Health Hack: What Does “Take On An Empty Stomach” Mean?

So, for the first time, I was prescribed a medication that had the instructions “Take on an empty stomach.”

I was aware such medications existed, but I’d never been prescribed one before so I’d never given those instructions much thought.  But, now, I started wondering – what exactly does that mean?  HOW empty?

I mean, I could take one dose in the morning when I first wake up but then how long do I have to wait before I can eat?  And what about the *other* doses I have to take throughout the day?

And does empty only refer to food, or does water or other drinks count too?  So many questions!

Turns out, it’s not as straightforward as you might think.

Even the “expert” medical websites don’t agree.

After reviewing multiple health websites, I decided I was probably safe waiting one hour after I took the medication before eating, and waiting two hours after I ate before taking the medication.  But I didn’t know for sure.

Turns out, some medications are particularly finicky.  Hopefully, if you are taking one of those, your doctor or pharmacist will give you detailed instructions.

The National Institutes of Health asserts that “on an empty stomach” means you should take these medications either 2 hours before eating or 2 hours after eating.

And what about beverages?  There’s even *less* information to be had about that.  A few sites mention “plain water” as being ok, in moderation. But it appears that there is no “blanket” advice on beverages.  Medications  vary widely, and some medications interact with certain drinks – grapefruit juice being a well-known example.  Milk can also interfere with absorption.  And hopefully everyone knows that many medications don’t mix with alcoholic drinks.

I eventually looked up my specific medication on the Mayo Clinic website, and learned that I could take it with water or fruit juice (8 ounces for adults).  This website also confirmed that 1 hour before meals or 2 hours after was correct for this medication.

Bottom Line: You should discuss specific instructions for taking medications with your doctor or pharmacist.  The Mayo Clinic website (see above) can also provide useful information.  A broad rule of thumb is 2 hours before or two hours after eating.  Taking your medication with plain water (up to 8 ounces) should be fine (but I am not a doctor or a pharmacist, so this information is for educational purposes only).

Finally, I leave you with a commentary, written by a medical professional, on how ludicrous these medication instructions can become.

WARNING: Food and medications can interact, which could make the medications less effective or could cause adverse side-effects.  See this FDA pamphlet for more information on Food-Drug Interactions.

Guest Post: Warning about ‘Healthy’ Food Labels

Low Fat! No Fat! High Fiber! High Protein! All Natural! Organic! Free Range! Zero Trans Fat! Sugar Free! No Sugar Added! Low Carb! Multigrain! Light! Cholesterol Free! Made with Real Fruit! [Follow link for more information on food label claims]

[This post is the next in the guest post series on healthy diet and lifestyle from Dave Banko.]

Buyer Beware!!!

There is very little regulation on the claims companies make about food products, and advertisers push it to the limits! Let’s face it, they are trying to make their product stand out from the others.

I no longer purchase anything based on the marketing slogan. When I shop, I read the labels and purchase whole food products with natural ingredients and as few chemicals and preservatives as possible. Don’t believe the slogan on the label until you do your research.

While I’m on the subject, also beware of fad diets like detox, liquid, no-carb, etc.  Any diet that demonizes one or more particular food groups is unbalanced and will force you to compensate with expensive alternatives.

As an example, ‘gluten-free’ is the rage where I live with many people believing they need to eat ‘gluten-free’ to be healthy.

Gluten is a composite protein found in many grains, such as wheat, rye, and barley. There is an autoimmune disease called coeliac which affects about 1% of the population. Coeliac (spelled “celiac” in the US) causes the body to react to gluten by triggering a serious autoimmune response which can damage many parts of the body.  If you have this disease, consuming gluten is dangerous and you need to seek out gluten-free products.

If you don’t have coeliac, gluten sensitivity, or a wheat allergy, you can consume gluten without problem. In fact, going gluten free if you don’t have coeliac can result in serious nutritional deficiencies.

‘Gluten-free’ products are being advertised as ‘healthier’ than regular products. The influence is so strong, I had someone who didn’t have enough food to eat come into the food bank where I volunteer and ask if she could have ‘gluten-free’ products because she was trying to eat healthier. She didn’t have coeliac and was surprised (and relieved) when I explained to her what it was. Believe or not, there is even a company promoting ‘gluten-free’ water, which is ridiculous considering there is no grain in water to begin with so all water is naturally gluten-free.

