Speaker 2: Good day, I'm doctor Paul. Welcome.
Speaker 1: Medicine and health in this series is called doctor pro Tips.
Speaker 1: These are just little things that might make your either
Speaker 1: interacting with doctor or doctors or healthcare providers and or
Speaker 1: possibly following their instructions go a little bit more smoothly.
Speaker 1: The first one is it's an area where a lot
Speaker 1: of people have questions and it makes sense when we
Speaker 1: look at the complexity and that's around pill taking. And
Speaker 1: so in the world of pills, and this could be
Speaker 1: prescription items or possibly supplements, et cetera, more and more
Speaker 1: people are taking things that are both prescribed as well
Speaker 1: as maybe over the counter, et cetera. So you really
Speaker 1: need to think about your timing of pill taking and
Speaker 1: certain other rules that go around with it. So the
Speaker 1: first thing is is that pills, generally speaking, will digest
Speaker 1: very similarly to whatever food item they are most similar to. So,
Speaker 1: for example, if you take a pill that is a
Speaker 1: fat based, say a capsule full of a fat based
Speaker 1: medicine or something like that, or even a fat based nutrient, etc.
Speaker 1: It's going to absorb in your digestive tract the same
Speaker 1: way that other fats absorb, which means it's going to
Speaker 1: go through a little bit different pathway than the water
Speaker 1: soluble type things. If you take something that is say
Speaker 1: an amino acid or an amino acid.
Speaker 2: Based product or drug, it's going to.
Speaker 1: Absorb the same way that amino acids that you eat
Speaker 1: in protein will absorb. If you take other things.
Speaker 2: Are going to absorb similarly.
Speaker 1: So there are also some drugs that we don't normally
Speaker 1: give orally because the digestive tract would break them down
Speaker 1: too far and it wouldn't really be very useful or
Speaker 1: there'd be just too much metabolism. So the next thing
Speaker 1: is if it's prescribed or recommended by a healthcare provider,
Speaker 1: and so what's that distinction. Well, generally speaking, we have
Speaker 1: to prescribe to you something that would be say a
Speaker 1: legend substance, and that means that in the state that
Speaker 1: you're in, and usually this covers the whole country, it
Speaker 1: is something that is on the order of prescription only,
Speaker 1: and so that to be an antibiotic or whatever. So
Speaker 1: there's a prescribed and then there might be a recommended
Speaker 1: thing where it's not really a prescription, but your doctor
Speaker 1: might say I want you to start taking calcium and
Speaker 1: magnesium and vitamin D and K and here's the amounts.
Speaker 1: So it's recommended as part of your chart usually, but
Speaker 1: it's not really a prescription. So all of those together though,
Speaker 1: will or should have some sort of instructions as far
Speaker 1: as when and how you take them. So usually what
Speaker 1: you have is either with food or before a meal,
Speaker 1: or after a meal, or maybe between a meal, and
Speaker 1: there's also bedtime posting. So the first thing is if
Speaker 1: it's a bottle with a prescription information or sometimes you
Speaker 1: got to walk out a receipt that will say take
Speaker 1: this much of this at this time. That's your first
Speaker 1: go to is, gee, what does the label say?
Speaker 2: Now?
Speaker 1: If the label is ambiguous, or if you have trouble
Speaker 1: taking pills or you feel like you're going to get
Speaker 1: nauseated from this pill, the next step is to talk
Speaker 1: to the pharmacist when you're filling the prescription. There's always
Speaker 1: a place where you can go and talk to the
Speaker 1: pharmacist when you're picking up your medications and just say, look,
Speaker 1: you know it doesn't really say it just says take
Speaker 1: three times a day. Can I take this with food?
