Should you take painkillers along with your food to protect the stomach
The version of the Australian Medicines Handbook states that this drug should be taken with food.
Oral doses should be taken with a glass full of water. You can take it without food, but if that upsets your stomach, try taking it after a meal.
The change isn’t that remarkable. As our knowledge of drugs improves, we often make minor adjustments to the way we dose them. Some medical media outlets found it so interesting that they read the story. Why the fuss?
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) along with other medicines like diclofenac and aspirin. These drugs can cause stomach ulcers and damage to the stomach lining.
The assumption was that taking painkillers along with food would reduce the risk of stomach injury. This advice has recently changed in Australia, Europe, and the United States. Has the direction changed because the assumption also has? Are we at risk of stomach damage if we take anti-inflammatories without eating?
Gastric injury
The stomach fluid is acidic and contains enzymes that break down protein in food. Gastric liquids can be as acidic as lemon juice or battery acid on an empty stomach.
In order to protect itself, the stomach secretes a mucus layer that can neutralize stomach acid. If either or both of these mechanisms fail, the stomach can suffer from damage to its lining and even ulcers.
Ibuprofen can be taken up to 1200mg a day. It is usually prescribed for up to 3 days. Max Mozart/Flickr, CC BY
Ironically, NSAIDs, because of their ability to relieve pain, can cause serious harm to the stomach lining. They do this by decreasing pain and inflammation by inhibiting the production of prostaglandins. This group of fatty acids promotes inflammation and increases pain perception.
Prostaglandins protect the stomach lining by decreasing acid secretion, increasing mucus production, and neutralizing it. Inhibiting prostaglandins reduces the protective function of these molecules.
NSAIDs can be used to treat the pain and inflammation associated with arthritis and musculoskeletal conditions. They are also used to relieve short-term pain: headaches, migraines, period pain, and fever. Long-term users are at a higher risk than those who take them only for headaches.
Gastric ulceration is a serious condition where the surface of the stomach is eroded by irritation. Internal bleeding, indigestion, and nausea are all symptoms. According to studies, ulceration in patients taking NSAIDs is dose- and time-dependent.
Ibuprofen can be taken up to 1200mg a day for three days. There is no or minimal damage to the stomach when taking less than 1600mg per day for three days. People who take the prescription doses over a month have a 2 to 4% risk of developing ulcers.
Long ago, it was believed that foods “cushion” the stomach against acidity. There is little evidence that food can protect guts from NSAID damage.
Take NSAIDs along with food.
The acidity of the stomach is reduced by eating, from around the level of battery acid to around tomato juice or black espresso.
NSAIDs absorb better from acidic solutions than neutral ones. After a fasting night, a sour stomach will allow NSAIDs to reach a higher concentration in the blood than after a meal. A less acidic stomach environment created by food will reduce NSAID absorption.
Stomach ulcers can cause vomiting and weight loss. Shutterstock.com
In studies in which animals received high levels of NSAIDs following a 24-48-hour fast, they developed stomach ulcers. Animals that were fed developed ulcers in the intestine, not their stomach. In other words, both conditions led to ulcers – but they appeared in different places.
Uncertain is whether these effects can be applied to humans, particularly with the typical doses of pain relievers, and if different food components are involved in this shift away from stomach ulceration to the intestine.
Levels in the blood are related to pain relief. There is reasonable proof that faster ibuprofen or other NSAID absorption will result in more immediate pain relief.
The peak concentrations of Ibuprofen are reached between 1.5 and three hours after taking a 200mg dose by people who have taken it with food. The maximum concentration of Ibuprofen in the blood is reached 45 minutes after taking it with water.
Taking Ibuprofen along with water will likely result in better pain relief and less need for more. The likelihood of experiencing gastrointestinal side effects is reduced when you take fewer dosages. People who wait to take Ibuprofen after eating will also suffer from pain longer.
Overall, switching from taking NSAIDs such as Ibuprofen to only water – unless you have stomach upset – may improve your pain relief. It is unlikely to cause harm to people who take it occasionally and according to the directions. Those who take Ibuprofen or other NSAIDs to relieve chronic pain should consult with their doctor on the best way to use it.
