Vitamin D is an essential vitamin that plays a role in inflammation and metabolism (creating energy).

The two main forms of vitamin D are ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D is necessary to treat and lower the risk of conditions related to low vitamin D levels, like rickets and osteoporosis.

You can get vitamin D from your diet, direct sun exposure, or as a supplement. It may interact with other medications and supplements you may be taking, so talk with your healthcare provider before starting vitamin D if you take other medications.

HMG-CoA reductase inhibitors, better known as statins, are medications taken to lower cholesterol levels. Examples of statins include Lipitor (atorvastatin), lovastatin, and Zocor (simvastatin).

Vitamin D may lower how well a statin is absorbed in your blood and travels through your body. A few small studies have shown that vitamin D supplements can lower the amount of statin medication found in your body. However, the risk of this affecting your blood fat (such as lipids and cholesterol) levels is low.

Statins may interact with vitamin D in several ways. Vitamin D is created in the body with the help of a certain type of cholesterol. Taking a medication that lowers cholesterol, such as statins, may impact the natural creation of vitamin D.

Statins and vitamin D are also metabolized (broken down) by the same liver enzyme, cytochrome P450 3A4 (CYP3A4). If you take both vitamin D and a statin, they will compete for the enzyme. This leads to higher levels of one drug (usually vitamin D) in the body and lower levels of the other. More research is needed to understand how these potential interactions affect vitamin D and statins.

It is generally safe to take vitamin D and a statin medication together. Tell your healthcare provider if you are taking a statin with vitamin D. They will watch your cholesterol levels closely or change your cholesterol medication if needed.

Orlistat is a medication taken to help with weight loss. It can be taken as a prescription (Xenical) or purchased over the counter (Alli).

Orlistat breaks down fat from your diet, blocking it from being absorbed in the stomach and intestines and eliminating it through your stool. The medication can also block vitamin D absorption in your stomach and intestines, lowering the overall amount of vitamin D in your body from diet and supplementation.

Talk with your healthcare provider if you are taking orlistat and vitamin D. They will likely monitor your vitamin D levels and recommend that you separate taking both medications by at least two hours.

Thiazide diuretics, also called water pills, treat heart and blood vessel conditions and help you eliminate extra fluid. Examples of thiazide diuretics include hydrochlorothiazide and chlorothiazide.

The drug interaction between vitamin D and thiazide diuretics is related to how vitamin D affects calcium levels. Vitamin D helps your body absorb calcium in the stomach and move the mineral to other areas for use. Both calcium and vitamin D are necessary for numerous body functions, including bone health and muscle contractions.

Thiazide diuretics increase calcium levels in the blood by lowering the amount of calcium lost through urine. Taking thiazides with vitamin D can also cause higher calcium levels (hypercalcemia). The risk for hypercalcemia is higher in older adults or people with kidney disease.

The risk of interaction is higher with larger doses of vitamin D. If you are concerned about a drug interaction between a thiazide diuretic and vitamin D, talk with your healthcare provider.

Corticosteroids are often prescribed to decrease inflammation and treat health conditions like ulcerative colitis or asthma. Examples of corticosteroids include prednisone, hydrocortisone, and dexamethasone.

Research may indicate that steroids can decrease calcium absorption, affecting how well vitamin D is absorbed and used in the body. Some studies have reported that low vitamin D levels are more common in people taking steroids.

Other studies have not found a direct relationship between vitamin D levels and corticosteroid use. They report that the lower vitamin D levels may be related to a person’s diet, sun exposure, and the effect of steroids on bone health.

Bile acid sequestrants are medications prescribed to lower cholesterol and blood sugar levels. Examples include cholestyramine, colesevelam, and colestipol.

Bile acid sequestrants bind bile acid (an acid that helps break down fat) in the intestines and prevent it from entering the blood. This forces the liver to take cholesterol from the blood to make more bile acid, lowering cholesterol levels.

The drug can also bind other drugs, including vitamin D, in the stomach and intestines, lowering the amount of vitamin D in the body. Data on this interaction is limited.

If you are taking a bile acid sequestrant and vitamin D, you should separate when you take each medication. For example, you can take vitamin D at least four hours before a bile acid sequestrant.

Lanoxin (digoxin) is a medication prescribed to treat heart conditions like atrial fibrillation and heart failure.

Taking high doses of vitamin D can increase your risk for hypercalcemia, where there is too much calcium in the blood. High calcium levels can increase your risk for abnormal heart rhythms (arrhythmias) if you also take digoxin.

If you avoid taking vitamin D above the tolerable upper level of 4,000 International Units (IU) daily, the interaction risk is low. If you take digoxin and vitamin D, your healthcare provider will likely monitor your digoxin, vitamin D, and calcium levels.

Cardizem (diltiazem) is a medication prescribed to treat certain heart and blood vessel conditions.

The interaction between vitamin D and diltiazem is related to how both drugs affect calcium levels. High doses of vitamin D can increase your risk for hypercalcemia. High calcium levels can increase your risk for arrhythmias if you are also taking diltiazem.

The interaction risk between diltiazem and vitamin D is low if taking vitamin D below the tolerable daily upper level of 4,000 IU. If taking diltiazem and vitamin D, let your healthcare provider know. They will closely monitor your calcium and vitamin D levels.

Mineral oil is an over-the-counter (OTC) laxative used to treat constipation. Mineral oil blocks water absorption in your colon, which softens your stool and makes it easier to have a bowel movement.

Vitamin D is a fat-soluble vitamin, meaning it is absorbed in your body with fats and oils from your diet. Mineral oil may interact with vitamin D by keeping the vitamin in the intestines, decreasing its ability to be absorbed and used in other areas.

The severity of an interaction between vitamin D and mineral oil is low, especially since mineral oil should only be taken as needed. Let your healthcare provider know you take vitamin D before you begin taking mineral oil. They will likely recommend separating your vitamin D dose from the mineral oil by a few hours.

Vitamin D does not appear to interact with many supplements. However, there are a few supplements you should closely monitor if taking with vitamin D:

• Calcium: At normal doses, taking vitamin D with calcium helps with calcium absorption in the intestines and throughout the body. However, high doses of vitamin D can lead to high calcium levels in certain people. Adding additional calcium supplementation may lead to even higher blood calcium levels, which can be harmful.
• Magnesium: Vitamin D may increase magnesium absorption in the body because the same protein that moves calcium through the intestines can also pick up and move magnesium. Some studies have found that taking vitamin D may improve magnesium levels in people with low magnesium and vitamin D levels. This effect is not likely in people with normal magnesium levels.

Most drug interactions related to vitamin D supplementation lead to decreased absorption and lower levels of the interacting medication in the body.

Some interactions can also lead to hypercalcemia. Symptoms of hypercalcemia include nausea, vomiting, increased thirst, frequent urination, muscle weakness, bone pain, and confusion. If you begin experiencing any of these symptoms, see a healthcare provider.

If taking medications for arrhythmias or other heart conditions, monitor for any signs or symptoms of worsening arrhythmias. Symptoms include fast or slow heart rate, feeling like your heart is skipping a beat, dizziness, lightheadedness, shortness of breath, chest pain, or sweating. See a healthcare provider immediately if you experience any of these symptoms.

Vitamin D is an essential vitamin required for a number of processes in your body, like inflammation and metabolism. It also treats and lowers the risk of conditions related to low vitamin D levels, like rickets and osteoporosis.

Vitamin D can be obtained from your diet, direct sun exposure, or taken as a supplement. It may interact with other medications and supplements you are taking, such as statins, thiazide diuretics, and magnesium.

Talk with your healthcare provider before starting vitamin D, especially if you take other medications. They can help you determine whether any medications seriously interact with the vitamin.

Cold and flu season is in full swing. And if you come down with another case of the sniffles, you may turn to the supplement aisle for additional immune support. 

