Ask the RD | September

Our registered dietitian, Jamie, offers answers to nutrition-related questions our community have submitted over the past month.

The information shared within this blog is meant for informational purposes only and should not be received as medical advice.

If you have a question to submit, please click the button and watch for a response the following month. Before submitting a question, we invite you to visit the main page for Ask the RD and enter a keyword into the search box — your question may already be answered!

• For someone with heart conditions, are there certain foods to avoid that may interact with common medications?

  There are a few common food/nutrient-drug interactions to be aware of when taking medications to support your heart.

  1. Grapefruit, grapefruit juice, and other products containing grapefruit can interfere with cholesterol-lowering statin medications (i.e., atorvastatin) and blood pressure-lowering calcium channel blockers (i.e., amlodipine) as it blocks the enzyme that is involved in metabolizing these medications.

  2. Vitamin K foods such as kale, spinach, broccoli, and other greens, can interact with the blood thinning medication warfarin. As vitamin K aids in blood clotting, variable intakes of vitamin K-containing foods can cause this medication to be more effective, or less effective, in thinning the blood. Because of this, people taking warfarin need to be consistent with their diet for this medication to work safely and appropriately.

  3. Potassium is a mineral typically found in fruits such as tomatoes, potatoes, avocados, citrus fruits, and bananas. Blood pressure medications such ACE inhibitors (i.e., lisinopril) and some diuretics (i.e., spironolactone) can lead to a buildup of potassium in the body. These medications, paired with a high potassium diet, could result in elevated potassium levels in the body which can cause dangerous heart arrythmias.

  4. Alcohol can interact with nitrates (i.e., nitroglycerin), commonly used to treat chest pain, and beta-blockers (i.e., metoprolol) which are used to control heart rate and blood pressure. Mixing these medications with alcohol can lead to dangerous drops in blood pressure, dizziness, and/or fainting.

  It is always recommended to discuss potential medication interactions with your physician and/or pharmacist, as well as complete the recommended lab checks to keep yourself safe in allowing the medication to work as intended.

• Are there recommended pairings for best absorption of vitamin and mineral supplements?

  Many foods work synergistically in the body; meaning that specific food or supplement pairings can lead to better absorption and utilization of inherent nutrients or compounds (i.e., bioavailability). Not only that, but they can also promote satiety and satisfaction when eating. 

  Examples of pairings:

  • Calcium + vitamin D. Vitamin D works to support your intestinal absorption of calcium.

    • High protein chia pudding made with soy milk and Greek yogurt

    • Grilled salmon or tuna with sautéed broccoli and bok choy

  • Plant-based iron + vitamin C. Non-heme iron from plant sources such as beans, lentils, nuts, seeds, and dark leafy greens benefit from vitamin C pairing to increase its’ bioavailability. Example:‍ ‍

    • Spinach salad topped with strawberry vinaigrette dressing

    • White bean salad topped with a squeeze of fresh lemon and a drizzle of olive oil

    • Hummus with sliced tomatoes and bell peppers

  • Fruits and veggies + healthy fats for best absorption of antioxidants, anti-inflammatory compounds, and fat-soluble vitamins A, D, E, and K. Examples:

    • Fresh tomatoes and basil drizzled with olive oil for maximal lycopene utilization

    • Roasted sweet potatoes topped with fried egg and avocado for enhanced beta-carotene absorption

    • Kale salad with olive oil-based dressing, added avocado, nuts or seeds for better vitamin K utilization

  • Turmeric + black pepper. This pairing helps to optimize the absorption of the antioxidant and anti-inflammatory compound curcumin from the turmeric. Example:

    • Season chicken, fish, tofu, or lentils with turmeric, black pepper, and a drizzle of olive oil

  Some supplement combinations to consider:

  • Iron + vitamin C

    • Take your iron supplements with vitamin C-rich food (i.e., citrus fruit, orange juice, strawberries, or bell peppers)

    • Avoid taking iron supplements with coffee, tea, or calcium supplements —these can block iron absorption

  • Zinc + vitamin C‍

    • Take together for antioxidant benefits, immune support, and wound healing ‍

  • Vitamins A, D, E, K + healthy fats

    • Pair any of these fat-soluble supplements with healthy fat (i.e., peanut butter, olive oil, avocado, salmon or tuna)

    • Take vitamin D with

      • Vitamin K2 for bone health benefit

      • Magnesium to activate the vitamin D into its’ usable form

  • Calcium + vitamin D‍

    • Take together — vitamin D aids in calcium absorption

    • