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One of my earliest posts on vitamins and supplements for bipolar still gets more traffic on a daily basis than anything else I’ve written, but it’s high time for an update since I’ve learned considerably more about the topic. I now take my vitamins and supplements at three (or more) intervals daily, have tweaked dosages considerably, and read labels more carefully.

It’s All In The Timing

The timing with which you take vitamins and minerals can make a big difference in their effects and effectiveness. I used to take them all in the morning, with breakfast, all in one go. Not anymore.

After the disaster that ensued last spring because I didn’t realize that Vitamin C increases amphetamine clearance, I just didn’t take Vitamin C at all for a long time. Then I started taking a high potency iron supplement because I was sick of chronic iron deficiency anemia causing constant bruises – supplementing iron has to be done carefully because too much can be poisonous, but for a chronically anemic premenopausal woman, 27mg/day is probably not only safe but necessary. One of my docs recommended taking Vitamin C with the iron supplement because the Vitamin C helps you absorb the iron better. Which means taking it in the evening, because it would otherwise interfere with Adderall XR, taken in the morning and mid-day. So now Vitamin C and iron are my “PM meds” taken with or after dinner.

Calcium can screw up drug absorption too, but in the other direction. Here’s the link: Vitamin C – citric or ascorbic acid – increases acids in your stomach, which I discovered when taking a 1000mg Vitamin C tablet gave me reflux for the first time in my life. However, calcium carbonate requires acids in order to break down, and should be taken with food because eating prompts your stomach to produce acids. Unfortunately, that means that it can interfere with other meds because it basically slows down the rate of absorption by using up a big chunk of the acid supply. Apparently calcium citrate doesn’t require the extra acids to break down and therefore may not reduce your stomach acidity, which would make it a more ideal option for taking with other medications.

Worse yet, calcium supplements can lead to arterial plaque – that’s right, they can actually cause heart disease – if you take too much at a time. Theoretically this is because you’re dumping a massive amount of calcium in your system all at once, rather than slowly acquiring it via dietary intake throughout the day. So calcium needs to be taken in no more than 500mg effective doses (not enough for your daily needs by a long shot) and that means taking calcium several times a day (always with vitamin D, but they’re often packaged together) if you don’t consume much dairy. I’ve started taking a slow-release calcium supplement to mitigate that problem and using Lactaid to increase my dairy consumption.

But I also can’t take calcium with Adderall, because it’ll slow down drug absorption, and similarly, calcium shouldn’t be taken with my evening acscorbo-ferric cocktail because it negates the benefit of C for iron absorption. Before I got slow-release calcium tablets, this was really a problem, given the timing of when I need Adderall and the fact that calcium should be taken with food.

My solution in the mornings is to take my prescription meds first, with a giant triple-strength 1200mg fish oil capsule (a lot of things absorb better and/or faster if co-administered with fats), and then eat my breakfast, intermittently popping my Vitamin D, Vitamin E, CoQ-10, and Vitamin B Complex tablets. I just make sure to take the calcium last, after my body has had a chance to start breaking down the prescriptions, and I figure the slow-release calcium formulation probably also helps reduce the absorption conflict. It’s not a perfect solution, but I don’t have a better one just yet. Calcium, you are nefarious!

More D-D-D-D-D

Most people don’t need more than 100% of the RDA (recommended daily allowance) but I hate to break it to you, we’re not all created equal in terms of metabolism and nutritional requirements. In the last year, I’ve adjusted several dosages in response to lab testing.

I started off at 1000 IU of Vitamin D-3 a day, which is around 133% of the US RDA for women. I eventually increased to 5000 IU and finally started to see some benefit. As we went into the winter months, I upped it to 10,000 IU (two very small gelcaps) to help make up for the lack of sunshine in the snowy Northern wastelands. But in December, a blood test gave normal-but-lowish levels of D-3, so I increased my intake to 15,000 IU daily. My last round of blood work showed “beautiful” Vitamin D levels, according to my NP, so I think I’ve finally figured out the right amount. The “right” amount for me is approximately 25-75 times higher than the guideline of 200-600 IU!

Likewise with Vitamin B Complex tablets – “Balanced B-100″ according to the label – after my last round of blood work, I had levels in the normal range but under the 50% mark. I added an extra Balanced B-50 per day to get those levels up. The orange tablets did their trick and my pee turned brilliant yellow again, which is a good sign that I’m getting an adequate dose.

So when it comes to dosages on vitamins, the RDA is just that – a recommendation – and your body may want a whole lot more than is recommended. If you’re already getting routine V58.69 testing or having diagnostic blood work done, you might as well ask your provider about evaluating your vitamin and mineral levels, especially with a 25-hydroxy Vitamin D test. Check where your levels fall within the reference range that the lab gives, and if you’re below the 50% mark, you might want to increase your vitamin intake. Obviously dietary sources are best, but if you’re seriously deficient in some vitamins, it may not be possible to make up the difference with kale alone, or at least, not quickly enough to help you feel better.

Not All Vitamins Are Created Equal

I really need to remember to read the labels better. There are substantive differences in vitamins and supplements according to quality of manufacture. Cheap vitamins are a waste of money but “neutraceutical” grade is very expensive. There’s a middle ground, if you have the patience to look for it. Labeling should usually mention potency testing, and conforming to USP standards for weight and disintegration.

And if you’re lactose intolerant or have other food sensitivities or allergies, you must scrutinize labels to make sure that allergens aren’t among the fillers. Lactose is a very common filler, which is why I’ll be switching to a more costly version of Vitamin C (and 10x more expensive brand Allegra instead of store-brand loratadine) as soon as I exhaust my current supply. In the meantime, I’ve started taking Lactaid with my vitamins (and allergy tablets) so that they don’t make my stomach unhappy. How ridiculous is that?!?

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