Is an Acid Stomach Bad??

Posted on January 22, 2012 by auxomed


 

Background

Proton pump inhibitors (PPIs) are the most widely prescribed medications in the country. They suppress acid in the stomach, raising the stomach pH from about 2 to 5-6. Medicines in this class include Prilosec, Nexium, Prevacid, and Protonix. They represent a multibillion dollar industry each year. Prilosec was the first in the class, but another class of acid suppressing medications preceded proton pump inhibitors. This class of medications, called the H2 blockers, includes Pepcid, Zantac, and Tagamet. The proton pump inhibitors are more effective in suppressing acid in the stomach and have surpassed the H2 blockers in popularity. A practice of starting them in hospitalized patients has been become a trend without significant evidence of benefit. The belief is that during periods of stress, such as a hospitalization, people are at more risk for stress ulcers. This may be true in intensive care settings, but probably not for less complicated hospitalizations. Many patients are discharged home, continuing these medications indefinitely after the hospitalization.

Nature and physiology

The acid environment of the stomach serves many purposes.
Acid acts as a natural defense to invading bacteria and other pathogens from the outside world. It was long ago noticed that people with a condition called achlorhydria, a disorder where the stomach acid is low, were at higher risk for contracting tuberculosis. There is evidence that chronic acid suppression with PPIs can make people at higher risk for certain infections such as pneumonia and certain gastrointestinal infections like Clostridium difficile, which causes infectious colitis.

The acid environment in the stomach aides in digestion.
The first part of digestion of proteins is facilitated by acid. Many important nutritional elements, such as iron, magnesium and calcium, are more readily absorbed when the stomach has its natural acid levels. Higher fracture rates are seen in people on chronic acid suppression and are thought to be related to impaired absorption of calcium. Chronic acid suppression with proton pump inhibitors may interfere with the absorption of vitamin B12.

Rebound acid.
Another problem with chronic acid suppression is that once you have been on them, it may be hard to get off of them. The body adjusts to the chronic use of PPIs by increasing gastrin levels. Gastrin is a hormone that is secreted to assist in digestion. One of gastrin’s functions is to keep the acid levels in the stomach appropriate. It has been shown that gastrin levels climb after long term use of PPIs. Once a person who has been on a PPI long term tries to stop, gastrin levels can be sufficiently high to cause a rebound, or hyper-secretion of acid, making it difficult to stop.

Effect on medications.
Many medications are designed to break down in the high acid environment of the stomach. When the stomach acid is absent, they may not digest as well. Enteric coated aspirin came to the market to help people who have a sensitive stomach. Ironically, it is designed to not break down in the acid environment of the stomach. It has a coating that is resistant to acid and breaks down more readily in the intestines where the environment is more basic (less acidic). The acid suppressing medications, like PPIs, can cause enteric coated aspirin to behave just like ordinary aspirin in the stomach, by-passing the intended effect of the coating, and quite possibly, causing stomach complaints because of the PPI. Some PPIs interfere with the metabolism of clopidogrel (Plavix).

Solutions/options

I have dealt with people who chronically take PPIs. I know how hard it is to stop these medications. For some people this is a quality of life issue. If you are awaken every night by a boring or burning in your chest and a pill prevents it, the medications can be life altering. I have solutions for people who are trying to improve their lives with acid suppression.

Try to taper acid suppression.
Taper the dose. Use the medication only when necessary and find out when it is “necessary.” This can be done by keeping a log of symptoms or food diary. By doing an assessment of your personal experience with foods and situations, you can begin to target these symptoms pre-emptively with medication. Reducing the amount of medication taken will help to reduce potential side effects and save money.

Diversify your armamentarium.
Try a varied approach to your acid suppression. Use H2 blockers, PPIs, and antacids. It may be that your really bad episodes related to stomach acid respond to a PPI, but others may respond to an H2 blocker or an antacid like Maalox or Tums. By diversifying your treatment, you will avoid chronic therapy directed at one site in the body. Although this has not been studied, it could “unbind” certain physiologic processes in the body, allowing them to return to normal during the varied treatment approach. This, in theory, could allow elevated gastrin levels to drop if they were altered by PPI therapy.