The same applies to other food allergies, like wheat, nuts, etc. These medical conditions are serious. If you have a food allergy and consume products containing them, the results can range from minor discomfort to death. The fact that products for these conditions are being advertised and labelled is a huge benefit to people with these conditions.

But, if you don’t have the condition, you don’t need to seek out these products in the name of being ‘healthy.’ Instead, eat a good balance of real food.

[Crew Dog: To summarize what Dave is saying – Don’t buy into the hype and confusion of food labels.  Think about what the food advertisers are saying and whether it makes sense – even if a cookie is low-fat, it isn’t healthy fuel for your body.  Don’t pay extra for things you don’t need (like gluten-free water) just because advertisers slapped faddish buzz words on the packaging.  It may seem like a lot of work to eat healthy, but it doesn’t have to be.  Just eat non-processed foods in their natural state (fruits, vegetables, nuts, seeds, meat, fish) or foods with a few simple ingredients.]

As always, feel free to contact me at if you have any questions or comments, and good luck!  [Crew Dog: Or comment below.]

Things I Never Knew Before I Had a Debilitating Health Condition

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When I began living with a chronic health condition, I thought I was learning what it was like to not be perfectly healthy.

After years of having excellent health, I was starting to understand physical limitations (I thought).

I was more sympathetic of others who had dietary restrictions (and I was grateful when other people were sympathetic of my dietary restrictions).  I was more aware of physical limitations, and therefore more sensitive to people who have them and ways to make environments more accessible to folks who are differently-abled.  I thought my health condition was making me a better person by making me more aware of others’ realities.

Then my health condition became debilitating, and I learned there was a big difference (at least in my case) between chronic and debilitating.

With a chronic health condition I could still live a fairly normal life, with some restrictions and modifications.  With a debilitating health condition, I rarely leave the house, except to go to doctor’s appointments.

When my health condition became debilitating, I learned there was still a lot I didn’t know about physical limitations and other people’s realities.

In the hopes that others might get a better idea of what it’s like, I made a list of things I never knew before I had a debilitating health condition:

I never knew I would choose to stay home and miss an opportunity to socialize because it was too much work to figure out what clothes to wear in public.

I never knew there would be days (weeks?) that I didn’t have the energy to change out of my pajamas.

I never knew how exhausting it could be to take a shower.

I never knew I could lack the energy to prepare a simple meal like scrambled eggs.

I never knew that some foods could be too exhausting to eat, and that some days all I would have the energy to eat would be foods like soup, apple sauce, macaroni & cheese, or ice cream, that require minimal processing.  (Easy to prepare, easy to chew, easy to digest.)

I never knew that I wouldn’t be able to deal with phone calls, and I would just let them go to voice mail, which I would delete every few months when I got tired of the icon blinking at me.

I never knew that it could take too much energy to sit up, so I’d have to lie on the couch instead.

I never knew that leaving my house to go to a doctor’s appointment, to socialize, or to run an errand could take so much out of me that it could take days to recover.

I never knew that I could be so exhausted that I wouldn’t have the energy to fight for my health – that I would ignore incorrect bills or live with health problems rather than fight with the system to correct these things, because I didn’t have any fight left in me.

I never knew that when I got this ill none of my friends would notice, and  I would become more and more isolated.

Call to Action: If you have a friend with a debilitating health condition, don’t let them fall through the cracks!  Ask yourself, “When is the last time I saw/heard from this person?”  Everyone gets busy, and it’s easy to go a while without contacting your friends, especially if they don’t answer their phone.

Texts, emails, or Facebook messages are a great way to keep in touch with a friend with a debilitating health condition.

Other ways you can help your friend: Ask them if there’s something you can pick up for them while you’re out running your errands.  Saving them a trip to a store can be a great kindness.  Or bring by something for them to eat that they don’t have to prepare themselves (microwave meal, home-cooked, deli, take-out – anything that is easy and within their dietary restrictions).  Even fresh fruit or a veggie tray is a great treat for someone who doesn’t get to the store very often.

