Supplements and Medications: Best friends and worst enemies.

What supplements complement each other? What drugs limit absorption? Let’s find out.

I saw an adorable video on Instagram. Probably AI. It was a series of quick facts about vitamin absorption animated with cartoon style pills and foods. The information was great but it came and went at the rate of a gen Z attention span. I’ve compiled some of that information here.

What to take together:

Vitamin C pairs well with iron. Specifically it helps plant based iron transform into a more useful version in the body. Think leafy greens and citrus. Mandarin orange spinach salad for the win!

Vitamin D has a lot of friends. Magnesium activates it, calcium is absorbed easier with it, and K2 makes sure that calcium goes to your bones and not your soft tissues.

Vitamins A, D, E, and K are all fat soluble vitamins. They should be taken with some kind of fatty food to ensure the body releases bile to aid absorption.

What to take separate:

Coffee and tea contain compounds (tannins and polyphenols) that can severely limit iron absorption. Also effected are: calcium, magnesium, zinc, vitamin D, B vitamins, and the trace minerals manganese, copper and selenium. Bottom line, enjoy your hot beverages an hour before or after you eat and take supplements. The one exception is B12, caffeine may enhance B12 absorption from food.

Food can affect nutrient absorption. It’s great to take fat soluble vitamins with food, but things like Iron, B and C vitamins, probiotics, and calcium are often better absorbed without food. If taking them on an empty stomach leads to nausea a light meal is ok.

DROGAS, aka DRUGS, aka pharmaceuticals have a lot of different interactions. The one most people have heard about is grapefruit. Here’s a master list of drugs affected by grapefruit straight from AI:

• Cholesterol (Statins): Lipitor (atorvastatin), Mevacor (lovastatin), and Zocor (simvastatin). High levels can lead to muscle breakdown (rhabdomyolysis) and kidney failure.
• Blood Pressure: Certain calcium channel blockers like Procardia (nifedipine) and Plendil (felodipine).
• Anxiety and Mood: Buspar (buspirone), Valium (diazepam), and Zoloft (sertraline).
• Heart Rhythm: Amiodarone (Cordarone, Pacerone) and Multaq (dronedarone).
• Erectile Dysfunction: Viagra (sildenafil) and Cialis (tadalafil) levels can be dangerously boosted.
• Organ Transplant: Cyclosporine (Neoral) and tacrolimus (Prograf).
• Allergies: Allegra (fexofenadine) is an exception where grapefruit decreases absorption, making the medicine less effective.

Now the flip side. Certain pharmaceuticals can affect nutrient and supplement absorption. This is often overlooked and if a medication is taken long term it can lead to many hidden deficiencies. If you’re taking one of the medications below make sure you check levels of the affected nutrients or get the appropriate supplement. Again, straight from the AI internet hive mind:

• Acid Blockers & Antacids: Proton Pump Inhibitors (PPIs) and H2 blockers can reduce absorption of Vitamin B12, Calcium, Magnesium, Iron, and Zinc.
• Diabetes Medications: Metformin is well-known for depleting Vitamin B12 and Folate.
• Cholesterol Medications: Statins can lower levels of Coenzyme Q10 (CoQ10) and may impact Vitamin D.
• Birth Control Pills: Oral contraceptives can deplete several B vitamins (especially Folate, B6, and B12), as well as Magnesium, Zinc, and Vitamin C.
• Blood Pressure Medications:
  • Diuretics: Often deplete Potassium, Magnesium, Zinc, and Vitamin B1.
  • ACE Inhibitors: May lower Zinc levels over long-term use.
• Corticosteroids: Long-term use can interfere with the absorption of Calcium, Vitamin D, and Potassium, potentially weakening bones.
• Antibiotics: Can reduce Vitamin K and various B vitamins by disrupting the beneficial gut bacteria that help produce or absorb them.
• Thyroid: Levothyroxine may affect vitamin D, vitamin B12, selenium and iodine.

