By Larry Newman
Chief Operating Officer
Technical & Regulatory Affairs
Kirkman Group, Inc.
Some of our customers must take a lot of supplements daily to adequately address their nutritional needs. A common question is: can they be mixed to cut down on the number of times taken a day. This article provides guidelines.
Administering nutritional supplements to children and older adults can sometimes be challenging. Perhaps they can’t swallow capsules or tablets without choking or perhaps they just have an aversion to swallowing objects. The products also could have really bad odors, tastes or textures, which make the whole process very unpleasant. Often to simplify administration, it is desirable to mix several supplements together to cut down on the number of times supplements have to be given in the course of a day. Which ones are all right to mix together and which ones should be separated? What follows are some guidelines and helpful hints for giving supplements.
Kirkman’s catalog contains a section on page one offering a list of the many different types of foods and beverages that can be utilized in giving supplements. That same information is on Kirkman’s website home page. Some are better choices for certain types of products than others. I will try and make those recommendations as well in these guidelines.
Generally speaking, hard shell capsules can be opened up and the contents can be mixed in food or beverage. Also, tablets can usually be crushed and added to food or beverage. The exception to this is certain timed release or controlled release products that depend on the intact matrix of the capsule or tablet to deliver the active ingredient over time. These timed-release products, which can’t be crushed or opened, will usually be labeled accordingly.
If the patient won’t swallow intact capsules or whole tablets with water, sometimes mixing the capsule or tablet with a semi-solid food that does not require chewing will aid in the swallowing. Examples of these foods could be apple sauce, pudding, yogurt, ice cream or sorbet. Tell the patient to swallow the food without chewing. The capsule or tablet just goes down with the food, hopefully unnoticed.
If that method won’t work for your particular situation, crush the tablet or open the capsule and mix the contents with a juice or food that the individual likes. The previously mentioned Kirkman® catalog/website list has a lot of different ideas for you.
If the powder or liquid has a particularly strong unpleasant taste and/or odor, try to match the food used for hiding with the product. Extra tart juices, ketchup, spaghetti sauce and popsicles are really excellent taste and odor maskers for these unpleasant tasting products. Popsicles also work well because cold icy treats don’t allow the full taste of the product to be detected as much as warmer foods. It takes the tongue longer to detect flavors when items are cold.
If a supplement contains gritty material, such as flaxseed, try to mix the supplement with a gritty media such as rice crispy treats or peanut butter so that the grit goes unnoticed. Making “smoothies” in a blender is another method of grinding the grit to a finer consistency.
It should be mentioned that certain nutrients are heat sensitive and should not be heated above about 100 degrees because they degrade and lose potency. Vitamins A, D, B and folic acid derivatives are examples of those heat sensitive ingredients. Vitamins C and E are intermediate and can be heated somewhat warmer than 100 degrees, but not exceeding 140. Heating these vitamins in excess of these temperatures will certainly degrade a portion of the potency; the more the vitamins are heated, the less potent they will become.
Probiotic products are not to be heated at all, and in fact, require refrigeration for their maximum stability. Probiotics should be given cold or at a maximum of room temperature. Also, probiotics are sensitive to acidic conditions (acid pH) such as are present in juices or citrus fruits. It is best to avoid these acidic medias with probiotics unless the mixture is instantly swallowed. Cocoa, syrups, honey, or jelly are more appropriate for hiding probiotics which are normally given at the beginning of a meal. Probiotics generally do not have an objectionable taste, so a lot of masking isn’t usually necessary.
Minerals can be heated and are very stable at high temperatures all the way up to those temperatures used in baking. This offers an opportunity to hide calcium, magnesium or other minerals in baked goods. They can make unnoticed additions to cookies, muffins, cakes and breads. Be careful, however, because you have to calculate the daily dose you want by approximating how many servings a baking recipe will make. If you are going to make two dozen cookies and want 500 mg. of calcium per cookie, you will have to use 24×500 mg. elemental calcium doses in the recipe. Using Kirkman’s Calcium Powder Hypoallergenic, that would be 24 multiplied by 1.5 grams or 36 grams for the 24 cookie recipe. That small amount is undetectable to most people.
Are there certain supplements that should be given at a particular time of the day?
Yes, in certain cases. If a supplement such as DMG, TMG, or B vitamins tends to make a person energetic or excited, you would want to give the supplements in the morning On the other hand, if a nutrient tends to relax a person or calm them down, it would be best administered at night before bedtime. Examples here would be taurine, magnesium, melatonin, and certain herbs like chamomile or valerian root. Certain herbs or multivitamins tend to cause nausea in certain people. In those cases the products should be given with adequate food.
Are there certain supplements that should not be given together?
Yes, there are a few which need special consideration. Enzymes and probiotics should not be given at exactly the same time, as the enzymes have the potential to kill the probiotic. To avoid this, give the enzyme at the very beginning of the meal, and follow with the probiotic at the end of the meal or at least a half hour later. That will keep the two products from direct contact. Also, there are certain herbal components in immune system supporting supplements or supplements for yeast control that can kill off probiotics and should therefore be separated from the probiotics by several hours. Examples of these include curcumin, oregano, garlic, grapefruit seed, astragalus, olive leaf and caprylic acid.
Certain dietary supplements are fat soluble and are best absorbed when given with fatty foods. Examples of these are vitamin A, vitamin D, coenzyme Q10, fish oils, and omega-3 and omega-6 fatty acids.
Many parents utilize activated charcoal to limit die off reactions or nausea. Activated charcoal binds nearly everything it contacts and “escorts” it out of the body. For this reason, do not give drugs or nutritional supplements at the same time as charcoal. The charcoal should be given several hours away from food, drugs, or vitamin preparations to deter these important compounds from becoming bound to the charcoal and unusable to the body.
Another important combination to avoid is probiotics and antibiotics. Antibiotics kill probiotics on contact, so it is extremely important to separate these two product types by three to four hours. The antibiotic may still kill some of the probiotic off, but some will still be present to populate the gut. When giving probiotics during a period when antibiotics are also being given, your physician may recommend increasing the dose of probiotics to compensate for a partial kill and ensure maximum effectiveness.
Giving the right supplements at the right time and getting patients to comply with a regimen is still not an easy task. Hopefully some of these administration considerations will help make your job a little easier.