Consider other modifications.
Avoidance of certain foods that you find cause problems is important. These foods aren’t the same for everyone so document your triggers. Classic food triggers include chocolate, caffeine, alcohol, fatty foods, and peppermint. If acid reflux is the issue, losing weight, even small amounts, helps. Keeping the head of the bed elevated helps. Wearing less restrictive clothing, such as tight belts or pants, may help reduce abdominal pressure. Many people don’t realize that snoring at night may increase acid reflux. When your upper airway is partially blocked at night, as it is with snoring or sleep apnea, your chest wall works harder to get air into the lungs. This creates a low pressure in the chest cavity and allows for acid from the stomach to seep into the lower pressure area of the esophagus. Treating the apnea or snoring can help reduce acid reflux. Some medications can predispose you to acid reflux but the list is too long to include here so discuss it with your doctor.

When Acid Suppressing medications should not be stopped.
I am not suggesting that you should stop your acid suppressing medications. There are many conditions where this would be a bad idea. If you have conditions such as Peptic Ulcer disease, esophageal varices, erosive gastritis or erosive esophagitis, Barrett’s esophagus, or Zollinger-Ellison Syndrome, you definitely are benefitting from suppressing acid. I am suggesting that outside of these conditions, you should have a discussion with your doctor about the best way to use the lowest effective dose of medication for your symptoms. Acid suppressing medications like PPIs have been on the market less than 25 years. The long term effects of these medications are probably still not completely known.

Posted in Advice for My Patients, Medications | 2 Comments

Tekturna being scrutinized by the FDA

Posted on December 23, 2011 by auxomed

Tekturna Study Ended due to complications

The blood pressure drug, Tekturna, was recently found to have an increase in adverse effects in a study examining the combination of Tekturna with the popular classes of ACE Inhibitors (ACE) and Angiotensin Receptor blockers(ARBs). The FDA has not yet ruled or added restrictions to the use of the drug, but changes are expected. Tekturna, a blood pressure medication that is in a unique class called direct Renin inhibitors (DRI), is a member of the broader class of medications that affect the Renin Angiotensin Aldosterone System (RAAS). ACE inhibitors (incl. enalapril, lisinopril, captopril, ramipril), ARBs (Losartan, Valsartan, Candesartan, Olmesartan and others) are “cousins” in the chemical reactions that block RAAS. Tekturna, the newest members of the class with a unique blood pressure fighting mechanism, was being studied in combination with others in the class (ACEs and ARBs). Several adverse events were noted in a recent study of the drugs combined including hypotension (extremely low Blood Pressure), Hyperkalemia (extremely high serum potassium) and an increase in the incidence of stroke. Patients taking Tekturna in combinations with an ACE or ARB should contact their physician. Also, people taking the combination drug, Valturna, should also discuss this with their physicians. Patients with questions can call Novartis at 877-263-6725.

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Decongestants

Posted on November 24, 2011 by auxomed


 

Decongestants are commonly used in the cold and flu season. Decongestants work by constricting small blood vessels in the upper airways and sinus passages. They work well to reduce nasal congestion and open nasal passages, allow sinuses to drain, and equalize pressure in the ears by opening the Eustachian tubes. Prior to 2005, there were three over the counter decongestants available. Phenylpropanolamine was taken of the market due to an association with stroke. Now, the two most commonly available oral decongestants are: Phenylephrine and Pseudofed. A recent Cochrane report questioned the efficacy of phenylephrine and pseudofed is generally considered a better decongestant. Pseudofed is no longer available along the aisles in the pharmacy. It must be asked for by the pharmacist because it is only stored behind the pharmacy counter. The reason for this is that it became a key ingredient in the illegal production of crystal Meth. There are limits to the amount one person can purchase and it requires a signature for dispensing. Standard pseudofed is short acting, lasting only 4-6 hours. There are longer acting formulas that are contained in non-dissolvable carriers that allow for sustained release while passing through the gastrointestinal tract.

Both of the commonly available decongestants have some potential side effects in certain people. The drugs are in a class of meds called Sympathomimetics – meaning that they activate some parts of the Sympathetic Nervous System. This is your “fight or flight” responses that get activated when you are under stress on involved in an intense situation.
So the side effects mimic the “fight or flight” responses. They can potentially increase your blood pressure, raise your heart rate, and make your heart more susceptible to extra beats or abnormal rhythms. If you have Narrow Angle Glaucoma (the less common form), decongestants can potentially increase the pressure in your eyes and worsen glaucoma. Decongestants also have a negative effect on the base of the bladder. They tighten the muscle at the base of the bladder that allows urine to flow out and therefore can weaken the urine stream and cause retention of urine, especially in men with enlarged prostates. These medications should not be taken if you are on drugs in the class of MAO inhibitors.

