May 2004 CanDrug.com Newsletter
Issue #9, May, 2004

• CanDrug Holiday Hours - Closed Memorial Day
• Not All Sugars Are Created Equal
• FDA Approves Spiriva HandiHaler
• Sale! Order Spiriva from CanDrug
• Sale! Order Norvasc from CanDrug
• Sale! Order Lipitor from CanDrug
• Enjoy CanDrug.com's New Shopping Cart Functionality
• Candrug Customer Feedback

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Not All Sugars Are Created Equal

By David Schardt
Nutrition Action

The artificial sweetener business must be a pretty good place to be these days. Thanks to the obesity epidemic, a growing number of people are trying to cut calories. That means more “diet” this and “no-sugar-added” that. And the low-carb craze has left food manufacturers scrambling to be the first on their block to take the sugar out of everything from chocolate to ketchup to Bloody Mary mix.
The result? We’re eating more low-calorie sweeteners than ever before. Yet not all sugar substitutes are Equal, so to speak.
- Sucralose and Neotame are safe.
- Sugar alcohols and tagatose, while safe, may give you the runs if you eat too much.
- Aspartame probably is safe.
- Acesulfame and stevia may or may not be safe; there’s not enough good research to tell.
- Saccharin isn’t safe (though the risk is small).
If you drink diet soda or chew gum (sugarless or regular), you’ll have a hard time avoiding aspartame and acesulfame. And if you’re a fan of “light” yogurt, you’ll be getting either aspartame or sucralose. That’s because manufacturers choose sugar substitutes depending on the food. Some are used in baked goods because they withstand heat better. Some are used in yogurt because they can survive in an acidic environment. Some lose their sweetness in the syrup used to make fountain sodas, but are fine for bottled or canned soft drinks. Just keep in mind that even an unsafe sweetener like saccharin poses only a tiny risk to any given person. The potential problems arise when tens of millions of people consume the sweetener for years. That’s why the government should require better studies on some sweeteners and should ban others. And remember: real sugar is hardly a toxic chemical. The problem is the large amounts that Americans eat. The U.S. Department of Agriculture has suggested a limit of ten teaspoons of added sugars per day for people who eat a 2,000-calorie diet. That’s 40 grams, about as much as you’d get from one 12-ounce soft drink or two six-ounce fruit-on-the-bottom yogurts.

Sucralose
Also known as: Splenda.
What is it? Sugar (sucrose) chemically combined with chlorine. It’s “made from sugar” label slogan is technically true, but misleading. Why it’s low-calorie: Our bodies can’t burn sucralose for energy.
Safety: Sucralose passed all safety tests in animal studies.
Comments: There is no reason to suspect that sucralose causes any harm.

Neotame
What is it? A synthetic derivative of a combination of aspartic acid and phenylalanine, the same two amino acids that are used to make aspartame.
The bond between the amino acids is harder to break down than aspartame’s, so Neotame is more stable.
Why it’s low-calorie: Our bodies can’t metabolize Neotame, and only tiny amounts are needed to sweeten foods.
Safety: Unlike aspartame, Neotame isn’t broken down in the body into the amino acid phenylalanine, which is toxic to people with the rare disorder phenylketonuria (PKU). Animal and human studies have raised no safety concerns.
Comments: Neotame is so new that it hasn’t yet appeared in any foods. It’s always possible that once millions of consumers start eating neotame, some
people may turn out to be sensitive to it.

Sugar Alcohols
Also known as: sorbitol, xylitol, mannitol,
maltitol, lactitol, isomalt, erythritol,
hydrogenated starch hydrolysates.
What are they? Sugar alcohols aren’t sugar and won’t make you tipsy. They’re made by adding hydrogen atoms to sugars. For example, adding hydrogen to glucose makes sorbitol.
Why they’re low-calorie: Some sugar alcohols are absorbed better than others. Erythritol, which is largely unabsorbed, has virtually no calories, while maltitol and hydrogenated starch hydrolysates are absorbed enough to provide three-quarters the calories of sugar.
Safety: Too much sugar alcohol traveling unabsorbed through the intestinal
tract can cause bloating, gas, and diarrhea. Unfortunately, the FDA only
requires a “laxative effect” warning notice on labels if consumers could ingest 50 grams of sorbitol or 20 grams of mannitol from the food in a day. But just 10 grams of sorbitol, for example, can cause GI distress. (If sugar alcohols have made you sick, send a letter to CSPI—JE, Suite 300, 1875 Conn.
Ave. N.W., Washington DC 20009. We’ll forward it to the FDA.)
Comments: Sugar alcohols don’t raise blood sugar as rapidly as sugar does, yet they’re as bulky as sugar. So they can be used tablespoon-for tablespoon to replace the sugar that’s been removed from lower-carb foods. But while they may have a minimal impact on your blood sugar, they may have more than a minimal impact on your waistline and hips. Safe, but large amounts can cause diarrhea

