March 17, 2012
The following two sections are probably the ones of most interest to most people and for that I apologize for the amount of information you had to wade through in Part One to get to this point. Although we want to know when to take these supplements and which daily dose is the right one; I always want to know what it is I take and what it's supposed to do. This is not so easy when researching HIV medications but is much easier with vitamins.
For many people living with HIV, their daily routine revolves around the time of day they take their HIV medications. It may be necessary to adjust your supplement intake accordingly but never the other way round -- your ARV intake is of prime importance.
Instructions on vitamin bottles can sometimes be so small; you need a magnifying glass to be able to read them. This is generally because of the amount of legally required information but that doesn't make it any easier for the user. Many people look at the recommended daily dose and take everything at the same time and when it's most convenient. However, this can lead to mal-absorption and thus a waste of your money.
Studies seem to show that concentrated man-made vitamins (the most commonly found on the supermarket shelves) need to actually bond with real food vitamins in order to be properly absorbed by the body. Just drinking water and popping vitamins may be a diet option but won't be maintaining your health the way you hope it will.
Another problem is the sheer variety of opinions amongst the medical and nutritional professions. I've tried to bring together the most often recommended times for taking vitamins but you will always find contradictions. The human body metabolizes food at different rates and times for different people. Some people metabolize slowly in the mornings and faster at the end of the day and for others it's the opposite. Hard and fast rules are difficult to prove then.
Most people start with a multi-vitamin. The general opinion is that the best time to take it is in the morning, within a half hour of a healthy, protein and fruit breakfast, (eggs, milk and an apple for instance). Busy people will see this as an unrealistic scenario, as they buy their sandwich and coffee to go in the bus or car to work but we have to try don't we! If you forget in the morning, it's best to wait until lunch, or the first substantial food intake, so that the multi-vitamin is properly digested and breaks down with your food.
Single vitamin supplements have their own "best times" and again, opinions differ according to what you read.
Most nutritionists state that vitamin Bs, vitamin B-complexes, vitamin C and vitamin E should be taken in the morning, with some food, so that you can best benefit from their energy giving properties.
If you then take your vitamin D (and necessary calcium) with the next meal, you won't have problems with the absorption of the calcium. Most multivitamins contain iron and iron can clash with the calcium, leading to poor absorption of both. Minerals such as calcium and magnesium (plus vitamin D) are natural muscle relaxants and can also be taken before going to bed.
Vitamins A, D, E and K should preferably be taken with foods containing fat or oil, so that they can form "micelles" to allow absorption (a handful of nuts is one option).
Although rare, some doctors advise taking vitamin supplements on an empty stomach because they feel the body will absorb the nutrients better. Vitamin C is not one of them because it is so quickly flushed out of the body. Vitamin C actually only lasts a few hours in the bloodstream, so should really be repeated two or three times a day but it's not a good idea to take it last thing in the evening because of its stimulant properties. Taking vitamins on an empty stomach can also cause heartburn and indigestion problems. If that's the case, it may be better to open up the capsules or grind the tablets and blend them into a smoothy.
Some nutritionists also advise taking vitamins on an empty stomach but with specific instructions that they should be chewed. Some think that a chewed tablet is far better than one swallowed whole. Again, the grinding into a drink option may be more appealing.
In general, most sources advise taking vitamins with, or just after food and the science seems to bear that out but as already mentioned, other experts think differently. Some people may be finding eating solid food difficult enough but still need the vitamin intake. It's best to take advice and then see what works for you.
More Information: Optimizing Your Diet: Best Foods for Specific Vitamins.
Another controversial topic is how much of each vitamin you need to supplement. Many people take their multi-vitamin and then take other vitamins at recommended daily dosages separately, forgetting that they've already ingested a substantial amount of their daily intake in the multi-vitamin. This can lead to health problems as well as being a waste of money.
Recommended daily intakes (RDI) are not an exact science. Your particular health problem may require larger doses of particular vitamins to help with your deficiency and you will possibly see different RDIs on every different brand. Multi-vitamins can be bewildering when you try to work out exactly how much they contain. It's a bit of a minefield and isn't helped by the various acronyms which almost nobody understands. Here's a short list of some of the nutritional values to help you make your decisions.
RDI: recommended daily intake (it is illegal in Canada for instance to print RDIs on a vitamin bottle, maybe for a good reason.)
RDA: Recommended Dietary Allowances
DV: daily value
RE: retinol equivalents
Mg: milligram (nutrients are expressed in a variety of units)
Ug (or mcg): microgram (for instance 0.5 mg is the same as 500 ug)
IU: international units
Unfortunately there's not enough room here to explain how you convert milligrams to IU, or what the other equivalents may be and some state that it's just not possible because they represent different values. Searching the internet may not make it any clearer; it's very complicated. What we can do is compare the same label descriptions between different makes but even that is risky because what some companies claim is both not accurate and in no way comparable with others, or an international standard. Besides that, the difference between synthetic and "natural" vitamins is very significant. If any industry required urgent regulation, it's this one!
More Information: Vitamin Converter.
However, as vitamin users we have to make a judgement somewhere, or just not use them at all. After searching through many nutritional websites, the following recommendations from the European Union are at the bottom end of the scale in comparison with most others but again, every individual is different and your health status and age may require different daily intakes. The link that follows refers to the United States FDA and Canadian recommendations, which are slightly different in some cases. It is also not my job to recommend any sort of vitamin dosage to other people; that would be irresponsible. Apart from this, these are recommended daily intakes for normal, healthy people and we are not. It's very difficult knowing what's best but your doctor should be able to advise you.
Vitamin A: 800 mcg
Vitamin B1: 1.4 mg
Vitamin B2: 1.6 mg
Vitamin B12: 2 mcg
Vitamin C: 60 mg
Vitamin D: 5 mcg
Vitamin E: 10 mg
Folic Acid: 200 mcg
More Information: Reference Daily Intake.
What follows are a few general tips that most reputable sites offer regarding vitamins and although they may go without saying, they're worth bearing in mind.
More Information: All Vitamins Are Not Created Equal.
We are a vulnerable group of people. We have health problems which can't be cured and sometimes the side effects of the illness, or the medication used to treat it can leave us looking for any relief, anywhere. It's human nature but we have to use our common sense and try to make decisions supported by expert advice and careful research. An unregulated industry can persuade you to swallow anything but people living with HIV and other diseases like neuropathy have learned to be skeptical of exaggerated promises and claims. It's only logical that we should be cautious with what we put into our bodies.
This and other posts are based on my opinions and impressions of living with both neuropathy and HIV. Although I do my best to ensure that facts are accurate and evidence-based, that is no substitute for discussing your own treatment with your HIV specialist or neurologist. All comments are welcome.