Chapter 10, Part 2: How to Choose and Use Dietary Supplements

Free Book Excerpt: A Guide to Complementary Treatments for Diabetes by Gene Bruno MS, MHS
August 10, 2016 (Updated: September 7, 2016)
Gene Bruno

An excerpt from the book, “A Guide to Complimentary Treatments for Diabetes: Using Natural Supplements, Nutrition, and Alternative Therapies to Better Manage Your Diabetes” by Gene Bruno, MS, MHS. Read additional excerpts or buy the whole book.

How and when should I take my supplements?

How to take a supplement depends upon what the supplement is. As a rule of thumb, most vitamin and mineral formulas are best taken with a meal. The reason for this is that the presence of food stimulates digestion, which allows many vitamins and minerals to break down efficiently for absorption. B vitamins in particular can be a little rough on your stomach without any food present to dilute them, and sometimes consuming them on an empty stomach results in mild nausea.

Herbal products, on the other hand, are generally best taken between meals or on an empty stomach. The reason for this is, unlike vitamins and minerals, you don’t want food to dilute them. With herbs, you’d like them to reach the intestines as soon as possible so they can be absorbed. Likewise, isolated amino acid products are generally best taken on any empty stomach, for the same reason. Other types of nutraceuticals, such as fish oils, should be taken with meals, since they can cause an upset stomach when taken without food.

When you should take your supplement also depends on the type of supplement you are taking. In general, supplements containing B vitamins (such as multivitamins) can make you feel energetic. Consequently, you probably would want to take these with breakfast or lunch, rather than with dinner, which could potentially keep you awake when you want to go to bed. If you are taking a supplement for general health pur- poses, you may want to spread out your dosage. Taking it in the morning and the evening allows you to maintain more consistent blood levels of the nutraceutical. However, for some products, dosage times are more obvious. For example, you should take a product formulated to help induce sleep about one hour before bedtime, and digestive enzymes should be taken with meals.

Table 10.3 is a good rule of thumb to follow for how and when to take supplements.

Table 10.3 How and When to Take Supplements
Supplement How to Take When to Take
Adaptogenic herbs (Ginseng,Rhodiola, Ashwagandha) On an empty stomach Upon arising in the morning
Amino acids On an empty stomach Anytime
B Vitamins With a meal Breakfast or lunch
Herbs On an empty stomach Ideally, twice daily
Multivitamin With a meal Breakfast or lunch
Other nutraceuticals With a meal Ideally, breakfast and dinner
Probiotics On an empty stomach Once daily
Vitamins or minerals With a meal Ideally, breakfast and dinner

Keep in mind these guidelines are not carved in stone. You may very well find that a variation to this schedule works best for you.

Are some forms of supplements better absorbed than others?

The short answer to this question is yes, some forms of supplements are absorbed better than others. Sometimes this matters and sometimes it does not. In some cases, better absorption means you will receive more of the supplement’s active ingredient—if you don’t receive more, then greater absorption has limited appeal. Coenzyme Q-10 is a good example of when absorption rate matters. Research has shown that coenzyme Q-10 is better absorbed as an oil base in a softgel capsule than as a tablet or two-piece hardshell capsule. When taken as an oil base, the body received more coenzyme Q-10.

On the contrary, an example of when absorption rate may not matter is calcium. Consider that calcium carbonate (the most common form of calcium used in supplements) has got- ten a bad rap. Some have accused it of not being absorbed well, while others have indicated that alternative forms of calcium are actually better absorbed. In any case, calcium does not naturally exist by itself. Rather, it is attached to some type of organic or inorganic acid. Minerals attached to acids are called “mineral salts.” All forms of calcium used in dietary supplements provide one or more calcium salts. For example, if you attached citric acid to calcium, you would have a calcium salt called calcium citrate (which is frequently touted as being a well absorbed form of calcium). The issue with different calcium salts is that they all provide different percentages of actual, or elemental, calcium by weight. Sticking with the example of calcium citrate, it provides about 22 percent elemental calcium. By comparison, calcium carbonate is about 38 to 40 percent elemental calcium—a much higher elemental potency, and clearly a good source of calcium. What this means is that in order to obtain 500 milligrams of elemental calcium, you would have to consume either 2,273 milligrams of calcium citrate or 1,282 milligrams of calcium carbonate. If you used the same amount of calcium citrate and calcium carbonate, say 1,282 milligrams of each, you would receive more calcium from the carbonate. Even though citrate has a 13 percent greater absorption rate, you would still end up with far more calcium from the carbonate source.

The bottom line is that while some calcium salts are better absorbed than others, what is most important is to get the correct elemental amount of the mineral and to make sure to take the mineral supplement with a meal so that the hydrochloric acid in your stomach will break it down efficiently for absorption.

If you ever hear or read that a certain form of a nutrient is better absorbed, always ask yourself the questions, “Is there proof?” and “Does the better absorbed form provide enough of the nutrient to do me any good?” Answering these will help you decide for your particular case how much the form the supplement is taken in matters.

