Micronutrient Smackdown: The Best Time to Take Your Vitamins and Minerals

When I meet with people for nutrition coaching, I always ask about their medicine and supplement intake in addition to what they are eating. Why? Because I can quickly spot gaps in their diet and want to be sure they are filling those gaps with supplements. Especially if they don't plan on adding food sources of the missing nutrients in the near future. And, I want to be certain they are taking their supplements the right way because many people were never told by their physician (or the supplement bottle doesn’t mention this) how to take a particular mineral.

You see, like sorority girls, minerals are finicky. There are many forms for each one (calcium carbonate, calcium citrate, calcium phosphate for example) and some just don’t like each other (calcium interferes with iron absorption) or certain medications (calcium decreases the absorption of some antibiotics) and others have formed a team and help one another (magnesium and calcium for example). So, how do you know what to take when? Here’s a quick rundown of some of the common ones people need and how to take them:

Multivitamin – take with food and preferably food with a little fat (to enhance the absorption of fat soluble vitamins you need fat in your gut).

Calcium – take up to 600 mg at a time. If your physician told you to take 1,200 total mg/day, take them in two separate doses of 600 mg, spaced apart. Your body only absorbs up to 500-600 mg at a time.

Calcium carbonate – take with food to enhance absorption.
Calcium citrate can be taken at any time of the day.

Magnesium – no single pill multivitamin contains 100% of your magnesium needs per day (it is a very big mineral) and according to population based data, many people don’t consume enough magnesium through their food intake. Diuretics and antibiotics can contribute to magnesium depletion. Magnesium can decrease the absorption of tetracycline (an antibiotic); so take it at a different time of the day. Many antacids and laxatives contain magnesium –be careful consuming these due to the potential for elevated blood magnesium levels. Enteric coating of magnesium supplements can decrease their absorption.

Iron – there are two types of supplements.
Non-heme iron is the most popular (all over the counter kinds of iron unless it says it contains heme iron) and should be taken with vitamin C rich foods, a heme iron source (meat) and not taken close in proximity to calcium containing foods or supplements. In addition, it’s best not to take this with leafy greens or bread as each has compounds that decrease the absorption of non-heme iron.

Heme iron – easy, take anytime of the day. You don’t need to worry about what you take it with or without.

Zinc – taking an iron supplement with large quantities of iron may decrease zinc absorption. According to NIH, taking iron between meals will help (see note above about iron). High intakes of iron can impair absorption of copper.

Potassium – found in very minor amounts in multivitamins. Don’t take extra potassium unless your physician tells you to do so. Having too much or too little potassium can be very serious.

Given that so minerals are picky and like to be treated a certain way, you are probably wondering why you should even bother taking a multivitamin mineral supplement. However, I do believe in multis and take one myself and I supplement with minerals as needed. After all, I try to eat a wide variety of foods but, I realize that there are probably vitamins and minerals I am missing out on.

Nutrition Confessions from a Dietitian

After writing my post the other day, I feel like I have a few nutrition confessions to make. These have weighed on me for some time because people have this perceived notion of dietitians even though we all have different specialties, different food likes and dislikes and very different food habits. So, here goes....my nutrition confessions revealed....

1) I'm a little afraid to try new foods. I am convinced this is a genetic trait as my mom still tells stories about how, at age 4, I picked bacon apart because I hated the "white stuff" and when I was a little older I sat at the table for hours because I wasn't about to put one single pea in my mouth. I've gotten better as an adult but even then, I struggle with the noted sliminess of oysters and mystery food like Cajun Boudin.

2) I don't like red meat. It was my freshman year of college and I had hit a record for fast food joints and all-you-can-eat buffets while on road trips with my college soccer and softball teams. One day after a particularly bad road trip where I didn't play and we lost, I decided, in a rather defiant mood, that I was done with red meat. That McDonald's hamburger was my last. I never liked the taste of red meat, the smell of steak reminds me of an ex-boyfriend whose table manners are trumped by 3 year olds and, I can find my protein, iron, zinc, creatine and B vitamins elsewhere.

3) I am not a foodie. *Gasp* I know, I've heard it before. I'm not totally sure what a foodie is but I imagine it to be the person who thinks about food throughout the day, reads cookbooks for entertainment and can't wait for their next gourmet meal. And, that isn't me. I am, however, fascinated with food as medicine and how food can fuel better performance, mentally and physically. And, I do enjoy the taste of various dishes. But, if you take me to a foreign country, you are more likely to find me wandering around taking in the sights then sitting at a restaurant for hours.

And, despite not being a foodie, I can cook just about anything (and will even cook red meat) and I'm one heck of a baker (or at least I like to think so) because my mom taught all of us how to cook when we were young and by 11 I had free range of the kitchen. Like a chemist in action I'd mix together ingredients, pop them in the oven and wait eagerly for my parents approval of my concoction. As a young teenager I made cinnamon swirl bread from scratch, multi-layered cakes, and infamous fat free muffins that had the consistency of a doorstop. And apparently, I passed my creativity on to my 5 year old niece who helped herself to the cabinets last night and found a strawberry cereal bar which she topped with cake icing and sprinkles. Absolutely brilliant! That's one I never thought of as a child but I see a future baker in the making....

