Gut Check
By Jack Challem
Why you don’t absorb the nutrients you should—and what you can do about it
A few years ago, while I was chatting with a nutritionally oriented physician, the conversation drifted to absorption. I asked him how a person really knows if he’s absorbing the supplements he’s taking. The doctor chuckled. “If your supplements go ping in the toilet,�?he said, “it’s a sure sign that you’re not absorbing them.�?/FONT>
Scatological jokes aside, it turns out that a lot can go wrong after you swallow your supplements or eat a meal. Digestion and absorption might seem like straightforward processes, but for many people, the 30-foot-long digestive tract can hold a series of ambushes on your nutrients. And worse, some of the problems may arise from the very supplements you take.
The bottom line? You aren’t what you eat. You are what you absorb. The good news is that most bioavailability (the degree to which a nutrient is absorbed into your system and thus physiologically available) problems are relatively easy to solve. We’ve investigated seven of the most common, and we offer clear recommendations to help you get the most out of your supplements and foods.
the tighter the pill
problem: Not all supplements are created equal. Occasionally, tablets get pressed too tightly during manufacturing, so they take much longer to break down and instead wind up passing through your system either partially or wholly unused.
Vitamin companies follow US Pharmacopoeia manufacturing guidelines, which stipulate that a tablet must break apart in your gut in 30 to 60 minutes. That doesn’t always happen, making tablet absorption difficult. Over the past 20 years, many vitamin companies have shifted from tablets to soft- and hard-gel capsules because digestive juices break down the thin gel wall more rapidly to release the capsule’s ingredients.
Excipients pose another potential problem, especially in tablets. These compounds aid consistency in supplement manufacturing; the name is really an umbrella term for fillers, binders, lubricants, and disintegrants. Excipients are technically safe and approved by the FDA, but just because they’re safe doesn’t mean you want these artificial colors and sugars in your vitamins.
Capsules contain fewer excipients than tablets because capsule ingredients don’t have to be pressed together to form a tablet. Tableting machines stamp out tablets in fixed sizes, so companies often have to make a tablet bigger than is strictly necessary to deliver a certain dose. They do that by adding more excipients to the mix. Capsules use excipients to ensure that the powdered mixture is consistent and to fill up a hard-gel capsule so it doesn’t look half empty. Generally speaking health-food store brands of capsules and tablets contain fewer and less-noxious excipients than drugstore or discount brands. In health-food brands, the most common excipient is plant cellulose; drugstore brands usually choose lactose. Cellulose is innocuous, but lactose can cause problems for people allergic to dairy products. “The biggest problems are usually with low-priced, mass-market supplements,�?says Al Czap, president of Thorne Research, a supplement company that sells primarily to nutritionally oriented physicians. “Dicalcium phosphate is a common excipient—it’s cheap, but it practically turns a tablet into a brick.�?Other excipients to avoid are magnesium stearate and any type of palmitate. “Magnesium stearate is added to keep the tableting machines from gunking up,�?Czap explains. “Faster manufacturing speeds require more magnesium stearate as a lubricant, but just a little too much of it can interfere with nutrient absorption.�?/FONT>
That doesn’t mean you have to avoid tablets. Susan Carlson, RPh, of Carlson Laboratories, another supplement company, points out that tablets cost less than capsules to manufacture. That’s important for people who have to watch their pennies. Well-made tablets can also carry up to twice the amount of
ingredients compared with the largest capsule.
Solution: Whenever possible, and depending on your budget, opt for capsules and buy your supplements at a health-food store. The safest excipients include cellulose, silicon dioxide, titanium dioxide, and magnesium citrate. Vegetarians take note: Most capsules are made from beef gelatin. Fortunately, vegetarian-source, hard-gel capsules are increasingly common. Check the label.
read the fine print
problem: Some nutrient forms are better absorbed than others. Mineral supplements can be particularly confusing in terms of bioavailability, not to mention label reading. And trying to decide which ones work best can really make your head spin.
Minerals always come as part of a compound, such as calcium citrate, magnesium malate, or chromium picolinate. As a rule, carbonates, gluconates, oxides, and sulfates are not well absorbed. You’ll do much better with a mineral citrate, malate, fumarate, succinate, aspartate, glycinate, ascorbate, or picolinate.
“Oxides are the cheapest form, but they’re not worth putting in your mouth,�?says Hyla Cass, MD, a nutritionally oriented physician in Pacific Palisades, California, and the author of Eight Weeks to Vibrant Health (McGraw-Hill, 2005). Cass recommends mineral “chelates,�?such as glycinates, citrates, and aspartates. In chelates, the mineral is bound to an organic molecule and is better absorbed.
Carolyn Dean, MD, ND, author of The Miracle of Magnesium (Ballantine, 2003), concurs. She takes and recommends magnesium citrate, taurate, glycinate, and aspartate. Dollar for dollar, though, citrate forms are probably the best compromise between high absorption and reasonable cost.
