Q: I received an unsolicited newsletter that gave a list of harmful ingredients in medications. On the list was xylitol.
I’ve been using Xlear spray two times per day for allergies and chewing Trident gum daily for some years. Both Xlear spray and Trident contain xylitol. Please tell me what the xylitol is doing to me.
A: Xylitol is a sugar substitute originally derived from xylose in birch bark. Raspberries and mushrooms, as well as other fruits and vegetables, contain small amounts of xylitol. The xylitol used in products like chewing gum, lozenges, toothpaste and sugar-free candy is primarily made by processing corncobs.
Like sorbitol and maltitol, which also are used as sugar substitutes, xylitol can cause bloating, flatulence and diarrhea if it is consumed in large quantities.
There is some evidence to suggest that chewing gum with xylitol reduces ear infections in children. It also may discourage cavities (Archives of Oral Biology online, June 6, 2016).
The big problem with xylitol comes with any canine companions. Xylitol is quite toxic to dogs and must be kept away from them.
Q: At my recent physical, my doctor gave me the results of my bloodwork. My testosterone was low, and he recommended T shots.
I had been experiencing some erectile dysfunction and lethargy, but attributed that to my age. The shots have helped me, but I wonder about adverse effects. Are there any?
A: Testosterone, either as an injection or topical gel, is controversial. The Food and Drug Administration cautions doctors not to prescribe this male hormone to healthy men with “low T” linked to aging. The agency states that testosterone is only for men with hypogonadism and warns about an increased risk of heart attacks and strokes.
A study in the New England Journal of Medicine (Feb. 18, 2016) contradicts the FDA’s stance. It demonstrated that men with low testosterone experienced improved sexual function and mood after using a testosterone gel, with no increased risk of cardiovascular complications. An analysis of available data also found no link to heart attacks and strokes (Expert Opinion on Drug Safety, October 2014).
Q: I have had a great deal of trouble sleeping since my husband passed away. For many years I have taken Tylenol PM or Advil PM along with alprazolam.
I have read that alprazolam can contribute to dementia, so I am trying to get off it. What about PM pills? Could they also contribute to dementia?
A: Alprazolam (Xanax) is approved for treating anxiety and panic, not insomnia. This drug is a benzodiazepine, in the same class as diazepam (Valium) and lorazepam (Ativan). Some studies have shown a connection between long-term use of benzodiazepines and the later development of dementia (Expert Opinion on Drug Safety, May 2015).
Stopping alprazolam suddenly could lead to worse insomnia or other withdrawal symptoms.
The PM part of your nighttime pain reliever is diphenhydramine. This antihistamine has strong anticholinergic activity. Drugs in this class also have been linked to an increased risk for dementia (JAMA Internal Medicine, March 2015).
We are sending you our newly revised 15-page Guide to Getting a Good Night’s Sleep, which lists anticholinergic drugs and offers nondrug suggestions for overcoming insomnia. It is available as a PDF download for $3.99 at www.PeoplesPharmacy.com.
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