By Dr. Anthony Policastro

When we take medication, we often get directions about whether to take it with food or without food. In many cases these directions are aimed at providing maximum absorption of the drug. Sometimes that is important. Other times it is not.

However, there are some foods that can significantly interfere with the medication that we are taking. They might decrease the amount absorbed. They might produce undesirable side effects from the drug.

For example doxycycline is an antibiotic. Its absorption can be significantly affected by dairy products. The result is that you might not get the dosage level necessary to combat the infection. 

Dairy products also interfere with the absorption of iron, calcium and magnesium. Thus individuals taking those minerals might not be absorbing them very well if they take a lot of dairy products.

Medications need to be distributed throughout the body in order to hit the targets they need. Food can interfere with that happening for certain drugs. An example of where that can occur is with the drug cyclosporine.

Other foods can effect the metabolism of certain drugs. Some of that is controlled by the genetics of an individual. However, there are more obvious examples. Grapefruit juice is contraindicated in individuals taking stating medications for their cholesterol. Actually there are over 85 drugs that grapefruit juice can impair.

Other drugs can interfere with the excretion of drugs. A good example of this is the drug lithium for bipolar disorder. Lithium is excreted through a similar mechanism as sodium. So if an individual puts a lot of table salt on their foods, the sodium will be excreted and the lithium will not. The result can be too high a level of lithium.

Warfarin is a blood thinner that is carefully monitored when patients are on it. Some dietary foods can interfere with it. That results in increased risk of bleeding. Examples include kale, spinach, blueberries and tomatoes. Other foods can interfere with the function of it and cause an increased risk of blood clots. Diets high in Vitamin K can do that.

Many people are on thyroid supplementation. Walnuts, calcium, iron and soy products can interfere with thyroid medication.

One of the more unpredictable causes of medication effectiveness is mixing it with alcohol. Individuals who are on multiple medications should limit their use of alcoholic beverages.

In general taking medications on a full stomach decreases their absorption. Taking them on an empty stomach improves it. It is more relevant that you are consistent with the timing of medications around your meals. That way they can be changed if they are not effective.

One of the questions I frequently got in pediatrics was the relationship of antibiotics to food. The label often read not to give with food or within two hours of eating. The medications often were given three or four times a day. Working medications around meal schedules could be a nightmare. My response was simple. Make sure they take the medication and worry less about the food intake.

The bottom line is that you can not always take eating habits for granted when taking medications. Problems could arise when you would not expect it.

COVID update- Overall the number of new cases continue to decrease. Nationally, the number of new cases this week was 145,000. That is the lowest it has been since 2020 in the early days of the pandemic.

Sussex County numbers have decreased to 117 new cases this week. That is the lowest number since March 2022.

The county has also moved from medium risk to low risk. That is primarily driven by significantly fewer hospitalizations for COVID-19. That suggests that not only are the total number of cases dropping but so is the severity of those cases.

That is not a huge surprise. By now many individuals have both natural immunity from the illness and/or vaccine induced immunity. Therefore, the severity should be decreasing for those reasons.