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HEALTH

You Docs: Advice on antacids, compounding pharmacies

Monday, November 5, 2012 - 12:01 am

Q: My wife says I take too many antacids and it's not good for me. Is there really a problem with taking them? — Scott M., Maitland, Fla.

A: Heartburn is no fun, and sometimes you need to get your hands on a fire extinguisher ASAP. But if you're taking over-the-counter heartburn meds for more than a few weeks in a row, you're treating your symptoms instead of your problem.

There are three types of heartburn medications: antacids, H2 histamine blockers and proton pump inhibitors (PPIs). Antacids neutralize stomach acid, H2 blockers reduce the amount of acid your stomach produces, and the heavy-duty PPIs block the enzyme system that produces gastric acid — reducing secretions by up to 99 percent.

They all temporarily reduce stomach acid. That seems like sweet relief, but over the long haul, this could cause big trouble for your gut. When you neutralize or turn off stomach acid, you dull the stomach's anti-microbial defense system and increase your risk of food poisoning from C. difficile, Listeria, Salmonella and other bacteria.

Without enough acid, your stomach won't properly absorb nutrients like calcium, putting you at increased risk of bone fractures. Changing your acid balance also can interfere with absorption of other medications that you take regularly, and can mask more serious problems such as stomach and esophageal cancer.

Want a safer way to extinguish the flames? Cut back on salt and fat; eat more fiber (in whole grains, fruits and veggies); avoid your trigger foods, like chocolate, chili, alcohol and colas; chew sugar-free gum after meals (it represses acid reflux); and, if you're overweight, lose 10 percent of your body weight. (That may happen naturally if you follow the other suggestions!)

You also may want to keep a food diary to help you identify which foods are causing problems. If your best efforts to ease your discomfort don't work, then turn the diary over to your doc for precise diagnosis of your problems. But chances are, if you follow our advice, you'll be able to take care of this yourself.

Q: What is a compounding pharmacy, and how could one have released a medication that infected so many people with meningitis? — Jeff O., San Jose, Calif.

A: A compounding pharmacy is a customized-drug provider that supplies people with individually tailored medications. They put together versions of all types of Food and Drug Administration-approved drugs for people who may be allergic to certain dyes or fillers, or who need alternative delivery methods to pills, sprays, creams or powders.

They also provide customized drugs for many treatments, from bioidentical hormone therapies (Bio-HT) to individually designed chemotherapy treatments.

Up until 1938, most pharmacies were compounding pharmacies; they would assemble medications to fill a doctor's prescription. That's when the FDA was created; one of its jobs was to regulate the growing number of drug manufacturers.

Individual states were left to regulate specialty/compound pharmacies. The compounding pharmacies were licensed to produce medications only in limited quantity (based on a doctor's individual orders or prescriptions from a veterinarian).

Since the 1990s, compounding drugs has become a $3 billion industry that accounts for 37 million prescriptions a year — big business. There may be as many as 7,500 compounding pharmacies in the country; no one knows the exact number.

The Massachusetts compounding pharmacy associated with the spread of fungal meningitis through contaminated steroids seems to have exceeded its state license when it mass-produced a drug and sold it around the country. It has since recalled all of its products, and a congressional and FDA investigation is in the works.

So don't hesitate to ask your doctors where they get their medications. If they're from a compounding pharmacy, ask how long the doc has been using it, and ask to see the label before you take an injection. But remember, compounding pharmacies play an important part in our health-care system, and the ones that play by the rules help a lot of people.

Dr. Mehmet Oz is host of “The Dr. Oz Show,” and Dr. Mike Roizen is Chief Medical Officer at the Cleveland Clinic Wellness Institute. Submit your health questions at www.doctoroz.com.