A common ingredient that you’ll find in many immune-supporting products like supplements and tea is echinacea. Also known as the purple coneflower, echinacea is an herbal plant in the same family as the sunflower and daisy. It’s been used for centuries by Native Americans for respiratory tract infections, tooth pain and snake bites. So, should you stock up on echinacea this cold and flu season? We talked with registered dietitians to get the lowdown on everything you need to know about echinacea. 

Health Benefits of Echinacea

Immune System Support

Most studies on the health benefits of echinacea involve its role in immune health. The National Institutes of Health (NIH) notes that, based on research, echinacea may help reduce your chances of catching a cold or other respiratory tract infection. However, it’s unclear whether it can shorten your cold’s length, yet newer research looks promising. For example, Julie Pace, RDN, a private practice dietitian nutritionist, points to a study that suggested that echinacea may reduce the need for antibiotics for respiratory tract infections by cutting treatment days by as much as 80%.

While we are still learning exactly how echinacea works its magic to support the immune system, researchers suspect that echinacea helps recruit and activate immune cells so you can fight off infection faster. More research is needed to clarify the timing and dosage of echinacea that is most effective for combating the common cold and respiratory infections.

Anti-Inflammatory Properties

Chronic inflammation, the low-grade type, can increase your risk for chronic conditions like diabetes, arthritis and heart disease. Not only that, lingering inflammation also means you’re more likely to come down with a cold or flu. Chronic inflammation can weaken your immune system, hampering its ability to fight off infections effectively. Echinacea is rich in anti-inflammatory compounds like antioxidants that help tamp down excess inflammation, supporting your immune system. In fact, research has found that supplementing with echinacea may lower cytokine levels like IL-6, IL-8, and TNF, which are common markers of inflammation.

Anxiety Reduction

Another benefit that echinacea might have is helping reduce the occasional bout of anxiety. According to Vicki Koenig, M.S., RD, CND, a registered dietitian in private practice, there is some preliminary research that has shown some positive effects of echinacea on anxiety compared to placebo, especially for those with high levels of anxiety.

On the other hand, participants in another similar trial didn’t see any changes in anxiety. Still, those taking the echinacea supplements reported improvements in emotional well-being compared to those on a placebo. Since there are so few studies on this topic, there’s still much to learn if echinacea can positively affect mental health. 

Improved Skin Health

The anti-inflammatory properties of echinacea can also be beneficial for alleviating skin conditions that are aggravated by inflammation, such as atopic dermatitis (also known as eczema). Research found that using echinacea topically for four weeks improved skin dryness and decreased itchiness. That’s because echinacea appears to help support the repair of your skin’s protective barrier, which can alleviate the symptoms of conditions like eczema. 

Risks and Considerations

Echinacea supplements appear to be safe and well-tolerated when taken for the short term. “Most studies examined taking echinacea for anywhere from 10 days to 5 months. The most common adverse effect was a mild gastrointestinal reaction that didn’t require medical care,” says Koenig. While most study participants were adults, some, including children, found that echinacea might also be safe for them and might benefit from its immune-support benefits. However, it’s always best to talk to your pediatrician before considering giving your kid a supplement. 

Since echinacea may stimulate the immune system, those with autoimmune disorders or taking immunosuppression medications may need to avoid it. There is also not enough research on the risks of taking echinacea while pregnant or breastfeeding. People allergic to plants in the daisy family may have an allergic reaction to echinacea.

When weighing the pros and cons of starting a new supplement, it’s always best to check in with your healthcare provider. 

What to Look for in Echinacea Supplements

In stores, you’ll most commonly see echinacea supplements in capsule, tablet or liquid (tincture) form or in teas formulated for immune support made from any part of the plant (root, flower, leaves). Some supplements may also contain flavoring, sugar or sugar-free sweeteners, so keep that in mind when selecting a supplement. Additionally, echinacea may also be included in lotions or other skincare products. When purchasing an echinacea supplement, look for one approved by an independent organization like NSF International or USP. This helps guarantee that the product actually contains the amount of echinacea advertised on the label. 

