• Nutrition

What to Eat with Doxycycline to Avoid Stomach Upset

Medically reviewed and edited by Kathleen Tidwell, FNP-C

If antibiotics have ever upset your stomach, you know how unpleasant it can be. 

Fortunately, it’s a fairly common experience that can be remedied by eating certain foods and avoiding others.

Taking antibiotics can eliminate beneficial bacteria in your gut, leading to an imbalance in the microbiome that causes stomach issues like diarrhea and cramps. By rectifying this imbalance, you can restore healthy bacteria and alleviate these side effects.

At least one in five people who take antibiotics experience antibiotic-associated diarrhea. If you’re one of them, keep reading to learn what to eat when you take doxycycline to avoid upsetting your stomach.

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What is Doxycycline?

Doxycycline is a tetracycline antibiotic used to treat bacterial infections, including sexually transmitted infections (STIs), Lyme disease, and acne. 

It is also used to prevent malaria and can serve as a substitute for penicillin in individuals allergic to that class of antibiotics.

Doxycycline, like other antibiotics, can cause various gastrointestinal (GIT) side effects. 

Typically, antibiotics cause stomach problems by targeting the naturally occurring beneficial bacteria — also known as “good bacteria” — in the gut.

Over time, humans have developed a mutually beneficial, or symbiotic, relationship with these bacteria. They assist our digestive system by outcompeting harmful bacteria and aiding in the digestion and absorption of nutrients. 

In return, we provide them with a suitable environment and a source of nutrients.

Why Would Doxycycline Upset My Stomach?

In milder cases, stomach issues from antibiotics can cause diarrhea, flatulence, and bloating. 

These symptoms occur due to the poor digestion of carbohydrates caused by a decrease in beneficial bacteria. 

Undigested carbohydrates draw water into the gut, making stools runny and causing bloating. 

Additionally, other bacteria may break down these carbohydrates, producing gas and causing flatulence. These symptoms typically subside once you’ve completed the course of antibiotics.

Sometimes an upset stomach can signal something more serious. When taking doxycycline, the elimination of beneficial bacteria can create an environment where harmful bacteria, like Clostridioides difficile (C. diff) can grow out of control. 

Because C. diff is often antibiotic-resistant, symptoms can persist long after the antibiotic course is completed.

C. diff causes the gut lining to become damaged and inflamed, leading to symptoms such as abdominal discomfort, severe diarrhea, fever, and cramps. This condition can be severe enough to require hospitalization. 

The Centers for Disease Control and Prevention (CDC) have deemed C. diff a major health hazard, with 223,999 cases of hospitalization and nearly 13,000 deaths reported in the U.S. in 2017.

Doxycycline can also specifically cause a condition known as "pill esophagitis," especially when taken without water. 

This occurs when the medication is released before reaching the stomach, irritating the lining of the esophagus. 

This may happen if a pill doesn’t move smoothly into the stomach. Symptoms of pill esophagitis include difficulty swallowing, nausea, and heartburn.

Should I take doxycycline on an empty stomach?

Doxycycline can be taken on an empty stomach, either one hour before a meal or two hours after a meal. Food can sometimes reduce the absorption of the medication, making it less effective at treating your specific illness.

Calcium-rich foods can significantly impair the absorption of doxycycline and other tetracycline medications. 

To ensure effectiveness, it is advisable to avoid these foods when taking this medication. 

Ideally, doxycycline should be taken 2-3 hours before or after consuming any calcium-rich meals, beverages, or dietary supplements.

What Should I Eat With Doxycycline to Avoid an Upset Stomach?

Doxycycline can generally be taken with your regular meals without concern. 

However, eating certain foods along with doxycycline can help you prevent unpleasant gastrointestinal side effects, like diarrhea, that may cause you to discontinue your medication altogether.

Simple meals

Eating simple, bland foods can help you reduce the risk of the stomach-related side effects associated with doxycycline. 

Generally, it’s wise to avoid meals that typically upset your stomach, such as acidic foods. 

The BRAT diet — consisting of bananas, rice, applesauce, and toast — can also alleviate symptoms like diarrhea and nausea linked to doxycycline. Bland foods are usually well-tolerated and soothing. 

However, relying solely on the BRAT diet can be overly restrictive, potentially leading to nutrient deficiencies and delayed recovery from illness.

Cultured or fermented foods

Cultured or fermented foods are useful for replenishing beneficial gut bacteria that are often depleted during antibiotic treatment. These foods are rich in probiotics, which help restore your gut’s microbiome. 

Some common examples of these probiotic-rich foods include:

• Yogurt: Contains live cultures such as Lactobacillus, which help with digestion and restore gut flora.

• Pickles: Fermented pickles (not those made with vinegar) contain beneficial bacteria that can help maintain intestinal health.

• Kefir: A fermented milk drink that is a potent source of probiotics and can be even more beneficial than yogurt in promoting gut health.

