Ask Tufts Experts: Taking Supplements With Food; Nitrates in “No Nitrate Added” Meats
Should I take my vitamin and mineral supplements with or without food?
Judith C. Thalheimer, RD, LDN, managing editor of Tufts Health & Nutrition Letter, answers: “If you’ve been told by a healthcare professional that you are in need of a dietary supplement, there are some things you can do to maximize absorption.
“Vitamins A, D, E, and K are fat soluble. This means they dissolve in fat, not water. These vitamins should be taken with a meal that contains some fat (preferably the healthy unsaturated fats found primarily in plant oils and plant foods like nuts and seeds). All other vitamins (the eight B vitamins and vitamin C) are water soluble and may be best absorbed when taken on an empty stomach with a glass of water (although with a meal is fine).
“Calcium supplements come in two forms: calcium carbonate and calcium citrate. Calcium carbonate requires stomach acid to be properly absorbed, so it is best taken with a meal since the presence of food in the stomach stimulates acid production. Calcium citrate can be taken with or without food and is often recommended for people who take antacids because it does not require stomach acid for absorption. Vitamin D is necessary for calcium absorption. If you aren’t getting enough vitamin D from sunlight or your diet, you may want to choose a calcium supplement that contains vitamin D. Keep in mind that only around 500 milligrams of calcium can be absorbed at a time, so don’t bother taking a supplement with more. In some cases, more may be harmful.
“Iron is best absorbed when taken on an empty stomach but it can be taken with or after a meal if it upsets your stomach. Over-the-counter supplements contain iron in the form of either ferrous salts or ferric salts. Ferrous salts are better absorbed. Vitamin C enhances absorption of iron, so taking an iron supplement formulated with vitamin C or taking your iron pill with a glass of orange or grapefruit juice may help absorption.
“Multi-vitamin and mineral supplements contain nutrients with different requirements for ideal absorption. If you follow a generally healthy overall dietary pattern, this type of dietary supplement is unnecessary. If you do take a multinutrient preparation, it is fine to take it with a meal.”
You have stated that cured meats that say ‘no nitrate or nitrite added’ still contain these potentially cancer-causing compounds. Can you please explain this?
Alice H. Lichtenstein, DSc, Stanley N. Gershoff Professor of Nutrition Science and Policy at the Friedman School and executive editor of Tufts Health & Nutrition Letter, answers: “Adding nitrates or nitrites to meat or poultry keeps it from turning brown, gives it the ‘cured meat’ flavor we’re accustomed to, and kills bacteria. Nitrates themselves are not harmful, but they can be turned into nitrites in the body. Nitrites can be converted to nitric oxide (which is good) or nitrosamines (which increase cancer risk). The presence of high amounts of nitrates and nitrites in cured meats (like bacon, ham, hot dogs, and deli meats, including turkey) is likely one of the reasons consumption of these products is associated with higher risk of colon cancer.
“Some manufactures stopped adding synthetic nitrates/nitrites to their processed meats to meet consumer demand for healthier products. The U.S. Department of Agriculture (USDA) required these products be clearly marked ‘Uncured’ and ‘No Nitrate or Nitrite Added.’ In 2019, a study by Consumer Reports found nitrates and nitrites in these ‘uncured’ products at levels similar to those in meats prepared with synthetic curing agents. These manufacturers were using natural sources of nitrates, including celery juice powder, beet juice powder, carrot juice concentrate, and sea salt. While naturally-occuring nitrates are not harmful at the levels they are found in foods like celery and beets, they are not chemically different from synthetic forms once they are extracted and concentrated.
“In response to complaints, the USDA has said it will prohibit the ‘No Nitrate or Nitrite Added’ label on products using any source of nitrates or nitrites. It will still be up to the consumer to check ingredient lists for sources of naturally occurring nitrates/nitrites.”
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