Dr Tom Smith 

Doctor, doctor: Alcohol and antibiotics, milk and prostate cancer

Can I drink alcohol while taking antibiotics? Is there a link between drinking milk and prostate cancer? Dr Tom Smith answers readers' questions
  
  

Doctor, doctor
Aaron Tilley for the Guardian Photograph: Aaron Tilley

Is it a myth that you shouldn't drink alcohol while taking antibiotics? I often do and haven't felt remotely nauseous. If this is the case, why do doctors tell us to refrain?
It isn't a rule for all antibiotics, only for those that react chemically with alcohol to produce unfortunate side effects. The two that matter most are metronidazole (Flagyl) and tinidazole (Fasigyn) that are prescribed for certain bowel infections, including the notorious C diff, caused by anaerobic bacteria (bacteria that thrive in the absence of oxygen). If you drink alcohol with either of them, you will convert it into acetaldehyde, a noxious chemical that causes nausea, vomiting, flushing, headache and palpitations. The only other interaction between an antimicrobial drug and alcohol is with cycloserine, an anti-tuberculosis drug – the two together increase the risk of convulsions. It seems that alcohol doesn't pose a problem with other antibiotics, provided you don't drink too much. Then forgetting the dose, vomiting it up, and your liver failing to process the drug may come into play.

I read that there is a link between prostate cancer and drinking milk – should I stop drinking it or drink less? I'm male and in my 40s, and my father has been successfully treated for prostate cancer.
Keep drinking the milk. But make sure you eat plenty of green and root vegetables as well. They contain phytoestrogens that have been claimed to be the cause of the low incidence of prostate cancer in the south-east Asia. The milk and red meat link with prostate cancer was reported in the US, where the regions in which people ate the most fats and dairy products had the highest level of prostate cancer. One suggestion was that high fat intake reduces our ability to absorb vitamin A, which is thought to prevent prostate cancer from developing. Hence the advice to eat plenty of vegetables (a good source of vitamin A) if you eat a lot of dairy products and red meat. However, I suspect that you don't drink as much milk as the American study subjects. Stopping drinking it is overdoing things. A varied diet, as always, is the healthy way to go.

• Got a medical query for Dr Tom Smith? Email doctordoctor@theguardian.com

 

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