May 20, 2025 • 18 mins
In this episode, hosts Don Weinberger and Steve Small separate fact from fiction about dyes in medications and food.
Why is the FDA banning certain artificial dyes, and what does it mean for your meds and favorite foods?
Can the color of your pills really affect how you feel about them?
Why do we talk so much about rats and sewers in this episode?
Folks are dye-ing to know the truth...let’s find out!
They’ll share research and insights into some interesting claims including:
- White tablets or clear solutions don’t have dyes.
- Certain dyes can cause adverse effects.
- Recent FDA mandates to remove artificial dyes only affect food products.
- Pill color can impact patients’ expectations about a medication’s effects.
******
TRC Healthcare Editor Hosts:
- Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
- Don Weinberger, PharmD, PMSP
******
Guest:
- Gina Corely, PharmD (TRC Healthcare Editor)
******
The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Be Aware of Adverse Reactions with Artificial Dyes
- Algorithm: Investigating Possible Drug Allergy or Sensitivity
******
Don’t miss out! Subscribe to Pharmacist’s Letter today to stay ahead with trusted insights and tools. If you're a student, good news—students can access a free version of Pharmacist’s Letter.
Rumor vs Truth is a production of TRC Healthcare.
If you’re not yet a subscriber, find out more about our product offerings at trchealthcare.com.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Narrator (00:00):
Welcome to Rumor vs.
Truth, your trusted source forfacts, where we dissect the
evidence behind risky rumors andreveal clinical truths.
Today, we're looking at claimsabout dyes and meds to find out
their true colors.
THIS TRANSCRIPT IS AUTOMATICALLY GENERATED.
Don Weinberger (00:21):
Hey, Steve, how you doing?
Are you feeling blue?
Stephen Small (00:25):
I am, if you can see my tongue.
Yeah, definitely can.
I've been having some hardcandies.
Yeah, exactly.
I've had some Blue Lake No.
1 candies here.
They're delicious.
And I'm honestly tickled pinkby this topic.
I'm Steve the pharmacist.
Don Weinberger (00:42):
And I'm Don the pharmacist.
And you'll hear buzz aboutadverse reactions to artificial
dyes since FDA announced its banof the red dye No.
3 due to showing cancer inrats.
In this episode, we're givingclaims about dyes and meds, the
red carpet treatments, and nopromises, but we will try to
(01:03):
keep the off-color puns to aminimum.
Again, no promises.
Stephen Small (01:08):
No promises at all.
And, you know, it's not justred dyes, Don.
It's also affecting other dyesthat the FDA is removing, like
FD&C red number 40, yellownumber 5, yellow number 6, and
blue number 1.
And actually, I found out thoseare all in the candies I'm
eating right now.
So that's concerning.
But these are all going to beremoved from the food supply by
(01:29):
the end of next year.
But it's important to thinkthat this wasn't out of the
blue, necessarily.
Questions have been buildingabout dyes for a long time.
And it seems like people aredying to know about the colors
in their meds.
Don Weinberger (01:44):
Well, we warned you already about the puns we're
going to be doing.
So.
Stephen Small (01:47):
So buckle up.
And ironically, though, let'sstart with meds that don't have
color.
The claim here is that whitetablets or clear solutions and
suspensions don't have dyes.
But it's important to thinkhere, just because a medication
is white doesn't mean it doesn'thave dyes, right?
In fact, some white tablets Ican think of contain yellow dye
(02:08):
to sort of brighten them up.
Some examples are cetirizine,10 milligram TADs, or even
oxycodone with acetaminophen.
So I'm thinking about that.
Don Weinberger (02:17):
Right, so then I'm thinking, Steve, looking at
product labels and that kind ofthing, what about those dye-free
things that are white or cleareven?
Stephen Small (02:28):
Yeah, we use those a lot for kids in my
practice being in pediatrics.
I'm glad you brought that upbecause dye-free suspensions
like ibuprofen, for example,don't have dyes, but they are
indeed white.
So sometimes they don't get touse a dye.
Maybe they're using things liketitanium dioxide or zinc oxide
pigments to get that white colorfor a lot of meds.
(02:49):
So based on this claim thatwhite tablets or clear solutions
don't have dyes, the verdictis...
Rumor.
It's important to not rely onproduct colors alone, as we saw.
And you can look at theinactive ingredients or the
package insert, or you can evencall the manufacturer to really
(03:10):
see what dyes these medscontain.
That's really going to be yourbest source of truth.
Don Weinberger (03:16):
I love that last point, Steve.
Now that colorless meds are outof the way, let's get into dyes
and let's go and start withsome of the news, you know, our
next claim.
