What is meant by an "empty stomach"?

[Heckity]

I’m not looking for any medical advice here, just clarification of what’s meant by an empty stomach. I’ve recently been told to change how I take a particular medication and ensure it’s not taken with any other medication (or vitamin) and taken on an empty stomach.

In my non-medical reasoning I know when I’m told to fast for testing (like checking cholesterol) I can’t have anything to eat or drink.

I wasn’t told to “fast” rather I was told to take it on an empty stomach. Does my regular coffee in the morning (I put in a tsp of ‘non-dairy whitener’ and that’s all) negate the empty stomach directive?

Is an empty stomach really fasting? Thanks!

[dolphinboy]

IANAD but I think it means no food in your stomach when you take your meds. Since it can take a while to move food through your digestive system I would think that no food in the past 4-6 hours would constitute an empty stomach. Any MDs around?

[njtt]

Yes, but for most of that time the food is moving through your intestine, and has long since left your stomach. I think if Heckity was meant to fast for several hour before taking it he/she would have been given much clearer and more explicit instructions to do so. “Empty stomach” is a colloquial term and in this case I should think it just means don’t take the medicine during or right after a meal. I would guess an hour’s wait should be plenty. (However, I am not a medical doctor.)

[Hirka_T_Bawa]

Depends on the medication. Some need to be taken with nothing in the stomach because it could cause problems with the esophagus, some can’t be taken with certain metals in the intestines, some have different absorptions if you eat something with fat… pretty much, it all depends on the actual medication. What medicationare you taking?

[Philster]

“Empty stomach” has guidelines of 30 minutes minimum (from eating) and 60 minutes or more is preferred:

Why must some medicines be taken on an empty stomach?

The instructions on some medicines state that they must be taken ‘before food’ or ‘on an empty stomach’. Most of the medicines that must be taken on an empty stomach do not pass into the bloodstream very well if there is food in the stomach.

The link is very helpful in understanding ‘why’ as well.

.

[Heyoka13]

And here I thought we would have a thread on disappointing haggis . . . .

[Heckity]

@Hirka_T_Bawa

Depends on the medication. Some need to be taken with nothing in the stomach because it could cause problems with the esophagus, some can’t be taken with certain metals in the intestines, some have different absorptions if you eat something with fat… pretty much, it all depends on the actual medication. What medicationare you taking?

I’m on Synthroid. I’ve been taking it for about 10 years and all of a sudden my doctor’s office contacted me and told me to take it as I described in my OP: Not with other meds & no vitamins (four hours after or before), an hour before or two hours after eating. I was told to take it with water. Which I’m doing.

But does my cup of coffee constitute a ‘not empty’ stomach? If I can only have water until I take that med, I’d rather set my alarm and wake at 1 o’clock a.m., take it and go back to sleep.

[Larry_Mudd]

@Heckity

But does my cup of coffee constitute a ‘not empty’ stomach? If I can only have water until I take that med, I’d rather set my alarm and wake at 1 o’clock a.m., take it and go back to sleep.

At least one study (with eight participants) suggests that coffee does indeed have a measurable impact on the absorption of your medication.

in patients and volunteers, compared to water, coffee lowered AIRST4 (by 36% and 29%), PIRST4 (by 30% and 19%), and AUC (by 36% and 27%) and delayed TMIRST4 (by 38 and 43 minutes)

[Motorgirl]

It occurs to me that the instructions on my husband’s levothyroxine pilbottle recently changed, which surprised us. I should go look at them to see what they say. Previously, he was instructed to take them one hour before, or two hours after a meal. Hmmm.

[TerpBE]

@Heckity

I’ve recently been told to change how I take a particular medication and ensure it’s not taken with any other medication (or vitamin) and taken on an empty stomach.

Make sure you’re interpreting the instructions correctly. The way you stated it could be interpreted as:

I’ve recently been told to change how I take a particular medication and ensure it’s:

• not taken with any other medication (or vitamin) and
• taken on an empty stomach.

or as:

I’ve recently been told to change how I take a particular medication and ensure it’s not:

• taken with any other medication (or vitamin) and
• taken on an empty stomach.

The former indicates that it MUST be taken on an empty stomach, and the latter indicates that it MUST NOT. When these instructions are written or spoken, they could easily be misinterpreted to mean the opposite of what is intended. Make sure you’re sure of what your doctor meant.

It reminds me of this SNL sketch: http://www.youtube.com/watch?v=6JrIYR8jArk

[Tim_T-Bonham.net]

@Heyoka13

And here I thought we would have a thread on disappointing haggis . . . .

If I ate that stuff, I would soon be ‘emptying’ my stomach!

[Heckity]

Thanks, Larry Mudd that study offers a compelling reason to eliminate coffee in the time frame of taking the Synthroid. My poor husband. I am not a happy girl with no coffee in the a.m.

