Your Sup­ple­ment Ques­tions, An­swered

IN­TE­GRA­TIVE MEDICINE EX­PERT TIERAONA LOW DOG, MD, GETS TO THE BOT­TOM OF YOUR MOST- ASKED QUES­TIONS

Better Nutrition - - AUGUST 2017 CONTENTS -

How do you know that you’re buy­ing the best- qualit y supplements? Are “whole food” vi­ta­mins re­ally worth the ex­tra ex­pense? Should you take all of your supplements at the same time? In the morn­ing? With din­ner? In­te­gra­tive medicine ex­pert Tieraona Low Dog, MD, an­swers th­ese ques­tions and more to help en­sure you’re get­ting the most out of your di­etary supplements.

When it comes to tak­ing your vi­ta­mins, min­er­als, fi sh oils, pro­bi­otics, and other supplements, you have ques­tions. Lots of them! What’s the best time of day to take them? Can you take them all at once? What’s the best place to store them? And the list goes on. We heard you. We turned to Tieraona Low Dog, MD, author of For­tify Your Life: Your Guide to Vi­ta­mins, Min­er­als, and More, for an­swers to some of your most com­mon queries.

Q: How can I make sure that I’m buy­ing a qual­ity sup­ple­ment?

Dr. Low Dog: Stick with rep­utable brands man­u­fac­tured in the U. S. Most of the re­ally dis­turb­ing news about “supplements” is not about vi­ta­mins, min­er­als, or com­mon nu­tri­tional supplements, which gen­er­ally con­tain what they claim on their la­bels. Steer clear of her­bal prod­ucts com­ing out of China and In­dia that have been found on nu­mer­ous oc­ca­sions to be adul­ter­ated with un­de­clared pre­scrip­tion drugs, as well as high lev­els of lead, mer­cury, and/ or ar­senic.

Also, look for third- party seals such as The United States Phar­ma­copeia, a sci­en­tifi c non­profi t or­ga­ni­za­tion that sets stan­dards for the iden­tity, strength, qual­ity, and pu­rity of di­etary supplements man­u­fac­tured, dis­trib­uted, and con­sumed world­wide; NSF In­ter­na­tional, an in­de­pen­dent or­ga­ni­za­tion of sci­en­tists and pub­lic health ex­perts that sets stan­dards for supplements and tests and cer­tifi es them; and Con­sumer Labs, a pri­vate com­pany that tests nu­mer­ous branded prod­ucts and al­lows com­pa­nies that pass its qual­ity tests to use its seal.

Q: How do I know if a man­u­fac­turer’s claims about a sup­ple­ment are ac­cu­rate?

Dr. Low Dog: The Food and Drug Ad­min­is­tra­tion ( FDA) has strict rules about what com­pa­nies can say about supplements. Man­u­fac­tur­ers can claim that a sup­ple­ment sup­ports gen­eral well- be­ing or the nor­mal struc­ture or func­tion of the hu­man body. For in­stance, such state­ments as “Cal­cium builds strong bones” or “An­tiox­i­dants main­tain cell in­tegrity” are per­mit­ted. How­ever, la­bels ( and ad­ver­tise­ments) can­not claim that a sup­ple­ment treats or cures diseases. So, while there are ran­dom­ized con­trolled tri­als that demon­strate that the herb St. John’s wort is eff ec­tive for the treat­ment of de­pres­sion, for ex­am­ple, a man­u­fac­turer can­not say this on the la­bel. In­stead, the la­bel would have to say some­thing like, “St. John’s wort sup­ports a healthy mood.”

Q: It seems like rec­om­mended sup­ple­ment dosages range ev­ery­where from min­i­mum daily val­ues to mega- doses. How do I know what’s right for me?

Dr. Low Dog: Fig­ur­ing out how much of a cer­tain sup­ple­ment you should take is im­por­tant, re­gard­less of the man­u­fac­turer’s rec­om­men­da­tions. When it comes to vi­ta­mins and min­er­als, we have a pretty good idea about how much is needed to pre­vent dis­ease. Most of us, how­ever, would

like to do more than just pre­vent rick­ets or beriberi; we would like to ex­pe­ri­ence vi­tal­ity and health. But just as im­por­tant, you’ll want to make sure that you aren’t tak­ing too much of any par­tic­u­lar in­gre­di­ent or nu­tri­ent. You must take into ac­count your age, gen­der, diet, and a host of other fac­tors.

