Health supplements: Are you doing it right?

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From combining Vitamin C with iron to boosting absorption, there is a science to it

Dubai: With an estimated worth of $128 billion (Dh470.78 billion) in annual sales as of 2017, the health supplements industry is upending the popular, and credible, advice by many health experts that a balanced diet is a far better option to maintain health than take supplements.

In the UAE alone, according to ‘UAE Dietary Supplements Market By Type, By Sales Channel, Competition Forecast & Opportunities, 2013-2023’, dietary supplements market is projected to surpass $139 million by 2023.

Whether multivitamins and other dietary supplements are necessary for the general population has always been a source of debate.

Supplements remain recommended for certain populations with specific conditions — such as pregnant women. Expectant mothers should take folic acid to reduce the risk of neural tube defects, or children in developing countries whose diets do not provide enough vitamin A and iron — but for the most part, a balanced diet is a far better option say health experts.

Plus, it saves you money. Many supplements can be expensive.

Recent studies have found there is insufficient evidence to recommend multivitamin supplements to the average healthy adult, and that in fact, taking too much of certain vitamins can cause harm.

Having said that, even if you are taking supplements, there are certain best practices to follow. For instance, did you know that calcium and magnesium are opposing minerals and that they best taken at different times of the day?

Optimal absorption of a supplement is what it all comes down to.

There is debate about whether taking your vitamins in the morning or at night is best. The theory goes that because you’re getting nutrients throughout the day from food, having your nutrition supplements at night helps your body get some nutrition as you sleep.

But Jeffrey Blumberg, a professor of nutrition science and policy at Tufts University in Boston, says, “Digestion slows down during sleep, so taking your nutrient supplement late at night would not be associated with an efficient absorption.”

Digestion slows down during sleep, so taking your nutrient supplement late at night would not be associated with an efficient absorption.

Neil Levin, an American clinical nutritionist, agrees that morning is best for multivitamins and any B vitamins. “Multivitamins tend to do best when taken earlier in the day, as the B vitamins in them might stimulate metabolism and brain function too much for a relaxing evening or before bed,” Levin says.

Although morning is probably ideal, the best time of day is the time you’ll remember. Put the supplement bottles on your kitchen counter next to your coffee maker, so they jog your memory when you reach for your morning cup. Or keep them in your lunch bag or briefcase so you’ll remember them.

Here’s a detailed advisory from Stephanie Karl, Nutritionist, Upandrunning Medical centre, Dubai, on when, how and why to take health supplements.

Omega 3 fatty acids: Recommended before bedtime because they can cause a fishy after-taste which is less distressing while you are asleep.

Multivitamins: With a meal and earlier in the day. (But not when you are also taking a calcium supplement). Remember that calcium can affect your body’s absorption of iron, zinc and magnesium. Take any calcium supplements at a different meal than any iron supplements or your multivitamin. Keep your calcium and iron separate.

B vitamins: Recommended earlier in the day. Mornings are best, as these have shown to keep people awake if taken at night.

Vitamin C: First half of the day.

Iron: It’s better taken in the morning along with Vitamin C. A classic example is having your iron supplements with a glass of orange juice to get the absorption-boosting effects of the vitamin C.

Also, avoid green leafy vegetables and coffee during this time frame as they compete with each other to be absorbed. Iron is always taken at the opposite time of zinc (which means if you take iron in the morning, take zinc at night).

Mineral supplements (copper, magnesium, selenium, etc): Combination supplements are better taken with food and not so influenced by timing. Mornings are a better time so as to not interfere with sleep.

Combo supplements such as Calcium + Vit D: Calcium absorption is maximised by Vitamin D and should be taken together. In the mornings is a good practice. Also, your body absorbs calcium more effectively when you take 600 milligrams or less at a time. If you’re taking more than that per day, you’ll want to split up the dosage into morning and evening doses. Taking in these nutrients simultaneously via supplements or boosting with food sources is ideal. Some nutrient dynamic duos include vitamin D to boost calcium absorption and vitamin C to boost iron absorption. That’s why taking in these nutrients simultaneously via supplements or boosting with food sources is ideal.

Calcium and magnesium.

Sodium and potassium.

Iron and zinc.

Zinc and copper.

One will affect the other. Where one needs both of these, they will be taken at different times of the day.

Probiotics: appear to be better absorbed on an empty stomach first thing in the morning before breakfast.

Amino acids: Mid-morning and mid-afternoon: due to stomach acid being greater, amino acids are generally recommended at these times. Bedtime is also a good time for relaxing amino acids that help with sleep such as tryptophan, glycine and GABA. Magnesium is also taken for relaxation and sleep as well as to help with bowel motility.

Fiber is another nutrient you’ll want to take apart from other supplements and medications because it interferes with absorption. Do so before bed if you aren’t taking anything else at that time.

