Why is alcohol banned with antibiotics?

DEAR DR. ROACH: I'm confused about the medical rule not to drink any alcohol while on antibiotics. After doing Internet research on reputable sites, I found, to my surprise, that the overwhelming medical opinion is that moderate alcohol use does not render most antibiotics ineffective. I do understand that alcohol should not be used with specific antibiotics, e.g. Flagyl, because of adverse physical reactions. I read that the warning not to mix alcohol with antibiotics stems from doctors fearing patients taking antibiotics to cure STDs would have lowered inhibitions and engage in unprotected sex. Could you please set the record straight for the public on this subject? – K.L.

ANSWER: I never learned the rule that alcohol shouldn't be taken while on antibiotics, with the exception of metronidazole (Flagyl), the combination of which causes extremely unpleasant nausea and vomiting, headache, shortness of breath and other symptoms. This reaction can happen to a lesser extent with sulfamethoxazole (a component of Bactrim or Septra) as well as other, less commonly used antibiotics such as tinidazole and some cephalosporins. The antituberculosis drug isoniazid can cause liver damage in combination with excess alcohol.

In general, if you are sick enough to need antibiotics, it is prudent to avoid alcohol, and certainly to avoid excess alcohol. But alcohol does not render antibiotics ineffective. Preventing STDs is much better than treating them, since not all can be cured. Part of being sexually responsible is making good decisions. You are correct that people are more likely to make unwise decisions with even moderate amounts of alcohol. That's true with or without antibiotics.

DEAR DR. ROACH: I suffered from a very painful case of plantar fasciitis for longer than a year when my husband and I (both in our 40s) discovered that we were expecting a baby. I was terrified over the prospect for several reasons, including the already painful state of my feet. It turned out that my plantar fasciitis was completely cured by the end of my pregnancy.

Now, at 47, with a darling 3-year-old, I'm wondering if there is any way of preventing the condition from returning. My OB/GYN guessed that perhaps the hormones that make a pregnant woman more "stretchy" are behind my cure. Do you have any ideas about this? – B.R.

ANSWER: Plantar fasciitis is an inflammation in the strong band of connective tissue that runs from the heel to the toes and supports the foot. The major symptom is pain with walking, especially with the first step of the day.

Pregnant women are indeed more likely to suffer from plantar fasciitis. Most authorities feel it is the relatively fast weight gain of a normal pregnancy, but some blame the hormone relaxin, which loosens the pelvic and other ligaments. This can change your gait and cause abnormal stresses on the feet, causing plantar fasciitis. Your obstetrician is suggesting that relaxin is acting on your already-existing plantar fasciitis, which I haven't heard of, but it is an interesting thought.

For prevention, regular stretching of the calf muscles, wearing shoes with good support and maintaining a healthy weight can help prevent recurrence.

DEAR DR. ROACH: I am a reasonably healthy 66-year-old male. I walk 5 miles a day. I have no knee problems. My doctor says I am walking too much and will wear out my knees. Do you agree? – M.D.

ANSWER: No, I don't agree at all. I think I understand why your doctor said that: osteoarthritis, the most common arthritis in the knee, used to be considered a wear-and-tear injury, and if that were the case it might make sense to protect your joints by not overdoing it. However, we believe now that osteoarthritis is caused by an injury to the joint, not by regular exercise. More importantly, studies show clearly that people who are very active don't have higher arthritis rates than sedentary people. Most important of all, people with osteoarthritis who exercise get better, not only in pain and stiffness levels, but also in ability to walk.

Exercise is so good for your body, mind and spirit that this persistent myth needs to be corrected.

The arthritis booklet discusses rheumatoid arthritis, osteoarthritis and lupus. Readers can order a copy by writing: Dr. Roach -- No. 301W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: When I was 60, my doctor told me to take a baby aspirin daily to prevent heart attack and stroke. So I did. When I was 70, a new doctor said the risk wasn't worth the benefit, so I stopped. I heard and read a lot more about the benefits of aspirin. But a friend of mine had a horrific nosebleed that was thought to be from the aspirin.

I and a few of my senior friends are confused. Should we or shouldn't we take aspirin? – A.H.

ANSWER: When you see multiple opinions on a topic in medicine, it usually means there is conflicting evidence, and that certainly is the case with aspirin. The difference of opinion takes place at the highest levels: the United States Food and Drug Administration recommends, in general, against using aspirin to prevent heart attack and stroke in people who have not already had a heart attack or stroke. However, the U.S. Preventive Services Task Force recommends aspirin in general for men age 45-79 and women age 55-79. The USPSTF makes no recommendation about men or women over age 79. Both groups agree that your physician should be helping you make the decision about whether to take aspirin.

Aspirin has the risk of causing bleeding, and the bleeding can be more serious than a nosebleed. A bleed inside the stomach or intestines can be life-threatening, and there also is a very small risk of bleeding in the brain.

As a physician, I prescribe aspirin for those at increased risk based on multiple factors, and do not prescribe aspirin to people at high risk of a gastrointestinal bleed. This is a judgment call about which physicians may differ.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. (c) 2016 North America Synd., Inc. All Rights Reserved