So the claim is actually recentFDA mandates to remove
artificial dyes only affectsfood products.
Interesting.
So, you know, thinking aboutthe recent FDA announcement in
April of 2025, it's managed toremove the six petrochemical
(03:39):
based dyes that you mentionedearlier from food and replacing
those with natural dyealternatives.
Unknown (03:44):
Interesting.
Don Weinberger (03:45):
But that announcement actually didn't say
anything about medications.
So did some digging.
The announcement actually backin January of 2025 had some
different mentions in it.
So they're removing the red dyenumber three from foods and
medications.
Stephen Small (04:03):
Okay, so it's both for that one.
But when I hear that, now I'mworried.
So does that mean they need tosubmit a lengthy new drug
approval from scratch to do thisfor each med just to change one
dye?
Don Weinberger (04:15):
Well, Steve, were we not?
Changing or removing dyes in amed generally only requires
submission to FDA in the annualreport.
It does not require a formaldrug application beforehand.
Stephen Small (04:26):
Okay, so it's kind of like an FYI.
That's good to know.
So I'm guessing then they maysubstitute those dyes with
natural coloring, but are thererisks with those natural dyes?
Don Weinberger (04:38):
See, that's the thing.
Natural, as we all know, doesnot necessarily mean harmless,
right?
So to stress that.
Also need to consider thingslike contaminants and unintended
consequences of that as well.
Stephen Small (04:50):
Yeah, good point.
Don Weinberger (04:52):
All right, let's dive back into that claim,
which is recent FDA mandates toremove artificial dyes only
affect food products.
And the verdict is...
True with conditions.
You know, there's not as muchred tape as I thought for
removing dyes.
Stephen Small (05:11):
Right.
And it's also important here tothink about flavorings and dyes
in those.
As a pharmacist, we get askedto add flavorings to medications
all the time for pediatrics,and there are dyes in those too.
So check that labeling closely.
Don Weinberger (05:23):
Right, right.
Very good point, Steve.
Okay.
You know, honestly, so what'sall the fuss?
What are the problem with dyes?
Really, to answer that, Irecently spoke to our dye
expert, Gina, who's a pharmacistand editor at Pharmacist Letter
with TRC Healthcare, to providesome of that color commentary
on one of those claims.
Let's go and take a look.
Well, hey, Gina.
(05:49):
How are you?
I
Gina Corley (05:50):
am good.
What about you?
Don Weinberger (05:52):
I am good.
And I'm much better now thatyou dress the parts.
So you have nice colors goingon.
Gina Corley (05:58):
Thank you.
Thank you.
Hopefully they will be lesscontroversial than some of the
red dyes that we talk about inthis
Don Weinberger (06:05):
show.
We'll see, right?
You never know.
Okay.
So I thought you are theperfect person to strike the
right tone with some of theseclaims.
So let's get to it.
You
Gina Corley (06:16):
ready?
Thank you.
Yes.
Don Weinberger (06:18):
All right, so I have one for you and it is some
dyes have adverse effects.
Gina Corley (06:23):
What do
Don Weinberger (06:23):
you think?
Gina Corley (06:24):
Yes.
So red dye number three hasactually been banned by the FDA
because it is shown to causecancer in rats.
And right now, companiescurrently have until 2027 to
remove red dye number three infoods and until 2028 for meds.
So don't be shocked if youstill find this dye listed in
(06:46):
some ingredient labels for foodsand meds in the next couple of
years.
Don Weinberger (06:51):
And
Gina Corley (06:52):
then another red dye, which is red dye 40 may
contain benzidine, which is aknown cancer causing substance.
And you may have heard aboutred dye 40 because it is the one
that people often talk aboutthat can cause increased
hyperactivity in kids.
Don Weinberger (07:11):
Yeah.
Okay.
So it seems like you love topick on red dye.
So I'm going to go ahead andask you, uh, Have you kind of
seen any other colors that mayhave adverse effects?
Gina Corley (07:24):
Yeah.
So technically, it's possiblefor patients to have adverse
rate reactions to any type ofdye, whether it's more of an
allergic reaction or more of asevere reaction, such as trouble
breathing.
I have read reports of yellowdyes causing hives.
But Really, if patients ask,why are dyes even in my food and
(07:48):
in my meds?
What we can tell them isthey're in there solely to make
things pretty.
They're in there to brighten upour food, brighten up our meds.
They have no nutritional ortherapeutic value at all.
So really, taking them out isnot a bad thing.
It just is going to make yourfood less visually appealing.
(08:08):
Food and meds.
Correct.
Correct.
Yes.
Don Weinberger (08:12):
Yeah.
