Dr. Vliet’s GUIDE to Supplement Smarts: Timing Is Everything! Small Details, Bigger Benefits

If you are like many of my patients and our readers, you have done your research, read my health tips, have chosen the highest quality products and have been taking your supplements regularly for weeks, months or even years. Especially since COVID, I and most of my patients have been even more vigilant about getting the right supplements and taking them properly.

But, as diligent as you may be, are you sure you are taking the right supplements at the right time of day and in the right combination for maximal effectiveness and benefit? Have you ever thought to yourself “Am I taking my supplements at the right time of day?” “Should this be taken with or without food?” “What supplements should be taken together? “Do I need to avoid certain medicines with my supplements?

If so, you are not alone. If you have ever wondered if you are taking your supplements correctly, this health tip is for you! Kathy and I are reviewing some of the instructions she and I go over with every new patient and review on a regular basis with my all my patients. I take this time in patient appointments because I know how important these timing details are when we are looking for maximal benefits on health and resilience and recovery from illness and injury. If you are going to spend the money to buy premium products, let’s make sure you are getting the most out of them.

Obviously I cannot go through each one of your supplement regimens directly with you, but in this health tip I wanted to share with you some of the principles and guidance I give my patients about how best to take some of our most popular supplements, starting with my core Resilience Formula – the supplement regimen I recommend and tweak for my patients and from which we build upon to address individual needs. Since the beginning of my career in medicine, I have recommended this combination of vitamins and supplements I considered essential to optimizing health and improving resilience against disease and recovery from injury or surgery.

If you have not already done so, I strongly recommend before starting on supplements, get the lab tests to check your levels needed to correct deficiencies. Then work with your physician or health care professional to develop an individual plan for your needs, just as I do with my own patients.

A good example of the importance of checking labs is the question “Should I take a multivitamin with iron or one without iron?”  Checking ferritin levels to measure iron stores, plus an “anemia panel” for iron status will tell you if you need to supplementing with iron or not. And whether you take iron or not makes a huge difference in how best to take all your other supplements!

Please remember this article is for general education and not a substitute for your personal health professional’s dosing guidelines, indication, lab-monitoring plan, or medication interactions. 

How To Take the Basics in our Resilience Formula – Your Supplement Foundation

Since the beginning of my career in medicine, I have recommended a combination of vitamins and supplements I considered essential to optimizing health –my core “Health and Resilience” formula. I recommend you start with our Resilience formula which is based upon my many years of medical practice and the basic supplements, plus a few new ones added to address the six classes of damage from Covid illness and adverse side effects from Covid injections as well as many common medical conditions. I believe this combination is an essential part in building a foundation for overall health and resilience to stand up to new environmental assaults – from our food supply, pollution, EMF radiation and novel viruses we face daily. From this foundation, you would then add any additional supplements to benefit your specific health goals.  You can see the ones in my Resilience formula in this chart below:

Over the years I have researched various supplement manufacturers to make specific suggestions for high quality balanced with cost and availability.  I had a few companies I felt met the standards I wanted to recommend for my patients. But the general public, most doctors, and most alternative practitioners selling products don’t know that over the last 5+ years, many of the smaller companies making top-quality supplements that I used to recommend have been bought out by big Pharma, giant food conglomerates, and even investment companies—these huge global corporations seek to capture the huge profits in the burgeoning supplement market.  To maximize profits, these mega-companies are not necessarily focused on maintaining high quality as they look to increase profit margins with cheaper ingredients.  I am no longer recommending the products I used to for my family and patients because of my concerns for changes in quality and source of the ingredients and lack of transparency.

This is what led me to develop our Truth for Health Foundation private label. After much time and research, I have been able to curate products with the quality I trust for my family, my patients and myself and put my name on to recommend for others. All Truth for Health products are made in the USA and meet or exceed certified Good Manufacturing Practices, indicated by the cGMP on each label. If this cGMP designation is not on the label of products YOU take, then they don’t meet this higher quality standard, and you may want to reconsider what you take.

