by Rachel Weiland, PharmD, BC-ADM
The most important rule when taking supplements is to tell all of your doctors and your pharmacy about what you take. Supplements might be called “natural”, “herbal” or have some other marketing tactic to get you to buy them, but they can interact with other medications you take, or even with a disease state you have. The first example that comes to my mind as a pharmacist is St. John’s Wort, which is used for depression. It interacts with hundreds of medications, as well as affects blood pressure and blood sugar. Your healthcare team can ensure that any supplements you take are safe for you.
There are, however, a few supplements I think are worth mentioning. The American Heart Association recommends 1000 milligrams per day of a combination of EPA/DHA, which is found in fish oil, for general cardiovascular health. The recommended dose for lowering triglycerides is 2000-4000 milligrams per day. It is very important to check the label of a fish oil supplement to see how much EPA/DHA is actually in there, as they try to trick you! Many advertise 1000 mg per softgel, but only have around 300 mg of EPA/DHA. The remaining 700 mg of ingredients are not proven to have as many benefits as EPA/DHA.
Many people are deficient in vitamin D, which helps you absorb calcium. This can be easily discovered through a simple lab test. Your doctor may recommend that you take a large dose of vitamin D once a week. Vitamin D is held in the fat in your body, so it does not need to be replenished every day.
To go with the vitamin D, scans can be done to determine bone density and determine if you need to supplement with calcium. If you do, there is an important distinction between the two different common over the counter calcium supplements. Calcium carbonate, which is less expensive, needs to be taken with food. This is because when you eat, your stomach releases acid, which helps the calcium carbonate get absorbed. This also means that if you are taking a medication to lessen acid, such as omeprazole, it will not be absorbed well. If you do take any medications like this, I would recommend you switch to calcium citrate. Calcium citrate is more expensive, but does not rely on acid. That also means it does not need to be taken with food. Another thing to consider is your absorption of calcium is not as good when you exceed 500 mg at one time. If you need more, take your tablets at two separate times throughout the day. All calcium supplements can interact with some medications – for example, some antibiotics, thyroid, and osteoporosis medications. Therefore, they need to be taken several hours apart. Ask your pharmacist if the medications you are taking interact with any over the counter medications you are taking, or are considering taking.