So I'm glad you brought thatlast point up because, you know,
as of now I'm hearing patientsin the pharmacy asking, okay,
why, you know, dyes are theconversation of the day.
Right.
And asking, okay, why are thesedyes in there?
They provide no value.
So I'm glad we, you got to thatpoint.
So thank you.
Gina Corley (08:28):
Of
Don Weinberger (08:28):
course.
Thank you very much for joiningus and solving that claim for
us.
And let's go and kick it backto Steve for his thoughts.
Gina Corley (08:36):
All right.
Stephen Small (08:41):
You know, she had a lot of really good points
there.
Something I really liked thatshe mentioned, it really comes
down to benefits versus risks,right?
We know that it causes cancerin rats, maybe not confirmed in
humans, but if they're just inthere to make drugs and meds and
food pretty, what's the pointthere?
Those risks probably outweighthose benefits.
So really good points there.
Don Weinberger (09:01):
Yeah, the benefits really seem almost nil,
right?
When you can kind of put itinto perspective.
Correct.
So, all right.
So let's go ahead and get backto the claim.
So it is, Certain dyes cancause adverse effects.
The verdict is...
It is true.
So some dyes have been shown tocause cancer in rats, and those
(09:25):
have been potentially linked toother symptoms such as low
reactions and hyperactivity.
Stephen Small (09:30):
And you know, Don, I'm trying to think of what
meds have that red dye numberthree in them.
And ones that can kind of cometo mind are like certain
doxycycline capsules, omeprazolecapsules, and even some
amoxicillin suspensions for kidsthat I've dispensed has that in
there probably.
Since we know a lot of the sortof fruity flavored ones have
(09:52):
red dye in there to help withthe look, so to speak.
Even though it comes as a whitepowder.
Definitely turns pink once youmix it.
So now that Gina mentioned thatdyes are only there to make
things pretty and that's trueand there's no nutritional or
therapeutic value, right?
Is there more to that?
And this leads us to our nextclaim that pill color or med
(10:13):
color can impact patients'expectations about a
medication's effects.
And this is pretty interestingbecause now it kind of gets into
the psychology behind all this.
We've actually looked atmedication colors in studies
since the 1950s.
And what's relativelyconsistent across multiple
studies is that blue and whitecolored meds rank the highest
(10:34):
for people thinking that theyhave a sedative or anti- I can
tell you the blue hard candiesI'm eating don't have that
effect, but some people it hasthat sort of placebo effect.
Also, white colored pills aremost associated with pain relief
for some folks.
Whereas, and this isinteresting, yellow and red
colored pills usually rankhighest for things like
(10:56):
hallucinatory effects.
So people tripping out on redcolored pills.
Although we know, for example,certain ibuprofen comes as red
colored pills and people aredefinitely not hallucinating on
that.
And what's interesting here isthere can be a lot of cultural
factors at play.
For example, I found one studythat compared responses to these
medication colors in the UnitedStates versus Kosovo.
(11:18):
And there were differentresponses, right?
However, USA respondents hadsimilar answers to what the
United Arab Emirates subjectshad.
So it kind of depends acrossinternational boundaries for
some.
And studies have shown thatparticipants usually report
these associations are based onsort of an emotional response or
a symbol, or maybe they'rethinking about past medications
(11:40):
that had this effect and theirbrain kind of makes those
connections psychologically.
Yeah.
And being a pediatricpharmacist, we also have to
think about the differences inage.
They found that childrenactually prefer red-colored
meds, and they actually ratewhite-colored meds lower in
terms of favorability.
So who knows?
I wonder what that kind oftells.
I'm sure that plays intomarketing for some meds, right?
(12:02):
So with that, with this claimthat pill color can impact
patients' expectations about amedication's effects, the
verdict is...
True.
Right?
We've seen just now that visualappearance of meds is
important, how we perceive them.
(12:22):
And I think our psychologyplays a pretty big role.
And I have to ask you, Don,this is kind of a gross
question, but what if Idispensed you a brown suspension
to drink?
What would you think if you hada med that that was that color?
Don Weinberger (12:36):
Honestly, what comes to my head first is you
pulled it out of a sewer.
Yeah.
When I think appetizingliquids, brown does not come to
mind.
Stephen Small (12:45):
And you know what?
I bet drug manufacturersdefinitely take that into
account.
Yeah.
And you know, it kind of makesyou think too of like the
methylene blue challenge.
You've heard of this, right?
It's kind of going around.
Don Weinberger (12:56):
Yeah.
Go ahead and kind of explainthat one.
Stephen Small (12:59):
Yeah.
I'll fill you in.
So my understanding is thatpeople are buying methylene blue
on the internet.
It's a really brilliant bluedye.