Our cGMP products are made in the US with ingredients that are properly sourced and tracked as required under cGMP standards.  Each product also has a detailed product data sheet, similar to the “package insert” in your prescription medicines.  The same regulatory approval process applies to the Product Data Sheet, which must include full disclosure of all ingredients, description of how they work, any applicable patents to improve bioavailability and/or absorption/utilization, research studies to support all the clinical applications, and any other unique information for that product.  You have full disclosure and transparency on every product we sell under the Truth for Health Foundation labeling.  You can also read my more detailed Health Tips on each product here in our archive: https://www.truthforhealth.org/category/health-tips/

First Step:  KEY POINTS ON IMPORTANT SPACING GUIDELINES

• Do not take magnesium and calcium together, either in a “combo” pill, OR just at the same time.  Calcium interferes with magnesium absorption, which is already poorly absorbed.  Calcium is better absorbed orally than is magnesium, and a calcium predominance in your supplement adds to the problem of constipation and calcium deposits in soft tissues.  IF you need a calcium supplement—and many people who eat dairy foods do NOT need a separate calcium supplement—take it at least four hours away from magnesium supplements, which most Americans really do need.
• Separate zinc and magnesium for about 2 hours because they can compete for absorption. Both may cause mild nausea if taken together on an empty stomach.
• Separate zinc and multivitamin for about 2 hours to prevent mineral crowding with calcium, magnesium, additional zinc and other minerals.
• Separate magnesium and multivitamins for about 2 hours due to competition for absorption among mineral supplements.
• Separate probiotics and antibiotics by at least 2 hours to reduce the chance of antibiotic inactivating the probiotic. You may take probiotics during antibiotic courses to help maintain a healthy gut microbiome, but it is especially important to continue taking a m ulti-strain high flora volume probiotic supplement for several weeks after antibiotic use to repair any damage to the microbiome.
• Separate magnesium or zinc from tetracycline/fluoroquinolone antibiotics, usually several hours apart. These minerals can bind the antibiotic and reduce its absorption.

Second Step: THYROID MEDICATION: A Special Challenge (includes Synthroid brand, generic T4-levothyroxine, Cytomel brand, generic T3- liothyronine, Armour thyroid, NP thyroid, and even the liquid gelcap Tirosint that is independent of pH)

It is trickier to time your supplements when you are taking THYOID MEDICINE first thing in the morning. There are about 22 million people in the U.S., about 7% of the population – roughly 1 in 14 people – that have an active thyroid prescription (T4-levothyroxine, OR T3-liothyronine), so I wanted to address the timing of your supplements relative to taking your thyroid medicine since many doctors don’t discuss this.

Tirosint brand of levothyroxine is a uniquely formulated gel CAPSULE of T4 in a patented liquid gel delivery method that is independent of gastric pH, so it can be taken with food.  But even Tirosint gel caps are still affected by certain mineral supplements and should be taken separately.

KEY POINT: TAKE THYROID MEDICINE AT LEAST FOUR (4) HOURS APART from IRON, CALCIUM, MAGNESIUM, AND OTHER MINERALS!

All of these mineral-containing supplements, especially iron, calcium or dairy foods, and even magnesium and zinc—should be at least 4 hours away from thyroid Rx, since the minerals interfere with both absorption AND effectiveness of thyroid medicines.

ALL TABLET forms of thyroid Rx should be taken alone in the early morning on an empty stomach with just water, no food or supplements.  Wait 30–60 minutes before eating breakfast.

Then wait at least 4 hours after your thyroid medicine in the morning before taking any supplements with minerals such as iron, calcium, magnesium, multivitamins with minerals. Iron actually can bind levothyroxine in the gut and reduce its absorption.  Consider taking your multivitamin-mineral and other mineral supplements at lunchtime.

Keep your thyroid medication timing consistent every day. Consistency makes interpretation of lab tests more reliable and reduces dose-adjustment confusion.

Sample routine:

• 6:00 a.m.: Synthroid with water only
• 6:30–7:00 a.m.: Breakfast
• 12:00 p.m.: Multivitamin with iron + vitamin C + L-ergothioneine
• 12:00 p.m. or dinner: D3/K2 + vitamin E + fish oil, with a fat-containing meal
• 6:00 p.m.: Zinc + NAC, with dinner
• 9:00–10:00 p.m.: B complex + Magnesium + probiotic

Important adjustments

• If the multivitamin contains calcium, magnesium, zinc, or substantial iron, lunchtime remains the best default because it is well beyond the 4-hour thyroid Rx window.
• If the multivitamin is being used to treat confirmed iron deficiency, ask whether the elemental iron amount and dosing schedule are sufficient; many standard multivitamins contain only a modest amount and most people who are below 60 on ferritin and/or have anemia will also need a high potency iron supplement, such as liquid polysaccharide iron complex, Nova Ferrum.
• Separate magnesium, zinc, and iron from antibiotics, GERD or acid-reducing medicines (Rx or OTC). and phosphonates due to interference and reduced absorption.  Check your medication-specific directions; or ask your pharmacist to guide you on an exact schedule if you use any of these medicines.

Supplement Smarts: Uses, Timing, and Cautions on Combinations to Avoid

Multivitamin and Multivitamin with iron A broad product combining vitamins/minerals. It is used to address dietary gaps and support prevention/treatment of vitamin or mineral deficiencies.

