Frank was 68, a retired construction worker from Ohio who still spent weekends fixing up his grandkids’ treehouse. He’d dealt with back pain for years—nothing a couple of over-the-counter painkillers couldn’t handle. So when he woke up one Saturday morning with a throbbing headache, he did what he always did: reached into the medicine cabinet, popped two pills, and headed to the garage to grab his tools. He never made it to the treehouse. By noon, his wife found him collapsed on the driveway. Paramedics tried to revive him, but it was too late. The cause? A sudden internal bleed—triggered by taking that common painkiller on an empty stomach.
If you’re over 50, chances are you’ve got a bottle of ibuprofen, naproxen, or aspirin stashed somewhere—for arthritis aches, post-golf soreness, or those random headaches that pop up. We take these pills like they’re candy, assuming they’re harmless. But doctors across the U.S. are sounding the alarm: when you take these nonsteroidal anti-inflammatory drugs (NSAIDs) without eating first, you’re playing a dangerous game—especially as you get older.
Let’s break down why (empty stomach) is such a problem. Your stomach lining is like a protective blanket—it secretes mucus that keeps digestive acids from eating away at your tissue. But NSAIDs? They punch holes in that blanket. They block enzymes that help make mucus, leaving your stomach vulnerable to those harsh acids. Normally, if you’ve eaten something—even a slice of toast or a glass of milk—that food acts as a buffer. It coats the stomach and slows down how fast the drug is absorbed. But on an empty stomach? The drug hits your lining like a freight train. It starts irritating cells immediately, and over time (or even in one strong dose), that irritation can turn into ulcers. And ulcers can bleed—sometimes slowly, so you don’t notice until it’s too late, or suddenly, like it did with Frank.
“Frank’s case isn’t rare,” says Dr. Elena Carter, a gastroenterologist in Detroit who treats dozens of seniors for NSAID-related issues every year. “I had a patient last month—72, healthy, takes aspirin for his heart—who popped a pill before breakfast and ended up in the ER with internal bleeding. He thought, ‘I’ve taken this a million times, why would today be different?’ But as we age, our stomach linings thin. We produce less mucus. We’re more likely to be on other meds that interact with NSAIDs—like blood thinners or steroids. All of that makes the risk skyrocket.”
Part of the problem is that we’re conditioned to think “over-the-counter” means “safe.” We see ads for these pills that show people hiking, gardening, or playing with their kids—no mention of the fine print. And let’s be honest: when you’re in pain, the last thing you want to do is wait 30 minutes to eat something before taking a pill. You just want relief—now. But that “now” can cost you.
Take Margaret, 65, from Arizona. She’s had knee pain for years, ever since she retired from teaching and started walking three miles a day. She’d take ibuprofen first thing in the morning, before coffee even, because she wanted to be on her feet by 8 a.m. “I never thought twice about it,” she says. “My mom took ibuprofen on an empty stomach, my sister does it—why would I worry?” Then one day, she felt dizzy while walking her dog. She brushed it off as dehydration, but later that night, she threw up something dark and tarry— a sign of internal bleeding. Her husband rushed her to the hospital, where doctors found a bleeding ulcer the size of a quarter. “They told me if I’d waited another day, I might not have made it,” Margaret says. “Now I keep crackers next to my medicine cabinet. No more empty stomach—ever.”
So which pills are the biggest culprits? Ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin (when used for pain—low-dose aspirin for heart health is a different story, but still needs caution). Acetaminophen (Tylenol) is safer on the stomach, but it can wreck your liver if you take too much—especially if you drink alcohol. The key is knowing the difference, and reading the labels—even if you’ve taken the pill a hundred times.
Dr. Carter says the rules for seniors are simple, but non-negotiable: “First, always eat something before taking NSAIDs. Even a banana, a yogurt, or a slice of bread works. Second, don’t take more than the recommended dose. I see patients who take three pills because two ‘didn’t work’—that’s a disaster waiting to happen. Third, don’t take them for more than 10 days in a row without talking to a doctor. If your pain lasts longer than that, there’s a bigger issue you need to address.”
She also warns about mixing NSAIDs with other meds. “If you’re on a blood thinner like warfarin, or a steroid like prednisone, NSAIDs can increase your bleeding risk by 10 times,” she says. “And a lot of seniors don’t realize that—they pick up an over-the-counter pill without telling their doctor, and boom—problems.”
Frank’s family wants his story to be a wake-up call. “He was so tough, always downplaying pain,” says his daughter, Lisa. “He’d say, ‘I’ve had worse injuries on the job—this headache is nothing.’ But that ‘nothing’ took him from us. I want people to know: it’s not worth it. Eat a cracker. Wait 10 minutes. Your life depends on it.”
For many of us, pain is a part of getting older. We’ve earned those arthritis aches, those post-workout sorenesses—they’re badges of a life lived actively. But managing that pain doesn’t have to mean putting our lives at risk. A little preparation—keeping a box of crackers by the medicine cabinet, reading the label, checking in with your doctor—can make all the difference.
Margaret, now recovered, has made it her mission to spread the word. She talks to her friends at the senior center, posts about it on her neighborhood Facebook group, even keeps extra packs of crackers in her purse to give out. “I don’t want anyone else to go through what I did,” she says. “Frank’s story could have been mine. It could have been yours. But it doesn’t have to be.”
So the next time you reach for that painkiller—whether it’s for a headache, a sore back, or a creaky knee—pause. Grab something to eat first. It’s a small step, but it’s one that could save your life. Frank didn’t get that chance. Don’t let his story be yours.