Why do I need to take some medicines with food?
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Have you ever been instructed to take your medicine with food and wondered why? Perhaps you’ve wondered if you really need to?
There are varied reasons, and sometimes complex science and chemistry, behind why you may be advised to take a medicine with food.
To complicate matters, some similar medicines need to be taken differently. The antibiotic amoxicillin with clavulanic acid (sold as Amoxil Duo Forte), for example, is recommended to be taken with food, while amoxicillin alone (sold as Amoxil), can be taken with or without food.
Different brands of the same medicine may also have different recommendations when it comes to taking it with food.
Food impacts drug absorption
Food can affect how fast and how much a drug is absorbed into the body in up to 40% of medicines taken orally.
When you have food in your stomach, the makeup of the digestive juices change. This includes things like the fluid volume, thickness, pH (which becomes less acidic with food), surface tension, movement and how much salt is in your bile. These changes can impair or enhance drug absorption.
Eating a meal also delays how fast the contents of the stomach move into the small intestine – this is known as gastric emptying. The small intestine has a large surface area and rich blood supply – and this is the primary site of drug absorption.
Eating a larger meal, or one with lots of fibre, delays gastric emptying more than a smaller meal. Sometimes, health professionals will advise you to take a medicine with food, to help your body absorb the drug more slowly.
But if a drug can be taken with or without food – such as paracetamol – and you want it to work faster, take it on an empty stomach.
Food can make medicines more tolerable
Have you ever taken a medicine on an empty stomach and felt nauseated soon after? Some medicines can cause stomach upsets.
Metformin, for example, is a drug that reduces blood glucose and treats type 2 diabetes and polycystic ovary syndrome. It commonly causes gastrointestinal symptoms, with one in four users affected. To combat these side effects, it is generally recommended to be taken with food.
The same advice is given for corticosteroids (such as prednisolone/prednisone) and certain antibiotics (such as doxycycline).
Taking some medicines with food makes them more tolerable and improves the chance you’ll take it for the duration it’s prescribed.
Can food make medicines safer?
Ibuprofen is one of the most widely used over-the-counter medicines, with around one in five Australians reporting use within a two-week period.
While effective for pain and inflammation, ibuprofen can impact the stomach by inhibiting protective prostaglandins, increasing the risk of bleeding, ulceration and perforation with long-term use.
But there isn’t enough research to show taking ibuprofen with food reduces this risk.
Prolonged use may also affect kidney function, particularly in those with pre-existing conditions or dehydration.
The Australian Medicines Handbook, which guides prescribers about medicine usage and dosage, advises taking ibuprofen (sold as Nurofen and Advil) with a glass of water – or with a meal if it upsets your stomach.
A systematic review published in 2015 found food delays the transit of ibuprofen to the small intestine and absorption, which delays therapeutic effect and the time before pain relief. It also found taking short courses of ibuprofen without food reduced the need for additional doses.
To reduce the risk of ibuprofen causing damage to your stomach or kidneys, use the lowest effective dose for the shortest duration, stay hydrated and avoid taking other non-steroidal anti-inflammatory medicines at the same time.
For people who use ibuprofen for prolonged periods and are at higher risk of gastrointestinal side effects (such as people with a history of ulcers or older adults), your prescriber may start you on a proton pump inhibitor, a medicine that reduces stomach acid and protects the stomach lining.
How much food do you need?
When you need to take a medicine with food, how much is enough?
Sometimes a full glass of milk or a couple of crackers may be enough, for medicines such as prednisone/prednisolone.
However, most head-to-head studies that compare the effects of a medicine “with food” and without, usually use a heavy meal to define “with food”. So, a cracker may not be enough, particularly for those with a sensitive stomach. A more substantial meal that includes a mix of fat, protein and carbohydrates is generally advised.
Your health professional can advise you on which of your medicines need to be taken with food and how they interact with your digestive system.
Mary Bushell, Clinical Associate Professor in Pharmacy, University of Canberra
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Water Fluoridation, Atheroma, & More
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I watched a documentary recently on Fluoride in our drinking water & the dangers of it. Why are we poisoning our water?❞
This is a great question, and it certainly is controversial. It sounds like the documentary you watched was predominantly or entirely negative, but there’s a lot of science to back both sides of this, and it’s not even that the science is contradictory (it’s not). It’s that what differs is people’s opinions about whether benefiting one thing is worth creating a risk to another, and that means looking at:
- What is the risk associated with taking no action (error of omission)?
- What is the risk associated with taking an action (error of commission)?
The whole topic is worth a main feature, but to summarize a few key points:
- Water fluoridation is considered good for the prevention of dental cavities
- Water fluoridation aims to deliver fluoride and doses far below dangerous levels
- This requires working on consumer averages, though
- ”Where do we put the safety margins?” is to some extent a subjective question, in terms of trading off one aspect of health for another
- Too much fluoride can also be bad for the teeth (at least cosmetically, creating little white* spots)
- Detractors of fluoride tend to mostly be worried about neurological harm
- However, the doses in public water supplies are almost certainly far below the levels required to cause this harm.