The Food and Drug Administration (FDA) doesn’t regulate herbs and supplements, and since echinacea falls under this umbrella, a standard dosage has not been established. Instead, it’s best to follow the specific recommendations provided by the supplement manufacturer on the packaging or any dosage instructions given by your healthcare provider.

The Bottom Line

You can take plenty of actions to strengthen your immune system naturally, like getting plenty of sleep, exercising and having a nutritious and balanced diet. If you are looking to invest in one supplement for extra immune-health security this cold and flu season, echinacea may be worth a second look. Research suggests that taking echinacea may reduce your risk of catching the common cold and it’s considered safe for short-term use. That said, more research is needed to confirm other claimed health benefits of echinacea, such as lowered anxiety or improved skin health.

Creatine has become one of the most sought after sports nutrition among gym and sports enthusiasts in recent years, and a new study published in Scientific Reports found that it has significant benefits in raising mean and peak power among combat sports athletes – especially when paired with sodium bicarbonate.

The analysis was conducted by researchers from Universiti Putra Malaysia, Malaysia’s National Sports Institute, Shenzhen Technology University, and Hubei University of Arts and Science.

A total of 67 randomised controlled trials were included in this research. These trials involved a total of 1,026 elite combat sports athletes randomly assigned to using 26 different dietary supplements or placebos.

Examples of the combat sports that these athletes played were judo, jiu-jitsu, wrestling, taekwondo, boxing, karate, kendo, and fencing.

The studies were conducted globally, with seven in Taiwan, two in Japan, one in Hong Kong and South Korea each. Most of them (19), however, were conducted in Brazil.

Caffeine was the most commonly studied supplement, with 24 trials assessing its effects.

Sodium bicarbonate was the next most commonly studied supplement, with 13 studies focusing on it alone, or in combination with either beta-alanine or creatine, and highly alkaline water.

Six other studies looked at beta-alanine alone.

The remaining studies assessed the effects of carbohydrates, electrolytes, branched-chain amino acids (BCAA), arginine, beetroot juice, vitamin C, E, coenzyme Q10, hydrogen-rich water, and omega-3 etc.

The researchers specifically examined the effects of these supplements on final heart rate, blood lactate concentration, mean powder, peak power, number of throws, number of attacks etc.

One of the key findings was that creatine, when paired with sodium bicarbonate, was associated with a statistically significant increase mean power and peak power as compared to placebo.

Out of the 67 trials included in the analysis, a total of 17 and 15 of them assessed the effects of dietary supplements on mean power and peak power respectively.

Using the surface under the cumulative ranking (SUCRA) rankings, the researchers found that the combination of creatine and sodium bicarbonate had the highest score in increasing mean power and peak power.

The combination had a SUCRA ranking of 99.9 per cent in terms of enhancing mean power. This was followed by the use of creatine alone, which had a score of 90.1 per cent, and then sodium bicarbonate alone with a score of 75.4 per cent.

Similarly, when it comes to boosting peak power, creatine and sodium bicarbonate ranked top with a SUCRA score of 98.4 per cent, followed by the use of creatine alone (91.9 per cent), and sodium bicarbonate alone (70.4 per cent).

Aside from creatine and sodium bicarbonate, beta-alanine was another ingredient that was commonly studied for enhancing mean and peak power.

Caffeine for pumping up heart rate, blood lactate concentrations

Caffeine, another commonly used sports nutrition, has been shown to be effective in pumping up final heart rate.

Measuring heart rate is important as this is linked to the amount of blood that is pump out of the heart and into the body to supply oxygen to working muscles.

As compared to placebo, caffeine supplementation was significantly associated with an increase in final heart rate.

Based on the SUCRA rankings, caffeine, arginine, and beetroot juice were identified as the top three interventions for enhancing final heart rate.

