Valium, Prozac, and Ritalin: Breakfast of Champions,” says Lou in Mean Guns, a 1997 action movie starring Ice-T. For the nearly 60% of Americans who take at least one prescription drug, Lou wasn’t so far off: Far more people start their day with pills than with Wheaties. Meds are part of a complete 21st-century breakfast.

When the first thing you consume after waking up is not food, but medication, it’s bound to change your understanding of nourishment, what your body needs to function. In a lot of cases—especially when a drug has side effects like loss of appetite, weight gain, or nausea, or must be taken with food or on an empty stomach—medication directly affects how and what people eat. 

What does breakfast look like if it’s structured around medicinal intake? I talked to prescription drug-takers, from a grad student on Adderall to a health blogger on HIV medicine, about their morning pill-and-breakfast-eating rituals and how medication has changed their relationships to food.

Katherine, 25, grad student: Adderall XR, 20mg; Yogurt with Chopped Banana, Egg and Cheese on Toast, Sauteed Kale 

I started taking Adderall for ADHD in 2011. If I don’t eat breakfast before taking my medication, my heart starts racing. I feel hollow inside. I get acid reflux. I get cranky and anxious and super high-strung. And it suppresses my appetite. It’s really important that I eat before taking my meds. Usually, I’ll get up around 8 a.m. and have yogurt with chopped banana and granola, then Adderall, and come back an hour later and make scrambled eggs, toast, and sauteed kale. If I ever end up eating too late, I skip the Adderall so I won’t be up all night, but then it’ll take me forever to get ready. It’s this domino effect: My functioning every day depends on eating and taking my meds correctly in the morning. 

I usually feel reluctant to actually take my meds. I’m always like, “Do I need this right now? I guess I do, I have XYZ to accomplish.” But I feel this sense of disappointment that I need it to get through my day and be a functioning human. I’ll sometimes think, “What’s gotta give for me to stop this? Am I gonna take this until this I die?”

It’s weird that it worked out this way, but I think taking medication positively affected my understanding of nutrition. Until I started taking meds, I never saw the correlations between my diet and how I felt. I’d go through the day feeling crappy and never understood why. When I started Adderall, there was about a year when I wasn’t eating enough breakfast and feeling like a frazzled mess every morning. I couldn’t ignore it. That’s when I made the connection between my mood and healthy eating and keeping my blood sugar up. I gained this deeper understanding of how my body ticks. 

Nathaniel, 23, clothing warehouse worker: 6mp (6-mercaptopurine); sausage, egg and cheese on a bagel, doughnut, iced coffee, marijuana 

I’ve taken a bunch of anti-inflammatory meds, steroids, and antibiotics for Crohn’s disease, [a chronic inflammatory bowel disease], over the past ten years. I honestly don’t remember their names, because they’re so long and strange-sounding. The one I’ve taken for six years is 6mp, which is short for something. “Merka-porcupine” is the way I read it in my head. I take my meds like it’s a fixed action pattern. I don’t think about Crohn’s very often, unless I have to. 

Sometimes when I wake up and try to eat, I get hit with intense nausea. A little while ago I made breakfast at home and was stoked about it: Bacon, egg, and cheese and cut-up banana. I immediately puked it up on the kitchen counter.

So I also smoke marijuana with my breakfast and meds. In other states, I would be prescribed legal medical pot for Crohn’s. More than my prescription meds, marijuana has helped me eat better. Before I started smoking regularly, I wasn’t keeping weight on—Crohn’s messes with my appetite and makes it hard to absorb nutrients. But marijuana gives me an appetite. Iced coffee and my one-hitter—they’re staples. Most mornings, I have sausage, egg, and cheese on a bagel from P & Z Deli in Sunset Park. Other days, I’ll go to Dunkin Donuts. I made friends with a barista there and we worked out a system: She gives me an extra free chocolate glazed doughnut and I give her a dollar tip every morning. It works for both of us. 

