BMJ 2014; 348 doi: https://dx.doi.org/10.1136/bmj.g401 (Published 4 February 2014)
Cite this as: BMJ 2014;348:g401
Kate C Tatham, research fellow1, Kinesh P Patel, research fellow2
Many patients avoid eating animal products for various reasons, but how many doctors consider this when prescribing a drug? Even if they do, Kate Tatham and Kinesh Patel find it is hard to determine whether drugs meet the patient’s dietary requirements
Specific dietary preferences regarding animal products in food are common in the general population.1 Influences such as religion, culture, economic status, environmental concern, food intolerances, and personal preferences all play a part in the foods that people choose to consume. In the United Kingdom, Food Standards Agency data indicate that 5% of population are vegan or vegetarian, increasing to 12% in non-white people.2 Vegetarians are defined as individuals that do not consume foods either directly obtained or using products from the slaughter of an animal, whereas vegans do not consume any foods originating from animals.3 4 Some religious groups also avoid certain animal products.
Many patients and doctors are unaware that commonly prescribed drugs contain animal products—for example, low molecular weight heparin (pigs), Gelofusine (cows), and conjugated oestrogen (Premarin, horses). Furthermore, with some commonly used ingredients, simply reading the list of ingredients will not make it clear whether the product meets the patient’s dietary preferences.
Problem ingredients
Lactose, which is derived from cows’ milk, is traditionally extracted using bovine rennet. It is used as a filler and diluent powder and as an aid in the manufacturing of medications. Some manufacturers now use vegetarian processes to extract lactose from milk, leading to potential confusion about its suitability for vegetarians.
Similarly, gelatine is widely used to encapsulate medications and is sourced from bovine or porcine skin, hide, or bone and occasionally fish. If derived from pigs it can be a problem for some Muslims and Jews. The largest kosher certification body, the Orthodox Union’s Kosher division, does not accept porcine