used together (whether prescription or OTC) the ways they affect the body can change. This is called a drug-drug interaction. This sometimes increases the chance that you will have side effects from medicines you are taking. The following are the main interaction types:

Duplication: If you take 2 medicines that have similar active ingredients, you may get more medicine than you need. An example is when you take OTC ibuprofen (2 brand names: Advil, Motrin) along with a prescription anti-inflammatory medicine given to you by your doctor. Too much of either an anti-inflammatory medicine or acetaminophen (brand name: Tylenol) can hurt your kidneys or liver. You should know all the active ingredients in the medicines you take. Be sure to check each new medicine to avoid duplication.

Opposition (antagonism): Medicines with active ingredients that have opposite effects on your body can interact. This may reduce the effectiveness of 1 or both medicines. For example, OTC decongestants may raise your blood pressure, so they can cause opposition when taken with certain medicines intended to lower your blood pressure.

Alteration: One medicine may change the way your body absorbs, spreads, or metabolizes another medicine. For example, aspirin can change the way certain prescription blood-thinning medicines work.

If you see more than 1 doctor, tell each of them about the medicines you take, even if you take something for just a short time. Include any herbal supplements, vitamins, and minerals you take. At least once a year, bring all of your medicines and supplements with you when you see your doctor.

What is a drug-food interaction?

Food may change how your body processes some OTC or prescription medicines. This is called a drug-food (or drug-nutrient) interaction. Sometimes what you eat and drink can affect the ingredients in a medicine you’re taking and prevent the medicine from working the way it should. For example, medicines taken by mouth (orally) must be absorbed through the lining of the stomach or the small intestine. The nutrients from the food you eat are also absorbed through the lining of the stomach. So if you take a medicine with food when it’s not recommended, a possible interaction is that your body might not be able to absorb the medicine as it should.

Are all OTC medicines affected by food?

No, but some OTC medicines can be affected by what you eat and when you eat it. This is why some medicines should be taken on an empty stomach (1 hour before eating or 2 hours after eating). On the other hand, it’s easier for your body to process other types of medicines when you take them with food.

Read the drug facts label to see if you should take your medicine with a snack or a meal, or if it should be taken on an empty stomach. If the label doesn’t give specific instructions, taking the medicine with or without food probably won’t affect the way the medicine works. If you have any questions, ask your family doctor or pharmacist. Your doctor and pharmacist can also warn you about possible interactions with your prescription medicines.

What is an allergic reaction?

It’s not common, but some people are allergic to certain medicines. If you’ve ever had an allergic reaction to a medicine, be sure to avoid medicines that contain the same ingredients. Signs of an allergic reaction include itching, hives, and breathing problems. Call your doctor right away if you think you’re having an allergic reaction. Keep in mind that side effects are not true allergic reactions.

Are older adults at increased risk for adverse effects?

Older adults often use many medicines at the same time, including prescription and OTC medicines. Their bodies process medicines differently than younger adults. This is why older adults need to pay careful attention to drug-drug interactions between OTC and prescription medicines. If you are an older adult, talk with your doctor about all of the medicines, vitamins, and herbal supplements you take. Your doctor can tell you whether you are at risk of having an adverse effect from taking an OTC medicine.

If you use a nonsteroidal anti-inflammatory drug (NSAID), you may be at risk of kidney disease and GI bleeding. NSAIDs include ibuprofen, aspirin, and naproxen (brand name: Aleve). NSAIDs can interact with many different prescriptions.

Source: Family Doctor.Org