Q: I had a bit of trouble with heartburn last summer. But since I started taking psyllium husk (pure organic) for constipation, I’ve had no more problems with heartburn. In addition, I’ve not had constipation, either. It helps my gut function better.

A: Psyllium, the active ingredient in Metamucil, is soluble fiber that has long been recommended for “regularity.” Some gastroenterologists recommend it to their patients with irritable bowel syndrome, regardless of whether the main symptom is constipation or diarrhea (Current Opinion in Gastroenterology, March 1, 2021).

You alerted us to another use. Dietary fiber such as that provided by psyllium husk can reduce heartburn symptoms (World Journal of Gastroenterology, June 7, 2018).

Another benefit of psyllium is that it helps control cholesterol (American Journal of Clinical Nutrition, Nov. 1, 2018).

Q: I was diagnosed with paroxysmal atrial fibrillation years ago and have taken propafenone SR every day since. If the AFib pops up from time to time despite the propafenone SR, I take a lower-dose regular propafenone tablet. That usually works in about 30 minutes.

This past year I’ve needed these rescue tablets more frequently, from an average of two per week to almost five a week this fall. After the election, it dropped back down. So far this year, I’m averaging one a week.


I attribute last year’s spike to work stress and political turmoil. The January drop might be due in part to less work pressure now and the stabilized political situation.

One other factor may be playing a role in my reduced episodes. On Dec. 16, my new primary care physician put me on 2,000 IU vitamin D3 daily. Could vitamin D3 play a role in reducing periods of atrial fibrillation?

A: You’ve suggested an intriguing possibility. Adequate vitamin D levels might indeed reduce the likelihood of atrial fibrillation.

One analysis of 13 studies concluded that vitamin D deficiency was associated with an increased risk of atrial fibrillation (Nutrition Journal, Nov. 14, 2019). A randomized controlled trial found that high-dose, short-term vitamin D supplements helped prevent atrial fibrillation after coronary bypass surgery (General Thoracic and Cardiovascular Surgery, May 2020).

This research adds weight to the importance of knowing your vitamin D level. To learn more about this crucial nutrient, you may want to read our eGuide to Vitamin D and Optimal Health. This electronic resource may be found in the Health eGuides section at www.PeoplesPharmacy.com.

Q: How does Primatene Mist differ from the prescription inhaler albuterol (ProAir)? I have used ProAir for years, one puff now and then, for “temporary relief of minor symptoms.” Would Primatene Mist work instead?

A: Primatene Mist contains epinephrine (adrenaline). This inhaler was available without a prescription starting in 1967. It disappeared in 2011 because the propellant that was used to deliver the drug was banned. The Food and Drug Administration approved a different propellant for this asthma drug in 2018, so it is once again available over the counter.

Both albuterol (ProAir) and epinephrine open airways. The FDA approved the reintroduction of Primatene Mist “to provide temporary relief for symptoms of mild, intermittent asthma.” It’s important to let your physician know how you are controlling your asthma.