Lots of people take vitamins and minerals without knowing the reason. It might be that a friend recommended them or because “everybody takes vitamins.” Occasionally, a doctor or other credentialed health care practitioner might suggest them. But what is the basis for such a recommendation? One reason is that the food supply is terribly deficient in nutrient content. Vegetables that are picked before reaching maturity so they don’t spoil in storage and shipping offer us only a fraction of what they did a few decades ago. Petroleum-based fertilizers and biocides upset the balance of minerals that we have trusted soil to provide. Another reason for using supplements is that we don’t always eat three squares a day and, even if we think we do, can’t guarantee their squareness. Those of us who live alone often fail to eat anything that even resembles a meal unless we spend time with friends and family, either at their tables or at some eating establishment. Still others of us may be harboring a medical condition or may be taking medications that interfere with nutrient absorption and metabolism. Whatever the case might be, including having more than a few drinks a day, there are legitimate reasons to use vitamin and mineral—and other—supplements.
Vitamins are simply organic compounds needed in small amounts to provide a biological activity that would be missing or haphazard in their absence or deficiency. They are not foods and cannot stand alone as food substitutes. They can, however, help us to get from our food all that the food has to offer by acting as catalysts and co-factors. Many of the health claims for vitamin effectiveness in addressing a particular concern can be proven. Those not substantiated by science should be discounted. Taking a quality multivitamin supplement to prevent or to overcome deficit has been supported by the AMA (Fairfield, 2002), who admonishes, though, to be prudent about taking too much of a good thing.
Minerals, unlike vitamins, play a structural role as well as a functional role in the body. Calcium, magnesium and phosphorus make bone, for example, but they also control electrical circuits and enzyme functions. Magnesium alone is part of more than three hundred enzymes. All these micro-nutrients act like spark plugs to initiate or to facilitate metabolic and physiologic processes, such as releasing energy from carbohydrates and fats. Some minerals are not found in supplement form, like sulfur, which is part of the proteins that make the skin, hair, liver and pancreas. Instead, they exist in amino acids.
Other things you might swallow from a bottle include the essential fatty acids and the phytonutrients found in plants. Common to these are fish oil, flavonoids and other organic compounds that afford physiologic activity. Most of us ignore an important consideration in the supplement regimen—timing. Popping too many tablets or capsules can backfire sooner or later and even present as a condition they’re trying to prevent, but so can taking them at the wrong time of day or in the wrong combination.
Since micro-nutrients work together with the macro-nutrients (proteins, carbs and fats), and since they appear together in foods (when they can), it might just be prudent to take supplements with meals, either during or after. If nothing else, it’ll prevent a belly ache and the exciting laxation that can follow essential fatty acids taken on an empty stomach. Besides, taking any supplement without something in the stomach hastens transit time, which impairs absorption and utilization. Additionally, food stimulates the production of stomach acid, which improves the benefits of the supplements (Mulligan, 2010) (Heaney, 1989) (Kelly, 1984).
Taken with breakfast, multivitamins can spend their time being amply assimilated, but this meal needs to be more substantial than a doughnut and a cup of coffee. Minerals are a bit fussier. Some forms of calcium should be taken with food because a rock-hard mineral refuses to dissolve without stomach acid. The citrate form, though, differs because of the citric acid to which the calcium is tied. Iron absorption peaks in the the presence of vitamin C, which also enhances calcium uptake. Be aware that calcium supplements tend to interfere with assimilation of other minerals, especially iron, magnesium and zinc, even in food. For that reason, taking calcium away from foods might be a prudent move, knowing that the citrate form of calcium will dissolve without stomach acid. Since we can absorb only about 500 milligrams of calcium at a time, spacing intake is important.
In the United States, about a third of prescription drug users also take at least one supplement. This opens the door to possible interactions. Admittedly, most of the allopathic medical community know little or next to nothing about nutrition and the use of supplements. Instead of taking the time and effort to learn about those topics, many practitioners take the easy way out and tell their clientele that supplements are useless. Nonetheless, we need to let our medical people know about supplement intake. If the doctor doesn’t know about drug-supplement interactions, the pharmacist might, the dietitian could, and the integrative/functional dietitian-nutritionist most likely will.
Drug-supplement interaction is a two-way street. A medication may inhibit or enhance the activity of a nutrient, and a nutrient may do the same to a drug. You do not take vitamin A with a tetracycline antibiotic or vitamin C with a blood thinner. Vitamin B1 has the potential to dilate blood vessels, so you might want to keep it away from your blood pressure pills. Supplement-supplement interactions also require attention. Taking vitamin C with grape seed extract may affect blood pressure. You don’t take fish oil with warfarin. Allowing at least a two-hour window between a drug and a supplement is a good idea. With some, four hours is better.
Yes, vitamin, mineral, and herbal supplements have a rightful place in our daily regimens; and yes, herbals could be taken on an empty stomach; and yes, each can support everything the body does and is. If separating doses is a bother, at least take supplements with a meal because fat-soluble vitamins require fat to be assimilated, most need stomach acid to dissolve, and all will be less likely to talk back to you.
Ranjit Kumar Chandraa Nutrition, immunity, and outcome; Past, present, and future. 11th Gopalan Gold Medal Oration Nutrition Research. Volume 8, Issue 3, March 1988, Pages 225–237
Domrongkitchaiporn S, Sopassathit W, Stitchantrakul W, Prapaipanich S, Ingsathit A, Rajatanavin R. Schedule of taking calcium supplement and the risk of nephrolithiasis. Kidney Int. 2004 May;65(5):1835-41.
Kathleen M. Fairfield, MD, DrPH; Robert H. Fletcher, MD, MSc Vitamins for Chronic Disease Prevention in Adults JAMA. 2002;287(23):3116-3126.
Heaney RP, Smith KT, Recker RR, Hinders SM. Meal effects on calcium absorption. Am J Clin Nutr. 1989 Feb;49(2):372-6.
Kelly SE, Chawla-Singh K, Sellin JH, Yasillo NJ, Rosenberg IH. Effect of meal composition on calcium absorption: enhancing effect of carbohydrate polymers. Gastroenterology. 1984 Sep;87(3):596-600.
Lonn EM, Yusuf S. Is there a role for antioxidant vitamins in the prevention of cardiovascular diseases? An update on epidemiological and clinical trials data. Can J Cardiol. 1997 Oct;13(10):957-65.
Mulligan GB, Licata A. Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D. J Bone Miner Res. 2010 Apr;25(4):928-30
Prasad KN, Hernandez C, Edwards-Prasad J, Nelson J, Borus T, Robinson WA. Modification of the effect of tamoxifen, cis-platin, DTIC, and interferon-alpha 2b on human melanoma cells in culture by a mixture of vitamins. Nutr Cancer. 1994;22(3):233-45.
Prasad KN, Cole WC, Kumar B, Prasad KC. Scientific rationale for using high-dose multiple micronutrients as an adjunct to standard and experimental cancer therapies. J Am Coll Nutr. 2001 Oct;20(5 Suppl):450S-463S; discussion 473S-475S.
David L. Watts, D.C., Ph.D., F.A.C.E.P. Nutrient Interrelationships: Minerals — Vitamins — Endocrines J of Orthomolecular Med. Vol. 5; 1st Quarter: 1990
*These statements have not been evaluated by the FDA. These products are not intended to treat, diagnose, cure, or prevent any disease.
October 03, 2013