Decongestants are usually well tolerated and can significantly improve how you feel if you are dealing with sinus pressure, nasal congestion and stuffy ears. Always discuss these medications with your doctor, especially if you are taking other medicines or have existing medical illnesses.

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Barriers to Weight Loss – Maladaptive Homeostasis

Posted on November 2, 2011 by auxomed


 


The treatment of obesity is a 28 billion dollar per year industry in the United States and we, as a nation, are getting more obese. Since the first National Health Examination Survey (1960-1962), the rate of obesity in this country has more than doubled, from 14.2 percent of adults to 30.4 percent in the 1999-2000 survey. In the 10 year period from 1990 to 2000, the number of morbidly obese adults has tripled.

Obesity is a complex medical condition. There are multiple genetic, behavioral and environmental factors at play causing our society to weigh more. For the individual, however, there may only be a few factors. In your attempts to lose weight, you need to figure out what factors are preventing you from losing weight. The first place to start is determining how many calories per day you are eating. Interestingly, this is one of the places most people get off track. Most people will not go through the effort to count the amount of calories per day that they are taking in. In the United States, we could not be in an easier place to do this. Food labeling in this country is pretty good. You can, with excellent accuracy, determine your daily intake. Several computer and smart phone apps are available to assist. I like Calorie Counter by Fat Secret. With this app you can actually scan the bar codes with the phone camara on food items and get the caloric total for each serving of a food. You can then add it to your daily total right on the app. Once you figure out how many calories per day that you are taking in, you can begin to determine how many calories you need to reduce weight. I would refer the reader at this point to my blog on “Weight Loss – Setting Goals” to determine your daily caloric deficit needed to lose weight.

Now, this is where it gets hard. This is where we get into realm of “willpower.” What I have described above is not that difficult – determining calories and then figuring out how many you need to reduce to lose weight. Actually doing it is hard. If you tried to lose weight before, you know how it feels when you are at a “caloric deficit” – when it is 9 pm and your body is saying “I’m hungry!”

Homeostasis

One thing that I have learned in medicine is that the body loves a “homeostasis” – it likes to keep things stable. Homeostasis is a biological term that is used to describe a system that is in equilibrium – at balance or in harmony with itself. It is not going one direction or the other. Most of the time, this is a good thing. Maintaining the ‘status quo’ can be beneficial if you are talking about maintaining blood pressure, body temperature, or blood glucose levels sufficient for you to do your daily activities.

Maladaptive Homeostasis

Sometimes homeostasis is not a good thing. Sometimes the body can develop a homeostasis that is ‘maladaptive.’ This can be seen in many aspects of medicine. I will cover some below:

Medication withdrawal – there are numerous medications that are difficult to stop once they have been taken for a while. The body tends to get used to these and develops a kind of happy affiliation with the medication. These can include antidepressants, pain medicines, certain blood pressure medications, or decongestants. Anyone who has taken one of these medications for a long period of time and has tried to stop abruptly knows what I mean. Narcotic withdrawal is one of the more well known examples of this.

Another example of maladaptive homeostasis is seen in untreated hypertension. Untreated hypertensive patients are difficult to get to goal. Once on treatment, patients often have difficulty taking the new medications. This is usually directly related to the misery they feel on the medication. A patient who is used to a systolic blood pressure of 175 and is suddenly dropped to a systolic pressure of 125 feels miserable even though this is the very blood pressure they had when they were 15 years old – they are fatigued, lightheaded, less sharp, and (men) can have a loss of erectile function. And we wonder why people don’t want to take their medications even if they know they are improving their general health by treating their high blood pressure. This maladaptive homeostasis is reflected in the body being used to the blood pressure of 175 (despite its potentially serious effects on the patient’s well being) and resisting getting back to the healthy blood pressure of youth.

I believe that obesity is often the result of a maladaptive homeostasis. Evolution has left us with a genetic make-up that is suited to survive in conditions of bounty as well as famine. In the history of mankind when food was not as prevalent, it was a beneficial trait to want to take in as much energy as possible and store it (in the form of fat) for times when food was not as plentiful. Our society is now “a place of plenty” and even the poorest in this country have access to food. Unfortunately, much of this food is highly processed, energy dense foods (full of fat and processed carbohydrates).