- That said, again this is working on consumer averages, though.
- However, the doses in public water supplies are almost certainly far below the levels required to cause this harm.
- A good guide is: watch your teeth! Those white* spots will be “the canary in the coal mine” of more serious harm that could potentially come from higher levels due to overconsumption of fluorine.
*Teeth are not supposed to be pure white. The “Hollywood smile” is a lie. Teeth are supposed to be a slightly off-white, ivory color. Anything whiter than that is adding something else that shouldn’t be there, or stripping something off that should be there.
❝How does your diet change clean out your arteries of the bad cholesterol?❞
There’s good news and bad news here, and they can both be delivered with a one-word reply:
Slowly.
Or rather: what’s being cleaned out is mostly not the LDL (bad) cholesterol, but rather, the result of that.
When our diet is bad for cardiovascular health, our arteries get fatty deposits on their walls. Cholesterol gets stuck here too, but that’s not the main physical problem.
Our body’s natural defenses come into action and try to clean it up, but they (for example macrophages, a kind of white blood cell that consumes invaders and then dies, before being recycled by the next part of the system) often get stuck and become part of the buildup (called atheroma), which can lead to atherosclerosis and (if calcium levels are high) hardening of the arteries, which is the worst end of this.
This can then require medical attention, precisely because the body can’t remove it very well—especially if you are still maintaining a heart-unhealthy diet, thus continuing to add to the mess.
However, if it is not too bad yet, yes, a dietary change alone will reverse this process. Without new material being added to the arterial walls, the body’s continual process of rejuvenation will eventually fix it, given time (free from things making it worse) and resources.
In fact, your arteries can be one of the quickest places for your body to make something better or worse, because the blood is the means by which the body moves most things (good or bad) around the body.
All the more reason to take extra care of it, since everything else depends on it!
You might also like our previous main feature:
We turn the tables and ask you a question!
We’ll then talk about this tomorrow:
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Healing Back Pain – by Dr. John Sarno
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Often when we review books with titles like this one, we preface it with a “what it’s not: a think-yourself-better book”.
In this case… It is, in fact, a think-yourself-better book. However, its many essay-length rave reviews caught our attention, and upon reading, we can report: its ideas are worth reading.
The focus of this book is on TMS, or “Tension Myoneural Syndrome”, to give it its full name. The author asserts (we cannot comment on the accuracy) that many cases of TMS are misdiagnosed as other things, from sciatica to lupus. When other treatments fail, or are simply not available (no cure for lupus yet, for example) or are unenticing (risky surgeries, for example), he offers an alternative approach.
Dr. Sarno lays out the case for TMS being internally fixable, since our muscles and nerves are all at the command of our brain. Rather than taking a physical-first approach, he takes a psychological-first approach, before building into a more holistic model.
The writing style is… A little dated and salesey and unnecessarily padded, to be honest, but the content makes it worthwhile.
Bottom line: if you have back pain, then the advice of this book, priced not much more than a box of top brand painkillers, seems a very reasonable thing to try.
Click here to check out Healing Back Pain, and see if it works for you!
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The Daily Stoic – by Ryan Holiday & Stephen Hanselman
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What’s this, a philosophy book in a health and productivity newsletter? Well, look at it this way: Aristotle basically wrote the “How To Win Friends And Influence People” of his day, and Plato before him wrote a book about management.
In this (chiefly modern!) book, we see what the later Stoic philosophers had to say about getting the most out of life—which is also what we’re about, here at 10almonds!
We tend to use the word “stoic” in modern English to refer to a person who is resolute in the face of hardship. The traditional meaning does encompass that, but also means a lot more: a whole, rounded, philosophy of life.
Philosophy in general is not an easy thing into which to “dip one’s toe”. No matter where we try to start, it seems, it turns out there were a thousand other things we needed to read first!
This book really gets around that. The format is:
- There’s a theme for each month
- Each month has one lesson per day
- Each daily lesson starts with some words from a renowned stoic philosopher, and then provides commentary on such
- The commentary provides a jumping-off point and serves as a prompt to actually, genuinely, reflect and apply the ideas.
Unlike a lot of “a year of…” day-by-day books, this is not light reading, by the way, and you are getting a weighty tome for your money.
But, the page-length daily lessons are indeed digestible—which, again, is what we like at 10almonds!
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The Epigenetics Revolution – by Dr. Nessa Carey
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
If you enjoyed the book “Inheritance” that we reviewed a couple of days ago, you might love this as a “next read” book. But you can also just dive straight in here, if you like!