I currently get up at 5 a.m. take 10 medications - drink a couple of cups of coffee prior to arriving at work at 7 a.m. Then another cup of coffee -take my Synthroid with water at 10 a.m, wait 2 hours and have lunch.
I tend to not drink much coffee in afternoon - I suppose I could eliminate it altogether (my afternoon meetings just got a lot longer) and take the Synthroid at 4 o’ clock (2 hours roughly before dinner).

Very good point TerpBE. Your first scenario is the correct interpretation of what I was told (I’m apparently not so good at retelling what I’m told :D)

[Mama_Zappa]

@Heckity

I’m on Synthroid. I’ve been taking it for about 10 years and all of a sudden my doctor’s office contacted me and told me to take it as I described in my OP: Not with other meds & no vitamins (four hours after or before), an hour before or two hours after eating. I was told to take it with water. Which I’m doing.

But does my cup of coffee constitute a ‘not empty’ stomach? If I can only have water until I take that med, I’d rather set my alarm and wake at 1 o’clock a.m., take it and go back to sleep.

Yeah, I’m in Synthroid as well. My doc says it might affect the absorption maybe 10%… and as long as I’m reasonably consistent in how I take it, then it’ll all even out. So I rarely take it on a truly empty stomach. If my tests show my TSH etc. in the right ranges taking it that way, then I’m good (even if it would mean a slightly lower dosage if I took it correctly).

For what it’s worth, I’ve always heard 'the guideline of “2 hours after a meal, and wait 1 hour until you eat” for empty-stomach meds.

I doubt coffee is a problem (of course IANAD!).

[CookingWithGas]

@Motorgirl

It occurs to me that the instructions on my husband’s levothyroxine pilbottle recently changed, which surprised us. I should go look at them to see what they say. Previously, he was instructed to take them one hour before, or two hours after a meal. Hmmm.

I take levoxyl and that’s exactly what my doctor told me. I also recently started taking minocycline and got the same instructions.

[Markxxx]

I had to take meds without food once, and the pharmacist told me that it should be two hours BEFORE eating or four hours AFTER eating.

[WhyNot]

One hour before and two hours after is the guideline they teach us in nursing school. Any variance from that should be printed on your label, in your package insert, or you can look it up at a good drug information site.

My nursing drug book says 30 minutes to 1 hour before meals for Synthroid, and yes, coffee counts. (It also mentions that different preparations of this medication are different in bioavailability - strength and absorption - so it’s important to buy it from the same pharmacy every time and look at the pills to make sure they refill them with the same brand. If they have to switch brands, let your doctor know so that she can order an additional test if need be.)

And, of course, pharmacists are the best people to ask a question like this; any 24 hour pharmacy will have a pharmacist on duty who can talk to you on the phone.

[Hirka_T_Bawa]

Now that I finally got out of work, I had time to look up the question on Levothyroxine’s interactions with caffeine and food. Here is what I found:

@Clinical Pharmacology

Certain foods, beverages, and enteral feedings can inhibit the absorption of thyroid hormones. To minimize the risk of an interaction, thyroid hormones should be administered on an empty stomach with a glass of water at least 30—60 minutes prior to food or enteral feedings. Foods that may decrease thyroid hormone absorption include soybean flour and soy-based infant formulas or enteral feedings, as well as high fiber diets, cottonseed meal, and walnuts. In addition to decreasing the oral absorption of thyroid hormones, limited data indicate that soy containing foods and supplements may also influence thyroid physiology. Concentrated soy isoflavones (e.g., genistein and daidzein) may interfere with thyroid peroxidase catalyzed iodination of thyroglobulin, resulting in a decreased production of thyroid hormones and an increased secretion of TSH endogenously. More studies are required to assess the exact mechanism of this interaction. Caution should be used in administering soy isoflavone supplements concurrently with thyroid hormones. Limited data show that coffee has the potential to impair T4 intestinal absorption. In one report, T4 intestinal absorption was evaluated after the administration of 200 mcg L-thyroxine (L-T4) swallowed with coffee/espresso, water, or water followed 60 minutes later by coffee/espresso. Researchers found that administration with coffee/espresso significantly lowered average serum T4 (p<0.001) and peak serum T4 concentrations (p<0.05) when compared to L-T4 taken with water alone. Coffee/espresso taken 60 minutes after L-T4 ingestion had no significant effect on T4 intestinal absorption. It is prudent to remind patients that thyroid hormones should be separated from food and beverages (other than water), including coffee, by at least 30—60 minutes.

What does all that actually mean? Basically, there have been studies showing that Caffeine does effect the absorption of levothyroxine if it they are co-administered within an hour of each other.

However, clinically, thyroid levels are regularly monitored while someone is on levothyroxine, and as long as your thyroid levels are within normal, I wouldn’t worry about a little caffeine use, as long as it is consistent. The main levothyroxine-food interactions that are clinically significant are dietary fiber, calcium, magnesium, and iron.

IMHO, if your thyroid levels are normal and stable on your current dose of levothyroxine, and your caffeine use is consistent, I wouldn’t worry about having coffee with your levothyroxine… As long as you don’t use a lot of milk or other calcium containing product in it.