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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We looked at genetic clues to depression in more than 14,000 people. What we found may surprise you
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The core experiences of depression – changes in energy, activity, thinking and mood – have been described for more than 10,000 years. The word “depression” has been used for about 350 years.
Given this long history, it may surprise you that experts don’t agree about what depression is, how to define it or what causes it.
But many experts do agree that depression is not one thing. It’s a large family of illnesses with different causes and mechanisms. This makes choosing the best treatment for each person challenging.
Reactive vs endogenous depression
One strategy is to search for sub-types of depression and see whether they might do better with different kinds of treatments. One example is contrasting “reactive” depression with “endogenous” depression.
Reactive depression (also thought of as social or psychological depression) is presented as being triggered by exposure to stressful life events. These might be being assaulted or losing a loved one – an understandable reaction to an outside trigger.
Endogenous depression (also thought of as biological or genetic depression) is proposed to be caused by something inside, such as genes or brain chemistry.
Many people working clinically in mental health accept this sub-typing. You might have read about this online.
But we think this approach is way too simple.
While stressful life events and genes may, individually, contribute to causing depression, they also interact to increase the risk of someone developing depression. And evidence shows that there is a genetic component to being exposed to stressors. Some genes affect things such as personality. Some affect how we interact with our environments.
What we did and what we found
Our team set out to look at the role of genes and stressors to see if classifying depression as reactive or endogenous was valid.
In the Australian Genetics of Depression Study, people with depression answered surveys about exposure to stressful life events. We analysed DNA from their saliva samples to calculate their genetic risk for mental disorders.
Our question was simple. Does genetic risk for depression, bipolar disorder, schizophrenia, ADHD, anxiety and neuroticism (a personality trait) influence people’s reported exposure to stressful life events?
We looked at the genetic risk of mental illness to see how that was linked to stressful life events, such as childhood abuse and neglect. Kamira/Shutterstock You may be wondering why we bothered calculating the genetic risk for mental disorders in people who already have depression. Every person has genetic variants linked to mental disorders. Some people have more, some less. Even people who already have depression might have a low genetic risk for it. These people may have developed their particular depression from some other constellation of causes.
We looked at the genetic risk of conditions other than depression for a couple of reasons. First, genetic variants linked to depression overlap with those linked to other mental disorders. Second, two people with depression may have completely different genetic variants. So we wanted to cast a wide net to look at a wider spectrum of genetic variants linked to mental disorders.
If reactive and endogenous depression sub-types are valid, we’d expect people with a lower genetic component to their depression (the reactive group) would report more stressful life events. And we’d expect those with a higher genetic component (the endogenous group) would report fewer stressful life events.
But after studying more than 14,000 people with depression we found the opposite.
We found people at higher genetic risk for depression, anxiety, ADHD or schizophrenia say they’ve been exposed to more stressors.
Assault with a weapon, sexual assault, accidents, legal and financial troubles, and childhood abuse and neglect, were all more common in people with a higher genetic risk of depression, anxiety, ADHD or schizophrenia.
These associations were not strongly influenced by people’s age, sex or relationships with family. We didn’t look at other factors that may influence these associations, such as socioeconomic status. We also relied on people’s memory of past events, which may not be accurate.
How do genes play a role?
Genetic risk for mental disorders changes people’s sensitivity to the environment.
Imagine two people, one with a high genetic risk for depression, one with a low risk. They both lose their jobs. The genetically vulnerable person experiences the job loss as a threat to their self-worth and social status. There is a sense of shame and despair. They can’t bring themselves to look for another job for fear of losing it too. For the other, the job loss feels less about them and more about the company. These two people internalise the event differently and remember it differently.
Genetic risk for mental disorders also might make it more likely people find themselves in environments where bad things happen. For example, a higher genetic risk for depression might affect self-worth, making people more likely to get into dysfunctional relationships which then go badly.
If two people lose their jobs, one with a high genetic risk of depression the other at low risk, both will experience and remember the event differently. Inside Creative House/Shutterstock What does our study mean for depression?
First, it confirms genes and environments are not independent. Genes influence the environments we end up in, and what then happens. Genes also influence how we react to those events.
Second, our study doesn’t support a distinction between reactive and endogenous depression. Genes and environments have a complex interplay. Most cases of depression are a mix of genetics, biology and stressors.
Third, people with depression who appear to have a stronger genetic component to their depression report their lives are punctuated by more serious stressors.
