Steve Plogsted, a pharmacist at Nationwide Children’s Hospital in Columbus, Ohio, is an expert on gluten in medications. His website, glutenfreedrugs.com, is widely recognized as the most reliable source of information on gluten-free prescription and over-the-counter drugs. Have a question about gluten and medications? Send it to [email protected]
Q: Is a drug that is considered gluten free in the United States also considered gluten free in Canada?
A: The simple answer is that you should not apply information obtained from U.S. manufacturers to any foreign-manufactured drug product if that product was intended for the foreign market. For example, I called a drug company about the antibiotic cephalexin. The U.S. version used cornstarch whereas the Canadian product used wheat. This does not mean that a drug product produced in a foreign country and sold in the U.S. is unsafe. All prescription drug products for the U.S. market must meet all of the stringent standards applied to U.S.-manufactured drugs. The foreign facility is routinely monitored and inspected by employees of the U.S. Food and Drug Administration (FDA). Paperwork, production lines and all other quality assurance requirements are monitored and enforced by the FDA.
Q: Some companies have told me that their product contains gluten not from a starch but, rather, from a sugar alcohol. What exactly is a sugar alcohol?
A: As you know, gluten is obtained from certain starches or starch derivatives. Sugar alcohols are also known as polyols because they are not true sugars or alcohols; they are carbohydrates. Because they are not sugars, products that rely on these polyols are labeled sugar free. Some examples of polyols are xylitol, maltitol, sorbitol, mannitol, lactitol, isomalt, erythritol and polydextrose. The body metabolizes them in a slightly different manner compared to a traditional sugar, and therefore they are safer for people with diabetes. These polyols can be obtained from many starches. There are a number of steps involved in purifying these polyols from their starch source, which results in the removal of the protein responsible for the gluten reaction (when wheat, barley or rye is used as the starch source). Certain drug manufacturers do not care that the polyol is purified; they only look at the original source and therefore label their product as containing gluten. This same principle applies to wheat-derived glucose, which MAY be used in producing gummy vitamins, or wheat-derived dextrin, which can be found in medications and other products, such as Benefiber. A 2004 study demonstrated that celiac patients who consumed products from wheat glucose experienced no adverse reactions. In 2011, Tricia Thompson, MS, RD, nutrition consultant and founder of Gluten Free Watchdog, LLC, addressed wheat dextrin in one of her newsletters, writing that wheat-derived dextrin products should be safe. This is not to say that any person with celiac should totally disregard these concerns but, rather, consider all of these facts when deciding whether to take a product that contains a wheat-based polyol or glucose.