Finally, make some time to visit your friend (please coordinate with them first – they might not be dressed!).  They probably won’t have the energy for a long visit, so stopping by wouldn’t take much of your time, but they would most likely appreciate the company.

Debilitating health conditions can be isolating and can lead to depression – Be a good Wingman/Battle Buddy and keep an eye on your friend.  They may not be able to help themselves.  Don’t let them fade away.

What It’s Like to Have an Allergic Reaction Pre-Surgery

It’s been pretty quiet on this blog lately.

Have you heard the saying that flying consists of hours and hours of boredom interrupted by moments of sheer terror?

Well, let me tell you about the time I was waiting for anesthesia prior to surgery, but I developed an allergic reaction and the surgery was cancelled…

[Image of allergic contact dermatitis from Google Images]

So far I’ve had two surgeries, both of which were Tricare referrals to civilian facilities.  This was to be my first surgery at a VA hospital.

The contrast between civilian and VA facilities and experiences was interesting, but I’ll save that for another post.

I will say, though, that the military “hurry up and wait” dynamic is alive and well at this VA facility.  That may have saved my life.

Every stage of the process at the VA hospital felt slow and inefficient.  There was a whole lot of waiting.  And communications could have been better as far as what would happen during each stage of the process.

One thing that was well communicated, however, was the pre-surgery cleansing process.

I was given a nifty hospital gown and robe, a pair of no-slip hospital socks, and some antiseptic body wipes, and was escorted to the bathroom.  Once there, I was directed to follow the cleansing protocol on the wall chart using the antiseptic wipes and I was left to accomplish the task.

There were three packages, each of which contained two wipes.  The wall chart showed a body with six defined zones and directed me to use one wipe for each zone, in a prescribed sequence.  Excluding the head and genitals, I was to start at the neck and wipe my entire body with the antiseptic wipes.  The chart spelled it all out: use the first wipe to clean the neck, shoulders, and chest; use the second wipe to clean the arms and hands; etc.  When I had completed wiping down my body with the antiseptic wipes, I let it air dry as directed.  (The antiseptic was supposed to remain on my body, rather than being rinsed off.)

After having completed the pre-surgery cleansing protocol as directed on the wall chart and donning my nifty gown, robe, and socks, I returned to my hospital bed and waited.  And waited.  I could feel the residue from the wipes on my body – it felt tacky.  I remember commenting that I hadn’t had to do this cleaning procedure for either of my previous surgeries.  We assumed the VA was being ultra-cautious about infections.

Eventually I was taken back to some kind of a surgical staging area.  The nurse anesthetist put in an IV line, and I had pre-surgery conversations with a nurse, the nurse anesthetist, the anesthesiologist, and my surgeon. Again there was more waiting around than I had experienced prior to previous surgeries.

The nurse anesthetist returned and said it was time to remove my robe.  As she assisted me in getting the robe off of my shoulders (while I was propped up in the hospital bed), she exclaimed, “Your back is really red and splotchy!”  This got the attention of the nearest nurse, who came over, looked at my back, and agreed it didn’t look normal.

They asked me questions:  “Do you have a history of eczema?” [No]. “Do you have a history of hives?” [I don’t think so].  “Is it spreading?”  I could feel that my face and neck were getting more and more flushed.  I could tell when the hives spread up my neck, although I couldn’t see them.

They started looking at the rest of my body, asking questions while they looked under my gown and folded back my blanket:  “Is it on your chest?” [Yes].  “Is it on your abdomen?” [Yes].  “Is it on your arms?” [A bit].  “Is it on your legs?” [Not yet].

Once they determined that I was probably having an allergic reaction, they started asking lots of questions: “Does it itch?” [No]. “Does your tongue feel swollen?” [No].  “Stick out your tongue and let me look at it.”  “Are you having any trouble breathing?” [No].  Other medical staff came and went, looking at the situation and asking questions.

At some point the nurse anesthetist went and got Benadryl (an antihistamine) and started administering it through my IV.  Then they started trying to determine the cause of my allergic reaction.

It was pretty clear to me that it must be the antiseptic wipes.  But the pre-surgery cleansing protocol had apparently been instituted fairly recently, and not many people in the pre-surgery staging area seemed to know about it.  I explained it to person after person.