Speaker 1: I get sick from pills, etc. And they'll break that
Speaker 1: down for you. Now, one of the important things about
Speaker 1: when you take pills can be that there's different fates
Speaker 1: of digestion of the pill that your healthcare provider may
Speaker 1: have in mind. So there might be a substance, for example,
Speaker 1: that really is best with no food, and that'd be
Speaker 1: something like thyroid hormone. A lot of people take thyroid hormone,
Speaker 1: and we try and have them take that when they
Speaker 1: first get up before they eat anything, because it binds
Speaker 1: to other things, especially minerals, really easily. So the worst
Speaker 1: thing that you could do would be to take your
Speaker 1: thyroid and then a mineral product and or food that
Speaker 1: has minerals at the same time, because the amount of
Speaker 1: thyroid you're gonnas are going to go weigh down. Then
Speaker 1: there are some medications, some supplements where we'll say, well,
Speaker 1: take it with a meal. Now in the case of
Speaker 1: pills that really require food in your stomach to keep
Speaker 1: you from getting nauseated, to help the pill break down,
Speaker 1: whatever the reason is for with food, what I usually
Speaker 1: try and tell people, especially with things that might be
Speaker 1: a little more upsetting to the stomach, is take it
Speaker 1: in the middle of your meal. And so the best
Speaker 1: way I've figured out to do this is to just
Speaker 1: set them by my plate, and then I see them
Speaker 1: there and I eat literally half of the food, and
Speaker 1: then I take the pills with a sufficient amount of water,
Speaker 1: and then I eat.
Speaker 2: The rest of my food.
Speaker 1: Now why is that Because if you take the pill
Speaker 1: at the beginning of your meal, it's with food, right,
Speaker 1: but it's going to go in there. There's not a
Speaker 1: lot of food or liquid in there, and it might
Speaker 1: stick to your stomach lining and make you very nauseat
Speaker 1: or even make you throw up. That happens with zinc
Speaker 1: and other zinc based products that are used in a
Speaker 1: number of drugs, like certain antibiotics, et cetera.
Speaker 2: Will do that as well.
Speaker 1: So if you imagine that your stomach, you know, it's
Speaker 1: sort of this big oblique bag, sort of an organ,
Speaker 1: and you got half your meal in there. Your stomach
Speaker 1: is literally sort of churning the food around. So the
Speaker 1: pill goes in with the water drink and it just
Speaker 1: makes us in and then it's going to digest more easily.
Speaker 1: It's not going to stick to the wall of your
Speaker 1: stomach and make you sick, which is what we don't want.
Speaker 1: Then you eat the rest of the food and it
Speaker 1: helps to push any of the you know, any of
Speaker 1: the pill down that didn't get there, et cetera. Now,
Speaker 1: there were some medications there are that are better without food,
Speaker 1: but still you don't want to get them stuck in
Speaker 1: your esophagus the tube that you swallow through to your stomach.
Speaker 1: So we would tell people then to take that pill
Speaker 1: and drink a large glass, like a twelve ounce glass
Speaker 1: of water with it, just to make through there was
Speaker 1: enough fluid going down.
Speaker 2: Because if you've ever tried and had.
Speaker 1: This happen and felt like you had a pill stuck,
Speaker 1: that's generally because the pills are you know, they're sticky,
Speaker 1: they have different things on the outside, and they will
Speaker 1: stick to the lining of your esophagus. So the more
Speaker 1: fluid you can put down, if you can't eat with it,
Speaker 1: eat food is better. But if you can't eat with it,
Speaker 1: the more fluid you do the better. Now why would
Speaker 1: and these are some of the hardest things to remember
Speaker 1: as far as prescriptions or recommendations, why would your healthcare
Speaker 1: provider recommend between meals? Well, one reason is to keep
Speaker 1: it away from foods. So like with thyroid, we usually
Speaker 1: say first thing in the morning before eating. But there
Speaker 1: are some medications and other things that we want between meals,
Speaker 1: and again you may have to set an alarm for yourself,
Speaker 1: or having a little pill container if you work at
Speaker 1: a desk and just have it there and remember when
Speaker 1: the alarm goes off to take that and it kind
Speaker 1: of goes back to that same thing. These are probably
Speaker 1: things that are better to move through your system and
Speaker 1: not have a lot of food going with them so
Speaker 1: that we get maximum absorption, etc. Now the other thing
Speaker 1: is if you have a reaction to anything but a medication,
Speaker 1: a recommended supplement of whatever you're doing with your health
Speaker 1: care provider, you want to get a hold of the clinic.