Caffeine was also found to have significantly increase blood lactate concentrations, especially when paired with sodium bicarbonate.

“To our knowledge, this is the first comprehensive systematic review with NMA (network meta-analysis) of available effectiveness data on dietary supplements for elite combat athletes.

“This study suggests that a range of dietary supplements, including caffeine, sodium bicarbonate, sodium bicarbonate combined with caffeine, creatine, creatine combined with sodium bicarbonate, and beta-alanine can improve the athletic performance of elite combat sports athletes,” said the researchers.

Source: Scientific Reports

Advantages of different dietary supplements for elite combat sports athletes: a systematic review and Bayesian network meta-analysis

https://doi.org/10.1038/s41598-024-84359-3

Authors: Luo, H., Tengku Kamalden, T.F., Zhu, X. et al.

The anti-ageing regime of an eccentric American entrepreneur who takes more than 100 pills a day could be harmful if copied, a leading nutritionist has warned.

Millionaire Bryan Johnson’s quest for longevity is captured in the Netflix documentary Don’t Die: The Man Who Wants to Live Forever.

Within the first 10 minutes, a breakdown of the 47-year-old’s routine shows him taking three pills upon waking, 54 at breakfast and 34 more later.

A list shown on screen includes pills for vitamin C, heme iron, zinc, metformin and taurine. Johnson has previously said his full plan includes more than 100 drugs and supplements.

Vicky Pennington, nutritionist at Boots, told the Express Johnson’s regime was “tailored to help achieve his personal goals and includes a blend of many different supplements with some at high levels”.

But she warned: “For most of us, taking too many supplements all at once can be harmful. In addition, your body might not require any additional supplements on top of your daily diet and taking an excess amount could be unsafe.

“For example, taking more than 100mg of vitamin D a day could be harmful, as it can cause calcium to build up in the body, which is known as hypercalcemia. This can weaken the bones and damage the kidneys and the heart.

“Therefore, it’s important to follow the instructions on the packaging for any supplements that you wish to take and consult a healthcare professional for personalised advice.”

Johnson’s daily “Blueprint” routine begins at 4.30am and includes more than 100 steps to keep his body “in its ideal state”.

Others include electromagnetic stimulation of his abdomen, wearing a laser cap to promote hair growth and something called “penis shockwave therapy”.

Johnson explains in the documentary: “By doing Blueprint, one of the key objectives is to achieve the lowest possible biological age. Just like a tree has rings, we all have a signature inside our body of our age.

“After doing Blueprint now for two years, I have reversed my biological age [by] 5.1 years…and my speed of ageing is 0.69, which means for every 12 months [lived], I age eight months.

“In terms of how far this goes, it’s open-ended – we have no idea. But I want to take my speed of ageing to the lowest possible number.”

Ms Pennington said most people can get all the nutrients they need by eating a varied and balanced diet, although supplements can support this if a particular nutrient is lacking.

She added: “If you decide to take any supplement it should always be taken following the instructions on the packaging.

“One supplement that all adults should consider taking is vitamin D. The Government recommends that we should all consider taking 10 micrograms of vitamin D daily throughout the winter months and some people should consider taking it all year round.”

Sunlight is the main natural source of vitamin D and our bodies can struggle to make enough between March and October.

Vitamin B12 is another supplement that may benefit people with a vegan or plant-based diet who do not get it from eating meat, fish, poultry, eggs or dairy, Ms Pennington said.

She added: “For many other vitamins and minerals, a supplement should only be considered if we don’t feel we are getting enough from our diet.

“Everyone’s dietary needs differ, and supplements can impact our bodies in different ways, so you may wish to speak to a healthcare professional such as a pharmacist or a GP if you are unsure or need any advice. There is also information on supplements available on Boots Health Hub.

“A multivitamin product is a really easy way to get a range of nutrients in one, but if you wish to take another supplement alongside a multivitamin, make sure you’re not doubling up on any nutrients, to avoid taking too much. Taking too much of certain nutrients may not be safe.”