Wal-Mart, CVS, Rite Aid, and Walgreens this month pulled the over-the-counter (OTC) heartburn drug Zantac from their shelves.

What You Should Know About the Zantac Recall

Wal-Mart, CVS, Rite Aid, and Walgreens this month pulled the over-the-counter (OTC) heartburn drug Zantac from their shelves, over concerns that it contains a chemical possibly linked to cancer. Other countries, including Canada, France, Hong Kong, and India, have issued recalls for Zantac and its generic version, ranitidine.

This is a radical step that CVS said it was taking “out of an abundance of caution.” Is this an overreaction, or is it justified? Our concierge family doctors at MD 2.0 in Jupiter want to give you the latest information available about this popular OTC product and offer some alternatives.


The chemical in question, nitrosodimethylamine (NDMA), is a type of nitrosamine, a known carcinogenic chemical also present in small amounts in some processed and grilled meats, as well as water, dairy foods, and even some vegetables. This is the same contaminant that prompted the recall of various blood-pressure drugs earlier this year.

Last month, the U.S. Food and Drug Administration (FDA) issued an alert reporting that some random Zantac samples it had tested contained NDMA.

The alert warned that it found low but “unacceptable” levels of NDMA, but stopped short of recommending a recall of the product. It did, however, recommend that patients who take the drug regularly consider switching to an alternative medication.

Zantac alternatives

Because each person is different and reacts to various drugs differently, the marketplace has produced a number of medications made to treat heartburn, or gastroesophageal reflux disease (GERD). This includes Pepcid (generic name famotidine) and Tagamet (generic name cimetidine), which are in the same family as ranitidine but so far have not been found to contain NDMA.

This class of drugs is known as H2 receptor blockers, which work by reducing the amount of stomach acid secreted by the stomach lining. They normally reduce or eliminate heartburn within about an hour.

Then there are the popular proton pump inhibitors (PPIs), including Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole), and Prevacid (lansoprazole). PPIs work by blocking and reducing the production of stomach acid, and take longer to work than the H2 receptor blockers, often several weeks.

And of course PPIs carry their own possible risks when used long-term. These include higher risks for kidney disease, fractures, dementia, and cardiovascular problems, including heart attacks.

The old standbys that preceded both H2 receptor blockers and PPIs are the OTC antacids like Tums, Maalox, and Rolaids. While they can cause either constipation or diarrhea in some, they are generally safe to use.

Lifestyle changes

But what can you do about the pain of heartburn (an aptly named condition)?

Start with lifestyle changes.

1. Identify triggers

Some people can tolerate chocolate, tomatoes, spicy foods, alcohol, garlic, citrus foods, ginger, and other foods with no problem at all. Those who are prone to GERD, however, quickly learn to avoid such triggers, either under certain conditions or in certain combinations or all the time. Greasy, fried, and fatty foods are also well-known contributors to heartburn, as are fizzy drinks and tobacco smoke. Know which foods to avoid.

2. Lose abdominal weight

Excess weight carried around the middle can constrict internal organs, causing upward pressure on the stomach and forcing acid upward into the esophagus, triggering heartburn. The same is true for constricting clothing such as tight waistbands or girdles. Even a heavy meal can have this effect, especially right before bed. Try to eat dinner at least two hours before retiring for the night.

3. Sleep on a slant

Either elevate the top half of your bed or sleep propped up on pillows to keep stomach acid from draining into the esophagus. Some people also find relief by sleeping on their left side, which also tends to keep acid contained in the stomach.

4. Reduce stress

Among other ill effects, stress can lead to an increase in production of stomach acid, and thus an increase in GERD. Try relaxation or meditation techniques, hobbies, or just slowing down in general as much as possible.

Home remedies

There are dozens of heartburn remedies that many people swear by including apple cider vinegar, aloe juice, and baking soda mixed in water, which will neutralize stomach acid. These or others may work for you.