Tess, 26, journalist: 300mg Wellbutrin, 40mg Cymbalta, Amitiza, instant oatmeal, pumpkin butter, decaf coffee 

I stopped drinking regular coffee when I went on antidepressants a couple years ago. Wellbutrin is sort of an upper, so it’s not quite a caffeine replacement, but I definitely can’t drink a lot of coffee with it. It feeds into anxiety. The other day, I accidentally ordered a caffeinated cold brew and I was shaky and angsty for the entire day.  For the most part, I now drink decaf. I bring my own decaf Keurig pods to my office, which makes me look like a snobby asshole. I drink it with instant oatmeal at my desk, maybe some pumpkin butter if I’m feeling fancy. I really like coffee—that’s my problem, I don’t want to give it up. Also, it’s harder to poop without drinking coffee. People are very confused when I say I drink decaf. But I’m not really in it for the caffeine. 

I was perfectly happy to start meds. I’d gone through so much pain before doctors finally said, “Okay, maybe you should take meds.” I was like, “Yes, please, give me all the meds, make me better.” I’m not married to the idea of being a person who doesn’t take any pills. There are so many armchair doctor articles about how too many people are on antidepressants. That might be true, but also, if that’s the best medical community has to offer right now, then that’s what I need. It would be lovely if modern life weren’t quite so stressful. But it is. 

Josh Robbins, 33, health agency owner and HIV blogger: HIV medication, toaster strudel, cereal, orange juice

I’ve always been a breakfast person. Right after I was diagnosed [with HIV, in 2012], I actually gained weight. I think I was trying to eat to live. I gained 15 or 20 pounds. I was eating a lot of breakfast foods. I love pancake sticks and toaster strudel: cinnamon and cream or strawberry, with the icing on top. And cereal. My boyfriend will buy all that wheat mess, but nobody likes that stuff. I feel like I’m eating nuts and berries from a tree. I prefer Cocoa Puffs, Frosted Mini-Wheats, Raisin Bran.

When it was time for me to start meds, doctors let me choose what time of day to take the pill, so I started with the morning. But the medicine affected my stomach a lot. HIV meds really affect some people—we’re stuck in the bathroom a lot, or we feel really bloated. Those were the problems with me. If I took it in the morning, I’d feel like a fat pig walking around the rest of the day, I’d literally feel like my stomach was out to my knee. I found that if I took the pill first thing in the morning, then showered, I’d not want to eat, because I’d fill up really fast, and be in that miserable Thanksgiving state for a while, which is terrible. So I’d skip breakfast. A few months ago, I started taking my meds a couple hours after I ate breakfast, at noon every day. I also take Vitamin D3, a supplement for immunity. 

The pill literally doesn’t have a taste; figuratively, it has an unpleasant but needed taste. [When I take it, I think,] “Oh god, here it comes.” Literally, I take a deep breath and I’m like, “please don’t make me bloated today.” There’ve been many times I’ve thrown meds out the window. I’m just like, “No, I’m not gonna do it today.” It may not be the smartest thing to do, but sometimes that’s what I need for the day. 

Amy, 50, nurse: Synthroid, 150mcg-175mcg, plain yogurt with honey and fruit

I take Synthroid for hypothyroidism each morning. You can't eat for half an hour to an hour after taking it. For years, I always missed breakfast because of this. I didn’t have time to eat before work, so every day before lunch, I'd feel nauseous from an empty stomach. After lunch, no matter what I ate, huge energy crash. But if I stopped taking Synthroid or took it incorrectly, the effects are horrible: Weight gain, dry skin, memory loss, depression, eventually a goiter, even death from heart failure can occur. With my current job as a nurse, I’m lucky that I now have time to make breakfast at work—plain yogurt with a little honey and fresh fruit. If I took Synthroid and the vitamins correctly and prepared breakfast at home every morning, I'd be up at 5 a.m. and at work at 10 a.m. No thanks.