The daily value ( DV) is a per­cent­age, cal­cu­lated on the av­er­age rec­om­mended daily al­lowance ( RDA) for adults. For each nu­tri­ent, there is only one DV for ev­ery­one 4 years of age or older. That means the DV does not dis­tin­guish be­tween the nu­tri­tional needs of an 80- year- old man, a 29- year- old woman, or a 6- year- old child. Be aware that your RDA might be higher or lower than the DV. For ex­am­ple, the DV for vi­ta­min D is 400 IU, whereas the RDA for any­one from 12 months to 70 years of age is 600 IU— and 800 IU if you’re over the age of 70. All vi­ta­mins will list 400 IU as 100 per­cent of the DV; how­ever, just as an ex­am­ple of how gen­eral the DV is, a 75- year- old man would ac­tu­ally need dou­ble that amount.

What you won’t fi nd on la­bels is in­for­ma­tion about the up­per limit ( UL), which is the tol­er­a­ble up­per in­take level for a given nu­tri­ent. In other words, the UL is the high­est daily in­take of a nu­tri­ent un­likely to pose a risk of ad­verse health eff ects to most peo­ple, as de­ter­mined by the Food and Nu­tri­tion Board. The UL rep­re­sents to­tal in­take of a vi­ta­min or min­eral from food, bev­er­ages, and supplements, and diff ers for in­fants, chil­dren, teenagers, men, and women of all ages, as well as preg­nant and nurs­ing women. For a chart de­tail­ing the up­per in­take lev­els of vi­ta­mins and min­er­als, visit The Na­tional In­sti­tutes of Health web­site ( nih. gov), or re­fer to my book, For­tify Your Life.

Q: Supplements come in so many forms— tablets, cap­sules, soft­gels, che­w­ables, lozenges, pow­ders, liq­uids— is there one that’s best?

Dr. Low Dog: There are ad­van­tages and dis­ad­van­tages of each.

Tablets: They’re cost- eff ec­tive, shelf- sta­ble, and have longer ex­pi­ra­tion dates. If you have a healthy di­ges­tive tract and aren’t tak­ing med­i­ca­tions such as pro­ton pump in­hibitors ( Nex­ium, Prilosec) that shut off pro­duc­tion of stom­ach acid, your di­ges­tive sys­tem shouldn’t have any prob­lem break­ing down a sup­ple­ment tablet made by a rep­utable man­u­fac­turer. One down­side: Tablets can be diffi cult to swal­low, but this can be eas­ily reme­died by us­ing a pill slicer to cut your tablets in half.

Cap­sules: They’re easy to swal­low and break down quickly. You can also open cap­sules and put the in­gre­di­ents into a smoothie, ap­ple­sauce, or yo­gurt, mak­ing cap­sules an at­trac­tive op­tion for chil­dren or those who have diffi culty swal­low­ing. Veg­e­tar­i­ans/ ve­g­ans take note: Although most sup­ple­ment man­u­fac­tur­ers use cap­sules made from veg­etable ma­te­rial ( veg­gie caps), some may con­tain gelatin de­rived from an­i­mals. Check the la­bels.

Soft­gels: Th­ese smooth, one- piece cap­sules are de­signed to hold liq­uid or oil- based prepa­ra­tions, such as vi­ta­min E or fi sh oil. They’re easy to swal­low and, be­cause they’re air­tight, off er a long shelf life. Un­like cap­sules, they’re cur­rently made al­most ex­clu­sively from gelatin from an­i­mal sources, so they aren’t suit­able for veg­e­tar­i­ans or ve­g­ans.

Che­w­ables: If you like to take your supplements in the form of gummy bears, don’t be em­bar­rassed. You aren’t the only one! Che­w­ables are one of the fastest- grow­ing and most pop­u­lar cat­e­gories of di­etary supplements. Most con­tain some form of sweet­ener and/ or fl avor­ing, which could be ei­ther nat­u­ral or ar­tifi cial— so read la­bels closely. And ve­g­ans and those sen­si­tive to dairy should be aware that some che­w­able supplements con­tain lac­tic acid, which may have been de­rived from dairy.

Lozenges: De­signed to dis­solve slowly in the mouth, lozenges are usu­ally used to soothe a cough or sore throat. Some supplements are avail­able in lozenge form as an al­ter­na­tive to che­w­ables. Be aware that they may con­tain some type of sweet­ener as well as fl avor­ings or col­or­ings. Keep them away from young chil­dren who may con­fuse them with candy.

