Medicines, vitamins and other chemicals are generally either water soluble or fat soluble. Water soluble chemicals can be absorbed directly into your bloodstream and don’t need to be taken with food. But fat-soluble chemicals won’t dissolve in water, and thus need some fat in your stomach. Generally when a pill is suggested to take “with food” or “with a meal”, it’s because it’s fat-soluble and almost all food has at least some fat/oil/lipids in it, so they don’t bother to specify what kind of food.
It also helps moderate the uptake rate so your system doesn’t get overwhelmed with a spike of drug absorbed all at once on an empty stomach. This is important with blood pressure medication so you don’t faint. It’s the same idea with alcohol.
In the case of some drugs like fenofibrate, you want to take it when your liver is actively digesting food because that’s when the drug works best.
Both these answers are here, but to collect them:
1. The stuff dissolves better in fat than it does in water. Most meals have fat in them, so this helps the drug dissolve and be absorbed rather than passing on through.
2. Some drugs are irritating to the stomach and it helps to dilute them out with a bunch of other stuff to cushion the impact.
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