Aspartame
Also known as: Equal, NutraSweet, NatraTaste.
What is it? A synthetic derivative of a combination of the amino acids aspartic acid and phenylalanine.
Why it’s low-calorie: Only tiny amounts of aspartame are needed to sweeten foods.
Safety: People with the rare disorder phenylketonuria (PKU) can’t metabolize phenylalanine, so they should avoid aspartame. Whether aspartame causes headaches is unclear. An industry-funded study of people who complained of aspartame-induced headaches concluded that it doesn’t. But an independent test in 1994 of 26 similar people found that the sweetener was linked to symptoms in the 11 who were “very sure” they were sensitive. That suggests that some people react to aspartame, though fewer than the number who believe they do. The most serious charge—that aspartame increases the risk of cancer—has never been proved. Among the many animal studies on aspartame, only one hints at an increased risk. There’s no foundation to claims floating around the Internet that aspartame causes everything from Alzheimer’s disease to multiple sclerosis.
Comments: Clouds hang over both aspartame and acesulfame, but researchers have done more—and better—studies on aspartame. Even so, because aspartame is used in so many foods, the FDA should err on the side of caution and require non-industry-funded studies to resolve any questions about aspartame’s safety. People who believe they suffer from headaches or other symptoms after consuming foods that contain aspartame should avoid the sweetener.
Probably safe, but certain people should avoid

Tagatose
Also known as: Naturlose.
What is it? A “mirror-image” form of sugar that’s manufactured from milk sugar (lactose).
Why it’s lowcalorie: Unlike sugar, tagatose can’t be digested by enzymes in the intestines. Most passes through the body unabsorbed.
Safety: Because tagatose isn’t well absorbed, consuming large amounts can cause flatulence, rumbling noises, bloating, and nausea. Studies have raised no other safety concerns.
Comments: Tagatose is so new that you’re only likely to find it in one food— Diet Pepsi Slurpees sold at 7-Eleven.

Acesulfame
Also known as: Sweet One, Sunett, acesulfame potassium.
What is it? A synthetic chemical.
Why it’s low-calorie: Our bodies can’t metabolize acesulfame.
Safety: The safety of acesulfame (pronounced ace-SULL-fame) rests on three animal studies conducted in the mid-1970s. The first was inconclusive because it found a variety of tumors both in mice fed acesulfame and in control mice fed acesulfame-free diets. The second was so plagued with sick animals that the FDA tossed out the results as unreliable. In the third study, female rats fed acesulfame were twice as likely to develop breast tumors as control rats. While most of the tumors were benign, there were some malignant tumors—one in the 60 control rats, two in the 60 rats given low doses of acesulfame, and three in the 60 rats given high doses of acesulfame. The sweetener’s manufacturer argued that acesulfame seemed to cause more tumors only because the control rats happened to remain unusually tumor-free. The FDA bought the company’s interpretation and refused to require more safety testing.
Comments: Acesulfame should be better tested. Until then, try to avoid it.

Stevia
Also known as: Sweet Leaf, Honey Leaf.
What is it? An extract from a shrub that grows in Brazil and Paraguay.
Why it’s low-calorie: Our bodies can’t metabolize stevia.
Safety: When male rats were fed high doses of stevioside (stevia’s active ingredient) for 22 months, they produced fewer sperm and there was increased cell proliferation in their testicles, which could cause infertility. And when female hamsters were fed large amounts of a derivative of stevioside, they had fewer and smaller offspring. That—combined with the absence of other animal studies that are normally required for food additives—led the FDA, Health Canada, the European Union, and the World Health Organization to conclude that stevia shouldn’t be allowed in food.
Comments: Stevia can’t be used as an ingredient in food. But it can be sold as a supplement, since safety rules for supplements are looser than for foods. Stevia is promoted by the health-food industry as a natural alternative to synthetic sweeteners like saccharin, aspartame, and sucralose. But “natural” doesn’t automatically mean “safe.”

Saccharin
Also known as: Sweet ‘N Low.
What is it? A synthetic chemical that was discovered in 1879 when a researcher at Johns Hopkins University in Baltimore noticed that a compound he spilled on his hand tasted sweet.

Why it’s low-calorie: Our bodies can’t metabolize saccharin, and only tiny amounts are needed to sweeten foods.
Safety: In 1977, the FDA tried to ban saccharin because animal studies showed that it caused cancer of the bladder, uterus, ovaries, skin, and other organs. Bowing to pressure from the diet-food industry and dieters, Congress intervened to keep saccharin on the market, though with a warning notice on the label.
(At the time, saccharin was the only high potency sweetener.) In the late 1990s, the Calorie Control Council—which represents the low-calorie food and beverage industry—convinced the FDA and the National Institutes of Health (NIH) that the main health concern about saccharin was bladder cancer in male rats, but that people didn’t develop bladder cancer through the same mechanism as the rats. In 2000, over the objections of a number of scientists, the NIH removed saccharin from its list of carcinogens and Congress removed the requirement for warning notices. Yet last year the National Cancer Institute noted that one of its own studies—the best human study of saccharin use ever done— had found “some evidence of an increased risk of bladder cancer” in heavy saccharin users, “particularly for those who heavily ingested the sweetener as a table top sweetener or through diet sodas.” “Heavy” meant “six or more servings of sugar substitute or two or more eight-ounce servings of diet drink daily.”