So clinically, people with higher genetic vulnerability might benefit from learning specific techniques to manage their stress. This might help some people reduce their chance of developing depression in the first place. It might also help some people with depression reduce their ongoing exposure to stressors.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Jacob Crouse, Research Fellow in Youth Mental Health, Brain and Mind Centre, University of Sydney and Ian Hickie, Co-Director, Health and Policy, Brain and Mind Centre, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Leverage Placebo Effect For Yourself
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Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago
The placebo effect is a well-known, well-evidenced factor that is very relevant when it comes to the testing and implementation of medical treatments:
NIH | National Center for Biotechnology Information | Placebo Effect
Some things that make placebo effect stronger include:
- Larger pills instead of small ones: because there’s got to be more going on in there, right?
- Thematically-colored pills: e.g. red for stimulant effects, blue for relaxing effects
- Things that seem expensive: e.g. a well-made large heavy machine, over a cheap-looking flimsy plastic device. Similarly, medication from a small glass jar with a childproof lock, rather than popped out from a cheap blister-pack.
- Things that seem rational: if there’s an explanation for how it works that you understand and find rational, or at least you believe you understand and find rational ← this works in advertising, too; if there’s a “because”, it lands better almost regardless of what follows the word “because”
- Things delivered confidently by a professional: this is similar to the “argument from authority” fallacy (whereby a proposed authority will be more likely trusted, even if this is not their area of expertise at all, e.g. celebrity endorsements), but in the case of placebo trials, this often looks like a well-dressed middle-aged or older man with an expensive haircut calling for a young confident-looking aide in a lab coat to administer the medicine, and is received better than a slightly frazzled academic saying “and, uh, this one’s yours” while handing you a pill.
- Things with ritual attached: this can be related to the above (the more pomp and circumstance is given to the administration of the treatment, the better), but it can also be as simple as an instruction on an at-home-trial medication saying “take 20 minutes before bed”. Because, if it weren’t important, they wouldn’t bother to specify that, right? So it must be important!
And now for a quick personality test
Did you see the above as a list of dastardly tricks to watch out for, or did you see the above as a list of things that can make your actual medication more effective?
It’s arguably both, of course, but the latter more optimistic view is a lot more useful than the former more pessimistic one.
Since placebo effect works at least somewhat even when you know about it, there is nothing to stop you from leveraging it for your own benefit when taking medication or doing health-related things.
Next time you take your meds or supplements or similar, pause for a moment for each one to remember what it is and what it will be doing for you. This is a lot like the principles (which are physiological as well as psychological) of mindful eating, by the way:
How To Get More Nutrition From The Same Food
Placebo makes some surprising things evidence-based
We’ve addressed placebo effect sometimes as part of an assessment of a given alternative therapy, often in our “Mythbusting Friday” edition of 10almonds.
- In some cases, placebo is adjuvant to the therapy, i.e. it is one of multiple mechanisms of action (example: chiropractic or acupuncture)
- In some cases, placebo is the only known mechanism of action (example: homeopathy)
- In some cases, even placebo can’t help (example: ear candling)
One other fascinating and far-reaching (in a potentially good way) thing that placebo makes evidence-based is: prayer
…which is particularly interesting for something that is fundamentally faith-based, i.e. the opposite of evidence-based.
Now, we’re a health science publication, not a theological publication, so we’ll consider actual divine intervention to be beyond the scope of mechanisms of action we can examine, but there’s been a lot of research done into the extent to which prayer is beneficial as a therapy, what things it may be beneficial for, and what factors affect whether it helps:
Prayer and healing: A medical and scientific perspective on randomized controlled trials
👆 full paper here, and it is very worthwhile reading if you have time, whether or not you are religious personally
Placebo works best when there’s a clear possibility for psychosomatic effect
We’ve mentioned before, and we’ll mention again:
- psychosomatic effect does not mean: “imagining it”
- psychosomatic effect means: “your brain regulates almost everything else in your body, directly or indirectly, including your autonomic functions, and especially notably when it comes to illness, your immune responses”
So, a placebo might well heal your rash or even shrink a tumor, but it probably won’t regrow a missing limb, for instance.
And, this is important: it’s not about how credible/miraculous the outcome will be!
Rather, it is because we have existing pre-programmed internal bodily processes for healing rashes and shrinking tumors, that just need to be activated—whereas we don’t have existing pre-programmed internal bodily processes for regrowing a missing limb, so that’s not something our brain can just tell our body to do.
