Gluten in Supplements, Probiotics and Medications

Plogsted HiRes[1]Steve Plogsted, a pharmacist at Columbus Children’s Hospital, is an expert on gluten in medications. His website, glutenfreedrugs.com, is widely recognized as the most reliable source of information on prescription and over-the-counter drugs. Have a question about gluten and medications? Send it to [email protected].

Q: I was interested in a gummy vitamin supplement, and during my search I came across a product that listed wheat as one of the ingredients. I was under the impression that gummy vitamins are generally gluten free. Can you explain this issue?

A: Vitamin E is a potential source of gluten in any gummy vitamin because it can be made from wheat germ, a potential source of gluten contamination. Unfortunately, some manufacturers label their product as containing wheat because the glucose used to give the product that gummy texture could have been derived from a wheat source and because of The Food Allergen Labeling and Consumer Protection Act. Glucose produced from a wheat source is considered safe for people with celiac disease, but manufacturers are trying to protect themselves. A simple call to the manufacturer should provide you with the answer. If the manufacturer says that the wheat is derived from vitamin E, it is best to avoid that product unless they can explain to you how the vitamin E was produced.

Q: I was reading all of the controversy surrounding gluten in probiotics, and I just don’t know what to do or who to believe. Do you know of any probiotic that I can really trust?

A: I recently attended a professional meeting and had the opportunity to speak with the manufacturer of the probiotic Florajen3. The product contains rice maltodextrin and is free of all allergens and dairy. The company does extensive testing for the presence of gluten and other contaminants. I am not recommending the product but providing you a gluten-free option to consider if you choose to take a probiotic.

Q: I have been taking Cytomel for my thyroid condition. I recently called the company that manufacturers it and was told that it could contain gluten. I can’t do without this medication. Can you help me?

A: Several manufacturers make a generic substitute for Cytomel. Ask your physician if switching to one of the generics is a viable option for you. Interestingly, although the manufacturer of Cytomel is telling people that it won’t disclose the source of the starch in Cytomel, it publishes a Material Safety Data Sheet, a document mandated by the Federal Occupational Safety and Health Administration that lists the ingredients of its product. This document, last revised on May 16, 2016, includes sugar, cornstarch, calcium sulfate, stearic acid and gelatin in the list of ingredients, with no mention of wheat.

Q: Can you tell me what the ingredient sodium starch glycolate is and whether it is safe for people with celiac disease?

A: Sodium starch glycolate (SSG) helps medications dissolve upon exposure to water by swelling, which helps break the tablet or capsule apart. . There are basically three types of SSG: Type A, Type B and Type C, with Type A the one most commonly used in medications. SSG Type A is primarily manufactured using potato starch, with a small percentage coming from a corn source. Theoretically SSG can be made from any starchy source, however, I have not found a manufacturer who uses a starch other than potato or corn to make SSG.  Several manufacturers produce SSG. Three of the most popular brands, Vivasta®r, Explotab® and Primojel®, use potato starch. Sodium starch glycolate is considered generally safe for people with celiac disease although it may cause an issue in those who experience symptoms when exposed to corn-derived products.  Still, it is wise to call the drug manufacturer to find out what type of SSG they use.

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