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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Total Recovery – by Dr. Gary Kaplan
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First, know: Dr. Kaplan is an osteopath, and as such, will be mostly approaching things from that angle. That said, he is also board certified in other things too, including family medicine, so he’s by no means a “one-trick pony”, nor are there “when your only tool is a hammer, everything starts to look like a nail” problems to be found here. Instead, the scope of the book is quite broad.
Dr. Kaplan talks us through the diagnostic process that a doctor goes through when presented with a patient, what questions need to be asked and answered—and by this we mean the deeper technical questions, e.g. “what do these symptoms have in common”, and “what mechanism was at work when the pain become chronic”, not the very basic questions asked in the initial debriefing with the patient.
He also asks such questions (and questions like these get chapters devoted to them) as “what if physical traumas build up”, and “what if physical and emotional pain influence each other”, and then examines how to interrupt the vicious cycles that lead to deterioration of one’s condition.
The style of the book is very pop-science and often narrative in its presentation, giving lots of anecdotes to illustrate the principles. It’s a “sit down and read it cover-to-cover” book—or a chapter a day, whatever your preferred pace; the point is, it’s not a “dip directly to the part that answers your immediate question” book; it’s not a textbook or manual.
Bottom line: a lot of this work is about prompting the reader to ask the right questions to get to where we need to be, but there are many illustrative possible conclusions and practical advices to be found and given too, making this a useful read if you and/or a loved one suffers from chronic pain.
Click here to check out Total Recovery, and solve your own mysteries!
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Managing Major Chronic Diseases – by Alexis Dupree
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Our author, Alexis Dupree, is herself in her 70s, and writing with more than three decades of experience of surviving multiple chronic diseases (in her case, Multiple Sclerosis, and then a dozen comorbidities that came with such).
She is not a doctor or a scientist, but for more than 30 years she’s been actively working to accumulate knowledge not just on her own conditions, but on the whole medical system, and what it means to be a “forever patient” without giving up hope.
She talks lived-experience “life management” strategies for living with chronic disease, and she talks—again from lived experience—about navigating the complexities of medical care; not on a legalistic “State regulations say…” level, because that kind of thing changes by the minute, but on a human level.
Perhaps most practically: how to advocate strongly for yourself while still treating medical professionals with the respect and frankly compassion that they deserve while doing their best in turn.
But also: how to change your attitude to that of a survivor, and yet also redefine your dreams. How to make a new game plan of life—while working to make life easier for yourself. How to deal, psychologically, with the likelihood that not only will you probably not get better, but also, you will probably get worse, while still never, ever, giving up.
After all, many things are easily treatable today that mere decades ago were death sentences, and science is progressing all the time. We just have to stay alive, and in as good a condition as we reasonably can, to benefit from those advances!
Bottom line: if you have a chronic disease, or if a loved one does, then this is an immensely valuable book to read.
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Meditations for Mortals – by Oliver Burkeman
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We previously reviewed this author’s “Four Thousand Weeks”, but for those who might have used a lot of those four thousand weeks already, and would like to consider things within a smaller timeframe for now, this work is a 28-day daily reader.
Now, daily readers are usually 366 days, but the chapters here are not the single page chapters that 366-page daily readers usually have. So, expect to invest a little more time per day (say, about 6 pages for each daily chapter).
Burkeman does not start the way we might expect, by telling us to take the time to smell the roses. Instead, he starts by examining the mistakes that most of us make most of the time, often due to unexamined assumptions about the world and how it works. Simply put, we’ve often received bad lessons in life (usually not explicitly, but rather, from our environments), and it takes some unpacking first to deal with that.
Nor is the book systems-based, as many books that get filed under “time management” may be, but rather, is simply principles-based. This is a strength, because principles are a lot easier to keep to than systems.
The writing style is direct and conversational, and neither overly familiar nor overly academic. It strikes a very comfortably readable balance.
Bottom line: if you’d like to get the most out of your days, this book can definitely help improve things a lot.
Click here to check out Meditations For Mortals, and live fulfilling days!
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Leek vs Scallions – Which is Healthier?
