DEAR DR. GOTT: Vitamin supplements cause me great digestive distress and chest pain — vitamin D, fish oil, multiple vitamins, vitamin C, to name only a few. I’ve tried taking them with food and still cannot tolerate them. Do you have any suggestions? Calcium tablets are also constipating.
I am 75 years of age and my doctor has said I need to be taking some of the above mentioned supplements. Diabetes, high cholesterol, hypertension, and CAD are some of my health issues. Any suggestions would be greatly appreciated. Thank you.
DEAR READER: Dietary supplements, as you have discovered, may carry unwanted side effects. For example, calcium can cause gas and/or constipation in some people and may interfere with the absorption of iron. This is also true of fiber supplements that contain psyllium, narcotic pain medicines, multi-vitamins and iron pills. The recommended daily allowance of calcium ranges between 1000 and 1300 mg depending on age.
Vitamin D supplements can interact with other medications. Side effects can include a metallic taste in the mouth, constipation, diarrhea, muscle pain, fatigue, and a great deal more. The recommended daily allowance of D for those ages one to 70 is 600 IU and for those 71 and over, it is 800 IU. Individuals diagnosed with heart problems or kidney disease should be careful when considering a D supplement. If you are taking a class of drugs known as calcium channel blockers, be sure to speak with your physician before beginning any regimen.
Fish oil is safe for most people when taken in doses of 3 grams or less per day. Amounts exceeding this level could keep blood from clotting and carry an increased risk of bleeding. It might also lower the activity of your immune system and reduce your body’s ability to fight infection. Side effects can include heartburn, nausea, loose stools, belching, excess gas, and nosebleeds. One possible way to counteract potential side effects of fish oil is to take the supplement in the proper amount with meals, or to freeze the capsules and take them in their frozen form.
Vitamin C should not be taken in amounts greater than 2000 mg per day because of the possibility of experiencing stomach upset and diarrhea, easy bruising, painful joints, anemia, dry/scaling skin, and more. The body is not unable to produce vitamin C on its own, nor does it store it. As an alternative, foods highest in C include orange juice, kiwi fruit, pineapple, strawberries, broccoli, tomatoes, winter squashes, spinach, and sweet and white potatoes.
Coated vitamins have a surface designed for several reasons, one of which is to allow ease of swallowing and the prevention of stomach upset. Enteric coatings allow a vitamin to hold up to stomach acids, passing into the small intestine for optimal absorption. Gelatin-coated products are compressed vitamins that make them easier to swallow and protect the stomach from upset. Finally there are time-released compression coatings that may be easier on the stomach.
Incorporate a healthful diet that includes fresh fruits, vegetables, fish, and whole grains. Instead of trying to take supplements, consider including more of the foods that are high in the vitamins/minerals that you are looking for. If you and your physician feel a fish oil supplement is beneficial, try including fresh fish high in omega 3’s (such as salmon, mackerel, etc.) or freezing the capsules before ingesting them and be sure to also take them with meals.
How much of each vitamin or supplement you need will depend on your age, gender, medications you may be prescribed and known illnesses. I can tell you what the Office of
Dietary Supplements recommends; however, as with any drug, over-the-counter or via prescription, you should work with your physician to determine what is appropriate for you.
Readers who would like related information can order my Health Report “Vitamins & Minerals” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.