While these foods can be good for you, there is preliminary evidence suggesting that some fermented foods may contribute to antibiotic resistance. 

This is because the microbes in these foods could potentially transfer resistant genes to pathogenic bacteria in the gut. However, research in this area is still ongoing and findings are not yet conclusive.

Should I be taking a probiotic supplement when using doxycycline?

In theory, probiotics can help mitigate the side effects of antibiotics like doxycycline by replenishing the good bacteria in your gut. 

Research has highlighted the effectiveness of probiotics in preventing antibiotic-associated diarrhea. However, there are potential risks associated with their use, primarily because probiotics are classified as dietary supplements rather than drugs. 

Supplements are not regulated by the FDA, resulting in less stringent monitoring of their quality and consistency. This is why it’s important to make informed decisions when taking dietary supplements like probiotics.

Prebiotic foods

​​Prebiotic foods are compounds found in plant fibers that stimulate the growth of beneficial bacteria in the gut. 

Unlike other foods, prebiotics are not directly digestible by the human body and don’t directly contribute to nutritional intake. 

Instead, they serve as fuel for beneficial bacteria, which, in the process of digesting these fibers, produce nutrients that our bodies can then absorb. 

Examples of prebiotic foods include:

• Chicory root

• Jerusalem artichoke

• Garlic

• Onions

• Leeks

• Asparagus

• Bananas

• Apples

Incorporating these foods into your diet can enhance gut health by supporting a healthy microbiome.

Water

Water is essential for overall health, with the general recommendation being to drink eight 8-ounce glasses per day to prevent dehydration. 

This is particularly crucial when taking antibiotics, as antibiotic-associated diarrhea can increase the risk of dehydration. 

Additionally, it’s important to drink a full glass of water with each dose of doxycycline to avoid throat irritation.

What Foods Should I Not Consume With Doxycycline?

As mentioned above, consuming beneficial bacteria by eating certain foods and taking dietary supplements can help you avoid digestive issues while you’re on doxycycline. 

However, there are also a few other foods you should be avoiding if you’re taking this antibiotic.

• High-fiber foods: While taking doxycycline, you should limit foods high in fiber, as they can interfere with the absorption of the antibiotic. Additionally, certain diarrhea treatments that contain high amounts of fiber, such as pectin, should be avoided to manage antibiotic-associated diarrhea effectively. 

However, once you’ve completed your course of antibiotics, reintroducing high-fiber foods can be beneficial as they help promote the growth of beneficial bacteria in your gut.

• Alcohol: Alcohol may hinder the absorption of doxycycline and can be detrimental to the healing process; this applies to most conditions treated with antibiotics.

• Caffeine and spicy foods: These foods and drinks should be avoided while taking doxycycline as they can worsen gastrointestinal irritation caused by the medication. They can increase stomach acidity and irritation, intensifying digestive discomfort.

• Dietary supplements: Iron, multivitamins, calcium supplements, and antacids can bind to doxycycline and affect the amount of medication absorbed. You should take doxycycline at least two hours before or four to six hours after these supplements to ensure effective treatment.

What Are Some Other Tips for Taking Doxycycline Properly?

• Sun protection: Use a high SPF sunscreen (SPF 30 or higher) and wear clothing to protect yourself from the sun, as doxycycline can increase your skin’s sensitivity to sunburn.

• Speak to your healthcare provider: Always consult your doctor before combining doxycycline with other treatments to avoid potential drug interactions.

• Take all your antibiotics: Complete the full course of antibiotics as prescribed to prevent bacterial resistance, which can make future infections harder to treat.

• Use backup contraception: Doxycycline may decrease the effectiveness of hormonal contraceptives. Consider using backup contraception such as condoms, diaphragms, or spermicides.

• Allergic reactions: Inform your healthcare provider if you’ve had an allergic reaction to other tetracycline antibiotics, as you may have a similar reaction to doxycycline. If you suspect you’re having an allergic reaction, contact your doctor immediately or call 911.

• Missed dose: If you’ve skipped a dose, take it as soon as you remember or skip it and continue with your regular dosing schedule if it’s almost time for your next dose.

Where Can You Learn More About Antibiotics and Gut Health?

Are you someone who struggles with gastrointestinal problems every time you use antibiotics? LifeMD can help.

At LifeMD, you can connect with board-certified healthcare professionals that can answer your questions on antibiotics, nutrition, and gut health, including how to safely use doxycycline to treat bacterial infections. We can also fill your prescription for antibiotics or other treatments you require.

Make your appointment today to take control of your health — all from the comfort of your own home.

Kathleen Tidwell, FNP-C

Kathleen earned her Master’s of Science in Nursing from Austin Peay State University in Tennessee. Kathleen loves helping her patients explore sustainable health changes that can easily fit into their lifestyle. She has found that this approach empowers them and leads to greater health outcomes. Kathleen loves spending time with her family, her dog, and three cats. She’s also passionate about traveling. Her favorite destination so far has been Iceland.

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