So for this reason, in terms of what placebo can and can’t do:
- Get rid of cancer? Yes, sometimes—because the body has a process for doing that; enjoy your remission
- Fix a broken nail? No—because the body has no process for doing that; you’ll just have to cut it and wait for it to grow again
With that in mind, what will you use the not-so-mystical powers of placebo for? What ever you go for… Enjoy, and take care!
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Mindfulness – by Olivia Telford
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Olivia Telford takes us on a tour of mindfulness, meditation, mindfulness meditation, and how each of these things impacts stress, anxiety, and depression—as well as less obvious things too, like productivity and relationships.
In the category of how much this is a “how-to-” guide… It’s quite a “how-to” guide. We’re taught how to meditate, we’re taught assorted mindfulness exercises, and we’re taught specific mindfulness interventions such as beating various life traps (e.g. procrastination, executive dysfunction, etc) with mindfulness.
The writing style is simple and to the point, explanatory and very readable. References are made to pop-science and hard science alike, and all in all, is not too far from the kind of writing you might expect to find here at 10almonds.
Bottom line: if you’d like to practice mindfulness meditation and want an easy “in”, or perhaps you’re curious and wonder what mindfulness could tangibly do for you and how, then this book is a great choice for that.
Click here to check out Mindfulness, and enjoy being more present in life!
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Sweet Potato & Black Bean Tacos
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Fiber, protein, and polyphenols! What more could one ask for? Well, great taste and warm healthy goodness, which these deliver:
You will need
For the sweet potatoes:
- 2 medium sweet potatoes, cubed (we recommend leaving the skin on, but you can peel them if you really want to)
- 1 tbsp extra virgin olive oil
- 2 tsp garlic powder
- 2 tsp smoked paprika
- 1 tsp chili powder
- 1 tsp black pepper
- 1 tsp ground cumin
- 1 tsp ground turmeric
- ½ tsp MSG or 1 tsp low-sodium salt
For the black beans:
- 2 cans black beans, drained and rinsed (or 2 cups black beans that you cooked yourself)
- ¼ bulb garlic, minced
- 1 fresh jalapeño finely chopped (or ¼ cup jalapeños from a jar, finely chopped) ← adjust quantities per your preference and per the quality of the pepper(s) you’re using; we can’t judge that from here without tasting them, so we give a good basic starting suggestion.
- 2 tsp black pepper
- 1 tsp red chili flakes
- ½ tsp MSG or 1 tsp low-sodium salt
For serving:
- 8 small corn tortillas, or your preference if substituting
- 1 avocado, pitted, peeled, cubed, and tossed in lime juice ← we’re mentioning this here because you want to do this as soon as you cut it, to avoid oxidation
- Any other salad you’d like to include; fresh parsley is also a good option when it comes to greenery, or cilantro if you don’t have the soap gene
- Tomato salsa (quantity and spice level per your preference)
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 400°F / 200°C.
2) Toss the sweet potato cubes in a large bowl with the rest of the ingredients from the sweet potato section above, ensuring they are evenly coated.
3) Bake them in the oven, on a baking tray lined with baking paper, for about 30 minutes or until tender inside and crispy at the edges. Turn them over halfway through.
4) While that’s happening, mix the black beans in a bowl with the other ingredients from the black bean section above, and heat them gently. You could do this in a saucepan, but honestly, while it’s not glamorous, the microwave is actually better for this. Note: many people find the microwave cooks food unevenly, but there are two reasons for this and they’re both easily fixable:
- instead of using high power for x minutes, use medium power for 2x minutes; this will produce better results
- instead of putting the food just in a bowl, jug, or similar, use a wide bowl or similar container, and then inside that, place a small empty microwave-safe glass jar or similar upturned in the middle, and then add the food around it, so that the food is arranged in a donut shape rather than a wide cylinder shape. This means there is no “middle bit” to go underheated while the edges are heated excessively; instead, it will heat through evenly.
If you really don’t want to do that though, use a saucepan on a very low heat, add a small amount of liquid (or tomato salsa), and stir constantly.
5) Heat the tortillas in a dry skillet for about 30 seconds each on each side, when ready to serve.
6) Assemble the tacos; you can do this how you like but a good order of operations is: tortilla, leafy salad (if using), potato, beans, non-leafy salad including avocado, salsa or other topping per your preference.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- White Potato vs Sweet Potato – Which is Healthier?
- Kidney Beans or Black Beans – Which is Healthier?
- Coconut vs Avocado – Which is Healthier?
- Glutathione: More Than An Antioxidant
- Our Top 5 Spices: How Much Is Enough For Benefits? ← we hit 4/5 today!
Take care!