It, does have somepharmacologic properties, but
people are taking it for thingslike anti-aging and cell
oxidation reversers and thingslike that that don't really have
a whole lot of evidence.
But like we were saying before,blue is known to kind of be
(13:22):
associated with stimulatoryeffects or relaxation.
Maybe people do feel that way,even though that Chemical isn't
really doing anything in thebody.
It could all be psychological.
So they're just drinking this,the methylene blue?
That's what they're doing?
I suppose so, yeah.
Whereas I'm just eating blue.
That's crazy.
Number one.
Yeah.
That's crazy.
Says the guy drinking
Don Weinberger (13:42):
blue.
That's so crazy.
Yeah.
Stephen Small (13:44):
I'm sorry.
Well, with that, I think we cansay that dyes may not be
completely harmless after all,but it is important to keep
things in perspective since ourpatients will probably ask for
dye-free items with undue alarm,right?
Don Weinberger (14:01):
Yep, I agree.
And it looks like our claimtoday, truth mostly wins with
flying colors.
But it's not 100% black andwhite when it comes to dyes.
Stephen Small (14:10):
I like that, Don.
And it's a good practice toreally view these extra
ingredients as excipients.
I really don't like the terminactive ingredients because as
we saw, they can havepharmacologic effects.
And after all, the modernpharmaceutical industry, as a
historical tidbit, was born fromdye companies when you think
about it.
Don Weinberger (14:28):
Oh, yeah.
Like Bayer and Sandoz.
Exactly.
Very true.
So when it comes to dyes, eachproduct for the same med can be
different, and it may not beobvious.
So know where to spot dyecontent on labeling and look for
dye-free alternatives ifneeded.
Make note of the patient'sallergy or intolerance in their
profile.
(14:49):
But keep in mind that someallergy warning software may not
know an exact product dye'scontent to fire off that alert.
Stephen Small (14:56):
Yeah, technology, you got to be careful with.
And another kind of last resortoption I can think of is be
ready to compound a medicationif needed to avoid dyes
completely.
But you have to balance yourrisks, right?
Because then that's making anunapproved med.
So weigh those options therecarefully.
Don Weinberger (15:11):
Right.
That's a good point, Steve.
So Steve, you know what?
We actually got a message fromour podcast that send us a text
link from audience member.
You know, we get excited aboutthose when they come.
Yes.
And they kind of, and they hadthis question and it was kind of
a big question because you haveexpired meds.
They just throw them away.
Can they be of use to anybody,right?
If they're slightly expired orwhatever it may be.
(15:34):
Good point.
The answer actually,unfortunately is no, officially.
Although as of 2024, 45, U.S.
states have laws allowing drugdonation for depository programs
and 20 and a half the activeprograms.
But, you know, there's thatrigid requirements, including
expiration dates, you know,being in dates or slightly
(15:57):
expired.
So it's important.
People do want to help.
They want to donate theirmedications.
You know, there's like expiredkind of get the knowledge of the
state programs and run withthat.
Stephen Small (16:07):
Yeah, that's a great point.
And in Iowa, where I'mcurrently broadcasting from, we
have one of the largest donationprograms in the US.
And for us, I believe the drugsneed to typically be donated at
least six months or more beforetheir expiration date, because
we don't want to have to dealwith those expiration dates
happening.
So that's a great point.
(16:27):
And if you'd like to have yourquestion about this episode
answered next month, send us amessage, please.
We'd love to answer yourquestions about dyes.
Uh, it's a very hot topic.
Don Weinberger (16:37):
Yes.
Uh, second that.
And also a couple more thingshere.
If you liked what you heard onthis episode, be sure to follow
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And of course, check us out ontrcealthcare.com.
You can also help grow our showby telling a friend about the
awesome things you learned aboutand where you found us.
And
Stephen Small (16:58):
definitely take a look at the show notes or
description for this episode.
We've linked directly to someof the great resources you
mentioned today, like thearticle in our May 2025 issue, a
pharmacist's letter, pharmacytechnician's letter, prescriber
insights, and our hospitalissues too.
And we also have a link to ourhandy algorithm for
investigating drug allergies andsensitivities, which you can
(17:18):
use for dyes.
Don Weinberger (17:21):
And if you aren't already a subscriber,
don't miss out on theseresources.
Sign up today to stay ahead ofWith trusted insights and tools,
we are an industry-leading,non-biased source of information
and continuing education.
Stephen Small (17:32):
And also, we need your help compiling more rumors
and truths to analyze, soplease send us your ideas at
trchealthcare.com forward slashcontact dash us, or use the
contact us link at the bottom ofyour TRC Healthcare homepage,
or send us a text, that button,right from the podcast show
notes.
