I wake up on a sunny Sunday morning, snag a cup of coffee with collagen and organic half and half, and proceed to weekly planning! It’s a common practice online, in social forums and on “the grams” to do your meal planning on Sunday, and it certainly happens at my house! In addition to meal planning, we do our supplement planning on Sunday as well. It helps keep us on track for the week and makes sure we aren’t regularly missing out.
So, what’s that look like? There’s the all day in a snack baggie method (please don’t… plastic/BPA/sea turtles, ugh just stop), the bottles on the counter method, and the full-on giant segmented pill planner that looks like you stole it from your grandma. Glances at counter at a beautiful color-coded one…
Well, it makes sense that your method of planning depends on your plan about when and how to take your supplements, and of course, what supplements you are taking. So, maybe it’s best to start with the basics. These are VERY general rules I share with my patients. So, if you don’t have your beautifully formatted PDF document that your doctor and made for you, you can try to remember some of these basic rules.
Herbs vs. Nutrients
I remind my patients, as a basic rule, that if you are taking something to act “medicinally” in your system, you take it without food. Think Western herbal therapies, homeopathic remedies and many Chinese herbal formulas. If you are taking something to act as a nutrient, you take it with food. This applies to most vitamins, minerals, amino acids, etc.
A “medicinal” supplement should be optimally absorbed into your bloodstream without competing with food for absorption. You want to get it in your system, know how much you are getting in, and often in a timed manner. This would mean you want to take them on an empty stomach. Empty stomach would mean 30 minutes prior to meals, or 60 minutes after meals.
If you think about it, a “nutrient” supplement would most often be coming from food itself. So you want your body to recognize it as such, and take it all in with optimal co-absorption factors, and utilize it properly for function or storage, respectively. With some exception, details to follow, you may get optimal absorption of vitamins, minerals, and macronutrient supplements (fats, proteins, carbohydrates) by taking them with meals.
Fat Soluble vs. Water Soluble Vitamins
When discussing vitamins in particular, there are 2 types of vitamins. Water soluble, and fat-soluble. The “soluble” part basically indicates how the nutrient is dissolved and absorbed in the body. Fat-soluble vitamins can dissolve in fats and oils, and are absorbed in the fat globules in the diet. They can also be stored in the fat tissues of the body. The fat-soluble vitamins include vitamins A, D, E and K. Water-soluble vitamins can dissolve in water, and are carried to the body tissues but (with one exception) are not stored in the body. Water-soluble vitamins include all of the B vitamins and vitamin C.
It stands to reason then, that fat-soluble vitamins should be taken with some form of fat for optimal absorption. So, not only should you take these nutrients with meals, but also be sure this meal contains some form of fat for optimal absorption.
Aside from the basic rules above, we still have our set of supplements we use for optimizing digestion. These may include HCL/betaine, digestive enzymes, probiotics (arguable at minimum), etc. Most often, if you’re trying to affect your digestion, you’ll take these items with meals. This starts to get rather specific to the timing around the meal itself, which we will review further in the cheat sheet. Take home message, you’ll need these handy at meal time for sure, so set these aside.
Okay, if you’re still with me, even a little, you’re picking up the pattern of what I’m putting down here… If you’re taking a nutrient to assist with sleep initiation or enhance sleep quality, you’re PROBABLY going to take these around, you guessed it, bedtime! I knew you were keeping up. Yay you!!
Essentially, even if a nutrient fits into the rules above, the timing gets trumped for the intended purpose. You will find minerals, herbs, amino acids and lots of other loveliness in my treatment plans to be taken before bed.
The Nitty Gritty
Now, let’s spend a little bit of time going over some of the most common supplements and recommendations on how to take them. Fair warning here friends… these may stray from the basics we discussed, and you’ll see why. Then, we will end with a little cheat sheet. Yeah, I see you speed scrollers.
Multivitamins are one of the most commonly used dietary supplements, with an estimated 40% of adult men and women reporting use. In a healthy population, 25% of people may not get adequate nutrient intake from their diet, and a multivitamin may be an appropriate solution. A multivitamin is most often a combination of vitamins and minerals. Some formulas contain additional herbs, enzymes, probiotics or any number of things. Though as a general rule, multivitamins, follow the “found in food” rule. As they most often contain Fat-soluble vitamins, you will get optimal absorption from your multi if you take it with meals. Since the amount of the nutrients found in a multi is often high dose, it is best to take them divided as well. E.g. two with lunch and two with dinner.
