The Impact of a GI Condition on Your Medications
You can have me read this article to you instead of reading it yourself…
Or you can read it the old-fashioned way below…
This is the third and final part of my series on managing a GI condition when you have other chronic (or acute) medical conditions to manage as well.
In the previous articles, we’ve talked about what happens when chronic conditions overlap with acute conditions, such as colds or injuries. We’ve also talked about what happens when one chronic condition collides with another (or multiple others).
But now we’re going to discuss how certain GI conditions can make it much more difficult to take any medication, regardless of what the medication is for.
Also, I should provide full disclosure up front. I go into great detail on this topic in my book – 23 pages to be exact. So what we are about to cover here is only a brief summary of a much larger, and very important topic.
Medications in the GI Tract
Before we discuss this topic, it’s very important to have a strong grasp on how the GI tract is structured. I’ve got a full article on that here, and I definitely recommend brushing up on it before reading further.
Medications are absorbed from the GI tract just like the nutrients in the foods that we eat. Absorption can happen in the mouth, the stomach, the small intestine, and even the large intestine. There are a number of factors that can change the way that a medication is absorbed, but we can focus on just a couple:
The drug itself: Each drug is a molecule. The size of that molecule can have a say in which part of the GI tract is able to absorb it. In addition, some molecules respond favorably to acids and some respond favorably to bases. Which environment the drug likes the most also has a large say in which part of the GI tract is able to absorb it.
The form of the drug: The formulation that the drug is provided in makes a huge difference in where the drug is absorbed. In fact, many dosage forms are made for the purpose of forcing a drug to be absorbed in a specific place. You might have heard terms like “enteric-coated” or “extended release” thrown around. These are often formulations that are made specifically to guide a drug to a certain part of the GI tract for absorption.
When medications are developed by scientists and drug companies, they are developed for the typical GI tract. I think it’s safe to say that those of us with gastroparesis or IBD do not have a typical GI tract, so things can start to get a little wonky.
Inflamed Gut
For those with Inflammatory Bowel Disease (IBD), the gut may spend quite a bit of time inflamed. This means that it is actively irritated, and especially sensitive to everything moving through the gut. This sensitivity can cause the gut to do two very opposite things: absorb MORE of everything moving through it or absorb LESS. Which one it chooses to do will depend on which foods or medications it is being exposed to, and also which part of the gut is inflamed.
Slowed Motility
Just as slowed motility can keep food hanging around in the GI tract for an extended period of time, it can do the same with medications. Medications that are expected to move through the stomach and into the intestine at a certain rate might not meet those expectations.
The most obvious issue that this creates is that medications can take much longer to work. However, this also creates the need to make other considerations about the foods and medications that you are consuming, and we’ll talk about those now.
Medications and Foods and…Other Medications
When a medication enters the GI tract, it does not go in alone. There is almost always something else joining it there, whether that be a liquid, a food, a vitamin, or another medication. With this in mind, we can never just think of each medication by itself. We have to consider it in terms of its environment.
Food
There are certain medications that must be taken on an empty stomach, which indicates that when that medication mixes with food, something goes wrong. It could be that the medication binds with the food, or that the medication and the food compete for absorption by the gut. But whatever it is, that medication doesn’t play well with foods, and so we need to do everything we can to avoid taking them together.
Other Drugs
There are also medications that interact with other medications. Certain types of drug-drug interactions can happen even if you took your medications 24 hours apart. We aren’t worried about those interactions here. Instead, we’re concerned about the interactions that occur right there in the GI tract – binding to each other, deactivating each other, competing with each other, etc. As you can imagine, if one of those interactions is present, it could make it somewhat difficult for your GI tract to absorb both drugs the way that it is expected to.
The Collision
As you can see, when certain medications mix with certain foods and other medications, undesirable things happen. And if you have slowed motility, those undesirable things are likely to happen a lot more often. Slowed motility will make all foods and medications sit in your stomach and intestine much longer than they would in a typical person. This means that they all get stuck hanging out with each other, which could lead to some of those interactions and competitions that we just discussed.
And it doesn’t matter what your medication is for – you could be taking it for a psychiatric condition, a heart condition, or to get rid of a nagging headache. If that medication doesn’t play well with any of the foods or other medications that you took, you might run into a problem.
The least concerning problem is for that medication to simply take longer to be absorbed. As long as it is absorbed, waiting a little bit longer for it is often relatively safe.
A more concerning problem is for that medication to have reduced absorption. This means that you are not getting as much of it into your system as you are expected to, and if its treating something crucial like a psychiatric condition or a heart condition, that could be a real problem.
The most concerning issue would be for that medication to have reduced absorption and cause another medication or nutrient to have reduced absorption as well. Then you’re getting a double whammy – putting you at risk in two ways at once.
So How Does This Affect You?
That was a really long-winded way to say that slowed motility and inflamed GI tracts can wreak havoc on your ability to take medications for any condition.
This is incredibly important to recognize. Most doctors do not even take this into consideration, especially if they are treating you for something other than your GI condition. Many cardiologists will not realize that your heart medication may not be working because of your gastroparesis. Nephrologists may not realize that your kidney medication isn’t working as well because of your IBD.
Unfortunately, this is one of those times when it is incredibly important for you to advocate for your own needs. Pointing this out to your specialists treating other conditions could be incredibly helpful to them. If they’ve been trying to figure out why you require high doses, or why a certain drug doesn’t seem to be working, you might be able to provide them with an answer they hadn’t considered.
And if you have personally been trying to figure out how to get your medications to go down more smoothly, there are a number of options available. I discuss each of these in my book, and also provide guidance on how to evaluate your options and choose the best solution.
The Bottom Line
Having a chronic condition of any sort can make it much harder to handle other diagnoses, whether they are acute or chronic. Having a chronic GI condition can make it even harder to handle other diagnoses, because altering the GI tract can alter the way that your body absorbs the treatments that you are consuming.
Being aware of these limitations and the need to manage them will allow you to recognize opportunities and solutions where you might not have seen them before.
If you’re interested in reading more about the ways that you can simplify your health, go here. Or if you want to learn more about the power of self-advocacy, check that out here.
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