I am not talking about the FDA (Food and Drug Administration – the entity in the US that approves food and drug sales) in this blog, or at least not directly, but the title just called out to me. What I am talking about is how the food you eat and the drink you drink impact the drugs you might take. I got inspired by a couple of tweets I checked out and re-tweeted that I found really interesting.
The question of food and pharmaceuticals, for most, likely brings to mind the little stickers you find on your prescriptions bottles or warnings on the labels of over the counter drugs that mainly circle around whether or not to have with food or alcohol and the safety of heavy machinery operation while using. I recently was put on doxycycline, a fairly potent antibiotic, and for the first time had a warning about dairy food specifically. Why do we receive these warnings? We get instruction of food and drink consumption – both specific types and generally – because of the risk of over or under-dosing. Some drugs have greater impact with food, some less; certain minerals can alter how drugs work for all of these reasons we get little stickers and warnings. This website has very complete information on drug interactions including foods.
How exactly do food and drink influence how drugs are absorbed and broken down in the body? There are a few answers to that question but one of the main ones is – enzymes. Enzymes are complex protein molecules that bring about cellular reactions within the body. Enzymes are how we digest food and are used to speed up, slow down, allow or disallow various chemical reactions to occur. Enzymes are produced by living cells and found in our bodies and in the things we eat and drink. Some enzymes also are able to block each other from acting – they shut down other enzymes. How drugs are processed by the body – especially how long they take to be broken down and absorbed impact how effective they are and how often and how much we need to take.
Alteration in drug processing in the body has profound ripple effects in terms of side-effects, efficacy and costs. The more of a drug you take the more likely you are to have side effects so if the dose can be lowered you have fewer side effects. The reason we often have to tolerate side effects is to ensure we receive enough of a drug to actually have it do the job it is supposed to do. The longer a drug stays at an effective level in our body the more of an impact it can have on our system, slowing down the bodies natural breakdown of a drug into its components can allow a drug to do more. Cost obviously ends up going down if we use less of a drug making lower doses desirable both medically and fiscally, especially in an era of rising medical budgets.
The particular article I read was speaking of grapefruit juice and the cancer drug, sirolimus. When ingested with grapefruit juice a one-third dose of sirolimus had the same effect. This represents a huge cost savings and a potential reduction in side effects as the lower does was accompanied by fewer side effect. Here is the interesting bit. Some dosing is lowered and ordered with a particular accompaniment; in other case, like sirolimus at this time, you take more and are told to avoid the food/beverage that increases the effectiveness of the drug to avoid overdose. I personally hope that current research will lead to increases the incidence of the former and reduces the latter.
The other interesting point that came up in the article is that not only will what you do or don’t take with drug impact their breakdown and bioavailability to your cells but it can also alter how your cells welcome the drug. Recent studies have shown that pre-treatment fasting (of 2-3 days) by chemotherapy recipients increases the impact of the treatment on cancer cell, but even more delightfully, it reduces the impact of the same treatments on the healthy cells. Basically, in healthy cell fasting creates decreased activity, basically the seek to reduce their consumption of fuel, in contrast cancer cells, which are already gluttons become even more ravenous when exposed to fasting causing them to absorb greater quantities of the chemotherapy drugs.
A 2-3 day fast is not a small thing but I suspect this news would be less daunting to the many cancer patients who have appetite loss as part of the symptoms or drug side effects. The reward of less nausea, headaches, malaise, nerve damage and hair loss – just to name a few – would be a nice reward for a bit of fasting too. Further, for those cancer patients and their families who face daily struggles to get enough food into themselves or their loved ones a brief respite would not be bad and all the parties could then focus their food efforts on their inter-treatment time. The volunteers with the trolleys of cookies and juice that wheel through the chemo room though would become a thing of the past.
What I find most interesting about all of these pieces of data is that they can be implemented with minimal hassle, little to no harm and many benefits. There is no costly drug research, no need for gene therapy the research I am talking about is from human and animal trials and new human trials are moving forward in several places already. This is exciting as a new drug or therapy can take years and years to even reach human trial stage. Plus, the cost of all of these options are negligible or well offset by saving. Not very often is that the case with modern medical innovation.
The tweets I’m talking about:
fasting and cancer treatment
grapefruit juice and drug efficacy