The People’s Pharmacy

Q: For over several decades, I have found capsaicin ointment to be very effective when other remedies for pain are inadequate. It eliminated the discomfort I experienced after vein removal from my calf. It gives long-lasting relief from peripheral neuropathy in my feet and the unbearable itch my wife got months after a severe case of shingles.

We do have to be careful not to get the ointment in the eyes or on other sensitive areas. Also, we don’t expose treated areas to sun exposure, because it produces an intense burning sensation. I apply the ointment with a foam brush or rubber gloves to keep it where it belongs.

A: You are smart to use a brush or gloves to apply this ointment. That reduces the chance you will get some in your eyes, nose, mouth or another sensitive spot.

Capsaicin is the compound that makes chile peppers hot. Repeated application to the skin depletes substance P from the sensory nerves, allowing temporary relief from pain. This apparently is because capsaicin activates the transient receptor potential channel vanilloid 1 (TRPV1) (Pharmacology & Therapeutics, April 2021).

Because of this action, scientists have been trying to find a way to improve absorption through the skin for treating diabetic neuropathy (Advanced Pharmaceutical Bulletin, Aug. 2022). As you have noted, though, available capsaicin ointments can help ease pain. The main side effect is the burning sensation when it is first applied.

Q: You have written often about vitamin B12 deficiency, but I can find nothing about too much B12. I had a blood test recently that revealed excess vitamin B12.


Although I take a daily multivitamin, I do not take a B12 supplement. Where could excess vitamin B12 come from? Also, what problems could arise from this? I will have to consult with my doctor, but I’d like to know what questions to ask.

A: First, check your multivitamin to make sure that the dose of vitamin B12 (cobalamin) is under 1,000 mcg (aka 1 mg). Health care providers might prescribe such a high dose to correct a deficiency, but it is too much to take without medical supervision.

Your doctor will probably run blood tests to rule out problems with the liver or kidneys. Another possible cause of elevated vitamin B12 levels is a blood disorder. In any case, the physician must do a complete diagnostic workup to track down the reason for elevated vitamin B12 levels.

Q: After struggling with stress for a long time, I developed chronic diarrhea. Someone suggested it might be irritable bowel syndrome.

I’ve been taking psyllium every day for years. Now I’ve added enteric-coated peppermint, with a small amount of ginger and fennel oil. This seems to help somewhat.

When I started eating 2 tablespoons of shredded coconut in 1/2 cup plain yogurt everyday with banana and cinnamon, I noticed a big change to more normal stools. It may take more than one thing to restore normal bowel function.


A: Other readers agree that coconut or peppermint can help control diarrhea. Combining them may offer extra benefit.

Researchers have confirmed that key ingredients in coconut can help control C. diff bacterial growth (Frontiers in Microbiology, Jan. 17, 2018).

To learn more about managing irritable bowel syndrome as well as controlling chronic diarrhea, you may wish to read our “eGuide to Overcoming Digestive Disorders.” This online resource may be found under the Health eGuides tab at