Swallowing isn’t easy to do when you’re thinking about it. When you eat it happens automatically. When you have a fistful of medications or supplements to get down, it can be unpleasant. There are few things worse than getting a large bitter pill stuck in your craw.
A 2015 study showed that 3/10 adults averaging age 50 would rather die than take a daily pill for the rest of their lives, and another 1/5 would gladly pay $1,000 to avoid having to take a daily medication. If taking pills is this undesirable, why don’t more people make the diet and lifestyle changes that would free them from pill taking? The answer is of course complex. During our lives, almost all of us will choose to swallow pills, if not longterm, at least long enough to give us relief from a temporary ailment.
At some time in your young life, someone asked you to swallow a pill. Children don’t know how, and are usually given chewable or liquid medicines until they learn. In old age it gets harder to swallow pills, so we end up looking for liquids and chewables again. In the meantime, between childhood and old age, we’re supposed to be able to swallow them. There are tricks. Here is a primer.
There are two main kinds of pills that you’ll be asked to swallow; capsules and tablets. Capsules are a little cylinder usually containing a powder. Usually they float, though some of them sink. Tablets, on the other hand, are made of a substance that is caked together into a mold. They can be any shape but smart designers make them round or oblong. Capsules are easier to split, and they usually sink.
It helps to know if your pills are floaters or sinkers. It’s easier to swallow the same kind together. You can test each pill in a glass or water, or in your mouth, to detect if it floats or sinks. Putting pills in a glass is a good way to see how long it takes the pill to dissolve, too. (Aside: If you put a pill in a glass of water and it doesn’t dissolve in a day’s time, you probably aren’t getting anything out of it.) Pay attention to which pills float or sink, and take the same kind together.
SWALLOWING PILLS THAT SINK
Sinkers are the easiest to swallow because they behave like food does, sitting on your tongue. All you have to do is tilt your head back a little bit and let them slide to the back of your tongue, and then take a sip of water and swallow it. It is also possible to simply place the pill(s) at the back of the tongue using your hand, then drink. They will go down.
SWALLOWING PILLS THAT FLOAT
Floaters are tricker. They are easiest to swallow with a bite of pre-chewed food. If you need to swallow them with liquids, here is a trick. With the pill(s) and a modest swallow of water in your mouth, assume your best military posture, with your neck long and chin tucked. The pills will float to the roof of your mouth (your soft palate), and the good posture with chin tuck helps them move to the back. When you feel the pills on the roof of your mouth, distract yourself and swallow, or take another sip to push them along.
WHEN YOU CAN’T SEEM TO MAKE YOURSELF SWALLOW
This usually happens when you are trying to swallow too many pills at once, or a pill that is so big that it scares you. It floats around and threatens to dissolve and taste horrible. It’s OK to swallow pills one at a time until you are ready to try more.
WHEN A PILL DOESN’T GO DOWN
Usually what happens, at least in younger folks, is that the pill gets stalled out in the throat somewhere, and the natural peristaltic movements of the esophagus bring it back into your mouth. Slippery pills (like gel caps) slide back up easily. Grainy or sticky tablets can get hung up and make you gag. When a pill feels stuck, keep swallowing. Take swallows of your drink or bites of of food, and keep doing it until it goes all the way down. Some pills (like osteoporosis drugs) can hurt your esophagus if they get stuck. Your doctor will warn you if your medications have this risk.
DISTRACT YOUR MOUTH
To swallow a bunch of pills at once, put them all in your mouth with a bit of water, and then using your tongue place one pill between your teeth and gums, and swallow the rest. Something about storing the one pill distracts your mouth enough to get the rest of the swallow to happen normally.
TAKE PILLS WITH BITES OF FOOD
Liquids are harder to swallow than food. Pills that are best taken with food are also easiest to swallow with food. Basically you take a bite of food, and chew it until it is thoroughly chewed and ready to swallow. Then pop a pill or three in there and swallow it. You can chew a little more if needed to feel ready to swallow it, but try not to break up the pills.
There are more tricks, but those are the basics. If you are like me, and struggle with swallowing pills, you may need some tricks. Good luck to you. May you heal quickly and no longer need pills. May you find the medicine you need in sunshine and laughter, and the nutrition you need in food.
The irony is rich. The term "snake oil" has come to mean everything that is fraudulent. The reference is to the infamous "snake oil salesman" who pitched and sold his wares out of the back of a wagon to the unsuspecting villagers of the American west.
Snake oil has real medicinal value. It was used as medicine before the North American continent was on the map. Centuries ago the Chinese used an oil made from a cold water snake called Enhydris chinensis to treat joint pain and bursitis. It was introduced to the US by Chinese laborers who worked on the Transcontinental Railroad in the mid 1800's. There's evidence that the ancient Egyptians used it too. In the early 1700's the English had a patent medicine made from snake oil. Snake oil was sold here as a panacea in the early 1900's, but the products sold were probably more filler and adulterant than they were actual snake oil.
So what's in it that's good for you? Snake oil, depending on the snakes used to derive it, can be a rich source of an fatty acid known as EPA, eicosapentanoic acid. EPA is used by the body to synthesize series 3 prostaglandins, which are anti-inflammatory and pain relieving. You can know EPA is important because it's in human breast milk. EPA is effective for treating depression, improving cognitive function, autoimmune diseases including rheumatism, high cholesterol, hypertension, and more.
EPA can be derived in the body from other fatty acids, but it's much easier to eat in your food. The richest sources are fish: herring, mackerel, salmon, trout, pilchards, menhaden and sardines. Fish do not make their own EPA. They get it from eating algae like spirulina, which we also can eat. Plant foods don't contain any EPA at all.
Part of the reason it's easier to eat EPA than to make it in your body has to do with human genetics. Some people have the gene to make the enzyme which lets them convert ALA (alpha linolenic acid) into EPA. Other people have mutations in their genes that limit their ability to do the conversion. Diabetes and some allergies also limit a person's ability to convert ALA to EPA. ALA is an essential fatty acid, meaning that no humans can make it; we have to get it from the diet.
If we don't make it very well, and we don't eat much fish, we need to get our EPA some other way to keep our cell membranes happy. Many healthcare professionals recommend that we take fish oil. Fish oil contains 12-18% EPA. Salmon oil tops the list at ~18%. Chinese water snake oil contains ~ 20% EPA, whereas rattlesnake oil is said to contain 8.5%. Cod liver oil has more DHA than EPA and is best reserved for specific uses, like building baby brains or healing brain injuries.
The reason why some snakes have more EPA than others has to do with the temperatures that they live in. Snakes and fish are both cold blooded, so they have to function with their bodies at the same temperature as their environments. Omega 3 fats like EPA don't harden in cold temperatures like omega 6s do. They help keep cell membranes flexible. Flexible membranes don't get injured as easily, and are able to function better. Cold water fish, or cold water snakes, will have more EPA than those that live in warm sunshine, like rattlesnakes.
The next time someone tells you that a treatment is "snake oil", remember this. Public attitudes and language reflect our history, not our future. Science continues to give us reason to revise belief systems, erase myths, and sometimes to welcome old treatments back into the fold.
Author: Teresa Gryder
Naturopathic Physician and Student of Life, Medicine, and the River.