Like a thermostat in a house, your body gets used to a daily amount of caloric intake. You are in a “caloric homeostasis.” When you drop that intake, the body is going to tell you something is wrong – the signal it will send to you loud and clear is “hunger!” If you don’t believe me, monitor your average caloric intake for a week and then drop it by 800 calories per day for three days. You may find yourself gravitating to the refrigerator each evening.

People who successfully achieve lasting weight loss overcome the maladaptive impulse to continue eating higher calorie diets. They reset their thermostats – or “caloristats.” It is hard, but it can be done. I think a good real world analogy to this can be seen in people who change from whole milk to skim milk. If you have known someone who has done this, they will tell you that despite the fact that skim milk initially tasted like water, once they made the change, they often cannot tolerate whole milk anymore. Many vegetarians will tell you that when they eat meat they develop indigestion despite having tolerated or enjoyed meat before. Similarly, once you get used to a new, lower caloric intake, through persistent change and, let’s face it, willpower, you will find it easier to maintain weight loss.

Despite the development of maladaptive tendencies, the human body is amazingly adaptive. You can adapt to and be comfortable with new eating habits. Smokers can quit smoking. Heroin addicts can quit heroin and you can lose weight. Stick with it and success will follow!

“I do not think there is any quality so essential to success of any kind as the quality of perseverance. It overcomes almost everything, even nature.”

John D. Rockefeller

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“Why is my mouth dry, Doctor?”

Posted on October 6, 2011 by auxomed


 


I often get the complaint in the office of “dry mouth.” Many things can cause a dry mouth. The medical term for “dry mouth” in Latin is “xerostomia” which means – “dry mouth”….(so smart, the Latins**).

Some simple things should be considered first when looking for causes of a dry mouth. Dehydration can cause dry mouth. Chronic mouth breathing, especially at night can dry a mouth. Sometimes a dry mouth can occur during the change of seasons. Heating systems without humidification create dry mouths. And finally, I see some people with dry irritated mouths when they switch toothpastes. Our toothpastes today have many chemicals for various purposes (tartar control, bleaching, sensitivity, fluoride). Some people are more sensitive to certain brands. Consider these things first.

The most common cause for dry mouth that I see is a medication. There are numerous medications that can cause dry mouth. Most of these medications have “anti-cholinergic” side effects. In simple terms, anti-cholinergics block the nervous system impulses that aid in the flow of saliva. They kind of create a “fight or flight” situation in the salivary glands. If you have ever been scared or have been nervous for a public speaking engagement, you may have noticed this effect of dry mouth. The most common medications that can do this are antihistamines, psychiatric medications, certain bowel and bladder medicines, and asthma medications but there are many others. If you read medication package inserts, you will commonly see “dry mouth” listed as a side effect. When you are on these medications, the salivary glands are essentially turned off. Most people use water to re-moisten their mouths. While water is good, it is only temporary. The most effective home remedy for this type of dry mouth is to use sialogogues. Sialogogues are substances that make the salivary glands turn back on. Have you ever taken a bite out of a lemon? You may feel a tightening in your cheeks. That is your salivary glands kicking into action in response to the lemon, a sialogogue. Anything tart is a pretty good sialogogue. Lemon drops, water with some lemon or lime in it, or a sweet tart may be just the thing to kick start your salivary glands in this situation.

Dry mouth can be caused by disease processes too. The classic disease that affects the salivary glands and causes dry mouth (and dry eyes) is called Sjogren’s syndrome (pronounced “SHOW-GRENS”). This is an autoimmune condition whereby the body attacks the salivary glands and the tear glands. It is sometimes referred to as “Sicca syndrome.” (For those interested the word “sicca” comes from the Latin root that gave us the word “desiccate.”) Certain neurologic conditions such as Parkinsonism and dementia cause affect salivary flow. Radiation to the head or neck can affect the salivary glands. In cases like these where there is lasting, irreversible damage to the salivary glands, there are medications on the market that stimulate salivary flow. One is called Salagen. It is only used in the worst cases of dry mouth due to potential side effects such as low heart rate, flushing, and diarrhea.

Over time, a chronically dry mouth can negatively affect health. Saliva is essential for the health of the teeth and gums. Dry mouths can lead to dental problems such as cavities and gingivitis, not to mention bad breath. Saliva also aids in the first part of digestion of food and more importantly swallowing. People with low salivary flow rates are more prone to choking on food and mucus. Mouth sores and dry, cracked lips can result from dry mouths. If you have a chronically dry mouth, please discuss this with your doctor.