Speaker 1: Leave a message. Nowadays, with electronic medical records, you can
Speaker 1: just send a message electronically and just say, Okay, I
Speaker 1: started this new prescription and here's what's happening. It could
Speaker 1: be any number of things. It makes me nauseated, it
Speaker 1: makes me get flushed, it makes me feel dizzy when
Speaker 1: I take it, It does this, that or the other thing.
Speaker 1: Let them know soon and then often they can tell you, okay,
Speaker 1: if that's happening, try this okay. So, for example, in
Speaker 1: our clinic, in most people's clinics, if you're getting nauseated,
Speaker 1: from it will reiterate the idea of eating half of
Speaker 1: your food and a meal, taking the pill with no fluid,
Speaker 1: and eat the other half of the meal of the food.
Speaker 1: That usually does take care of a lot of those problems. Now,
Speaker 1: sometimes there's other things like you're asking me to take
Speaker 1: this at bedtime, and I'm taking these other pills at bedtime.
Speaker 1: Can we just double check, you know, check with a
Speaker 1: practitioner who's adding on the new pill, and can we
Speaker 1: just double check and take a look at, you know,
Speaker 1: making sure everything goes together that we're taking at night.
Speaker 1: And this is very important, especially with certain medications and
Speaker 1: a lot of supplement recommendations, because let's say, for example,
Speaker 1: there's some nighttime medication you're taking that's fairly critical for
Speaker 1: a function. Let's it helps you with a dysrhythmia, a arrhythmia,
Speaker 1: or it helps you with some other thing. And then
Speaker 1: let's say somebody adds on another thing to take that
Speaker 1: may actually bind to the other medication.
Speaker 2: And I've actually seen this with.
Speaker 1: Patients where all of a sudden they start having you know,
Speaker 1: arrhythmias again, or their blood pressure went up or something,
Speaker 1: and there was no reason for it, and you go
Speaker 1: back and you look, and it turns out that there's
Speaker 1: two things going in at the same time with say
Speaker 1: their heart medication or something else, and one is inhibiting
Speaker 1: the other, so you get those symptoms from that. I've
Speaker 1: also seen this with neuropsychiatric meds and other things, So
Speaker 1: you just want to make sure you get a good
Speaker 1: top down look at that. And in another section we're
Speaker 1: going to talk about doctors disagreeing and stuff like that.
Speaker 1: But generally speaking, whomever the healthcare provider is that's adding
Speaker 1: this new thing for your regimen, you should be able
Speaker 1: to say, Okay, look at my med profile or my
Speaker 1: supplement profile, is there any reason I shouldn't be able
Speaker 1: to take this at that time? And so for some people,
Speaker 1: for example, there would be things that we would prefer
Speaker 1: were at bedtime, but there were other medications that were
Speaker 1: a little bit more critical that they'd be taken at
Speaker 1: that time, and so we would have them back up
Speaker 1: and take it right before dinner or some other time,
Speaker 1: just to make it work out a little bit better
Speaker 1: for them. Now, one thing that comes up as far
Speaker 1: as tolerance of pills, et cetera, is sometimes you'll have
Speaker 1: a pharmacy and one of their jobs is to make
Speaker 1: sure you're not going to have drug interactions and things
Speaker 1: like that, and so drug interactions generally, there's pretty decent
Speaker 1: data on most drugs. It's like, don't take this with that, etc.
Speaker 1: We get into the world of some supplements and some
Speaker 1: botanical or herbal medicines, et cetera. Sometimes the interaction checkers
Speaker 1: are very theoretical, so it's a good place to start
Speaker 1: because there's maybe a paper that showed, you know, in
Speaker 1: a Petri dish that this reaction happened, but there's no
Speaker 1: papers showing was that a problem or not when we
Speaker 1: put it into people. Okay, there's a big difference between
Speaker 1: a Petrie dish reaction and people reaction. So again, if
Speaker 1: you are working with healthcare provider in adding something like that,
Speaker 1: the things that they should be looking for to help
Speaker 1: you out. Number one are is there anything we're adding
Speaker 1: in here that's going to create a problem for anything
Speaker 1: else you're taking. The next thing is are the things
Speaker 1: that we're adding in going to pharmacologically play well with
Speaker 1: the other stuff that you're taking. We do this constantly
Speaker 1: and well all the types of patients I see, but
Speaker 1: especially on ecology patients because there are a lot of
Speaker 1: critical drag metabolism things, which thankfully most of them work
Speaker 1: out pretty well, but there's some that are a little
Speaker 1: more dicey than others. So as you're going through communicate, communicate, communicate.