Why does a dietary supplement need other ingredients?

The manufacturing of dietary supplements is a complex process. For example, in order to form the active ingredients in a multivitamin (vitamins, minerals, etc.) into a tablet and remain that way, it is necessary to add ingredients to the product that will bind the active ingredients together, and yet at the same time, release them during digestion. The tablet must be firm enough to withstand the rigors of handling during the processes of coating, packaging, and shipping, but it cannot be too firm or it will not break down completely in the digestive tract.

In addition, tablets have a tendency to become affected by mechanical problems during manufacturing, which can cause pieces of the tablet to fall off or get stuck in the tablet punch machinery. All of this requires additives to be incorporated into the mix in order to prevent manufacturing problems, while still making the tablet an effective product for the customers’ needs. Additionally, capsules have unique challenges that require specific additives to facilitate the manufacturing process.

Just below the “Supplement Facts” box on the label of a dietary supplement is a listing of “other ingredients.” These other ingredients are the additives that help keep the tablet or capsule together, or in some way facilitate the manufacturing process. Without these other ingredients, there would be no tablet or capsule.

Is it better to use one ingredient or a combination of ingredients to address a health issue?

In most cases, a combination of ingredients is always the better option to treat a health issue. The reason for this is that sometimes ingredients work better when paired with other ingredients than they do on their own. For example, it doesn’t matter how much calcium you take—it will not be absorbed unless you have a sufficient amount of vitamin D present. This type of synergistic relationship is especially common with vitamins and minerals, and illustrates the importance of using combinations of ingredients.

Complementary relationships between ingredients are another reason to utilize combinations. For example, a dietary supplement formulated to help lower cholesterol levels might include one ingredient that reduces the amount of cholesterol produced by the liver. It might also include another ingredient that interferes with the absorption of dietary fat or cholesterol in the intestines. A third ingredient may not lower cholesterol levels, but may increase HDL (“good” cholesterol) levels, which in turn may improve the balance of blood lipids.

By using a combination of different ingredients, it is often possible to achieve better results. In addition, combination formulas are generally more cost effective than purchasing ingredients individually.

Does a product that costs more have greater quality?

Sometimes cost is indicative of quality—but it is up to you to know what you are looking for and be a smart shopper. Buy- ing the cheapest product may be a bad idea since it could reflect inferior ingredients and substandard manufacturing practices. Buying the most expensive product, however, does not necessarily mean that you are getting the highest-quality product. For example, if you purchase a product from a multi-level marketing company, the product is almost always overpriced since the distributor, supervising distributor, regional distributor, and so on all have to get a share of the profit. This does not mean that the multi-level marketing product is not good, it just means that you are likely going to pay a lot more for it than you would for its counterpart at a retail store.

In other cases, price can indeed be an indicator of quality. For example, if you are paying a higher price for a probiotic product, it may be because it cost more to manufacture and store the product under refrigerated conditions to maintain the viability of its microorganisms. A very cheap probiotic product, on the other hand, may not contain any live micro-organisms.

What it often comes down to is how comfortable you are with the brand you have purchased. If the product is from a trustworthy brand, the chances are very good that you are get- ting a quality product.

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How are the nutrients in supplements measured?

The way a nutrient is measured depends on what the nutrient is. Most water soluble vitamins (B and C vitamins), minerals, and amino acids are typically measured in milligrams. There are 1,000 milligrams in 1 gram. However, some vitamins and minerals, such as biotin, folic acid, vitamin B, chromium, and selenium are required in such small amounts that they must be measured in micrograms. There are 1,000 micrograms in 1 milligram, and 1,000,000 micrograms in 1 gram. Milligrams and micrograms are both measures of weight.

Conversely, the biological activity (the level of effectiveness in the body) of a fat soluble vitamin (A, D, and E vitamins) is expressed in terms of International Units (IU). It is not expressed in milligrams, because the IU can change based on the source of the vitamin. For example, 1 milligram of natural vitamin E has more IU of biological activity than 1 milligram of synthetic vitamin E. Therefore, the amount of a synthetic vita- min E product must be increased to reach the equivalent number of IU found in a natural vitamin E product. For this reason, fat soluble vitamins must be expressed in terms of IU.

How much you take of any supplement is important. Understanding the amount of what you are taking can be crucial in helping you reach your goal. When you read any label, you will see the amount of ingredients contained in each capsule or table. By understanding these measurements, you will be able to make better decisions about what to take.

Which is best, capsules, tablets, or liquids?

Whether you take your supplement in capsule, tablet, or liquid form depends upon what type of supplement you are buying, as well as your personal preferences. If you want high doses of a nutrient and do not want to take a lot of capsules, tablets are a good choice because you can fit more of a specific nutrient in a tablet than you can in a capsule. If you want a supplement to digest very quickly, a capsule is a good choice. Many herbal products are put in capsule form, since a rapid breakdown and exposure to stomach acid may be necessary to obtain certain active components from the herb.

