If you live with autoimmunity, it’s likely you’ve chosen a specialized diet free of substances such as gluten, grains, nightshades, and more. This change can be a big lifestyle adjustment: there’s the emotional component of giving up favorite foods; learning how to make new foods; convincing family to hop on the food wagon with you; perhaps even managing a dual-purpose kitchen that’s gluten-free for you, but not for the rest of the family. Then there’s the task of fielding questions about your diet or resistance to your eating habits at work and in social situations. Understandably, there can be a big sense of relief once we get things dialed in. Whew!
However, even on a squeaky clean autoimmune diet, sometimes people still experience symptoms associated with eating the suspect foods they’ve eliminated. What many folks don’t realize is that hidden sources of these items may exist in supplements and medications, leading to the mystery symptoms. You might ask, “How much could a speck of gluten or corn in a pill actually affect someone?” But if you have celiac disease, non-celiac gluten sensitivity, or a sensitivity to grains or nightshades, you know that the smallest bit is all it takes to throw you down the symptomatic rabbit-hole.
Fillers: Know Their Sources!
Here’s the scoop: many over-the-counter supplements and nearly all medications contain fillers called excipients, that perform several functions: they provide bulk, help with disintegration of the tablet in the digestive tract, or facilitate absorption or solubility of the drug. Some excipients’ only purpose is to increase non-stick properties in production machinery. Many of these fillers are sourced from wheat, corn, barley, rice or potato, but their label names do not reveal their source.
Below are some common excipients to look out for, along with their hidden sources (worth noting is that some of these fillers are found in packaged foods as well: read your labels!). If you’re curious about the source of other excipients, click here.
- Dextri-maltose (barley malt)
- Dextrins (primarily corn and potato, but can come from wheat, rice, tapioca)
- Dextrans (sugar)
- Dextrose (corn starch)
- Dextrate (starch – source not listed)
- Maltodextrin (corn, wheat, potato, rice)
- Maltodextrin (corn, wheat, potato, rice)
- Pregelatinized starch (corn, wheat, potato, tapioca)**
- Sodium starch glycolate (commonly potato, but has other starch sources)**
- Not fillers, but worth honorable mention: some vitamin E is sourced from wheat germ, and most vitamin C is sourced from corn.
- Be on the lookout for any starches; they are primarily derived from corn, potato (and tapioca), and they have been known to contain starch from wheat
*Any product containing pregelatinized starch or sodium starch glycolate is to be avoided if not specifically labeled gluten-free.
Issues with thyroid or diabetes? Some factors to keep an eye out for:
- Some thyroid medications have gluten- or corn-based fillers, which cause immune cross-reactions for patients. Click here for a regularly updated page on thyroid medication ingredients.
- Reportedly, some oral Type 2 diabetes medications contain gluten; check all ingredients.
- While a diabetic may not be sensitive to gluten in the same way as someone with celiac disease or non-celiac gluten sensitivity, in the case of Type 1 diabetes, gluten has been shown to cross-react with pancreatic islet cells.
Staying on Top of Labeling
Active ingredients in supplements and medications are monitored and controlled closely by the FDA. Excipients, however, are considered inactive ingredients, and are only required to be in the broader category of FDA-approved substances.
Why does this matter? In an effort to make products more economical, sometimes producers use different fillers in generic medication than in the brand-name version; the FDA isn’t concerned with the details as long as it’s an FDA-approved ingredient. This means that even when you’ve taken the time to research a product’s ingredients, when you switch from brand-name to generic (or vise versa), you need to pay close attention to the new ingredient list, because the fillers may differ.
Even within the generic and brand-name categories, manufacturers change the fillers in products regularly, which means while your current bottle of meds or supplements may have checked out okay for ingredients, you need to keep an eye out for changes when you buy your next one. Be alert for labeling changes such as, “New formulation,” “New and improved,” “New product appearance,” or “New manufacturer.” Even if you don’t see these words, keep an eye out for a new label design when you buy your next bottle; when in doubt, check the new bottle against the old one.
10 Tips for Assuring Safe Ingredients
Below are some guidelines for assuring your meds and supplements remain free of gluten, grains, and nightshades:
1. Read all ingredient labels, even on a new bottle of the same old product. Become familiar with the names of fillers sourced from ingredients you need to avoid, or carry a list of suspect fillers when you shop (this also applies to packaged foods).
2. Keep an eye out for changes in labeling terms and appearance that could indicate a change in ingredients.
3. Remember to periodically re-confirm the gluten/grain/nightshade-free status of all your medications and supplements, regardless of labeling changes. This website contains information on gluten-free medications.
4. If uncertain about a prescription product, ask your pharmacist. Remember that your pharmacist is a drug expert, but may not know the source for an ingredient, so they may need to call the producer to ask.
5. Call the drug company yourself. You can get the contact information from your pharmacist, or find it online. Insist on specific answers to your questions.
6. Remind your doctor that you will be verifying the gluten-, grain-, or nightshade-free status of your medications. In light of this, ask for first- and second-choice medications so you have options. This can save you time, and help avoid problematic gaps in medication when you find out your scrip won’t do and your doctor just left for a six week silent meditation retreat in Madagascar.
7. Your insurance company may not approve a brand-name label when generic medication is available. If you need the brand-name label for health reasons (ie: it’s GF but the generic isn’t), call your insurance company and ask how to get approval for the more expensive medication.
8. If you require an unusual medication that does not offer a gluten- grain- nightshade-free option, find a compounding pharmacy that will make a custom medication for you. They can be surprisingly creative! My compounded thyroid meds are made in a base if ginger powder.
9. Some inpatient medications for surgery, radiology and other procedures contain gluten! Ask ahead about hospital medications; explain the potential risks to your health, and don’t settle for a dodgy answer. Prior to your visit, get firm confirmation that gluten-free meds will be used, and re-confirm upon arrival at the hospital. If you don’t set this up ahead of time, don’t count on the nurses on hand to know what’s in the drugs, or to truly understand the importance of your request.
10. Never settle for an unclear answer about the source for a medication or supplement.
Your Health is a Priority!
If you have lingering symptoms that you think may be related to your medications or supplements , I encourage you to determine the source of their ingredients. One of two valuable things will likely happen; you’ll either experience a welcome removal of symptoms (and know what to avoid in the future), or you’ll know that the problem lies elsewhere AND you now have meds and supps that are clear of suspect ingredients. In the long run of maintaining your health, it’s a win-win for you!