Pow­ders: Pow­ders are use­ful when you want to use larger amounts of a sup­ple­ment. For ex­am­ple, the amount of in­os­i­tol used for anx­i­ety or sleep is typ­i­cally 6– 12 grams, or 2– 4 tea­spoons. That would be 12– 24 cap­sules per day! Pow­ders can be added to smooth­ies and food, and have a de­cent shelf life. But they are less con­ve­nient when trav­el­ing or on the go.

Liq­uids: Some liq­uid vi­ta­mins and min­er­als are avail­able in a sub­lin­gual form, drops that are placed un­der the tongue

Che­w­ables are one of the fastest- grow­ing and most pop­u­lar cat­e­gories of di­etary supplements.

for rapid ab­sorp­tion. A clas­sic ex­am­ple is vi­ta­min B . Liq­uids al­low a great deal of 12 fl ex­i­bil­ity when it comes to dos­ing, and you don’t have to worry about ab­sorp­tion is­sues. How­ever, they have a shorter shelf life and are harder to trans­port, as many need to be re­frig­er­ated af­ter open­ing.

Topi­cals: Many creams, lo­tions, oint­ments, gels, and liq­uids con­tain vi­ta­mins, min­er­als, nu­traceu­ti­cals, and her­bal in­gre­di­ents. Many peo­ple open a vi­ta­min E cap­sule and ap­ply it to pre­vent scar­ring when skin has been in­jured. Ep­som salts can de­liver mag­ne­sium through the skin and re­lax sore mus­cles. Cal­en­dula ointment is com­monly used for mi­nor cuts and wounds.

Q: Are “whole food” vi­ta­mins worth it?

Dr. Low Dog: The terms “whole food” or “food- based” re­fer to vi­ta­mins that have un­der­gone a fer­ment­ing process us­ing yeast. Th­ese prod­ucts are made by feed­ing vi­ta­mins ( some nat­u­ral, some syn­thetic) to yeast in a liq­uid broth so­lu­tion. As the yeast grows, it in­cor­po­rates the vi­ta­mins and min­er­als into its cel­lu­lar struc­ture.

The yeast is then killed and dried, and the vi­ta­mins pressed into cap­sules, liq­uids, or pow­ders. The the­ory is that the nu­tri­ents in­cor­po­rated into the yeast are now in a highly bioavail­able form. On la­bels, you may see in­gre­di­ents listed as “de­rived from yeast” or “from S. cere­visiae.” Are th­ese food- based or bio- trans­formed prod­ucts worth the ex­tra price? Many peo­ple think so, as this is one of the faster- grow­ing seg­ments in the sup­ple­ment in­dus­try. In fact, I take a mul­ti­vi­ta­min- min­eral prod­uct made us­ing this type of process.

In some cases, though, there is no diff er­ence be­tween a syn­thetic and nat­u­ral vi­ta­min where the body is con­cerned. This is the case with vi­ta­min C. If your sup­ple­ment con­tains more than 100 mg of vi­ta­min C, chances are high you’re get­ting at least some syn­thetic vi­ta­min C. How­ever, nat­u­ral and syn­thetic ascor­bic acid are chem­i­cally iden­ti­cal, and there are no known diff er­ences in their bi­o­log­i­cal ac­tiv­i­ties or bioavail­abil­ity.

Q: Should I take all of my supplements at once?

Dr. Low Dog: Some nu­tri­ents can en­hance or di­min­ish the ab­sorp­tion of other nu­tri­ents. Large amounts of cal­cium ( 250 mg or more) can im­pair the ab­sorp­tion of iron, while vi­ta­min C in­creases it. In­ter­est­ingly, in the South­west, peo­ple like to eat beans, which are high in iron, with chili pep­pers, which are packed with vi­ta­min C. This tra­di­tional mix­ture max­i­mizes the ab­sorp­tion of plant- based iron, which is less ab­sorbable than the iron found in meat. Tak­ing large doses of cal­cium or mag­ne­sium ( 250 mg or more) can com­pete with the ab­sorp­tion of other min­er­als, in­clud­ing each other. I gen­er­ally rec­om­mend tak­ing mag­ne­sium at bed­time to help with sleep and re­lax­ation. Take your mul­ti­vi­ta­min- min­eral sup­ple­ment at least two hours apart from your cal­cium or mag­ne­sium.

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