Speaker 1: Remember if it comes to pills, the person who's recommended
Speaker 1: or prescribed whatever it is in question should be able
Speaker 1: to answer questions about is it okay to take the
Speaker 1: new stuff you're giving me with these old drugs or
Speaker 1: supplements I'm taking. Sometimes there's a replacement where one of
Speaker 1: the new things will take over for the new thing
Speaker 1: and one of the old things and they'll take you
Speaker 1: off of it. But again that's a communication thing. If
Speaker 1: you start having a problem and you can't trouble shoot
Speaker 1: it yourself. For example, I've got a lot of people
Speaker 1: who got sick from certain pills and they looked and
Speaker 1: it said don't take with dairy products, and they took
Speaker 1: that to me, don't take with any food, And indeed
Speaker 1: it was just saying don't take with dairy products or
Speaker 1: calcium containing things. So they were able to eat a meal,
Speaker 1: they just couldn't have dairy products with it. And then
Speaker 1: that took care of some of the problems. But if
Speaker 1: you're not getting a resolution, then ask your healthcare provider
Speaker 1: what to do about it. Because one of the things
Speaker 1: that's not going to help you medically speaking, and we're
Speaker 1: just about a time here, but I'll get into this
Speaker 1: real quick. It's not going to help you medically speaking
Speaker 1: or for your medical management is if you stop taking
Speaker 1: a person decribed or recommended therapy and you don't see
Speaker 1: your doctor for two, four, six, eight weeks and then
Speaker 1: you get back and they're like, well, are you better
Speaker 1: or what has changed? And they don't realize that you've
Speaker 1: been off of things that they recommended for that whole time,
Speaker 1: and so you know, they're not mind readers. So you
Speaker 1: can go back and you know, just communicate with their office,
Speaker 1: let them know. Usually it's something fairly simple. If you're
Speaker 1: really having a bad reaction, you have an allergy or
Speaker 1: something like that, they also need to know about that
Speaker 1: because they're going to have you stop taking it and
Speaker 1: look for an alternative v and do, or if there's
Speaker 1: a bat allergic reaction, they're going to have you go
Speaker 1: to the emergency room. And so that pretty much goes
Speaker 1: through everything on the basics around pill taking, how to
Speaker 1: optimize them how to help out your pill taking journey
Speaker 1: and experience. And then there are other things that can
Speaker 1: be helped or done. Sometimes these are things that the
Speaker 1: pharmacy can do. For example, in our patients that have
Speaker 1: a little trouble keeping track of things, or there's a
Speaker 1: lot of different pills at different.
Speaker 2: Times, they can be packaged by.
Speaker 1: Different pharmacy services into bubble packs that will allow and
Speaker 1: it will say, you know, mourning, you know, lunchtime, bedtime,
Speaker 1: something like that, and that really helps us sort of
Speaker 1: keeping track of things. The other thing is we've had
Speaker 1: people sometimes where they because of various reasons, due to digestion,
Speaker 1: absorption and all of the other things that go on,
Speaker 1: they were unable to really swallow the pills or it
Speaker 1: was really really difficult. And so in some cases what
Speaker 1: was done is either through the pharmacy or somebody who's
Speaker 1: competent to do it, they got you knowed versions of
Speaker 1: a medication or powdered versions of supplement, etc. And they
Speaker 1: can mix it into a smoothie or other things like that.
Speaker 1: So as we kind of wind down here in the
Speaker 1: pill taking discussion, we'll just go back through the first
Speaker 1: thing is communicate with your provider as they're recommending the
Speaker 1: new things. It doesn't hurt ever to just double check
Speaker 1: that everything is copasetic together, read the labels, and communicate
Speaker 1: back if you're having any trouble at all. All right,
Speaker 1: well we're going to go on to the next session
Speaker 1: and we'll take a little break here