When you’re picking up over-the-counter drugs or prescription medications, you’re focused on the ingredients that will make you feel better, not the ones that are along for the ride. But those inactive ingredients comprise as much as 99 percent of a pill or capsule, and they’re there to keep your medication stable, help you absorb the good stuff, help prevent tampering, and enhance the taste. Now, a new study in Science Translational Medicine shows that some of these inactive ingredients may cause allergic reactions or tummy troubles in some people.
To arrive at their findings, researchers searched a database of about 42,000 recipes for oral medications in the U.S. and found that close to 93 percent contained at least one of 38 inactive ingredients that can trigger allergic reactions. What’s more, 55 percent of pills contained at least one member of a class of sugars that fall in the category of FODMAP—they cause digestive problems in people with irritable bowel syndrome. Here are some questions you should always ask before taking prescription medications.
Some potential allergens found in the inactive ingredients included lactose, gluten, corn starch, gelatin, soybean oil, peanut oil, vanilla, sesame oil, sucrose, aspartame, wheat starch, brilliant blue dye, and Allura red dye, the study showed.
While that sounds pretty scary, don’t panic, says study author C. Giovanni Traverso, MB, BChir, PhD, a gastroenterologist and biomedical engineer at Brigham and Women’s Hospital in Boston. “Inactive ingredients are actually tested rigorously by regulatory agencies to ensure they are not dangerous,” he says. In general, the amounts in an individual pill aren’t worrisome even if you are allergic, but people taking multiple medicines may unknowingly get too much of a certain inactive ingredient.
“Allergic reactions are rare but, of course, possible to some,” he says. Crucially, medications that contain peanut oil must list it on the label, as a peanut allergy can be life-threatening. But there aren’t warnings for most other allergens or irritants, says Dr. Traverso, and sometimes you have to become an amateur detective to see if lactose or gluten is in the medicine. He recommends telling your doctors and pharmacists if you have a sensitivity. They can help you go over the ingredients of your medications on the drug inserts, or you can look up the list on Pillbox Database, a website run by the National Library of Medicine at the National Institutes of Health.
But these steps aren’t always fail-safe. “Inactive ingredients in a medication change frequently, which means something that’s safe when a prescription is filled one time might not be safe the next time, especially if the drug comes from a different manufacturer,” Dr. Traverso says. “If a patient notices abnormal symptoms when starting a new medication or switching to a different formulation, they should consider the possibility that it could be some of the other ingredients.” These are some more secrets your pharmacist won’t tell you.
The new findings are particularly worrisome for people with celiac disease, says Alice Bast, CEO of Beyond Celiac, an Ambler, PA-based nonprofit group that aims to raise awareness about celiac disease. Celiac disease is an autoimmune disorder triggered by consuming gluten found in wheat, barley, and rye. Symptoms may include diarrhea, abdominal pain, depression, and a host of others. Sometimes symptoms of a gluten allergy are so subtle that many cases are missed. The only treatment is eliminating gluten from the diet.
The new study listed wheat starch as one of the troublesome inactive ingredients; it can contain gluten and be harmful to people with celiac disease, says Bast. “Any time starch is used, there’s a question of whether it’s made from wheat. Medications with dextrin, dextrates, modified starch, pregelatinized starch, and pregelatinized modified starch are all suspect.”
If you have celiac disease, wheat starch and the other terms for starch are a clue that you need to verify the source, she says. Though starch is the biggest problem, ingredients made from barley could also be harmful; Dextri-maltose and caramel coloring can be made from barley, she says.
While gluten is not found in a lot of medications, it’s very hard to identify the few drugs that have it, she says. “People with celiac disease sometimes stop taking their pills for serious conditions because of fear about gluten.”
With over-the-counter drugs, you can find ones that are labeled gluten-free. “For those that aren’t and for prescription drugs, celiac disease patients have to be diligent about getting the information they need,” she says. “First, make sure any physicians prescribing a medication know you have celiac disease and need gluten-free drugs.” Ask your pharmacist for advice as well. Beyond Celiac is working to get legislation passed that makes labeling of gluten in drugs mandatory, she says. No matter the inactive ingredients in your medications, always be on the lookout for the signs you’re taking too many prescriptions.
Genetics play a big part in health conditions, so looking at your mom’s health can give you a clue what’s to come. This is especially true of complications that affect women more than men, like osteoporosis, a weakening of the bones. According to the CDC, osteoporosis affects 25 percent of women over 65, but only six percent of men—and recent research has found genetic variants predisposing some people to the disease. “There is strong evidence for an increased risk of osteoporosis if your mother had it,” says Todd Sontag, DO, a family medicine specialist with Orlando Health Physician Associates. “Many times this has to do with an inherited body structure of having lower body weight—less than 58kg [128 pounds] in adults or a BMI of less than 22.” Another risk factor is simply having a parental history (mom or dad) of hip fracture, he says. To mitigate these affects, make sure you’re getting enough calcium and vitamin D, and are living a healthy lifestyle. Here are the signs you’re not as healthy as you think.
