Although pharmaceuticals usually go through decades of development and testing to ensure they are safe and effective, there are thousands of types of drugs on the market and millions of combinations of foods they could be paired with. Scientific reviews suggest food interactions can be a major threat to safe and effective oral pharmacotherapy. Experts are only now starting to track these interactions systematically, and some even hope to harness these combinations to make drugs work better than they would on their own.
“Most drugs are unaffected by food,” says Patrick Chan, professor of pharmacy practice and administration at Western University of Health Sciences in California. “In the certain cases where certain drugs are affected by food, those are the ones we need to watch out for.”
Both the US Food and Drug Administration and the European Medicines Agency require that drugs undergo food-effect testing, with trials involving people who have either fasted or eaten a high-calorie, high-fat meal – two slices of toast with butter, two slices of fried bacon, two fried eggs, some hash-brown potatoes, and a large glass of whole milk.
But it is almost impossible for them to test everything. And human metabolism is complicated, says Jelena Milešević, a research associate at the Center of Research Excellence in Nutrition and Metabolism in Belgrade, Serbia. “It’s like a little factory and you have a lot of inputs and a lot of outputs,” she says.
Once all the chemical reactions of the body, of the food, and of the drug are meshed together, “it’s huge, and it’s very difficult to separate”, says Milešević, who has been researching how vitamin D affects drugs in the body, and vice versa.
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