The differences between natural and synthetic supplements can be fuzzy with two exceptions: vitamin E and carotenoids (a family of colorful antioxidants found in fruits and vegetables). “Natural-source vitamin E is assimilated twice as well as the synthetic form,�?explains Robert Acuff, PhD, a vitamin researcher at East Tennessee State University, Johnson City. In studies, Acuff found that blood and tissue levels of vitamin E rose twice as high with the natural form of vitamin E as with the synthetic variety. When shopping, look at the fine print on the label: Natural vitamin E will be identified as d-alpha tocopherol (though the “tocopherol�?spelling may vary), whereas the synthetic form will be listed as dl-alpha tocopherol.
With carotenoids, again check the fine print. Natural-source beta carotene comes from D. salina algae, which contain small amounts of other antioxidant carotenoids, including alpha carotene. Similarly, tomato-derived lycopene contains small amounts of related antioxidants, while the synthetic form contains only lycopene. If these natural sources are not identified, the supplement is probably synthetic.
Solution: It’s easy to tell the difference between natural and synthetic vitamin E and carotenoids. Unfortunately, it’s more difficult navigating mineral supplements. To simplify your shopping, aim for citrates, aspartates, glycinates, and picolinates.
those meddling meds
problem: Any kind of medication can do a number on your nutrients. In fact, almost every pharmaceutical drug interferes with nutrient absorption, at least while you’re taking it—and sometimes long after you’ve stopped.
“Drugs work by interfering with normal biochemical processes in the body,�?explains Bernard Rimland, PhD, director of the Autism Research Institute in San Diego and long a critic of conventional medicine. “In contrast, nutrients support normal biochemistry.�?Among the worst offenders are antacids, antibiotics, oral contraceptives, and the nonsteroidal anti-inflammatory drugs (NSAIDs). Antacids and related drugs (such as proton-pump inhibitors and H2 blockers) lower stomach acidity, which in turn reduces the absorption of many nutrients, including potassium, phosphorus, iron, vitamin B1, and folic acid. Acid-reducing drugs, such as Prilosec, can interfere with vitamin B12 absorption and likely other nutrients as well, according to Ronald Hunninghake, MD, medical director of the Bright Spot for Health clinic in Wichita, Kansas.
Oral antibiotics, especially broad-spectrum antibiotics, destroy beneficial gut bacteria that aid in digestion and protect against intestinal flus and food poisoning. When that happens, diarrhea is often an immediate consequence, and absorption of vitamins and minerals may be hindered for weeks—or until gut bacteria recover.
Oral contraceptives don’t usually hurt the gut, but they do manipulate hormone levels and lower blood levels of B-complex vitamins, zinc, and manganese. Regular use of NSAIDs, says Hunninghake, increases the risk of ulcers, which lead to problems with the absorption of other drugs and myriad nutrients.
Solution: After taking gut-busting antibiotics or antacids, daily probiotic supplements can help restore normal gut flora. Acidophilus,
Bifidobacterium, and Bulgaricus species are the most common probiotics. Hunninghake recommends taking 500 mg of L-glutamine 15 minutes
before meals—the cells that make up the gut wall use this protein building block as fuel. If you regularly take any type of medication, consider supplementing with a high-potency daily multivitamin.
how are those villi?
problem: Celiac disease can pose a problem for any kind of assimilation. Lest you think this is a rare condition that does not apply, by a conservative estimate celiac affects nearly 3 million Americans, most of whom are not diagnosed.
The condition is characterized by an allergy-like immune response to gluten, a family of proteins in wheat, barley, and rye. For years physicians thought celiac disease was rare. But according to nutritionist Melissa Diane Smith, author of Going Against the Grain (Contemporary Books, 2002), the numbers may be far higher: One-third of people who appear to be symptom-free may have malabsorption problems related to gluten intolerance.
“Simple gluten intolerance—sort of low-grade celiac disease—sets off a ‘silent�?autoimmune reaction in the gut, which damages the intestine and leads to nutrient malabsorption,�?explains Smith. One common clue is unexplained iron deficiency, especially when supplements haven’t helped. Another possible indicator is osteoporosis, because celiac disease often interferes with calcium absorption. According to research by William F. Stenson, MD, of the Washington University School of Medicine, St. Louis, “Three-and-a-half percent of people with osteoporosis have celiac disease—enough to justify blood testing for all osteoporosis patients.�?/FONT>
Solution: Chronic stomach upset and diarrhea are common signs of celiac disease, but these symptoms may not occur in all people. If you have poor bone density, iron-deficiency anemia, or significant bloating after a meal, urge your doctor to test for celiac disease. The specific tests are for HLA-DQ2 and HLA-DQ8 genes, IgG and IgA antigliadin antibodies, antitissue transglutaminase (anti-tTG), or IgA antiendomysial IgA reflex. If you’re gluten sensitive, you’ll have to avoid all foods containing wheat, barley, and rye. Read food labels carefully since many of these ingredients can be hard to spot.
gut instincts
problem: Poor digestion (and an imbalance in stomach acid) can hinder absorption. Medications and celiac disease aside, many people just can’t digest their food. Eating junk food, wolfing down meals, and stress do a number on our guts.