Wonder if you’re going to get wrinkles or skin damage? Take a look at your mom’s face. Research has shown that male and female skin ages differently due to different hormones. “Your mother’s ability to break down collagen and the age when it started breaking down—the age when she got wrinkles—are passed down to you, as well as the pattern of collagen breakdown: Did she get wrinkles around her eyes first, or deeper lines around her mouth?” says dermatologist Purvisha Patel, MD, creator of Visha Skin Care. “Looking at pictures of her as she ages helps you understand how to combat your aging process.” Daily sunscreen and an anti-aging serum with retinol, vitamin C, ferulic acid, and vitamin E work to fight these genetic effects, she says. In addition, your skin type, passed down from your mother and your father, can affect your chances of sun damage and skin cancer. Those with fairer skin are most at risk. This is what dermatologists wish you knew about preventing wrinkles.
If you’re aware of what psychologists wish you knew about depression, you might already know that depression is diagnosed twice as often in women as in men, possibly as a result of hormonal fluctuations and women’s response to trauma and stress. “Another important aspect in gender studies shows that women have a more chronic course of depression than do men,” says psychologist Deborah Serani, PsyD, award-winning author of Living With Depression. “This means that females experience depression more often and for a longer duration of time than males.” Plus, it’s genetically linked, with Harvard Medical School experts noting that certain genetic mutations associated with depression occur only in women. So if your mother had depression, you should be on the lookout for symptoms, and get treatment if needed. “This is why knowing your family medical history is so important to become proactive about your own personal health,” Dr. Serani says. Here are the signs you’re healthy from every type of doctor.
Women are more likely to have the eye condition glaucoma, and are also more likely to be visually impaired or blind from it, says the American Academy of Ophthalmology (AAO). Thanks to menopause, women are also more likely to have dry eye syndrome, which frequently occurs with glaucoma. Plus, glaucoma runs in families—so if your mom (or dad) has it, be sure to let your eye doctor know, and get screened for it regularly. “You are at higher risk for developing glaucoma and [another eye condition] macular degeneration if your mother had it,” says Dr. Sontag. “Just like everything else, there are other lifestyle factors that contribute as well.” The AAO says to also avoid smoking to reduce your risk. Here’s how to improve your eyesight—without eating carrots!
There are multiple reasons you might have a migraine, and your mother is just one of them. According to the Mayo Clinic, women are three times more likely than men to have migraines, likely because of hormonal fluctuations. The National Headache Foundation notes that 70 to 80 percent of migraine sufferers have a relative who gets the debilitating attacks as well. “One of the main risk factors for migraines is family history of migraines,” Dr. Sontag says. “So yes, if your mother has migraines, you are more likely to develop them as well.” Emerging research is identifying how and why genetics play a role, with one large international study suggesting it may have to do with how the blood vessels function in the brain. But until we know more, if your mother suffers from migraines, you can try to reduce your risk by limiting other risk factors, like getting regular exercise and sleep, managing stress, and avoiding caffeine and any individual food triggers.
Nearly two-thirds of those with Alzheimer’s are women, according to the Alzheimer’s Association. The exact reasons why are yet unknown, but seem to go beyond the simple fact that women live longer than men. Researchers have also found genetic links for Alzheimer’s. “There are genetic alleles that have been identified that increase risk of developing Alzheimer’s disease,” Dr. Sontag says. “A maternal history does increase the risk.” The National Institute on Aging reports that if your mother or father has a genetic mutation for early-onset Alzheimer’s (which appears from your thirties to mid-sixties), there’s a 50/50 chance you will inherit it—and if you do, there is a strong possibility of developing the disease. If your mother had Alzheimer’s or other dementia, you can reduce your risk by exercising, eating a heart-healthy diet, maintaining social ties, and staying mentally active. These are the early signs of Alzheimer’s disease every adult should know.
Weight, body shape and fitness level
As with many other aspects of health, the condition of your body is partly genetic, partly environmental. So if your mother has a certain body type or weight, you may be more likely to have the same one—but that could be the result of learned behaviors, too. “While there is some solid research to support a maternal’s body shape and weight and its influence on her children, this is definitely not the only contributing factor,” Dr. Sontag says. “Many times, the lifestyle of the mother is what is learned and passed down to her kids, which includes the way she eats and exercises.” So if you grow up eating the same way as you mother, it’s not surprising if you develop a similar body. Likewise, the fitness level you can achieve is part hereditary, part lifestyle. “Genetics do play a strong role in our muscle make-up,” Dr. Sontag says. “No matter how much certain people train, they will never be as fast as Usain Bolt or Michael Phelps.” Still, if your mom is overweight, you can help avoid the same fate by eating healthy and exercising, with the goal of being the healthiest you can for your individual body.