• Absorption is best with food for a multivitamin without iron and can minimize any stomach upset. Take with a meal that includes some fat for better absorption of vitamins A, D, E and K.
• A multivitamin with iron is best taken with vitamin C but away from high fiber food, dairy/calcium, tea, or coffee.  If it causes some stomach upset then take with a small snack.
• Avoid taking iron-containing multivitamins with wine, magnesium, zinc, antacids, and acid-suppressing medicines as these can reduce iron absorption. Keep separate from levothyroxine, tetracycline/fluoroquinolone antibiotics, and bisphosphonates.

You can also read my more detailed Health Tips on our Multivitamin products in our archive: https://www.truthforhealth.org/category/health-tips/

Vitamin D3 Cholecalciferol is the form of vitamin D3 is used to support calcium/phosphate regulation, bone health, immune function, as well as neurological, musculoskeletal, cellular, and cardiovascular health.

• Take with a meal containing dietary fat, preferably breakfast or lunch. Taking it with K2, magnesium, and fish oil is usually convenient.
• Monitor dose by checking serum level of 25(OH) vitamin D, which you can order yourself on line if your doctor isn’t checking it.  I also recommend checking serum calcium, kidney function while taking vitamin D at higher doses due to deficiency.  Follow your doctor’s guidance if you have kidney disease, kidney stones, hypercalcemia, sarcoidosis/other granulomatous disease, primary elevated parathyroid hormone. Orlistat and bile-acid sequestrant medicines can reduce absorption of vitamin D3.

You can also read my more detailed Health Tips on Vitamin D3 here in our archive: https://www.truthforhealth.org/category/health-tips/

Vitamin K2 Is a menaquinone (a subgroup of the fat-soluble vitamin K) often MK-7 or MK-4. K2 MK-7 is preferred for bone and vascular support because it reduces arterial calcium deposits and is necessary for bone mineralization. It activates osteocalcin, the protein needed to bind calcium to the mineral matrix in bone.

• Take with a fat-containing meal; pairing with D3 is common and practical.  Vitamin K has really emerged as a key player when it comes to bone health.
• If taking warfarin or an anticoagulant – Do not start, stop, or change K2 without your prescriber’s direction. Consistency of vitamin K intake is central to warfarin management.

Read my more detailed Health Tips on Vitamain K2 here in our archive: https://www.truthforhealth.org/category/health-tips/

Vitamin C with Bioflavonoids Water-soluble ascorbic acid, required for synthesis of collagen, neurotransmitters, and carnitine, supports antioxidant and immune function, and non-heme iron absorption. Bioflavonoids support healthy metabolism and cognition by functioning as cell-signaling agents.

• Take with or without food. Pair it with iron to improve iron absorption. Divide doses if larger amounts cause reflux, cramping, or diarrhea.
• It can enhance iron absorption, so use thoughtfully in iron overload disorders such as hemochromatosis. Higher doses may be problematic for people prone to oxalate kidney stones or with significant kidney impairment.

Read my more detailed Health Tips on Vitamin C with Bioflavinoids here in our archive: https://www.truthforhealth.org/category/health-tips/

Zinc An essential trace mineral involved in immune function, wound healing, DNA/protein synthesis, taste/smell, bone health and reproductive function especially in supporting testosterone levels in men and women (though to a lesser extent).

• Take with food if it causes nausea. Lunch or dinner is often easiest.
• Separate from iron, magnesium, calcium, and multivitamins containing minerals by about 2 hours when possible. Also separate from tetracycline antibiotics, fluoroquinolone antibiotics, and penicillamine—these require medication-specific timing guidance. Long-term high-dose zinc can induce copper deficiency; dose and duration matter.

You can also read my more detailed Health Tips on zinc here in our archive: https://www.truthforhealth.org/category/health-tips/

Magnesium An essential mineral and enzyme cofactor involved in neuromuscular function, glucose metabolism, energy production, and bone physiology. Common uses include support for constipation, migraine prevention, sleep, or muscle symptoms.

• Take with food if GI sensitivity occurs; evening is often convenient. Glycinate is often chosen for gentler GI tolerability, whereas citrate more often loosens stools.
• Separate from iron and zinc for about 2 hours. Magnesium can reduce absorption of levothyroxine, tetracycline/fluoroquinolone antibiotics, and bisphosphonates; these medicines need substantial separation according to their instructions. Use medical guidance in moderate-to-severe kidney disease.