** – the Latins were really Roman.

Posted in Advice for My Patients, Medications | 2 Comments

Listeria Outbreak in Canteloupe

Posted on September 28, 2011 by auxomed

Thirteen deaths and more than 72 illnesses have been traced to Listeria from tainted canteloupe shipped from Jensen Farms in Colorado. Eighteen states are thought to be involved so far in the outbreak, including California, Colorado, Florida, Illinois, Indiana, Kansas, Maryland, Missouri, Montana, Nebraska, New Mexico, North Dakota, Oklahoma, Texas, Virginia, West Virginia, Wisconsin, and Wyoming. Listeria usually affects the elderly, immunocompromised patients, and alcoholics. Most of the illness and deaths have been in the elderly. The mean age has been 78 years old. The affected canteloupes may be labeled “Colorado Grown,” ”Distributed by Frontera Produce,” ”Jensenfarms.com” or “Sweet Rocky Fords.” Some were distributed without labels. Listeria can survive despite being refrigerated. Listeria primarily causes blood born infections and meningitis. It can present with HA, malaise, fever, and weakness.

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Cold Preparations

Posted on September 20, 2011 by auxomed


 


Many people have questions about over the counter cold preparations. There are numerous preparations on the pharmacy shelves – many of which are not very different in their components. You should choose cold preparations that have components in them that target your symptoms. I will review these components below.

There are basically five main components found in cold preparations: 1) Analgesics 2) cough suppressants 3) expectorants 4) decongestants and sometimes a sleep aid, usually an antihistamine. Cold preparations are generally safe to use short term. I will list the possibly side effects of each component below.

Analgesics: These are excellent pain reducers and fever relievers. The most commonly used medications here are aspirin, ibuprofen, and acetaminophen. Analgesics like aspirin and ibuprofen can affect the lining of the stomach, leading to gastritis and ulcers if overused. They can also negatively affect blood flow to the kidneys causing elevated blood pressure and fluid retention in sensitive patients, such as those with congestive heart failure, kidney disease, and uncontrolled hypertension.

Cough suppressants: The most common used is dextromethorphan. It works to suppress cough through its action on central nervous system reflexes that create cough. Dextromethorphan is fairly effective in adults. It is not felt by many pediatricians be effective in children under the age of twelve. It can have some central nervous system side effects if too much is taken such as confusion and hallucinations. It can interact with some antidepressants such as MAO Inhibitors and SSRIs.

Expectorants: Guafenesin is the most commonly used expectorant. It works by moving water into the mucous in the upper airways making the mucous less “paste-like” and more “liquid-like,” facilitating clearance. It works better in the patient who is well hydrated however. That is one of the reasons why it is good to hydrate during a cold. The color of your urine can be an indicator of your state of hydration when you are sick (provided you are not taking something that changes the color of the urine like a multivitamin) darker usually means that you are not well hydrated. Expectorants have very few side effects.

Decongestants: Decongestants decrease swelling and the secretion of mucous from the upper airways and sinuses by constricting blood vessels. They are effective in opening airways, especially the nasal passages, and allowing for easier breathing. The most common used are pseudoephedrine and phenylephrine. Phenylephrine has increasingly been used in cold preparations since the widespread abuse of pseudoephedrine to illegally make methamphetamine was discovered. It is extensively metabolized by the intestines prior to absorption so it is felt by many to not be very effective in the oral form. Pseudoephedrine is the most commonly used decongestant. Decongestants can cause several side effects all of which are similar to the effect of epinephrine (adrenaline) on the body. These include palpitations, racing heart, increased blood pressure, anxiety, and weakened urine stream in men with enlarged prostates.

Sleep aids: Some cold preparations add a sedating antihistamine like doxylamine or dephenhydramine to help with sleep. Nyquil is one of the more common night time cold medications. Antihistamine are good at inducing and maintaining sleep. Antihistamines can cause dry mouth, confusion, weakened urine stream, constipation, and palpitations.

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Stevia

Posted on September 10, 2011 by auxomed

The sweetener Stevia is derived from the tropical plant Stevia rebaudiana. Stevia has been used as a sweetener in Japan since 1971 and in certain cultures in South America for centuries. There are several sweet substances that are extracted from plant. Steviol is the extract from the plant that is the chemical backbone for other sweet compounds called “steviol glycosides.” These steviol glycosides are used as sweeteners. The sweetest steviol glycoside is a compound called Rebaudioside A, or commonly listed as “Reb A” or “Rebiana” on ingredient labels. It is the most commonly used Stevia extract and is the main sweetener found in the branded Stevia products, Truvia and PureVia. Truvia is marketed by the Cargill Corporation in collaboration with Coca-Cola and PureVia is marketed by PepsiCo Inc.

