Like many people, my wife has always had trouble swallowing pills. Her problem isn’t just the size of the pill, which doesn’t seem to matter. It’s just the fact that she sees it as a pill.
She must have a glass of water or some other liquid to take it with her otherwise it’s a complete non-starter. But then she has a little ritual where she looks like she’s throwing the pill and water in her mouth and throwing her head back as she swallows.
Even that doesn’t always work, forcing her to swallow a few more gulps of liquid to wash it down.
All of this is for a single pill and will have to be repeated in order if she has to take more than one pill.
So don’t ask her to take several pills at once or to take a pill “dry” (with no extra fluids to replenish her saliva).
My wife’s ritual came to mind when I read about ‘Duke’.
Duke is a computer representation of a 34-year-old, anatomically normal human male created by computer scientists at the IT’IS Foundation, a non-profit organization in Switzerland that works on a variety of healthcare technology projects.
With the help of Duke, researchers at Johns Hopkins University in Baltimore created a computer model called “StomachSim” to investigate the digestive process.
Their research, published in the journal Physics of Fluids, yielded several surprising findings about the dynamics of pill-taking, the most common way drugs are used worldwide.
They chose to study the stomach because the functions of most other organ systems, from the heart to the brain, have already attracted much attention from scientists.
Several known things affect a pill’s ability to distribute its contents in the gut and be used by the body. These include stomach contents at the time the pill is taken (for example, a heavy meal or a mixture of liquids such as juice, milk, and coffee) and the movement of the stomach lining.
But the research suggests that Duke’s attitude also played a big role.
The researchers ran Duke through computer simulations in a variety of postures: upright, leaning to the right, leaning to the left, and reclining, while all other parts of their analyzes remained the same.
They found that posture determines a whopping 83% of how quickly a pill spreads in the gut. The most efficient position was leaning to the right. The least leaned to the left, which prevented the pill from reaching the antrum (the last part of the stomach before the small intestine), thus preventing anything but traces of the dissolved drug from rapidly entering the small intestine.
That makes sense when you think about the shape of the stomach, which empties into the gut on the right side of the body. Gravity changes your position where the pill goes.
This can be an important factor in how a pill dissolves in people with gastroparesis, a condition in which the stomach loses the ability to empty properly, especially as a complication of diabetes.
Pill posture may be especially important for the elderly, who take a lot of pills and are more prone to swallowing problems due to age-related changes in their esophagus. It can also be important for bedridden people, who cannot easily change their attitude.
For now, the research suggests that standing or sitting up straight after taking a pill is fine. If you must take a pill while lying down, stay on your back or on your right side. In general, avoid lying on your left side after taking a pill.
Unfortunately, Duke doesn’t seem to offer much to the computer in terms of advice to make it easier for my wife to swallow pills, which I think is mostly psychological as she generally swallows food and drink without any problems. But since her current ritual seems to be working for her, she may not need Duke’s help.