There is so much more that goes into health than simply popping pills. I never like to focus on supplements, because supplements are simply things to add alongside something else (hint, a healthy diet), in order to enhance it. In fact, in clinic they are the very last thing I prescribe with patients, often not getting to them for a few sessions because there is so much that can be done with diet alone. In any case, we must always ask ourselves why we need to supplement… Is our intake of food/nutrients not enough? Our absorption compromised? Do we have something else going on that is influencing this particular nutrient? And have we had pathology testing to confirm our deficiency or requirement for a top up?
There is actually quite a bit that needs to be considered when taking supplements for both safety and efficacy There is the form, the dosage, interactions with drugs, other supplements and food, and the time of day to yield optimal results. The form and dosage is very condition/symptom specific and should definitely be discussed with a qualified natural health profession. However the time of day, is something I can provide you with more general guidance on (of course, still checking in with your healthcare practitioner to ensure you aren’t on a specifically timed protocol). For the first year of practice, I was constantly having to refresh myself on these, amongst many things! As well as educate my patients. So I thought I would shed some light on some of the most common oral supplements, to ensure you get the most from those sometimes necessary little pills.
B Vitamins (including B12, B complex and multivitamins)
B vitamins are best taken in the morning, as they tend to provide energy. Whilst they’re well-absorbed on an empty stomach, you’ll likely need to take them with a meal due to potential nausea. Try them with breakfast and see how you go. Note, if you take a multi or prenatal with B’s in it, and are taking additional B’s, best to separate the dose i.e. one with breakfast, one with morning tea or lunch (before 12:30pm ideally), as B’s are water-soluble and only so much can be absorbed at once. If using a multivitamin for Bs, try to move your coffee or caffeinated tea away from supplementation (an hour before or two hours after), as caffeine can interfere with most minerals included in your multi.
Vitamin C can really be taken at any time of day, or throughout the day. As it is also a water-soluble vitamin, splitting the doses here is quite important if supplementing a large amount (1,000 milligrams +). High doses all at once can definitely cause gastrointestinal symptoms. Try to take it away from B12 if possible, as it interferes with absorption. Whilst many people encourage you to take it with iron supplements for increased absorption of iron, be cautious if you suffer from inflammatory conditions e.g. gastrointestinal or autoimmune. Whilst it improves iron absorption, it also enhances the oxidative effects of iron (iron is a pro-oxitant, opposite of an antioxidant) which can be destructive in the presence of inflammation.
Iron is best taken on an empty stomach, preferable first thing in the morning. Fasting for over 24 hours decreases hepcidin three fold (key iron regulator), which naturally rises around 11am. It comes back down in the evening. The lower hepcidin, the better iron absorption. Therefore iron should never be taken in the middle of the day. The role of hepcidin is particularly important in women, as testosterone in men has a suppressive effect on natural hepcidin elevation! Some research shows that taking iron every other day further lowers hepcidin and thus iron uptake. Do not exceed 40mg at a time, as it won’t be absorbed (discuss with practitioner).
If you notice stomach sensitivity/nausea when taking iron on an empty stomach, try it with a light breakfast or move it to the evening when hepcidin lowers again and there is a bit more food in your belly. Avoid coffee, dairy and calcium supplementation an hour before and 2 hours after supplementation.
As mentioned above, whilst vitamin C is helpful to increase iron absorption, it can also increase toxicity in cases where inflammation is rampant. Therefore these types of considerations need to be made by a professional who knows your full case and is up-to-date with the research.
Research shows that zinc is best taken on an empty stomach, but I am yet to meet anyone who can tolerate it (nausea). Therefore, I recommend taking it at the end of the day, perhaps before bed. This way it is away from food (2 hours or so) but your stomach is well-lined. See how you go and adjust accordingly. Ensure you take away from iron and calcium supplementation.
Vitamin D is a fat soluble vitamin and is therefore best taken with a meal that contains healthy fats. This is also why for natural vitamin D from the sun, it is best to expose our “fatty bits” (bum, chest, belly), where uptake is better. Avoid supplementing at night as it may disrupt the body’s production of melatonin which interferes with sleep. Try it before 4pm, with a handful of nuts as a snack or alongside your lunch salad if it has avocado, olives, seeds or olive oil. Note, many vitamin D’s are made from lanolin (sheep-sweat-derived) so source a vegan spray (usually mushroom-derived, sounds better right?!).
Our nighttime mineral! Magnesium promotes calmness, sound sleep and recovery. I recommend taking it about 30 mins prior to bedtime. Take away from calcium supplementation. If taking very high doses, you might split it up for maximum absorption and to avoid loose bowel movements (you’ll know if you’ve taken too much!). In this case, taking a serving morning and again at night, so long as it doesn’t make you feel drowsy during the day (can change the form perhaps for morning dose if this is the case. Again, you will need to discuss with your healthcare professional).
It depends on the probiotic, but for the most part, much of the evidence suggests probiotics be taken WITH food. This is very controversial, as we once thought probiotics needed to be taken away from food. Research now shows improved probiotic bacterial survival when taken with a decent-sized meal (especially including starch), due to favourable changes in stomach acidity in the presence of food, as well as the availability of food for the bacteria to feed on. Think about it logically, all wild animals eating food from the earth, are naturally consuming bacteria simultaneously (from the dirt, where we used to get it from before cleanliness became a priority). Throughout time, primates have eaten probiotics with their meals! Take them with any main meal.
An excellent fibre source and constipation-remedy/preventative, psyllium is ideally taken two hours after a meal with a full glass of water. High-dose fibre may inhibit your body’s absorption of fat and specific minerals, therefore it is best taken away from food and supplementation. The water is very important for effectiveness.