Stevia, in its raw form, is very bitter. Reb A is much sweeter and less bitter than pure Stevia. Truvia is a mixture of RebA and Erythritol (see Sugar Alcohols). PureVia has Erythritol and Isomaltose added.

Safety: Stevia was originally thought to be a mutagen (compound causing damage to DNA). The study that created this claim was considered to be a poorly done however and in 2008 the Food and Drug Administration (FDA) gave the Reb A form of Stevia the “Generally recognized as Safe” (GRAS) approval. This was based on numerous animal studies not showing any harmful effects. Truvia and PureVia were marketed in the United States as sweeteners at that time. Reb A is heat stable – it does not breakdown when subjected to high temperatures. For the specific details of the FDA’s approval of Reb A, go to the following link:

http://www.accessdata.fda.gov/scripts/fcn/gras_notices/grn000278.pdf

The Reb A based sweeteners are the sweeteners that I prefer to use.

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Saccharin

Posted on August 30, 2011 by auxomed

The story of saccharin is riddled with controversy. It is a little known fact that saccharin was actually discovered in 1878 in a chemistry lab. As with many discoveries, saccharin was discovered by accident. A chemist working with derivatives of coal based carbon tasted “sweetness” on his hands (supposedly while smoking) one evening after work. That substance was benzoic sulfilimine which is our modern day saccharin. The chemist and his lab published papers on the new substance and its sweetness. The chemist who initially discovered saccharin applied for a patent within five years of his discovery. He became very wealthy. In the early 20th century, saccharin was put in several products, not to lower calories, but because it was cheaper to make, more sweet than sugar in taste and extremely water soluble. Saccharin is not stable at high temperatures so it is not good to cook with, but it does have a long shelf life at normal temperatures. Another appeal to saccharin was that it could be made in a lab instead of relying on the output and price fluctuations from various Caribbean countries such as Cuba.

Saccharin was first investigated in 1907 under the Pure Food and Drug Act. It was then being substituted in many foods for sugar without the consumer knowing. Saccharin had a brief setback in 1911 as being an “adulterated ingredient” only to be reversed in 1912. Saccharin acquired new popularity in World War II when sugar was in short supply.

It was used regularly in the United States until studies that were uncovered in the 1970s showed that saccharin in high doses caused bladder cancer in laboratory rats. For about 30 years, the sweetener carried the warning of “causing cancer in laboratory animals.” The warnings were lifted in this country in 2000 when it was determined that male rats had a unique physiology to set them up for bladder cancer when high doses of saccharin were consumed. Specifically, they have a high level of calcium phosphate and protein in their bladders causing saccharin to crystallize and repetitively irritate the bladder. This does not exist in the humans and much of saccharin is not absorbed into the body. Saccharin has been shown to cause an elevation in blood insulin levels after consumption.

A great historical perspective on artificial sweeteners can be read in Carolyn de la Pena’s book – Empty Pleasures: The story of artificial sweeteners from Saccharin to Splenda that was published in 2010.

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Sucrolose

Posted on August 26, 2011 by auxomed

Sucrolose is essentially a chlorinated sugar. Table sugar, sucrose, is chemically altered by replacing some of the alcohol groups with Chlorine. Sucrolose is extremely sweet – about 600 times sweeter than sugar. Sucrolose is a very stable chemical and does not break down easily. It therefore can be used for cooking and is stable at temperatures up to 450 degrees F. It is minimally absorbed by the body and passes out mostly in the stool. Because of its stability, there is some concern that it does not break down in the environment. Some are concerned as to the long term environmental effects of the increasingly popular sweetener. A Swedish study showed that standard wastewater treatment does not break down sucrolose, suggesting that it can build up in the environment.

Sucrolose is found the commercially available product called Splenda. Splenda has about 90 percent dextrose and maltodextrin – a sugar and a starch – so it does provide some calories. But if a serving of something provides less than 5 calories (like a packet of Splenda), the substance can be considered “no calorie.”

Sucrolose is “generally recognized as safe” by the Food and Drug Administration. There are no documented adverse effects on humans. Based on animal studies, there is some concern that sucrolose alters bowel flora (the intestinal “good bacteria”) since much of it does not get absorbed and passes through the bowels.

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