Don Weinberger (17:51):
And we know you've got great ideas for us to
demystify.
Do not miss our next episode.
We will celebrate our 40thanniversary of Pharmacist's
Letter with a throwback toclaims we investigated decades
ago and see if they still holdup in the 2020s.
Yeah,
Stephen Small (18:05):
I'm looking forward to looking at that
ancient history.
So thanks for joining us onRumor vs.
Truth, your trusted source forfacts, where we dissect the
evidence behind risky rumors andreveal clinical truths.
See you next time.
(18:30):
Want to put faces to these voices? Catch the video version on YouTube - just search 'TRC Healthcare' or click the link in our show notes. While you're there, check out our other TRC podcasts like Medication Talk and Clinical Capsules.
Welcome to Rumor vs.
Truth, your trusted source forfacts, where we dissect the
evidence behind risky rumors andreveal clinical truths.
Today, we're looking at claimsabout dyes and meds to find out
their true colors.
THIS TRANSCRIPT IS AUTOMATICALLY GENERATED.
Don Weinberger (00:21):
Hey, Steve, how you doing?
Are you feeling blue?
Stephen Small (00:25):
I am, if you can see my tongue.
Yeah, definitely can.
I've been having some hardcandies.
Yeah, exactly.
I've had some Blue Lake No.
1 candies here.
They're delicious.
And I'm honestly tickled pinkby this topic.
I'm Steve the pharmacist.
Don Weinberger (00:42):
And I'm Don the pharmacist.
And you'll hear buzz aboutadverse reactions to artificial
dyes since FDA announced its banof the red dye No.
3 due to showing cancer inrats.
In this episode, we're givingclaims about dyes and meds, the
red carpet treatments, and nopromises, but we will try to
(01:03):
keep the off-color puns to aminimum.
Again, no promises.
Stephen Small (01:08):
No promises at all.
And, you know, it's not justred dyes, Don.
It's also affecting other dyesthat the FDA is removing, like
FD&C red number 40, yellownumber 5, yellow number 6, and
blue number 1.
And actually, I found out thoseare all in the candies I'm
eating right now.
So that's concerning.
But these are all going to beremoved from the food supply by
(01:29):
the end of next year.
But it's important to thinkthat this wasn't out of the
blue, necessarily.
Questions have been buildingabout dyes for a long time.
And it seems like people aredying to know about the colors
in their meds.
Don Weinberger (01:44):
Well, we warned you already about the puns we're
going to be doing.
So.
Stephen Small (01:47):
So buckle up.
And ironically, though, let'sstart with meds that don't have
color.
The claim here is that whitetablets or clear solutions and
suspensions don't have dyes.
But it's important to thinkhere, just because a medication
is white doesn't mean it doesn'thave dyes, right?
In fact, some white tablets Ican think of contain yellow dye
(02:08):
to sort of brighten them up.
Some examples are cetirizine,10 milligram TADs, or even
oxycodone with acetaminophen.
So I'm thinking about that.
Don Weinberger (02:17):
Right, so then I'm thinking, Steve, looking at
product labels and that kind ofthing, what about those dye-free
things that are white or cleareven?
Stephen Small (02:28):
Yeah, we use those a lot for kids in my
practice being in pediatrics.
I'm glad you brought that upbecause dye-free suspensions
like ibuprofen, for example,don't have dyes, but they are
indeed white.
So sometimes they don't get touse a dye.
Maybe they're using things liketitanium dioxide or zinc oxide
pigments to get that white colorfor a lot of meds.
(02:49):
So based on this claim thatwhite tablets or clear solutions
don't have dyes, the verdictis...
Rumor.
It's important to not rely onproduct colors alone, as we saw.
And you can look at theinactive ingredients or the
package insert, or you can evencall the manufacturer to really
(03:10):
see what dyes these medscontain.
That's really going to be yourbest source of truth.
Don Weinberger (03:16):
I love that last point, Steve.
Now that colorless meds are outof the way, let's get into dyes
and let's go and start withsome of the news, you know, our
next claim.
So the claim is actually recentFDA mandates to remove
artificial dyes only affectsfood products.
Interesting.
So, you know, thinking aboutthe recent FDA announcement in
April of 2025, it's managed toremove the six petrochemical
(03:39):
based dyes that you mentionedearlier from food and replacing
those with natural dyealternatives.
Unknown (03:44):
Interesting.
Don Weinberger (03:45):
But that announcement actually didn't say
anything about medications.
So did some digging.
The announcement actually backin January of 2025 had some
different mentions in it.
So they're removing the red dyenumber three from foods and
medications.
Stephen Small (04:03):
Okay, so it's both for that one.