Hydration is also important, according to Jeffrey Blumberg, a professor of nutrition science and policy at Tufts University in Boston. “Fluid intake is especially important for the disintegration of the supplement tablet or capsule and for dissolution of water-soluble nutrients such as vitamin C and B vitamins,” he says. So be sure to wash down all supplements with a glass of water.

What’s the rule of empty stomach vs after a meal or during?

An empty stomach is higher in natural stomach acid and helps especially for amino acids. Other supplements are better tolerated with food as they can make sensitive people nauseous.

Which supplements can be particularly irritating on an empty stomach?

Multivitamins can be a problem especially if they are quite potent. A strong vitamin B complex is often not well tolerated. Vitamin B2 is an aromatic compound and turns the urine a yellow colour. This is nothing of concern but it does happen.

Iron can cause stomach problems and constipation.

It is never recommended that high levels of vitamins and minerals are taken for a long period of time. If levels are low and supported with validated lab tests, a higher than normal dose maybe recommended for a short period of time and followed up with another test.

Try to identify the root cause of low levels is important. Often when a number of supplements are being consumed, levels of isolated nutrients can be compounded and levels highly exceeded.

What’s the rule on fat-soluble vitamins?

Fat-soluble vitamins, A,D,E and K are stored in fat tissue and more likely to respond to toxicity if taken in high amounts. Vitamin A comes with a warning particularly during pregnancy due to an association with possible birth defects.

Have your multivitamin and any fat-soluble vitamins (A, D, E and K) with food that contains some fat. Fat-soluble vitamins A, D, E and K are better absorbed when you have them with a meal or snack that contains at least a teaspoon of fat, about 5 grams.

The same goes for your multivitamin, which contains these vitamins. For example, if you’re taking your multivitamin with your breakfast, make sure you’re having some almond butter with your oatmeal or avocado with your eggs and toast.

Vitamin C and the vitamin B complex: thiamin (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), Vitamin B6, biotin (B7), folic acid (B9), Vitamin B12 are all water-soluble vitamins. Vitamin A in its Beta-Carotene form is also water-soluble and is less likely to cause a risk to health as it tends to be flushed out. This is not always the case with Vitamin B12 which if it is not being activated can increase levels and cause problems. High intake of vitamin C can cause tooth erosion.

I do not have a guide for optimum ratios of vitamin D to calcium. It is also important to consider magnesium and vitamin K2 in this combination.

Supplementation and nutrigenomics is in its infancy and everyone is different.

Recommendations always err on slow and steady and should in fact be managed by a clinician.

Iron is not well absorbed and highly reliant on vitamin C. There is no real ratio as nature is the key here. Digestive function also plays a part as it is the face of nutritional status.

Some nutrient dynamic duos include vitamin D to boost calcium absorption and vitamin C to boost iron absorption. That’s why taking in these nutrients simultaneously via supplements or boosting with food sources is ideal. A classic example is having your iron supplements with a glass of orange juice to get the absorption-boosting effects of the vitamin C.

Do most diets, whether from East or West, have optimally all minerals and vitamins? Do we get all vitamins from a balanced diet?

Vit C, the active form of vit D, B12 and 9 of the 20 amino acids are not made in the body. Animal proteins have the widest range of amino acids and a mixed diet will supply all that is needed. Plants, on the other hand, do not have a full complement of amino acids but pairing grains with beans, for example, increases the range.

It is quite interesting examining the diets of different cultures and regions of the world. The healthiest groups live in the World’s Blue Zones and predominantly eat complex carbs, plants and little meat and fish. Diets have almost worldwide changed to adopt more convenience foods, rely more on supermarkets and lifestyle changes dominate everyday activity. Nutrient requirement doesn’t just rely on diet as we are seeing with Vitamin D.

Consensus prevails that the use of supplements does not compensate for poor food choices and an inadequate diet, but supplements that provide essential nutrients may be a short-term option when food intake or food choices are restricted due to other factors.

The idea that we need certain food ingredients or substances, is not new. These days we are faced with a bewildering choice of health enhancing combinations promising greater things. Some are supported while others are not. There is no systematic regulation of dietary supplements and herbal remedies and no way of knowing what exactly is in it or guarantee that it works as claimed. Provided the supplement label lists the ingredients, manufacturers are free to make claims, valid or not.

Relying on the wide range of supplements is a tendency to compensate for a poor diet or demanding lifestyle.

Should people decide by themselves that they need to take extra calcium? Or iron? Or any vitamin?

I would not suggest this as all vitamins and minerals have an effect on their opposing nutrient.

[Prescription supplements] are not the only way but there are some nutrients that are very important for health and involved in blood sugar regulation, bone health, energy and learning, mood, immunity — Vit D, Vit C, magnesium, iron and calcium; and then there are others worthy of consideration when health is struggling — zinc, magnesium, B12, iodine, calcium.

Supplementation may help you get up and running quicker, but being aware of foods is by far what the body is designed to do. I believe that if you constantly supplement, you are interfering with your body’s natural function.

- With inputs from Washington Post

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