Comments: Just because saccharin no longer carries a warning doesn’t erase the evidence that it may cause cancer in humans.

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FDA Approves Spiriva HandiHaler

Source: Boehringer Ingelheim

The United States Food and Drug Administration (FDA) has approved Spiriva HandiHaler (tiotropium bromide inhalation powder) for the long-term, once-daily maintenance treatment of bronchospasm associated with Chronic Obstructive Pulmonary Disease (COPD).

COPD, which includes chronic bronchitis and emphysema, is a lung disease primarily caused by smoking. Spiriva (tiotropium bromide) was discovered and developed by Boehringer Ingelheim and will be co-promoted in the U.S. with Pfizer Inc.

Spiriva, a novel inhaled anticholinergic medication, is the first inhaled treatment to provide significant and sustained improvements in lung function with once-daily dosing. Spiriva works through targeting of the primary reversible component of COPD – constriction of the airways. Spiriva helps COPD patients breathe easier by opening narrowed airways and helping to keep them open for 24 hours. According to treatment guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), long-acting bronchodilators such as Spiriva are the preferred treatment option for COPD maintenance therapy.

In clinical trials, Spiriva demonstrated significant bronchodilation that was sustained over the duration of the studies.5,6,7 In trials, Spiriva demonstrated significant improvements in lung function over Atrovent (ipratropium bromide), a current first-line therapy for COPD, which were maintained over one year.6,7 In addition, in one-year, placebo-controlled studies, patients treated with Spiriva required fewer doses of rescue medications.5 Clinical studies both ongoing and completed include more than 9,400 patients.

Spiriva was generally well tolerated.5,6,7 The most common adverse reaction patients reported in Spiriva clinical trials was dry mouth, which was usually mild and often resolved during treatment.5,6,7 Constipation and increased heart rate have been reported infrequently in patients receiving tiotropium. As an anticholinergic drug, Spiriva must be used with caution in patients with glaucoma and prostatic hyperplasia, as it may worsen symptoms of these conditions.

It is anticipated that Spiriva will be available in retail pharmacies in the United States by the middle of this year.

COPD Defined
COPD is a slowly progressive disease of the airways that is characterized by a gradual loss of lung function.1 The signs and symptoms patients may experience are chronic cough, excess mucus production, wheezing and shortness of breath after mild exertion. Most people with COPD are at least 40 years old or around middle age when symptoms start.2

There are an estimated 24 million Americans who suffer from COPD, with over 50% under the age of 65. However, only 10 million have been diagnosed with the illness and approximately 6 million currently are receiving therapy.3,4 COPD is the fourth leading cause of death in the United States and is projected to become the third leading fatal illness by 2020.1 The Centers for Disease Control and Prevention estimates 119,000 Americans died of the condition in the year 20003 with fatalities for women outnumbering men for the first time. The annual cost to the nation for COPD in 2000 was estimated to be approximately $30.4 billion.1 Health care expenditures accounted for $14.7 billion, and indirect costs (decreased income due to loss of work or premature death) were $15.5 billion.1

References:

National Heart, Lung, and Blood Institute. Data Fact Sheet: Chronic Obstructive Pulmonary Disease (COPD)
National Heart, Lung and Blood Institute. Diseases and Conditions Index: Lung Diseases: COPD: Who is at risk? Available at www.hij.govAccess January 21, 2004
Centers for Disease Control and Prevention. MMWR. Chronic Obstructive Pulmonary Disease Surveillance, United States, 1971-2000. August 2, 2002/51 (SS06);1-16. Available at www.cdc.gov/mmwr/preview/mmwrhtml/ss5106al.htm. Accessed September 26, 2003
Datamonitor Epidemiology and treatment Algorithm Survey. Page 12. December 2002
Casaburi R, Mahler DA, Jones PW, et al. A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. European Respiratory Journal 2002; 19:217-224
Vincken W, van Noord JA, Greefhorst APM, et al. Improvement in health status and exacerbation in patients with COPD during one year treatment with tiotropium. European Respiratory Journal 2002; 19:209-216
Van Noord JA, Smeets JJ, Custers FJL, Korducki L, Cornelissen PJG. Pharmacodynamic steady state of tiotropium in patients with chronic obstructive pulmonary disease.
European Respiratory Journal 2002; 19:639-644

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