But when I hear that, now I'mworried.
So does that mean they need tosubmit a lengthy new drug
approval from scratch to do thisfor each med just to change one
dye?
Don Weinberger (04:15):
Well, Steve, were we not?
Changing or removing dyes in amed generally only requires
submission to FDA in the annualreport.
It does not require a formaldrug application beforehand.
Stephen Small (04:26):
Okay, so it's kind of like an FYI.
That's good to know.
So I'm guessing then they maysubstitute those dyes with
natural coloring, but are thererisks with those natural dyes?
Don Weinberger (04:38):
See, that's the thing.
Natural, as we all know, doesnot necessarily mean harmless,
right?
So to stress that.
Also need to consider thingslike contaminants and unintended
consequences of that as well.
Stephen Small (04:50):
Yeah, good point.
Don Weinberger (04:52):
All right, let's dive back into that claim,
which is recent FDA mandates toremove artificial dyes only
affect food products.
And the verdict is...
True with conditions.
You know, there's not as muchred tape as I thought for
removing dyes.
Stephen Small (05:11):
Right.
And it's also important here tothink about flavorings and dyes
in those.
As a pharmacist, we get askedto add flavorings to medications
all the time for pediatrics,and there are dyes in those too.
So check that labeling closely.
Don Weinberger (05:23):
Right, right.
Very good point, Steve.
Okay.
You know, honestly, so what'sall the fuss?
What are the problem with dyes?
Really, to answer that, Irecently spoke to our dye
expert, Gina, who's a pharmacistand editor at Pharmacist Letter
with TRC Healthcare, to providesome of that color commentary
on one of those claims.
Let's go and take a look.
Well, hey, Gina.
(05:49):
How are you?
I
Gina Corley (05:50):
am good.
What about you?
Don Weinberger (05:52):
I am good.
And I'm much better now thatyou dress the parts.
So you have nice colors goingon.
Gina Corley (05:58):
Thank you.
Thank you.
Hopefully they will be lesscontroversial than some of the
red dyes that we talk about inthis
Don Weinberger (06:05):
show.
We'll see, right?
You never know.
Okay.
So I thought you are theperfect person to strike the
right tone with some of theseclaims.
So let's get to it.
You
Gina Corley (06:16):
ready?
Thank you.
Yes.
Don Weinberger (06:18):
All right, so I have one for you and it is some
dyes have adverse effects.
Gina Corley (06:23):
What do
Don Weinberger (06:23):
you think?
Gina Corley (06:24):
Yes.
So red dye number three hasactually been banned by the FDA
because it is shown to causecancer in rats.
And right now, companiescurrently have until 2027 to
remove red dye number three infoods and until 2028 for meds.
So don't be shocked if youstill find this dye listed in
(06:46):
some ingredient labels for foodsand meds in the next couple of
years.
Don Weinberger (06:51):
And
Gina Corley (06:52):
then another red dye, which is red dye 40 may
contain benzidine, which is aknown cancer causing substance.
And you may have heard aboutred dye 40 because it is the one
that people often talk aboutthat can cause increased
hyperactivity in kids.
Don Weinberger (07:11):
Yeah.
Okay.
So it seems like you love topick on red dye.
So I'm going to go ahead andask you, uh, Have you kind of
seen any other colors that mayhave adverse effects?
Gina Corley (07:24):
Yeah.
So technically, it's possiblefor patients to have adverse
rate reactions to any type ofdye, whether it's more of an
allergic reaction or more of asevere reaction, such as trouble
breathing.
I have read reports of yellowdyes causing hives.
But Really, if patients ask,why are dyes even in my food and
(07:48):
in my meds?
What we can tell them isthey're in there solely to make
things pretty.
They're in there to brighten upour food, brighten up our meds.
They have no nutritional ortherapeutic value at all.
So really, taking them out isnot a bad thing.
It just is going to make yourfood less visually appealing.
(08:08):
Food and meds.
Correct.
Correct.
Yes.
Don Weinberger (08:12):
Yeah.
So I'm glad you brought thatlast point up because, you know,
as of now I'm hearing patientsin the pharmacy asking, okay,
why, you know, dyes are theconversation of the day.
Right.
And asking, okay, why are thesedyes in there?
They provide no value.
So I'm glad we, you got to thatpoint.
So thank you.
Gina Corley (08:28):
Of
Don Weinberger (08:28):
course.
Thank you very much for joiningus and solving that claim for
us.
And let's go and kick it backto Steve for his thoughts.
Gina Corley (08:36):
All right.
Stephen Small (08:41):
You know, she had a lot of really good points
there.
Something I really liked thatshe mentioned, it really comes
down to benefits versus risks,right?
