Dr. Paul explains how a pill's composition determines whether it should be taken with food, on an empty stomach, or at bedtime. A pill's fat or water content mirrors how your body digests similar foods. Use the half-meal method: eat half your meal, take the pill with water, finish eating to reduce nausea and stomach irritation.
Chapters
Good day. I'm Dr. Paul. Welcome to Medicine and Health, and this series is called Dr. Pro Tips. These are just little things that might make your either interacting with the doctor or doctors or healthcare providers and/or possibly following their instructions go a little bit more smoothly. The first one is, uh, it's a area where a lot of people have questions, and it makes sense when we look at the complexity, and that's around pill taking. And so in the world of pills, and this could be prescription items or possibly supplements, etc., more and more people are taking things that are both prescribed as well as maybe over-the-counter, etc. So you really need to think about your timing of pill taking and certain other rules that go around with it. So the first thing is, is that pills, generally speaking, will digest very similarly to whatever food item they are most similar to. So for example, if you take a pill that is a fat-based, say, a capsule full of a fat-based medicine or something like that, or even a fat— based nutrient, etc., it's going to absorb in your digestive tract the same way that other fats absorb, which means it's going to go through a little bit different pathway than the water-soluble type things. If you take something that is, say, an amino acid or an amino acid-based product or drug, it's going to absorb the same way that amino acids that you eat in protein will absorb. If you take other things, they're going to absorb similarly. So there are also some drugs that we don't normally give orally because the digestive tract would break them down too far and they wouldn't really be very useful, or there'd be just too much metabolism. So the next thing is if it's prescribed or recommended by a healthcare provider. And so what's that distinction? Well, Generally speaking, we have to prescribe to you something that would be, say, a legend substance, and that means that in the state that you're in, and usually this covers the whole country, it is something that is on the order of prescription only. And so that could be an antibiotic or whatever. So there's a prescribed, and then there might be a recommended thing where it's not really a prescription, but your doctor might say, I want you to start taking calcium and magnesium and vitamin D and K, and here's the amounts. So it's recommended. It's part of your chart usually, but it's not really a prescription. So all of those together though will, or should, have some sort of instructions as far as when and how you take them. So usually what you have is either with food or before a meal or after a meal or maybe between a meal. And there's also bedtime dosing. So the first thing is, if it's a bottle with prescription information, or sometimes you get a walkout receipt that will say take this much of this at this time, that's your first go-to is, gee, what does the label say? Now, if the label is ambiguous, or if you have trouble taking pills, or you feel like you're going to get nauseated from this pill, the next step is to talk to the pharmacist when you're filling the prescription. There's always a place where you can go and and talk to the pharmacist when you're picking up your medications and just say, look, you know, it doesn't really say, it just says take 3 times a day. Can I take this with food? I get sick from pills, etc. And they'll break that down for you. Now, one of the important things about when you take pills can be that there's different fates of digestion of the pill that your healthcare provider may have in mind. So there might be a substance, for example, that really is best with no food. And that'd be something like thyroid hormone. A lot of people take thyroid hormone and we try and have them take that when they first get up before they eat anything, because it binds to other things, especially minerals, really easily. So the worst thing that you could do would be to take your thyroid and then a mineral product and/or food that has minerals at the same time, because the amount of thyroid you're gonna absorb are gonna go way down. Then there are some medications, some supplements where we'll say, well, take it with a meal. Now, in the case of pills that really require food in your stomach to keep you from getting nauseated, to help the pill break down, whatever the reason is for with food, what I usually try and tell people, especially with things that might be a little more upsetting to the stomach is, Take it in the middle of your meal. And so the best way I've figured out to do this is to just set them by my plate, and then I see them there, and I eat literally half of the food, and then I take the pills with a sufficient amount of water, and then I eat the rest of my food. Now, why is that? Because if you take the pill at the beginning of your meal, it's with food, right? But it's gonna go in there. There's not a lot of food or liquid in there, and it might stick to your stomach lining and make you very nauseated or even make you throw up. That happens with zinc and other zinc-based products that are used in a number of drugs, like certain antibiotics, et cetera, will do that as well. So if you imagine that your stomach, you know, is sort of this big oblique bag sort of an organ, and you got half your meal in there, your stomach is literally sort of churning the food around. So the pill goes in with the water you drink, and it just mixes in, and then it's going to digest more easily. It's not going to stick to the wall of your stomach and make you sick, which is what we don't want. Then you eat the rest of the food, and it helps to push any of the, you know, any of the pill down that didn't get there, etc. Now, there were some medications— there are— that are better without food, but still, you don't want to get them stuck in your esophagus. the tube that you swallow through to your stomach. So we would tell people then to take that pill and drink a large glass, like a 12-ounce glass of water with it, just to make sure there was enough fluid going down. Because if you've ever tried and had this happen and felt like you had a pill stuck, that's generally because the pills are, you know, they're sticky, they have different things on the outside. And They will stick to the lining of your esophagus. So the more fluid you can put down, if you can't eat with it, food is better, but if you can't eat with it, the more fluid you do, the better. Now, why would— and these are some of the hardest things to remember as far as prescriptions or recommendations— why would your healthcare provider recommend between meals? Well, one reason is to keep it away from foods. So like with thyroid, we usually say first thing in the morning before eating. But there are some medications and other things that we want between meals. And again, you may have to set an alarm for yourself or have it in a little pill container if you work at a desk and just have it there and remember when the alarm goes off to take that. And it kind of goes back to that same thing. These are probably things that are better to move through your system and not have a lot of food going with them so that we get maximum absorption, etc. Now, the other thing is, if you have a reaction to anything but a medication or recommended supplement or whatever you're doing with your healthcare provider, you want to get a hold of the clinic, leave a message. Nowadays, with electronic medical records, you can just send a message