Fish Oil/Omega-3 Fatty Acids
Omega-3 fatty acids are among the most commonly used supplements in the United States, with nearly 9 million Americans reporting use in a 2012 survey. An Omega-3 fatty acid supplement is, by definition, a fat based supplement, whether in the form of fish oil, or a vegan formulation. In the same manner that a fat-soluble vitamin is optimally absorbed with food containing fat, the same holds true for your Omega-3. Studies show a whopping 60% increase in absorption of omega-3 fatty acids when co-ingested with a meal containing fats.
- Pro-tip 1: I am all about bang for your buck! Though there are a few supplements that I recommend getting in the highest quality, which may carry a higher price tag. Due to of the sourcing of fish oil, the stability concern because of the fat based nature and the importance of supplementation, you want to be sure your fish oil comes from a reputable source, has been properly tested for contamination and heavy metals, and has been processed and stored properly. This is NO JOKE. A poor quality supplement may be offering next to no benefit, at best, and harming you at worst. Stick with the best, and pay a few extra dollars, you’re worth it!
- Pro-tip 2: If your fish oil supplement gives you nausea, or you get the infamous “fish burps”, try keeping your supplement in the refrigerator (which I would recommend in any case), and some patients find that keeping them in the freezer slows their breakdown and absorption, and minimizes these effects.
Vitamin D has gotten an immense amount of attention in recent years. Studies show an astounding 64% of people are by medical definition, deficient in vitamin D! This is a staggering number. Vitamin D has been associated with bone health for many years. Recent studies have also found that Vitamin D is closely associated with cardiovascular diseases, diabetes, cancers, autoimmune diseases, infectious diseases, and many others.
Vitamin D is a fat-soluble vitamin, and taking it with a large meal containing fat increases absorption up to 50%. There is no need to divide doses, as your body can store fat-soluble vitamins, so take them at the meal that is most convenient to you.
- Pro-tip: Vitamin D dosing is highly variable and dependent on your personal needs and current serum levels. It’s important to have your levels tested with your doctor, base your dosing on that recommendation, and re-test your levels while supplementing at high dose.
Oh boy! Here is possibly the trickiest one yet. Iron is a mineral, and is found in the diet, but this guy breaks the “found in food” rules and turns them sideways. In my office, I have one entire handout devoted specifically to iron supplementation. Iron is difficult to absorb, and is most efficiently assimilated on an empty stomach. Many things should be ingested separately from iron, including food, fiber, calcium supplements and high calcium foods such as milk, as well as certain medications. Iron is optimally absorbed in the presence of vitamin C, so you can take your iron in a supplement that has this added for you or some patients like to take their iron with a bit of orange juice.
It is important to note, that some of the most common side effects of iron supplementation include nausea and constipation. These effects may be mitigated by taking iron supplements with food, though will reduce absorption. Ok, you got all that, right?
- Pro-tip: If iron supplementation is required in your health plan, discuss your options with your doctor, try different iron formats and work around a schedule that makes the supplement convenient for you. If you’re not taking it due to side effects, it’s not working. #Compromise
Now, to one of my favorites! Magnesium is a magical mineral. There are so many practical uses, the cost is very reasonable, it’s easy to take, and did I say it’s magical? Magnesium is useful to assist treating everything from constipation to sleep issues to stress/anxiety to hormone balance. Though it is a mineral, it is well tolerated by most people, and the timing of your intake may relate more to the intended purpose, than for any other reasons. I.e. if you’re taking mag to help you sleep, well, you get the picture. One combo to note: zinc supplementation may decrease magnesium absorption in high doses. So, split those up.
- Pro-tip: There are many forms of magnesium available, including magnesium oxide, citrate, chloride and others. Absorbability and intended use varies widely among these types of magnesium, so be sure to discuss with your doctor which format is right for you. If you want to take it for general health, magnesium citrate may be most optimally absorbed. That’s why it hits my fave status.