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Our Verdict
When comparing leek to scallions, we picked the leek.
Why?
In terms of macros, scallions might have a point: scallions have the lower glycemic index, thanks to leek having more carbs for the same amount of fiber. That said, leek already has a low glycemic index, so this is not a big deal.
When it comes to vitamins, leek has more of vitamins B1, B2, B3, B5, B6, B9, E, and choline, while scallions have more of vitamins A, C, and K. Noteworthily, a cup of chopped leek already provides the daily dose of vitamins A and K, and the difference in levels of vitamin C is minimal. All in all, an easy 8:3 win for leeks here, even without taking that into account.
In the category of minerals, leek has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and selenium, while scallions have a little more zinc.
Both of these allium-family plants (i.e., related to garlic) have an abundance of polyphenols, especially kaempferol.
Of course, enjoy whatever goes best with your meal, but if you’re looking for nutritional density, then leek is where it’s at.
Want to learn more?
You might like to read:
The Many Health Benefits Of Garlic
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Savory Protein Crêpe
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Pancakes have a bad reputation healthwise, but they don’t have to be so. Here’s a very healthy crêpe recipe, with around 20g of protein per serving (which is about how much protein most people’s body’s can use at one sitting) and a healthy dose of fiber too:
You will need
Per crêpe:
- ½ cup milk (your preference what kind; we recommend oat milk for this)
- 2 oz chickpea flour (also called garbanzo bean flour, or gram flour)
- 1 tsp nutritional yeast
- 1 tsp ras el-hanout (optional but tasty and contains an array of beneficial phytochemicals)
- 1 tsp dried mixed herbs
- ⅛ tsp MSG or ¼ tsp low-sodium salt
For the filling (also per crêpe):
- 6 cherry tomatoes, halved
- Small handful baby spinach
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Mix the dry crêpe ingredients in a bowl, and then stir in the milk, whisking to mix thoroughly. Leave to stand for at least 5 minutes.
2) Meanwhile, heat a little olive oil in a skillet, add the tomatoes and fry for 1 minute, before adding the spinach, stirring, and turning off the heat. As soon as the spinach begins to wilt, set it aside.
3) Heat a little olive oil either in the same skillet (having been carefully wiped clean) or a crêpe pan if you have one, and pour in a little of the batter you made, tipping the pan so that it coats the pan evenly and thinly. Once the top is set, jiggle the pan to see that it’s not stuck, and then flip your crêpe to finish on the other side.
If you’re not confident of your pancake-tossing skills, or your pan isn’t good enough quality to permit this, you can slide it out onto a heatproof chopping board, and use that to carefully turn it back into the pan to finish the other side.
4) Add the filling to one half of the crêpe, and fold it over, pushing down at the edges with a spatula to make a seal, cooking for another 30 seconds or so. Alternatively, you can just serve a stack of crêpes and add the filling at the table, folding or rolling per personal preference:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Three Daily Servings of Beans?
- Lycopene’s Benefits For The Gut, Heart, Brain, & More
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Sea Salt vs MSG – Which is Healthier?
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Can you drink your fruit and vegetables? How does juice compare to the whole food?
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Do you struggle to eat your fruits and vegetables? You are not alone. Less than 5% of Australians eat the recommended serves of fresh produce each day (with 44% eating enough fruit but only 6% eating the recommended vegetables).
Adults should aim to eat at least five serves of vegetables (or roughly 375 grams) and two serves of fruit (about 300 grams) each day. Fruits and vegetables help keep us healthy because they have lots of nutrients (vitamins, minerals and fibre) and health-promoting bioactive compounds (substances not technically essential but which have health benefits) without having many calories.
So, if you are having trouble eating the rainbow, you might be wondering – is it OK to drink your fruits and vegetables instead in a juice or smoothie? Like everything in nutrition, the answer is all about context.
It might help overcome barriers
Common reasons for not eating enough fruits and vegetables are preferences, habits, perishability, cost, availability, time and poor cooking skills. Drinking your fruits and vegetables in juices or smoothies can help overcome some of these barriers.
