To Depend Upon Multivitamins and Supplements -- Or Not

The best way to get the vitamins, minerals, and other nutrients you need isn’t with a shopping spree at your local drugstore. It’s from food.  WebMD

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

"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."
Neil Levin, clinical nutritionist, NOW Foods

The issue is multivitamins, and who should take them along with other dietary supplements. Expert reaction is mixed, but mostly on the side of recommending supplements only for people with specific conditions; pregnant women for one group, prescribed folic acid to reduce risk of neural tube defects; children in developing countries where diets fail to provide sufficient vitamin A and iron.

Otherwise, according to recent studies insufficient evidence has been found to recommend multivitamin supplements to the healthy, average individual who eats a varied whole-food diet. On the other hand, taking too much of certain vitamins can be harmful. So, no, healthy people with a varied diet really have no need for dietary supplements such as multivitamins.

Of course the supplement industry, valued an an estimated $128 billion in yearly sales globally respectfully begs to disagree. And a 2011-2012 U.S. National Health and Nutrition Examination Survey saw 52 percent of respondents reporting the use of dietary supplements, a percentage of participation remaining unchanged from a similar 1990-2000 survey.

There is a useful place for supplements as a complement in nutritional intake for those with certain deficiencies who require help in meeting needed nutrient intake on a daily basis. For those who meet this criteria, those supplements should be taken regularly at certain times of the day that are both convenient and which promotes optimal absorption.

Debate around taking vitamins in the morning or at night confuses some people, but experts in the field agree that morning is the best time for multivitamin intake, along with any B vitamins. The timing should be consistent and the supplements or vitamins should be kept in a visible place to remind to take them, same time of day, every day. Vitamins and supplements are often prescribed for older people.

Most supplements are best taken with food with a view to reducing stomach upset, and to stimulate digestion and improve absorption. Iron, magnesium and fish oil supplements most commonly may cause digestive upset taken on an empty stomach. Fat-soluble vitamins A, D, E and K are absorbed better with a meal or snack containing a teaspoon of fat (almond butter, avocado) , as does a multivitamin containing those vitamins.

Preliminary research suggests that taking probiotics with a meal or 30 minutes before a meal could produce better effects than taking them after eating. It is elementary that hydration while taking a supplement or multivitamin is essential. Certain types of minerals change the "take with food" equation where chelated mineral supplements can be taken without food.

Chelation refers to a mineral bound to an acid so there is no reliance on stomach acid to break down the mineral. Nutrient duos include vitamin D to boost calcium absorption and vitamin C to boost iron absorption; these nutrients should be taken simultaneously through supplements or even better with whole food sources; iron supplements taken with a glass of iron juice for example, where vitamin C boosts the iron.

Calcium supplements should ideally be taken at a different meal than iron supplements or multivitamins since calcium can affect the body's absorption of iron, zinc and magnesium. The body absorbs calcium more effectively taken at 600 milligrams or less. Fiber should be taken at a different time from other supplements and medications to avoid interference with absorption.

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Calcium. “There really should be no reason that people should be calcium deficient,” says Angel Planells, a dietitian from Seattle. Known for the role it plays in making your bones stronger, calcium is found in dairy products like milk and yogurt. Women -- especially those who are likely to have osteoporosis -- may think about taking calcium supplements. But talk to your doctor first.
Vitamin D. This nutrient, made by the body from sunshine, helps you take in calcium and phosphorus, so it’s key for healthy bones and teeth. Older adults don’t make it as well, so supplements can help make you less likely to have bone loss and broken bones.
Vitamin B12. This is important for keeping blood cells and nerve cells healthy. Aging affects how well you take in and use B12 from foods, so if you’re over 50, it’s probably best to get your B12 from supplements and B12-fortified foods like cereals, as well as foods that are rich in it, like meat, low-fat dairy, and fish.
Folate. This helps prevent anemia. Spinach, beans, peas, oranges, fortified cereals, and enriched breads can have it.
B6. This helps your metabolism and immune system. You can get it in fortified cereals and soy products, as well as organ meats and whole grains.
Your body also needs these:
Vitamin C. Oranges, right? (And red and green bell peppers, along with other vegetables and fruits.) It may help protect you from cataracts, help wound healing, and possibly lower your odds of having certain kinds of cancer.

Magnesium. Among other things, it helps keep your blood pressure and blood sugar levels steady. It’s also good for your bones. You can get it from nuts, spinach, and dairy products, and it’s used to fortify some breakfast cereals. Experts aren’t sure how well it works as a supplement.
And here are some popular items you can find in the supplements aisle that you might talk with your doctor about:
Probiotics. Gut health is also very important for your immune system. Some studies show that probiotics -- living organisms like those found in yogurt -- help prevent some types of diarrhea and ease symptoms of irritable bowel syndrome.
Coenzyme Q10. Also called coQ10, this is made naturally in your body and found in most body tissues. It may help your immune system work better.
Melatonin. A hormone released mostly at night, it’s believed to help you fall asleep. The science on it is promising.
Fish oil. The American Heart Association recommends at least two servings a week of salmon and other types of fish with omega-3 fatty acids. In supplement form, though, no studies have shown that it protects against heart disease. Omega-3s also may help with symptoms of rheumatoid arthritis.

WebMD Feature, John Donovan --  Reviewed by Neha Pathak, MD on January 03, 2019