Often, liquid supplements are touted as being superior because they are available for immediate absorption. While this may be true, it is not always an advantage. For example, if you take a liquid multivitamin with a meal, none of the nutrients it contains will be absorbed until the food passes through the stomach and reaches the intestines—so there is no real advantage in this case. Furthermore, it is hard to maintain nutrient stability in liquid supplements. A good example of this is liquid creatine (a muscle enhancing supplement). In a liquid form, the creatine is rapidly converted into creatinine, which has no muscle-enhancing value. That means you are better off taking creatine as a powder or tablet.

However, many people have trouble swallowing pills. If you fall into this category, a liquid supplement may be your best (and only) choice. Also, liquid extracts can be effective dosage forms for medicinal herbs—of course, the solid herbal extracts in capsule form are also effective.

How do I know what I’m getting?

Caveat emptor is Latin for “let the buyer beware,” a policy that is always beneficial to follow. Being an aware buyer, how do you know that what is listed on the label is actually what is in the bottle? The unfortunate answer is you cannot know for sure. You can, however, increase your chances of buying a reputable product by making sure to limit your purchases to brands that you trust.

Naturally, the next question is how do you know what brands to trust? There are a few ways you can ascertain trustworthy brands. One is to check Appendix B of this book, in which I have listed a number of dietary supplement brands which, in my three decades of experience in the dietary supplement industry, I have found to be reputable. Another way is to talk to people who know the brands—specifically, talk to people who are in the business of selling supplements, such as those who work in vitamin stores or offices that sell supplements. Finally, when deciding what brands you can trust, you can find out if the manufacturer who makes the brand in question is GMP certified.

What does “GMP certified” mean?

The current Good Manufacturing Practice (cGMP) regulations enforced by the FDA provide for systems that assure proper design, monitoring, and control of manufacturing processes and facilities. Adherence to cGMP regulations assures the identity, strength, quality, and purity of dietary supplement products by requiring that manufacturers adequately control manufacturing operations.

There are two recognized agencies that offer GMP certification. These include the Natural Products Association (NPA) and NSF International (NSF). Dietary supplement manufacturers who pass an extensive auditing process are awarded GMP certification from either NPA or NSF. Possession of GMP certification is verification that the manufacturer is generally in compliance with the FDA’s cGMP. However, if a manufacturer does not have GMP certification it does not necessarily mean that it is not in compliance with cGMP—it is just more difficult to verify compliance. If this is the case, you may have to use one of the other methods discussed to ensure you are using a brand you can trust.

What all this means is that when you are looking for a brand of dietary supplements to purchase, try to look for one that has been manufactured in a GMP-certified manufacturing facility. In some cases, the label of the product will have a logo or statement indicating the GMP certification status. Unfortunately, this is not always the case. If GMP certification is not indicated on the bottle, you can contact the dietary supplement company and ask them if their products have been manufactured in a GMP-certified facility, and if so, by whom were they certified. You can also visit the websites for NPA and NSF  and see if the manufacturer or brand is listed.

From whom can I get reliable advice about dietary supplements?

Unfortunately, there is no consistent across-the-board answer for whom you can trust for dietary advice. In some cases, people who own vitamin stores are very knowledgeable and can offer reliable and trustworthy advice. But, there are many other cases in which retail salespeople give out bad or incorrect information. Some independent store owners and small retail vitamin chains provide their employees some training and/or education to help assure that they will make good recommendations to the retail customers, but depending on circumstances you cannot always count on this. In some cases, you will come across healthcare professionals who sell and/or recommend dietary supplements as part of their practice. Such individuals tend to make it their business to learn a great deal about dietary supplements. Licensed, naturopathic physicians in particular tend to have a significant knowledge of dietary supplements. Likewise, quite a few chiropractors have had coursework in the use of supplements. In addition, some nutritionists in private practices also have an expertise in the area. Appendix B will provide you with a listing of where you can find such healthcare professionals.

I encourage you to learn as much as you can about dietary supplements. Reading this book is a positive step in that direction, but there are other things you can do too. For a list of ways to become more familiar with supplements, see the Resources section.

Your aunt, co-worker, friend, or a random stranger are not the people to rely on for dietary supplement advice. They may have told you about something they took that worked for them, but that does not mean it will work for you, nor is it likely that any of these people have any real knowledge about dietary supplements beyond what they may have read in a magazine article or experienced firsthand. Although it is perfectly reasonable to love and respect these people in your life (with the possible exception of the random stranger), it does not make any sense to rely on their dietary supplement recommendations, however well-intentioned they may be.

CONCLUSION

Between the information provided in this chapter and the resources offered in Appendix B, you should now know enough to make some informed choices about buying and using dietary supplements. Also, do not be afraid to ask questions of people who are knowledgeable about dietary supplements if you need some help.

I can promise you this: the more you go out there, look around, and purchase these products, the less intimidated you will be. And the more questions you ask, the more you will learn. Remember, unless you actually take dietary supplements, you will never have an opportunity to benefit from them.


 

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