We know that it causes cancerin rats, maybe not confirmed in
humans, but if they're just inthere to make drugs and meds and
food pretty, what's the pointthere?
Those risks probably outweighthose benefits.
So really good points there.
Don Weinberger (09:01):
Yeah, the benefits really seem almost nil,
right?
When you can kind of put itinto perspective.
Correct.
So, all right.
So let's go ahead and get backto the claim.
So it is, Certain dyes cancause adverse effects.
The verdict is...
It is true.
So some dyes have been shown tocause cancer in rats, and those
(09:25):
have been potentially linked toother symptoms such as low
reactions and hyperactivity.
Stephen Small (09:30):
And you know, Don, I'm trying to think of what
meds have that red dye numberthree in them.
And ones that can kind of cometo mind are like certain
doxycycline capsules, omeprazolecapsules, and even some
amoxicillin suspensions for kidsthat I've dispensed has that in
there probably.
Since we know a lot of the sortof fruity flavored ones have
(09:52):
red dye in there to help withthe look, so to speak.
Even though it comes as a whitepowder.
Definitely turns pink once youmix it.
So now that Gina mentioned thatdyes are only there to make
things pretty and that's trueand there's no nutritional or
therapeutic value, right?
Is there more to that?
And this leads us to our nextclaim that pill color or med
(10:13):
color can impact patients'expectations about a
medication's effects.
And this is pretty interestingbecause now it kind of gets into
the psychology behind all this.
We've actually looked atmedication colors in studies
since the 1950s.
And what's relativelyconsistent across multiple
studies is that blue and whitecolored meds rank the highest
(10:34):
for people thinking that theyhave a sedative or anti- I can
tell you the blue hard candiesI'm eating don't have that
effect, but some people it hasthat sort of placebo effect.
Also, white colored pills aremost associated with pain relief
for some folks.
Whereas, and this isinteresting, yellow and red
colored pills usually rankhighest for things like
(10:56):
hallucinatory effects.
So people tripping out on redcolored pills.
Although we know, for example,certain ibuprofen comes as red
colored pills and people aredefinitely not hallucinating on
that.
And what's interesting here isthere can be a lot of cultural
factors at play.
For example, I found one studythat compared responses to these
medication colors in the UnitedStates versus Kosovo.
(11:18):
And there were differentresponses, right?
However, USA respondents hadsimilar answers to what the
United Arab Emirates subjectshad.
So it kind of depends acrossinternational boundaries for
some.
And studies have shown thatparticipants usually report
these associations are based onsort of an emotional response or
a symbol, or maybe they'rethinking about past medications
(11:40):
that had this effect and theirbrain kind of makes those
connections psychologically.
Yeah.
And being a pediatricpharmacist, we also have to
think about the differences inage.
They found that childrenactually prefer red-colored
meds, and they actually ratewhite-colored meds lower in
terms of favorability.
So who knows?
I wonder what that kind oftells.
I'm sure that plays intomarketing for some meds, right?
(12:02):
So with that, with this claimthat pill color can impact
patients' expectations about amedication's effects, the
verdict is...
True.
Right?
We've seen just now that visualappearance of meds is
important, how we perceive them.
(12:22):
And I think our psychologyplays a pretty big role.
And I have to ask you, Don,this is kind of a gross
question, but what if Idispensed you a brown suspension
to drink?
What would you think if you hada med that that was that color?
Don Weinberger (12:36):
Honestly, what comes to my head first is you
pulled it out of a sewer.
Yeah.
When I think appetizingliquids, brown does not come to
mind.
Stephen Small (12:45):
And you know what?
I bet drug manufacturersdefinitely take that into
account.
Yeah.
And you know, it kind of makesyou think too of like the
methylene blue challenge.
You've heard of this, right?
It's kind of going around.
Don Weinberger (12:56):
Yeah.
Go ahead and kind of explainthat one.
Stephen Small (12:59):
Yeah.
I'll fill you in.
So my understanding is thatpeople are buying methylene blue
on the internet.
It's a really brilliant bluedye.
It, does have somepharmacologic properties, but
people are taking it for thingslike anti-aging and cell
oxidation reversers and thingslike that that don't really have
a whole lot of evidence.
But like we were saying before,blue is known to kind of be
(13:22):
associated with stimulatoryeffects or relaxation.
Maybe people do feel that way,even though that Chemical isn't
really doing anything in thebody.
It could all be psychological.
So they're just drinking this,the methylene blue?
That's what they're doing?
I suppose so, yeah.
Whereas I'm just eating blue.
That's crazy.
Number one.
Yeah.
That's crazy.
Says the guy drinking
Don Weinberger (13:42):
blue.