Finally one or two people who were aware of the new cleansing protocol got involved.  A consensus was reached that I was having an allergic reaction, as evidenced by allergic contact dermatitis and hives (urticaria), and that it was caused by the antiseptic wipes.

A decision was made to delay my surgery while they monitored my condition.  The nurse anesthetist was prepared to administer steroids if necessary.  The patient who was scheduled after me was moved up to my surgical time slot.  I started to feel light-headed and buzzed from the Benadryl.  A nurse told me that my blood pressure was “slightly high.”  When I asked her “How slightly?”, she responded “185/99.”

I was informed that the hospital was tracking adverse patient reactions to the new protocol.  Someone sent for the Chief Surgeon, who came and looked at me, asked me a few questions, proclaimed that I was manifesting a classic dermatologic allergic reaction, and told me he was sorry I was having this negative reaction and that it would be logged.

I was also informed that this allergy would be added immediately to my VA medical records.  The substance to which I reacted is Chlorhexidine.  In the wipes, it was a 2% Chlorhexidine Gluconate solution.  I was told that Chlorhexidine reactions were rare, but could be severe.

The anesthesiologist suggested that I have a shower to wash off the antiseptic.  No one responded to his suggestion, although a nurse went and got a wet wash cloth and proceeded to wipe down my back and part of my neck.

The rash/dermatitis/hives seemed to stop spreading in response to the Benadryl.  My blood pressure also started coming down.  My surgeon, who had been monitoring my situation, returned and informed me that he had decided to cancel my surgery and re-schedule it for another day.

Initially I was disappointed by this decision, since I wanted to get the condition I needed surgery for dealt with, and because I would have to go through the surgical preparation logistics all over again.

But after I got home and started feeling better, I researched Chlorhexidine reactions and found multiple medical journal articles describing patients with Chlorhexidine reactions having anaphylactic reactions* under anesthesia, either in pre-op or during surgery.  Then I was very grateful for my surgeon’s caution.

(And for the inefficiency of the hospital staff.  Had my surgery started on time, I might have been under anesthesia when my allergic reaction manifested.)

Additionally, I was warned that my symptoms could return (presumably after the Benadryl wore off).  It would not have been good for my symptoms to get worse or to return while I was under anesthesia.

After monitoring, and the return of my blood pressure to an acceptable level, I was permitted to go home, with the caution to continue to monitor my symptoms and to get help if the symptoms returned/got worse and I started to have trouble breathing.

[I insisted on a shower before leaving the hospital, to remove the offending substance from my skin, however no shower was available, so I was given wash cloths and towels, and escorted to a bathroom to clean up in the sink.  I washed myself as best as I could, and took a complete shower after I got home.]

I did have symptoms again at home the next day, which I treated with an OTC antihistamine and an NSAID.  Had my symptoms gotten worse, I would have called 911 or driven to the emergency room.

I am still waiting to re-schedule the surgery…

BOTTOM LINE: The VA has a new (as of April 2016) pre-surgery cleansing procedure which consists of using 2% Chlorhexidine Gluconate body wipes.  Some people, like me, are allergic to Chlorhexidine.  Chlorhexidine is also used in hospitals in catheters, antimicrobial skin dressings, and antimicrobial surgical mesh, among other things.  It is also used sometimes to sterilize medical equipment.  If you are allergic to Chlorhexidine, be VERY, VERY cautious in a medical setting and make sure all of your healthcare providers know.

Chlorhexidine is also used in dentistry, in certain mouthwashes and rinses and in certain dental procedures, so be cautious there as well.

WARNING:  If you are allergic to Chlorhexidine, you should be aware that it is an ingredient in many products besides pre-surgery antiseptics.  Please see this website for other products (including everyday household products) which may contain Chlorhexidine.

NOTE: Prior to this incident, I was aware that my skin was sensitive to some laundry detergents (they make my skin itch) but I had never had an allergic reaction, nor had I been diagnosed with any allergies.  I had no idea I would have an allergic reaction to the antiseptic wipes.

*NOTE: An anaphylactic reaction/response is a severe allergic reaction.  The most dangerous anaphylactic reaction is one in which the airway is compromised due to swelling of the mouth, tongue, throat, and/or lungs.  For more information on anaphylaxis, see this Mayo Clinic website.