Heart disease and diabetes
Women may believe they don’t have to worry about heart disease, but just like men they need to understand their genetic heart disease factors. Given genetic similarities in weight and body shape, you and your mother might also have a similar risk of heart disease, the number one killer of women, as well as type-2 diabetes. A recent study presented at the American Society of Human Genetics found that maternally inherited gene variants of how women store fat can affect their risk of type-2 diabetes. “There is strong evidence that if your mother has heart disease, type-2 diabetes, or strokes, that you are at a higher risk to develop them,” Dr. Sontag says. “The younger the age that the mother developed it tends to correlate with a higher risk in the children.” But again, there are lifestyle factors to consider. “If your mother had a heart attack at 50, but weighed 300 pounds, never exercised, and smoked, the risk may be completely related to her lifestyle,” he says. “You can’t have soda every day and ice cream every night and then use your family history as an excuse when you develop diabetes.” Still, if your mother (or father) had early heart disease, Dr. Sontag recommends a checkup with a cardiologist. These are the physical and emotional ways heart disease is different for women.
Pregnancy and fertility
If you’re looking to see what your pregnancy experience will be like, ask your mother about carrying you. “Gestational diabetes is more common in women who are risk for adult onset diabetes, which does run in families, so if you have a strong family history of diabetes, you are at increased risk for gestational diabetes,” says Pamela Berens, MD, an OBGYN with McGovern Medical School at UTHealth and Children’s Memorial Hermann Hospital. In addition, “preeclampsia is more common in women who have had high blood pressure, and high blood pressure may be inherited.” A Norwegian study showed severe morning sickness, or hyperemesis gravidarum, may be inherited as well. As for issues getting pregnant, most causes of infertility and miscarriage are not genetic—but some may be. “There appears to be an increased risk of endometriosis in first-degree relatives of women with endometriosis,” Dr. Berens says. “Rarely, some women with recurrent miscarriages can have an inherited chromosome issue that makes miscarriage more common, and genetic testing can be done.” For some other infertility conditions, such as PCOS, it’s not clear yet whether genetics are at play.
You should also ask your mom if she suffered from postpartum depression after pregnancy. Like other aspects of mental health, it may be passed from mother to daughter. “Studiesshow that postpartum depression is genetically linked,” Dr. Serani says. “Your risk for PPD increases if your mother, or another family member—sister, aunt—has experienced it.” One small study from Johns Hopkins found specific chemical alterations in two genes that, when they occur during pregnancy, can predict whether a woman will develop postpartum depression with 85 percent accuracy. The researchers hope this will eventually lead to a blood test that can give pregnant women a better indication of their risk—but for now, knowing your family history is important. “Ask your mother about her postpartum experiences,” Dr. Serani says. “This can informally clue you in to whether or not depression is a risk factor for you.” Here are seven dangerous postpartum depression myths.
Breast and ovarian cancers
Awareness on the genetic link of breast and ovarian cancers may be due in part to Angelina Jolie, whose mother died from breast cancer. After discovering she carried the BRCA1 gene, the actress underwent a preventive mastectomy, reducing her breast cancer risk from 87 percent to under 5. “The gene mutations that are most commonly associated with hereditary breast and ovarian cancer are the BRCA1 and 2 gene mutations,” Dr. Berens says. “If you have a suspicious family history—for example, if you have multiple family members with breast or ovarian cancer, if the breast cancer happened at an early age, or if the same family member had both cancers—it is more suspicious that you could have a genetic tendency.” Talk to your doctor about your individual risk if you mom or other female relatives had one of these cancers, and consider seeing a genetic counselor for genetic testing.
Studies have shown that the age at which your mother went through menopause will be partly responsible for when you do. In addition, if your mother went through menopause early, you should let your doctor know. “Premature ovarian insufficiency, before 40, can be caused by a number of conditions, and some of these conditions can be inherited—for instance women who are fragile X carriers,” Dr. Berens says. Fragile X is a gene mutation linked to the X chromosome, and it can trigger anxiety, hyperactivity, and intellectual disability. As for menopause symptoms such as hot flashes and night sweats, Dr. Berens says scientists are trying to clarify if there’s a genetic link. The first study of its kind in humans, from UCLA, might have found a related gene variant, but more research is needed. Next, check out what your sweat says about your health.