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Wakefulness, Cognitive Enhancement, AND Improved Mood?
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Old Drug, New Tricks?
Modafinil (also known by brand names including Modalert and Provigil) is a dopamine uptake inhibitor.
What does that mean? It means it won’t put any extra dopamine in your brain, but it will slow down the rate at which your brain removes naturally-occuring dopamine.
The result is that your brain will get to make more use of the dopamine it does have.
(dopamine is a neutrotransmitter that allows you to feel wakeful and happy, and perform complex cognitive tasks)
Modafinil is prescribed for treatment of excessive daytime sleepiness. Often that’s caused by shift work sleep disorder, sleep apnea, restless leg syndrome, or narcolepsy.
Read: Overview of the Clinical Uses, Pharmacology, and Safety of Modafinil
Many studies done on humans (rather than rats) have been military experiments to reduce the effects of sleep deprivation:
Click Here To See A Military Study On Modafinil!
They’ve found modafinil to be helpful, and more effective and more long-lasting than caffeine, without the same “crash” later. This is for two reasons:
1) while caffeine works by blocking adenosine (so you don’t feel how tired you are) and by constricting blood vessels (so you feel more ready-for-action), modafinil works by allowing your brain to accumulate more dopamine (so you’re genuinely more wakeful, and you get to keep the dopamine)
2) the biological half-life of modafinil is 12–15 hours, as opposed to 4–8 hours* for caffeine.
*Note: a lot of sources quote 5–6 hours for caffeine, but this average is misleading. In reality, we are each genetically predetermined to be either a fast caffeine metabolizer (nearer 4 hours) or a slow caffeine metabolizer (nearer 8 hours).
What’s a biological half-life (also called: elimination half-life)?
A substance’s biological half-life is the time it takes for the amount in the body to be reduced by exactly half.
For example: Let’s say you’re a fast caffeine metabolizer and you have a double-espresso (containing 100mg caffeine) at 8am.
By midday, you’ll have 50mg of caffeine left in your body. So far, so simple.
By 4pm you might expect it to be gone, but instead you have 25mg remaining (because the amount halves every four hours).
By 8pm, you have 12.5mg remaining.
When midnight comes and you’re tucking yourself into bed, you still have 6.25mg of caffeine remaining from your morning coffee!
Use as a nootropic
Many healthy people who are not sleep-deprived use modafinil “off-label” as a nootropic (i.e., a cognitive enhancer).
Read: Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: A systematic review
Important Note: modafinil is prescription-controlled, and only FDA-approved for sleep disorders.
To get around this, a lot of perfectly healthy biohackers describe the symptoms of sleep pattern disorder to their doctor, to get a prescription.
We do not recommend lying to your healthcare provider, and nor do we recommend turning to the online “grey market”.
Such websites often use anonymized private doctors to prescribe on an “informed consent” basis, rather than making a full examination. Those websites then dispense the prescribed medicines directly to the patient with no further questions asked (i.e. very questionable practices).
Caveat emptor!
A new mood-brightener?
Modafinil was recently tested head-to-head against Citalapram for the treatment of depression, and scored well:
See its head-to-head scores here!
How does it work? Modafinil does for dopamine what a lot of anti-depressants do for serotonin. Both dopamine and serotonin promote happiness and wakefulness.
This is very promising, especially as modafinil (in most people, at least) has fewer unwanted side-effects than a lot of common anti-depressant medications.
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Military Secrets (Ssh!)
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Can you keep a secret?
When actor Christopher Lee was asked about his time as a British special forces operative, he would look furtively around, and ask “can you keep a secret?” Upon getting a yes, he would reply:
“So can I”
We can’t, though! We just can’t help sharing cool, useful information that changes people’s lives. Never is that more critical than now, as the end of January has been called the most depressing time of year, according to Dr. Cliff Arnall at the University of Cardiff. It doesn’t have to be all doom and gloom, though:
Today we’re going to share a trick… It’s called the “secret of eternal happiness” (yes, we know… we didn’t come up with the name!) and is taught to soldiers to fend off the worst kinds of despair.
The soldiers would be ordered to take a moment to reflect on the sheer helplessness of their situation, the ridiculous impossibility of the odds against them, all and any physical pain they might suffer, the weakness of their faltering body… and just when everything feels as bad is it can possibly feel, they’re told to say out loud—as sadly as possible—this single word:
“Boop”
It all but guarantees to result in cracking a smile, no matter the situation.
Now this knowledge is yours too! Keep it secret! Or don’t. Sharing is caring.
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