You can also read my more detailed Health Tips on magnesium here in our archive: https://www.truthforhealth.org/category/health-tips/

NAC N-acetylcysteine, a cysteine donor that replenishes glutathione and is a standard medical antidote for acetaminophen poisoning. NAC and glutathione support antioxidant and detoxification activity in the body. It is also supports normal mucous production and respiratory function and eye health, especially when consumed over a prolonged period. Research suggests that NAC may protect cell and tissue health by supporting normal metal status in the body.

• Can be taken with or without food. Empty stomach may be preferred for some, but taking it with food is fine if nausea occurs. Morning or midday is convenient.
• Can cause GI upset and have a sulfur-like odor. If taking nitroglycerin, review use with your prescriber because it may augment headache and blood pressure-lowering effects. Use caution with asthma/bronchospasm history and around surgery or anticoagulant/antiplatelet therapy.

You can also read my more detailed Health Tips on NAC here in our archive: https://www.truthforhealth.org/category/health-tips/

Vitamin E A group of fat-soluble tocopherols/tocotrienols that functions as an antioxidant to helps protect cell membranes and other lipids from oxidative damage.  Make sure you only take a supplement that is the natural d-alpha tocopherol with full spectrum mixed tocopherls and tocotrienols like our TruVitamin E.  I do not recommend taking vitamin E using the synthetic form dl-alpha-tocopherol that is the form in almost all of the inexpensive commercial vitamin E supplements.  Take Vitamin E with a meal containing fat.  You can take it at the same time as D3/K2 and fish oil.

You can also read my more detailed Health Tips on Vitamin E here in our archive: https://www.truthforhealth.org/category/health-tips/
Higher supplemental doses of Vitamin E can increase bleeding tendency, especially if you also take a “spike Detox” product with nattokinase, bromelain, and curcumin, or also take Rx medicines such as warfarin, apixaban, rivaroxaban, clopidogrel, aspirin, NSAIDs, or high-dose fish oil. Avoid assuming “more is better”; high-dose Vitamin E on daily basis is not appropriate for everyone.  Check with your own physician to guide you.

L-ergothioneine A naturally occurring sulfur-containing amino-acid derivative found especially in mushrooms. It accumulates in certain tissues through a specific transporter and is used for antioxidant and cytoprotective roles in the body. TruMitochondrial™ Boost features the concentrated form of the histidine derivative L-ergothioneine to combat oxidative stress throughout the body and provides multiple health benefits including support of neurologic and cognitive health,

• Can generally be taken with or without food; take it consistently at a time that fits best for you although earlier in the day is preferrable for benefit throughout the day.
• No contraindications with other supplements, minerals or vitamins, fish oil, etc.

You can also read my more detailed Health Tips on L-ergothioneine here in our archive: https://www.truthforhealth.org/category/health-tips/

Probiotics A preparation of live microorganisms intended assist in establishing and maintaining a health gut microbiome. Effects are strain- and indication-specific, not generic to every product. Commonly considered for selected antibiotic-associated diarrhea, some functional GI symptoms, and an ever-expanding variety of health outcomes being studied throughout the body.

• Follow the product label because formulations vary. Look for a product designed to survive the acidic stomach environment and make it to the intestines for maximal benefit. It is recommended to take most probiotics at least 30 minutes before a meal or 2 hours after. Can also be taken at bedtime; but avoid mixing with hot liquids. If taking an antibiotic, keep separate for at least 2 hours unless your prescriber/product directs otherwise.
• Avoid self-prescribing in severe immunosuppression, critical illness, central venous catheter use, severe pancreatitis, or other high-risk situations without explicit specialist direction. Probiotics have an overall history of apparent safety in healthy people, but serious infections have been reported in vulnerable patients.

You can also read my more detailed Health Tips on probiotics here in our archive: https://www.truthforhealth.org/category/health-tips/

Vitamin B complex A combination of water-soluble B vitamins, preferably an activated B-complex containing methylated forms: commonly B1, B2, B3, B5, B6, biotin, folate, and B12. These support energy metabolism, red blood cell formation, nervous-system function, and methylation-related pathways.

• You can take B complex with breakfast or lunch, with food especially if nausea is an issue. But the B vitamins are particularly important in the sleep-regulating pathways so if you are having problems with insomnia I tell my patients to take it at bedtime.  For those who feel the vitamins give them too much energy, take it in the morning.
• Check duplication with multivitamins. Avoid chronic high-dose B6 unless prescribed, as it can cause sensory neuropathy. Niacin can cause flushing and, at high doses, liver toxicity; folate can obscure hematologic signs of B12 deficiency. Metformin and acid-suppressing therapy can affect B12 status, so regular laboratory tests are appropriate before starting and for monitoring additional vitamin B supplementation in addition to what is in a multivitamin.

