In a special three-part series, the “Today” show tries to clear up some of the confusion surrounding vitamins. We know they're important to our health, but what's the best way to get vitamins and which ones do we really need?  Dr. Andrew Weil, author and director of the program in integrative medicine at the University of Arizona in Tucson, was invited on the “Today” show to navigate through the nutrition maze.

When it comes to obtaining the micronutrients your body needs, your best possible source is food, especially fruits and vegetables. But circumstances may prevent you from eating optimally every day. The main reason I take supplements is for insurance against gaps in my diet. Also, researchers are finding that some important vitamins (D and E particularly) and minerals are protective against disease in amounts that may be difficult to obtain through diet alone, no matter how conscientious you are. This is another reason I take supplements faithfully and encourage my patients to do so as well.

I recommend a comprehensive antioxidant and multivitamin for women and men as the basic foundation for nutritional insurance. My recommended daily antioxidant regimen includes 200 mg of vitamin C, 400 to 800 IU of natural vitamin E (or 80 mg of mixed tocopherols and tocotrienols), 200 mcg of selenium, 15,000 to 20,000 IU of mixed carotenoids, and 30 to 100 mg of coenzyme Q10.

Supplementation to cover dietary gaps is only one aspect of optimum health, which also includes the following lifestyle approaches:

Be active
For optimum health, I recommend walking every day.

Eat a diet rich in antioxidants and omega-3 fatty acids
Vegetables and fruits are the best sources of antioxidants, although tea and dark chocolate contribute as well. Cold-water fish, freshly ground flaxseed and walnuts all provide omega-3 fatty acids.

Do not smoke and avoid secondhand smoke
Smoking is the single greatest cause of preventable major illness. The best defense against the harmful effects of tobacco is to never use it.

De-stress
Practice breathing exercises and explore other relaxation techniques such as yoga and meditation to find ones that work for you.

Question and answer
Q. What is the optimum time of day to take vitamin and mineral supplements? Are there certain foods that interfere with absorption?

A. There are no rules about the best time of day to take supplements. My advice is to take them when they agree with you most. Many people find taking pills of any kind as part of a morning routine makes it easier to remember, so taking them with breakfast is a popular option. Vitamin and mineral supplements can cause nausea, heartburn, and other gastric disturbances, especially when taken on an empty stomach. For best absorption and the least irritation to the stomach, I generally suggest taking your supplements with a meal containing fat. This is particularly important for the fat-soluble vitamins (A, D and E). Experiment with taking your supplements with lunch or dinner if they cause you problems with breakfast.

Foods — or an empty stomach — can also interfere with absorption of some vitamins and minerals. With calcium, for instance, you need enough stomach acid to assimilate it, so you’re better off taking it after you’ve eaten, because food in the stomach stimulates acid secretion. Tannins in tea can block absorption of iron, while vitamin C enhances iron absorption, as do fermented soy foods such as miso and the lactic acid in both yogurt and sauerkraut. Foods that interfere with iron absorption include caffeinated beverages, eggs, milk and bran. (You shouldn’t be taking iron supplements or a multivitamin/mineral containing iron unless you’re a premenopausal woman with a heavy menstrual flow or your doctor has recommended an iron supplement because a test has shown you’re iron deficient). In addition to these foods, excess consumption of alcohol can interfere with absorption of several vitamins and minerals.

If you’re eating a healthy, balanced diet, however, you have no reason to worry about foods interfering with the absorption of your vitamin and mineral supplements.

Q. I cannot take a multivitamin or any supplements. I become nauseated and, sometimes, vomit — even if I take it with a meal. Any suggestions?

A.  I’ve come across a number of accounts like yours, but without exception they are from pregnant women or women trying to get pregnant who were taking prenatal vitamins. The culprit seems to be the iron the supplements contain, which can cause nausea or worsen morning sickness during early pregnancy. Check your multi to see if it contains iron. If so, consider whether you really need that mineral. If you’re pregnant, you do need iron, but probably can postpone taking it until your second trimester when you probably won’t be suffering from morning sickness.

If you’re not pregnant, you probably shouldn’t be taking a vitamin/mineral supplement that contains iron. In fact, the only people who need extra iron are women of reproductive age who have heavy menstrual bleeding, which can lead to loss of iron, and people who have been medically diagnosed with iron deficiency, or anemia. No one else should take a supplement containing iron because excess amounts can accumulate in the body and increase the risk of cancer and cardiovascular disease.

If iron is not an issue in your case, I would suggest trying alternative forms of vitamin and mineral supplements designed for people who gag or become nauseated when taking pills. You can get supplements in both spray and liquid form. With spray vitamins, you simply spritz the supplements into your mouth, where they’re directly absorbed by the oral tissues, bypassing the stomach.

With liquid vitamins, you can swallow your daily doses straight or mix the liquid with juice or water. The downside to these alternative forms of vitamin/mineral supplement is cost — a month’s supply may run up to $50 or more for only basic formulations.

Q. I’m curious about interactions between herbs and drugs. Are there many that we should worry about?

A. For the most part, I think warnings about interactions between herbs and drugs are overstated. For example, a few years ago the American Society of Anesthesiologists warned that certain herbs and supplements could pose a hazard to patients undergoing surgery. The group claimed that several herbs have anti-blood-clotting activity and conceivably could interfere with clotting during and after surgery. St. John’s wort was also singled out in 2003 as an agent that could diminish the effectiveness of certain drugs because of its effect on enzyme systems involved in drug metabolism. (Many pharmaceutical drugs have the same effect.)

In general, I think you’re pretty safe taking most supplements, but you certainly should tell your doctor about anything you’re taking regularly, particularly if you’re also taking either prescription or over-the-counter drugs. Here’s a quick rundown of some commonly used supplements and drugs that could interact to your detriment:

St. John’s wort: May affect metabolism of antidepressants; HIV protease inhibitors used to treat HIV/AIDS; digoxin, a heart medication; theophylline, used to treat asthma; cyclosporine, an immunosuppressant; chemotherapy; birth control pills (it may reduce their effectiveness); the blood pressure and heart disease medications nifedipine and diltiazem; Coumadin, a blood-thinner; and non-nucleoside reverse transcriptase inhibitors for HIV/AIDS treatment.

Co-enzyme Q10, dong quai, feverfew, garlic, ginger, ginkgo, ginseng, vitamin E and St. John’s wort: May increase the risk of bleeding if you’re taking prescription anticoagulants such as Coumadin.

Echinacea: May increase levels of HIV protease inhibitors used to treat HIV/AIDS, calcium channel blockers used to treat high blood pressure, and anti-anxiety drugs.

Capsicum (red pepper, cayenne pepper): May increase the absorption and effect of ACE inhibitors used to treat high blood pressure, heart failure and kidney disease; theophylline (for asthma); sedatives; and antidepressants.

Garlic: May decrease the effectiveness of immunosuppressant drugs and HIV protease inhibitors. It also may reduce the need for insulin among diabetics (by lowering blood sugar).

Ginkgo: May increase the amount of antidepressant drugs in your blood; may cause seizures when combined with anti-psychotic drugs.

Ginseng: Can cause headache, trembling and manic behavior when combined with the antidepressant Nardil; may interfere with the action of the heart medication digoxin; may reduce blood sugar levels in people with Type II diabetes, thus affecting the need for insulin or other medication for diabetes.

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