electronically and just say, okay, I started this new prescription and here's what's happening. It could be any number of things. It makes me nauseated, uh, it makes me get flushed, uh, it makes me feel dizzy when I take it, uh, it does this, that, or the other thing. Let them know soon, and then often they can tell you, okay, if that's happening, try this. Okay, so for example, in our clinic, uh, in most people's clinics, if you're getting nauseated from it, we'll reiterate the idea of eating half of your food in a meal, taking the pill with enough fluid and eat the other half of the meal, of the food. That usually does take care of a lot of those problems. Now, sometimes there's other things like, um, you're asking me to take this at bedtime and I'm taking these other pills at bedtime. Can we just double-check? You know, check with a practitioner who's adding on the new pill. And, uh, can we just double-check and, uh, take a look at, you know, making sure everything goes together that we're taking at night? And this is very important, especially with certain medications and a lot of supplement recommendations. Because let's say, for example, there's some nighttime medication you're taking that's fairly critical for a function. Let's say it helps you with a dysrhythmia, an arrhythmia, or it helps you with some other thing. And then let's say somebody adds on another thing to take that may actually bind to the other medication. And I've actually seen this with patients where all of a sudden they start having, you know, arrhythmias again, or their blood pressure went up or something, and there was no reason for it. And you go back and you look, and it turns out that there's 2 things going in at the same time with, say, their heart medication or something else, and one is inhibiting the other. So you get those symptoms from that. I've also seen this with, you know, neuropsychiatric meds and other things. So you just want to make sure you get a good top-down look at that. And in another section, we're talk about doctors disagreeing and stuff like that. But generally speaking, whomever the healthcare provider is that's adding this new thing for your regimen, you should be able to say, okay, look at my med profile or my supplement profile. Is there any reason I shouldn't be able to take this at that time? And so, for some people, for example, there would be things that we would prefer were at bedtime, but there were other medications that were a little bit more critical that they be taken at that time. And so we would have them back up and take it right before dinner or some other time just to make it work out a little bit better for them. Now, one thing that comes up as far as tolerance of pills, etc., is sometimes you'll have a pharmacy and one of their jobs is to make sure you're not going to have drug interactions and things like that. And so drug interactions, generally there's pretty decent data on most drugs. It's like, don't take this with that, etc. When you get into the world of some supplements and some botanical or herbal medicines, etc., sometimes the interaction checkers are very theoretical. So it's a good place to start because there's maybe a paper that showed, you know, in a Petri dish that this reaction happened, but there's no papers showing Was that a problem or not when we put it into people? Okay, there's a big difference between a petri dish reaction and people reaction. So again, if you are working with a healthcare provider and they're adding something like that, um, the things that they should be looking for to help you out— number one are, is there anything we're adding in here that's going to create a problem for anything else you're taking? The next thing is, are the things that we're adding in going to pharmacologically play well with the other stuff that you're taking? Uh, we, we do this constantly and, well, all the types of patients I see, but especially oncology patients. Because, you know, there are a lot of critical drug metabolism things, which thankfully most of them work out pretty well, but there's some that are a little more dicey than others. So as you're going through, communicate, communicate, communicate. Remember, if it comes to pills, the person who's recommended or prescribed whatever it is in question, should be able to answer questions about, is it okay to take the new stuff you're giving me with these old drugs or supplements I'm taking? Sometimes there's a replacement where one of the new things will take over for the new thing and one of the old things, and they'll take you off of it. But again, that's a communication thing. If you start having a problem and you can't troubleshoot it yourself, for example, I've had a lot of people who got sick from certain pills and they looked and it It said, uh, don't take with dairy products, and they took that to mean don't take with any food. And indeed, it was just saying don't take with dairy products or calcium-containing things. So they were able to eat a meal, they just couldn't have dairy products with it. And then that took care of some of the problems. But if you're not getting a resolution, then ask your healthcare provider, uh, what to do about it. Because one of the things that's not going to help you medically speaking— and we're just about out of time here, but I'll give get into this real quick. It's not going to help you medically speaking, or for your medical management, is if you stop taking a prescribed or recommended therapy, and you don't see your doctor for 2, 4, 6, 8 weeks, and then you get back and they're like, well, are you better? Or what has changed? And they don't realize that you've been off of things that they recommended for that whole time. And so, you know, they're, they're not mind readers, so you can go back and, you know, just communicate with their office, let them know. Usually it's something fairly simple. If you're really having a bad reaction, you have an allergy or something like that, they also need to know about that because they're gonna have you stop taking it and look for an alternative. And/or if there's a bad allergic reaction, they're going to have you go to the emergency room. And so, um, that pretty much goes through everything on the basics around pill taking, how to optimize them, how to help out your pill-taking journey and experience. And then there are other things that can be helped or done. Sometimes these are things that the pharmacy can do. For example, in our patients that have a little trouble keeping track of things, or there's a lot of different pills at different times, they can be packaged by different pharmacy services into bubble packs that will allow— and it'll say, you know, morning, you know, lunchtime, bedtime, something like that. And that really helps to sort of keep in track of things. The other thing is we've had people sometimes where they, because of various reasons due to digestion, absorption, and all of the other things that go on, They were unable to really swallow the pills, or it was really, really difficult. And so in some cases, what was done is either through the pharmacy or, or somebody who's competent to do it, they got, you know, powdered versions of a medication or powdered versions of supplement, etc., and they could mix it into a smoothie or You know, other things like that. So as we kind of wind down here in the pill-taking discussion, we'll just go back through. The first thing is communicate with your provider as they're recommending the new things. It doesn't hurt ever to just double-check that everything is copacetic together. Read the labels. And communicate back if you're having any trouble at all. All right, well, we're going to go on to the next session and we'll take a little break here.