If you have questions about Zantac or any other heartburn medication you’re taking, feel free to ask us, especially if you’re worried about the recall. And if heartburn is a continuing problem for you, be sure to let us know. It could be masking an ulcer, which requires medical treatment.

rare disease afm

Mysterious Illness Spreading, But Still Very Rare

Your concierge family practice doctors in Jupiter, Florida, at MD 2.0., have been hearing concerns from our patients about the recent publicized increases of a rare polio-like disease occurring mainly in children. The Centers for Disease Control and Prevention (CDC) is investigating as many as 127 cases of acute flaccid myelitis (AFM) in at least 22 states this year. Some news outlets place the number of states affected closer to 30, because reporting cases to the CDC is voluntary, and this information may not have reached the CDC yet.

The symptoms of AFM are very similar to polio, a disease that was eradicated in the U.S. through the use of universal immunization. AFM affects a person’s nervous system, specifically the spinal cord, causing weakness in one or more limbs. It tends to begin about a week after a slight fever or respiratory illness, but can suddenly appear as weakness in the arms and legs. Other symptoms can include slurred speech or difficulty swallowing, or a “drooping” appearance in the face. Many patients recover quickly, while others continue to have paralysis requiring ongoing care.

More than 90 percent of the cases the CDC has confirmed have occurred in children under age 18; the average age is four. Although one death from AFM was reported last year, no deaths have been associated with the illness so far this year.

Cause still unknown

AFM was even rarer prior to its first major U.S. outbreak in 2014 when 120 cases were confirmed. The illness seemed to slack off in 2015 with only 22 confirmed cases, then spiked again in 2016 (149 cases), dropped in 2017 (33 cases), and now in 2018, we have 62 confirmed cases so far with an additional 65 suspected cases being investigated by the CDC. So not only do the cases seem to be rising then declining from year to year for reasons that are still unclear, but they also seem to cluster in the fall months. There are no state clusters, however, suggesting the illness is not spread from person to person but arises spontaneously.

The most frightening thing about AFM is that scientists have been unable to pinpoint a cause. All the confirmed AFM patients have been tested for poliovirus, and have definitively tested negative. The CDC has also tested every case for evidence of a wide range of known pathogens (germs) or viruses and has been unable to detect a consistent pattern among those affected.

What is known

Scientists continue to look for a common thread. Given the persistent controversy over vaccinations, it should be noted that those affected have differing histories on vaccinations: Some of the patients were vaccinated, some were not. (Incidentally, in October an unvaccinated child in Florida became the first person to die from this year’s flu.)

Unless it can be found that all those who contracted the illness share a common trait, such as being or not being vaccinated or contracting the same type of cold or flu, or having traveled to a certain place or having come in contact with some pollutant, the cause of the syndrome will remain a mystery.

What is also known is that the chances of developing AFM is less than one in a million, according to the CDC.

Should you worry?

The likelihood of you or your child developing this distressing illness is miniscule, but there is a chance, especially since this is a year in which the cases are spiking. But we believe there is little cause for concern. As a parent, you should take the typical precautions you always do to ensure your child stays healthy: obtaining the recommended vaccinations, ensuring they wash their hands regularly and practice accepted hygiene methods, eating well, exercising, and getting enough sleep.

Just be aware that AMF strikes with little warning, and watch your child for any signs of the symptoms described above. If you have any concerns or questions, please don’t hesitate to contact us immediately.

lyme disease outbreak

Lyme Disease Now Found In All 50 States

In case you thought we here in Florida didn’t have to concern ourselves with Lyme disease because it’s been confined to the Northeast U.S., new data demonstrate that’s no longer the case. Your concierge family practice doctors in Jupiter want to warn you that living here is no longer protection from this tick-borne disease, and to outline the steps you need to take to protect yourself and your family.

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Happy 100th Birthday Mr. Arbree

Joseph Arbree, to quote the adage, was slightly ahead of his time. A patriotic American, Joe graduated from bombardier school on September 11th, but many decades before that date was forever etched into the nation’s memory. It was 1943, shortly after the US entered War II. Then Lt. Arbree, of Tenafly, New Jersey was training to become one the nations newest bombardiers during an extremely dark period in US history. And he had just landed a very dangerous job.

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