That's so crazy.
Yeah.
Stephen Small (13:44):
I'm sorry.
Well, with that, I think we cansay that dyes may not be
completely harmless after all,but it is important to keep
things in perspective since ourpatients will probably ask for
dye-free items with undue alarm,right?
Don Weinberger (14:01):
Yep, I agree.
And it looks like our claimtoday, truth mostly wins with
flying colors.
But it's not 100% black andwhite when it comes to dyes.
Stephen Small (14:10):
I like that, Don.
And it's a good practice toreally view these extra
ingredients as excipients.
I really don't like the terminactive ingredients because as
we saw, they can havepharmacologic effects.
And after all, the modernpharmaceutical industry, as a
historical tidbit, was born fromdye companies when you think
about it.
Don Weinberger (14:28):
Oh, yeah.
Like Bayer and Sandoz.
Exactly.
Very true.
So when it comes to dyes, eachproduct for the same med can be
different, and it may not beobvious.
So know where to spot dyecontent on labeling and look for
dye-free alternatives ifneeded.
Make note of the patient'sallergy or intolerance in their
profile.
(14:49):
But keep in mind that someallergy warning software may not
know an exact product dye'scontent to fire off that alert.
Stephen Small (14:56):
Yeah, technology, you got to be careful with.
And another kind of last resortoption I can think of is be
ready to compound a medicationif needed to avoid dyes
completely.
But you have to balance yourrisks, right?
Because then that's making anunapproved med.
So weigh those options therecarefully.
Don Weinberger (15:11):
Right.
That's a good point, Steve.
So Steve, you know what?
We actually got a message fromour podcast that send us a text
link from audience member.
You know, we get excited aboutthose when they come.
Yes.
And they kind of, and they hadthis question and it was kind of
a big question because you haveexpired meds.
They just throw them away.
Can they be of use to anybody,right?
If they're slightly expired orwhatever it may be.
(15:34):
Good point.
The answer actually,unfortunately is no, officially.
Although as of 2024, 45, U.S.
states have laws allowing drugdonation for depository programs
and 20 and a half the activeprograms.
But, you know, there's thatrigid requirements, including
expiration dates, you know,being in dates or slightly
(15:57):
expired.
So it's important.
People do want to help.
They want to donate theirmedications.
You know, there's like expiredkind of get the knowledge of the
state programs and run withthat.
Stephen Small (16:07):
Yeah, that's a great point.
And in Iowa, where I'mcurrently broadcasting from, we
have one of the largest donationprograms in the US.
And for us, I believe the drugsneed to typically be donated at
least six months or more beforetheir expiration date, because
we don't want to have to dealwith those expiration dates
happening.
So that's a great point.
(16:27):
And if you'd like to have yourquestion about this episode
answered next month, send us amessage, please.
We'd love to answer yourquestions about dyes.
Uh, it's a very hot topic.
Don Weinberger (16:37):
Yes.
Uh, second that.
And also a couple more thingshere.
If you liked what you heard onthis episode, be sure to follow
rate and review rumor versustruth.
wherever you get your podcasts.
And of course, check us out ontrcealthcare.com.
You can also help grow our showby telling a friend about the
awesome things you learned aboutand where you found us.
And
Stephen Small (16:58):
definitely take a look at the show notes or
description for this episode.
We've linked directly to someof the great resources you
mentioned today, like thearticle in our May 2025 issue, a
pharmacist's letter, pharmacytechnician's letter, prescriber
insights, and our hospitalissues too.
And we also have a link to ourhandy algorithm for
investigating drug allergies andsensitivities, which you can
(17:18):
use for dyes.
Don Weinberger (17:21):
And if you aren't already a subscriber,
don't miss out on theseresources.
Sign up today to stay ahead ofWith trusted insights and tools,
we are an industry-leading,non-biased source of information
and continuing education.
Stephen Small (17:32):
And also, we need your help compiling more rumors
and truths to analyze, soplease send us your ideas at
trchealthcare.com forward slashcontact dash us, or use the
contact us link at the bottom ofyour TRC Healthcare homepage,
or send us a text, that button,right from the podcast show
notes.
Don Weinberger (17:51):
And we know you've got great ideas for us to
demystify.
Do not miss our next episode.
We will celebrate our 40thanniversary of Pharmacist's
Letter with a throwback toclaims we investigated decades
ago and see if they still holdup in the 2020s.
Yeah,
Stephen Small (18:05):
I'm looking forward to looking at that
ancient history.
So thanks for joining us onRumor vs.
Truth, your trusted source forfacts, where we dissect the
evidence behind risky rumors andreveal clinical truths.
See you next time.
(18:30):
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