That is a lot of information. I’ve put things in BOLD to make this blog easy to scan. One more little blast that seems important is WHY?!?!?!?! Why should someone take vitamin D?CoQ10? B12? There are entire textbooks devoted to this, but I’ll put a quick cheat sheet below for the most commonly taken. Again, I asked AI so you don’t have to. Stick around after this chart for a few caveats:

• Multivitamins: These serve as “nutritional insurance” to fill gaps in a Western diet. Some evidence suggests they may also help maintain or enhance cognitive function in older adults.
• Vitamin D: Intended to support bone growth by improving calcium absorption. It also plays a key role in immune function and reducing inflammation.
• Omega-3s (Fish Oil): Taken primarily for heart health (lowering triglycerides and blood pressure) and brain function. They are also used to reduce inflammation and joint stiffness.
• Magnesium: Used for over 300 biochemical reactions. Specific effects depend on the form:
  • Magnesium Glycinate: Promoting sleep and relaxation.
  • Magnesium Citrate: Relieving constipation or providing digestive support.
  • Magnesium Malate: Supporting energy and muscle function.
• Probiotics: Intended to restore balance to the gut microbiome, often after antibiotic use, to support digestion and immunity.
• B-Complex & B12: Essential for metabolism, cell function, and energy levels. B12 is specifically used to treat pernicious anemia and is crucial for those on plant-based diets.
• Calcium: Crucial for building and maintaining strong bones and teeth, muscle movement, and nerve signaling.
• Zinc: Frequently taken to support immune function and assist in wound healing. 

SPECIAL CONSIDERATIONS

• Pregnancy: Folic acid is a standard recommendation to reduce the risk of certain birth defects like spina bifida. – NO! – see below
• Age-Related Eye Health: The AREDS formula (Vitamin C, E, Zinc, and others) is used specifically to slow vision loss in people with macular degeneration.
• Herbal Intensions: Popular botanicals include Turmeric for inflammation, Ashwagandha for stress, and Melatonin for sleep cycle regulation.

Even AI and the internet can be wrong unless properly prompted. A lesson we are all learning in real time with such a disruptive new technology. Look up AI induced psychosis for more info. ANYHOW knowing which questions to ask and how to further prompt these information demons can lead us to the truth:

Folate vs. Folic Acid: Folic acid is the synthetic form used in supplements and fortified foods, while folate is the natural form. Methylfolate is an alternative for those with MTHFR gene mutations who cannot process folic acid properly.

Most people with an MTHFR gene issue will not know about it, and around 40-50% of the population carries some form of this mutation. There are hypotheses that the abundance of this gene expression is an unintended consequence of the push to promote folic acid supplementation for pregnant women. This is certainly a much better circumstance than spina bifida, but we can most likely avoid it all together when we double down on nature. Folate (L-methylfolate (5-MTHF)) is a usable form of vitamin B9, folic acid is the lab made consolation prize. Always choose FOLATE.

FORTIFIED FOODS: OK, I’m almost done. If you’re in the lucky 40-50% of the population that has an MTHFR gene mutation, you may be subtly poisoning yourself every time you eat, especially at restaurants. The road to hell is paved with good intentions. Fortified foods are an attempt to reintroduce nutrients to processed foods that have been otherwise stripped of the good stuff. Hubris. Common foods “fortified” with folic acid include:

• Breads: Enriched white bread, rolls, buns, and bagels.
• Pasta: Enriched macaroni, noodles, and spaghetti.
• Rice: Enriched white rice (organic and gluten-free versions often skip this).
• Flour and Cornmeal: Enriched all-purpose flour and corn grits.
• Breakfast Cereals: While mandatory for some cereal grains, many manufacturers voluntarily add up to 100% of the Daily Value. 
• Corn Masa Flour: Used to make corn tortillas, tamales, and pupusas.
• Energy Bars and Drinks: Often fortified with a range of B vitamins, including folic acid.
• Plant-Based Meats: Some brands, like Impossible Foods, fortify their products with folic acid.

Signs and symptoms of MTHF issues may present themselves when you eat these foods. They look like:

• Neurological & Cognitive: Brain fog, difficulty concentrating, chronic headaches or migraines, and extreme mental fatigue.
• Mood & Behavioral: Heightened anxiety, irritability, depression, or a “wired but tired” feeling.
• Digestive: Inconsistent bloating, gas, or nausea, which may be mistaken for IBS.
• Physical: Chronic fatigue, tingling or numbness in hands and feet (neuropathy), and unexplained muscle pain.
• Buildup Risks: Some studies suggest high UMFA levels may mask a Vitamin B12 deficiency, which can lead to permanent nerve damage if undetected.

My big theory: a lot of people who think they are gluten sensitive have MTHFR gene mutations and are being affected by folic acid enriched foods. This is potentially why going grain free or doing an elimination diet like whole 30 can drastically help certain folks. Do your own N of 1 study on yourself. It’s free and could change your life.