This one, as the title suggests, focuses entirely on epigenetics—how our life events can shape our genetic expression, and that of our descendants. Or to look at it in the other direction, how our genetic expression can be shaped by the life experiences of, for example, our grandparents.
The style of this book is very much pop-science, but contains a lot of information from hard science throughout. We learn not just about longitudinal population studies as one might expect, but also about the intricacies of DNA methylation and histone modifications, for example.
Depending on your outlook, you may find some of this very bleak (“great, I am shackled by what my grandparents did”) or very optimism-inducing (“oh wow, I’m not nearly so constrained by genetics as I thought; this stuff is so malleable!”). This is also the same author who wrote “Hacking The Code of Life“, by the way, but we’ll review that another day.
Bottom line: this book is the best one-shot primer on epigenetics that this reviewer has read (you may be wondering how many that is, and the answer is… about seven or so? I’m not good at counting).
Click here to check out The Epigenetics Revolution, and learn how dynamic you really are!
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Gut-Healthy Spaghetti Chermoula
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Chermoula is a Maghreb relish/marinade (it’s used for both purposes); it’s a little like chimichurri but with distinctly N. African flavors. The gut-healthiness starts there (it’s easy to forget that olives—unless fresh—are a fermented food full of probiotic Lactobacillus sp. and thus great for the gut even beyond their fiber content), and continues in the feta, the vegetables, and the wholewheat nature of the pasta. The dish can be enjoyed at any time, but it’s perfect for warm summer evenings—perhaps dining outside, if you’ve place for that.
You will need
- 9oz wholewheat spaghetti (plus low-sodium salt for its water)
- 10oz broccoli, cut into small florets
- 3oz cilantro (unless you have the soap gene)
- 3oz parsley (whether or not you included the cilantro)
- 3oz green olives, pitted, rinsed
- 1 lemon, pickled, rinsed
- 1 bulb garlic
- 3 tbsp pistachios, shelled
- 2 tbsp mixed seeds
- 1 tsp cumin
- 1 tsp chili flakes
- ½ cup extra virgin olive oil
- For the garnish: 3oz feta (or plant-based equivalent), crumbled, 3oz sun-dried tomatoes, diced, 1 tsp cracked black pepper
Note: why are we rinsing the things? It’s because while picked foods are great for the gut, the sodium can add up, so there’s no need to bring extra brine with them too. By doing it this way, there’ll be just the right amount for flavor, without overdoing it.
Method
(we suggest you read everything at least once before doing anything)
1) Cook the spaghetti as you normally would, but when it’s a minute or two from being done, add the broccoli in with it. When it’s done, drain and rinse thoroughly to get rid of excess starch and salt, and also because cooling it even temporarily (as in this case) lowers its glycemic index.
2) Put the rest of the ingredients into a food processor (except the olive oil and the garnish), and blitz thoroughly until no large coarse bits remain. When that’s done, add the olive oil, and pulse it a few times to combine. We didn’t add the olive oil previously, because blending it so thoroughly in that state would have aerated it in a way we don’t want.
3) Put ⅔ of the chermoula you just made into the pan you used for cooking the spaghetti, and set it over a medium heat. When it starts bubbling, return the spaghetti and broccoli to the pan, mixing gently but thoroughly. If the pasta threatens to stick, you can add a little more chermoula, but go easy on it. Any leftover chermoula that you didn’t use today, can be kept in the fridge and used later as a pesto.
4) Serve! Add the garnish as you do.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Less Obvious Probiotics Benefits
- Making Friends With Your Gut (You Can Thank Us Later)
- What Matters Most For Your Heart? ← spoiler: this is why, while we do watch the sodium, we care more about the fiber
- All about Olive Oil: Is “Extra Virgin” Worth It?
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Reduce Your Skin Tag Risk
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝As I get older, I seem to be increasingly prone to skin tags, which appear, seemingly out of nowhere, on my face, chest and back. My dermatologist happily burns them off – but is there anything I can do to prevent them?!❞
Not a lot! But, potentially something.
The main risk factor for skin tags is genetic, and you can’t change that in any easy way.
The other main risk factors are connected to each other:
Skin folds, and chafing
Skin tags mostly appear where chafing happens. This can be, for example:
- Inside joint articulations (especially groin and armpits)
- Between fat rolls (if you have them)
So, if you have fat rolls, then losing weight will also reduce the risk of skin tags.
Additionally, obesity and some often-related problems such as diabetes, hypertension, and an atherogenic lipid profile also increase the risk of skin tags (amongst other more serious things):
See: Association of Skin Tag with Metabolic Syndrome and its Components
As for the chafing, this can be reduced in various ways, including:
- losing weight if (and only if) you are carrying excess weight
- dressing against chafing (consider your underwear choices, for example)
- keeping hair in the armpits and groin (it’s part of what it’s there for)
See also: Simply The Pits: These Underarm Myths!
Take care!
Don’t Forget…
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