You can also read my more detailed Health Tips on B Complex here in our archive: https://www.truthforhealth.org/category/health-tips/

Fish oil:  Not part of my core Resilience Formula, but a common supplement many people are taking and there are some tips on the best way to take it that I wanted to share with you.   Fish oil is a source of omega-3 fatty acids—primarily EPA and DHA, but some contain DPA. It is commonly used to lower triglycerides at prescription-strength dosing and supports cardiovascular and mental health plus healthy glucose and insulin metabolism.

• Take with a meal containing fat to improve tolerability and reduce “fishy” reflux
• OR, take one TruOmega Pure that is formulated to reduce this unpleasantness of fishy reflux, Gi upset, and diarrhea many people experience with concentrated fish oil supplements. It can be taken with D3/K2/vitamin E.
• Check the label for actual EPA+DHA+DPA, not merely “fish oil” total. Higher-dose omega-3s warrant medication review in people using anticoagulants/antiplatelets, with bleeding disorders, or with a history/risk of atrial fibrillation.

You can also read my more detailed Health Tips on fish oils here in our archive: https://www.truthforhealth.org/category/health-tips/

Putting it all together

Many supplement regimens, my Resilience Formula included, contain both fat-soluble nutrients, water-soluble nutrients, minerals, amino-acid derivatives, and microbiome support. Some of the main issues are spacing iron, zinc, and magnesium apart and taking the fat-soluble products with a meal that contains fat. Here are some important spacing rules.

Key combinations and separations
Reasonable combinations

• D3 + K2 + vitamin E + fish oil with a meal containing fat.
• Vitamin C with the iron-containing multivitamin.
• Magnesium in the evening, separated from iron and zinc.
• B complex with breakfast—provided the combined multivitamin + B-complex doses are reviewed.

At-a-glance Schedule for Multivitamin without Iron
With a multivitamin without iron, the schedule is simpler: you no longer need to protect iron absorption or pair the multivitamin with vitamin C. The primary spacing issue remains separating zinc and magnesium from the multivitamin if it contains meaningful amounts of competing minerals.

A simpler daily routine

• Breakfast: Multivitamin without iron + L-ergothioneine
• Lunch with fat: D3/K2 + vitamin E + fish oil
• Dinner: Zinc + NAC + vitamin C
• Bedtime: Magnesium + probiotic + B complex

If zinc causes nausea at dinner, move it to lunch. If magnesium causes loose stools, lower the dose, divide it, or discuss changing the formulation with your physician. I generally suggest taking Magnesium at bedtime to encourage regular bowel movements in the morning and prevent issues like loose stools during the day.  If constipation is a problem, I have seen that patients have better relief using at least 400 mg of a magnesium oxide powder in a capsule at bedtime or possible a powdered form added to water at bedtime.  Other forms of magnesium have other benefits but often are not as effective at relieving constipation.  See my more detailed magnesium Health Tips in our archive here: https://www.truthforhealth.org/category/health-tips/

Medication and safety review

Before starting any supplements or supplement regimen and are taking medications, have your physician or pharmacist reconcile it against all prescriptions and over-the-counter products—especially warfarin or other blood thinners, thyroid hormone, antibiotics, bisphosphonates, acid-suppressing drugs, diabetes medications, diuretics, and drugs for blood pressure.

As you put all the pieces together that I have described today, I encourage you to consider our other natural medicines with our top quality, cGMP-compliant professional formulas: TruMitochondrial™ Boost,  TruNAC™, Tru BioD3, Tru B™ Complex Full Spectrum, TruZinc™, TruC with BioFlavonoids  (Natural sourced Vitamin C with complete Bioflavonoids), and TruProBiotic™ Daily to replenish critical bifidobacteria depleted by COVID shots, viral illnesses, and antibiotic therapy.

All Truth for Health Foundation Products Meet or Exceed cGMP Quality Standards, the highest quality standard for supplements sold in the USA. For more information, references from studies are listed in the Product Data Sheets for each product, available on our website.  Check us out at www.TruthforHealth.org Click on tab for Store.  OR www.shopTruthforHealth.com

CAUTION: As always, we urge you to avoid supplements without checking knowledgeable sources to evaluate your medical situation, proper lab tests to verify what is needed, and to make sure to avoid adverse interactions with prescription medicines and other supplements you take.  Under medical practice regulations, we are unable to answer individual medical questions or make specific individual supplement recommendations for people who are not established patients of Dr. Vliet’s independent medical practice (www.ViveLifeCenter.com).

To Your good health and improving resilience!
Elizabeth Lee Vliet, MD