Sometimes the reason is genetic. Back in the 1950s, nutrition pioneer Roger Williams, PhD, noted that there was a 200-fold difference in gastric acid production among people, which would certainly affect digestion. In a world of acid indigestion and gastric-reflux disorders, it would seem that people are wrestling with too much stomach acidity. Studies have clearly shown that poor eating habits are behind these disorders, which affect almost half of Americans one or more times a month. Yet millions of people would rather take a drug than stay away from the foods that upset their digestive tract.
Getting older doesn’t help either. After age 65, you’ll have a one-in-three chance of producing too little stomach acid, or atrophic gastritis. That hinders absorption overall, but it can specifically lead to a deficiency of vitamin B12 (even if you eat B12-rich foods). A severe deficiency can cause potentially fatal pernicious anemia and Alzheimer’s-like symptoms.
When stomach acid decreases, whether because of age or acid-reducing medications, you risk developing an overgrowth of unwanted gut bacteria and a Candida yeast infection. That can lead to gut inflammation and “leaky gut syndrome,�?in which bits of undigested foods pass into the bloodstream and trigger allergy-like reactions. “You don’t absorb what you should, and you absorb what you’re not supposed to,�?says Hunninghake. Belching, having excessive flatulence, and regularly experiencing either diarrhea or constipation are all signs that your eating habits or digestion is off-kilter.
Solution: First, cut back on junk foods, emphasizing fresh whole foods. Second, start taking daily probiotic supplements. Third, drink plenty of water to stay hydrated—you need water to make digestive juices. Fourth, spice up your diet. To accomplish this, Smith recommends liberal use of ginger, onion, red pepper, and mustard, as well as other herbs and spices. “They all increase the secretion of digestive enzymes,�?she says. Finally, add a digestive aid. Digestive aids can come from animal or plant sources. Animal-source digestive enzymes include pancreatin, pepsin, and ox bile. Plant sources include amylase, bromelain, cellulase, lactase, lipase, papain, and protease. If you’ve had acid reflux problems, betaine hydrochloride might aggravate your problems until your gut heals.
raised by wolves?
problem: Eating too fast limits the effectiveness of enzymes. If you don’t chew your food well, you could end up with acid reflux or indigestion.
When we’re stressed, it’s all too easy to “wolf down�?our food (as our mothers used to say) instead of relaxing and savoring the flavors of what we eat. But there’s another reason to chew your food: You’ll get more nutrients from what you eat and reduce acid indigestion.
The entire digestive process is like a series of stepping-stones, with each step built on the previous ones. It all begins in the mouth with chewing and the release of digestive enzymes in saliva, particularly amylase (for breaking down starches) and proteolytic enzymes (for breaking down protein). Here’s the catch: Digestive enzymes work only on the surface of food particles. The more you chew, the smaller the particles, and the greater the surface area covered by digestive enzymes. If you don’t chew well, says Smith, you won’t produce the small amounts of bicarbonate in saliva you need to buffer the reflux response and reduce acidity. This means, she says, that “the epidemic of heartburn may actually be related to inadequate chewing.�?/FONT>
Solution: Take the time to chew your food, and stick with reasonable portions. Supplemental digestive enzymes can help, but even they are no match for golf-ball-size chunks of food. If you occasionally overdo, grab the Swedish bitters. As the name implies, these herbs are no taste treat, but they do promote the secretion of digestive enzymes.
carbs vs. ‘zymes
problem: Not eating enough nutritious foods limits nutrients. Fat- and sugar-laden foods can do a real number on your nutrient levels.
First, they displace more nutritious foods, reducing your overall intake of vitamins and minerals. Second, eating large amounts of sugars and refined carbs can lower your vitamin B1 levels. The breakdown of these foods depends partly on a family of enzymes known as dehydrogenases. More carbs mean you need more dehydrogenases—and therefore more vitamin B1.
Solution: Eating fresh and unprocessed foods provides great nutrition—think fish, chicken, legumes, rice, nuts, and lots of veggies. Supplements should supplement, not replace, good eating habits.
Getting tested
There’s really only one surefire way to determine your blood levels of vitamins and minerals, and that’s through blood testing. Conventional docs might be reluctant to test your nutrient levels, but you can find a sympathetic nutritional physician at http://www.acam.org/. Depending on how many nutrients you want tested, the cost could range from $200 to $2,000. Be forewarned: Your insurer probably will not cover these costs.
Bright Spot for Health
Wichita, Kansas
http://www.brightspot.org/
316.682.3100
Great Smokies Diagnostic Laboratory
Asheville, North Carolina
http://www.gsdl.com/
Pfeiffer Treatment Center
Warrenville, Illinois
http://www.hriptc.org/
Your Future Health
Tavares, Florida
http://www.yourfuturehealth.com/
After getting your test results, check in with your complementary healthcare provider for advice. Together you can adjust your diet or supplements to boost levels of low nutrients. It’s probably worthwhile doing a follow-up test on any problematic nutrients one to two years later.
Courtesy of Alternative Medicine
http://www.alternativemedicine.com
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