Juicing or blending can help disguise tastes you don’t like, like bitterness in vegetables. And it can blitz imperfections such as bruises or soft spots. Preparation doesn’t take much skill or time, particularly if you just have to pour store-bought juice from the bottle. Treating for food safety and shipping time does change the make up of juices slightly, but unsweetened juices still remain significant sources of nutrients and beneficial bioactives.
Juicing can extend shelf life and reduce the cost of nutrients. In fact, when researchers looked at the density of nutrients relative to the costs of common foods, fruit juice was the top performer.
So, drinking my fruits and veggies counts as a serve, right?
How juice is positioned in healthy eating recommendations is a bit confusing. The Australian Dietary Guidelines include 100% fruit juice with fruit but vegetable juice isn’t mentioned. This is likely because vegetable juices weren’t as common in 2013 when the guidelines were last revised.
The guidelines also warn against having juice too often or in too high amounts. This appears to be based on the logic that juice is similar, but not quite as good as, whole fruit. Juice has lower levels of fibre compared to fruits, with fibre important for gut health, heart health and promoting feelings of fullness. Juice and smoothies also release the sugar from the fruit’s other structures, making them “free”. The World Health Organization recommends we limit free sugars for good health.
But fruit and vegetables are more than just the sum of their parts. When we take a “reductionist” approach to nutrition, foods and drinks are judged based on assumptions made about limited features such as sugar content or specific vitamins.
But these features might not have the impact we logically assume because of the complexity of foods and people. When humans eat varied and complex diets, we don’t necessarily need to be concerned that some foods are lower in fibre than others. Juice can retain the nutrients and bioactive compounds of fruit and vegetables and even add more because parts of the fruit we don’t normally eat, like the skin, can be included.
So, it is healthy then?
A recent umbrella review of meta-analyses (a type of research that combines data from multiple studies of multiple outcomes into one paper looked at the relationship between 100% juice and a range of health outcomes.
Most of the evidence showed juice had a neutral impact on health (meaning no impact) or a positive one. Pure 100% juice was linked to improved heart health and inflammatory markers and wasn’t clearly linked to weight gain, multiple cancer types or metabolic markers (such as blood sugar levels).
Some health risks linked to drinking juice were reported: death from heart disease, prostate cancer and diabetes risk. But the risks were all reported in observational studies, where researchers look at data from groups of people collected over time. These are not controlled and do not record consumption in the moment. So other drinks people think of as 100% fruit juice (such as sugar-sweetened juices or cordials) might accidentally be counted as 100% fruit juice. These types of studies are not good at showing the direct causes of illness or death.
What about my teeth?
The common belief juice damages teeth might not stack up. Studies that show juice damages teeth often lump 100% juice in with sweetened drinks. Or they use model systems like fake mouths that don’t match how people drinks juice in real life. Some use extreme scenarios like sipping on large volumes of drink frequently over long periods of time.
Juice is acidic and does contain sugars, but it is possible proper oral hygiene, including rinsing, cleaning and using straws can mitigate these risks.
Again, reducing juice to its acid level misses the rest of the story, including the nutrients and bioactives contained in juice that are beneficial to oral health.
So, what should I do?
Comparing whole fruit (a food) to juice (a drink) can be problematic. They serve different culinary purposes, so aren’t really interchangeable.
The Australian Guide to Healthy Eating recommends water as the preferred beverage but this assumes you are getting all your essential nutrients from eating.
Where juice fits in your diet depends on what you are eating and what other drinks it is replacing. Juice might replace water in the context of a “perfect” diet. Or juice might replace alcohol or sugary soft drinks and make the relative benefits look very different.
On balance
Whether you want to eat your fruits and vegetables or drink them comes down to what works for you, how it fits into the context of your diet and your life.
Smoothies and juices aren’t a silver bullet, and there is no evidence they work as a “cleanse” or detox. But, with society’s low levels of fruit and vegetable eating, having the option to access nutrients and bioactives in a cheap, easy and tasty way shouldn’t be discouraged either.
Emma Beckett, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation – School of Health Sciences, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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