Calcium is another commonly used mineral. Most commonly associated with bone health, calcium may also be useful in the prevention and/or treatment of certain cancers, hypertension and weight management. The National Institutes of Health also identifies the following at-risk populations for calcium deficiency: post-menopausal women, individuals with lactose intolerance and vegans/vegetarians, if diet is not properly managed.
The two most commonly used formats for calcium in supplements is calcium carbonate and calcium citrate, though there are many others. Calcium carbonate is more efficiently absorbed with food, whereas calcium citrate is equally well absorbed with or without food. Gastrointestinal side effects are common with calcium supplementation, though dividing doses and/or taking with food mitigate side effects. Calcium citrate side effects appear to be lower than that of carbonate.
Turmeric or curcumin is hyped right now! The most common use is to promote anti-inflammation. Multiple studies are showing that curcuminoids (the active components of turmeric) may reduce heart attacks, control osteoarthritis pain, and reduce skin irritation from breast cancer treatment. There are other preliminary studies showing possible use in multiple cancers, colitis, diabetes, Alzheimer’s disease and rheumatoid arthritis. Holy moly! What can this stuff NOT do?
Turmeric is very poorly absorbed, and then degraded rapidly in the liver. So, it is difficult to get levels in the blood stream that are beneficial for reducing inflammation. Turmeric is fat soluble, and therefore may be more optimally absorbed with fat and may be most efficiently absorbed when taken with piperine (a component of black pepper). Though certain forms of curcumin are more optimally absorbed without the need for fat or piperine. Ideally, your turmeric supplement is high quality and well studied. Theracurmin ® is brand of curcumin formulation that is the most studied in clinical trials and found in only certain supplements. If you take a Theracurmin® supplement, you may take this at whatever time of day is most convenient for you.
- Pro-tip: I am all about bang for your buck! Though there are a few supplements that I recommend getting in the highest quality, which may carry a higher price tag. Turmeric is so well studied, but also so well known to be poorly absorbed. That bargain bin bottle you picked up, may be doing as much good in your body as it was in that bin! If you’re serious about using turmeric for health benefits, stick to a well-studied format, and spend the extra few dollars. It’s so very worth it.
Those sassy little bacteria that live in your gut are an integral component of processes happening in your whole body! Probiotics are very well studied to be beneficial for digestive conditions like IBS and constipation, to urinary tract infections, vaginitis and eczema, all the way to depression and mood complaints. I could spend an entire article just reviewing the studies on probiotics. (insert future love here) Move over magical magnesium, probiotics take center stage.
While there is little argument about the immense and varied benefit of taking a probiotic, there is much discussion about when the proper time to take them may be. Your doctor may have a strong opinion about this, so run it by him/her first. If you’re taking probiotics on your own, or for general health benefits, studies show that some dietary fat may protect those little lovelies as they travel through your digestive tract, so you may want to take your probiotics with a meal containing fat.
- Pro-tip: Oh yeah, those babies get 2 favorites. I do what I want! There’s some general argument for refrigerated vs. non-refrigerated probiotics, as well as whether to take with prebiotics or without. This is a big talk for another day. So, I gave an encapsulated option for travel and ease, and a refrigerated version that contains prebiotics in a powder blend that’s my personal favorite. You do what you like friend!
Some Final Notes
Oh how I do love a good “last word”. There’s an immense amount of information out there regarding what supplements to take, how to take them and what not to take and so on. Those beautiful bottles are not getting you anywhere if you’re not ingesting their contents. Find a schedule/routine that works for you, gives you the least amount of heartache (or gut ache for that matter) and do your best. You don’t need to raise your cortisol levels with the stress of your pill planning. If you miss an optimal time, take it later, if you forgot to take your herbs before lunch, take them after. It really is all good.
The Clipped Notes/Cheat Sheet
As promised, here’s summary of the novella above for quick reference. You will see some supplements listed more than once (I like options). You will also see some extra items that aren’t listed above, but since you may have them in your repertoire, I threw them in for good measure. You. Are. Welcome.
- Adrenal/cortisol boosters
- Stimulating herbs for memory, cognition etc.
- Multiple herbal formula doses of any kind
- Additional herbal dosing
- Digestive enzymes
- Fish oil
- Vitamin D
- Second herbal dosing
- Digestive enzymes
- Additional herbal dosing
- Fish oil
- Vitamin D
- Adrenal/cortisol lowering supplements
- Additional herbal dosing