4) I don't care what people eat. Okay, I care if you are a client or family member. But, unlike a dietitian friend of mine who slapped my wrist when I reached for dessert or my uncle who flipped out when I salted my food in front of him, I'm not going to shame you, comment or even pay attention. Eat whatever you'd like. Just don't make silly comments like "oh this is going straight to my hips" or (as overheard in a restaurant) "I really want your corn muffins but I'm trying to avoid carbohydrates, but they are really good, but..." or "I'm eating salad for a week straight after today". Please, for the sake of the people you are dining with, leave your shame and guilt behind and enjoy what you are eating.

So there you have it, I've confessed all of my dietitian sins. I'll cook or bake whatever you'd like but might not try a dish you made (don't be offended) and don't expect me to pay attention or comment on what you are eating. I'm off duty when I'm dining out :)

A Few Nutrient Packed Foods You Should Add to Your Diet

Whenever I see lists of foods you "should" eat, I typically cringe. Why? Because I think it is absolutely ridiculous to single out the "Top 10 Foods You Should Eat" (no doubt after I say this some editor is going to ask me to write such a list). Who says blueberries are nutritiously superior to blackberries? Or that spinach contains more antioxidants than my favorite leafy green, arugula. What criteria are these lists based on and what if I don't like the food on there? (FYI: you'd have to pay me to eat spinach unless it is finely chopped and sprinkled on top of pizza so I can't taste it).

Despite my disgust in the "Foods You Should Eat Daily" lists, there are a few nutrition powerhouses that cross my mind as "maybes" as in "maybe one day I'll get up the gusto to try that food." These include liver, oysters and sardines. So when I saw this list on Dr. Oz's website (add clams in there), I felt a bit of shame and guilt for my wuss-like fear of trying new food.

So why are these 3 foods on my mind? All are loaded with iron (which is especially great for non-meat eaters). In fact, as Dr. Oz points out a serving of chicken liver contains 70% of your iron needs for the day and it contains heme iron (the kind your body absorbs more of). Different types of liver contain varying amounts of iron, pork liver contains more than twice the amount found in chicken liver. Liver is also a natural source of vitamin D (which is not found in many foods), packed with vitamin A, B vitamins, copper (very hard to find in food and some trace minerals.

Oysters remind me of one of my basic nutrition classes in college. We had to create one day's worth of food that contained 100% of the daily value of everything we needed. Then we had to do the same thing but we had 3 days to meet that 100% value. That one exercise made me realize that by my estimates, 99.99% of the population does not get what they need from food alone (unless maybe they are loading up on vitamin and mineral fortified foods and beverages). The nutrient hardest to get: copper. So, I added oysters to my mock diet and came out with a winning nutrition plan that I bet no one would ever eat. But, nevertheless, oysters are rich in iron, vitamin A, vitamin D, a few B vitamins, copper, magnesium, calcium, zinc, manganese and phosphorus. One day I swear I'm going to try one of those slimy little creatures.

And last but not least are an Italian favorite, sardines. Sardines are rich in omega 3 fats, vitamin D, a few B vitamins, iron, phosphorus and the trace mineral, selenium.

While all of these "Top 10" type lists contain no-brainer fruits and vegetables, it's also a wise idea to take a look at a variety of types of protein. If your mainstay is chicken, try chicken livers (I did eat my share of these as a kid), oysters and sardines. I promise I too will try oysters and sardines as soon as I get to a good seafood restaurant! Or, I may try a family favorite - sardines on pizza because, after all, if I can eat spinach on pizza, I'm sure I can try sardines!

Blood Tests for Iron Deficiency Anemia

Iron deficiency anemia is a little confusing. Hemoglobin and hematocrit are the two most common tests for this kind of anemia but they really don't tell the full picture. Instead, a full iron panel can tell your physician more about what is going on in your body. Here's a look at what a full iron panel tests for:
Hemoglobin (Hgb) – is a protein in red blood cells that carries oxygen to your body’s tissues and carbon dioxide from your tissues to your lungs. Low levels of hemoglobin indicate that the body has a reduced capacity to carry oxygen throughout the body.

Hematocrit (HCT; or PCV, packed cell volume) – this measures the percentage of red blood cells in the blood. So for instance, if your HCT is 40%, this means that 40% of your blood volume is composed of red blood cells.

Red Blood Cell Count (RBC) – bed blood cells are your oxygen carrying cells. A low RBC signals anemia.

Transferrin – a transport protein that carries iron. If a person is iron deficient, transferrin levels will be high.

Serum Iron – measures the quantity of iron in the blood that is bound to transferring. Serum iron levels are low if you are deficient in iron.

TIBC (Total Iron Binding Capacity) – measures your body’s ability to transport iron. If a person is iron deficient, their TIBC will be high.

Ferritin – measures your iron stores in the body. When your blood levels of iron drop, your body can pull iron from your ferritin. Lower levels of ferritin signal iron deficiency.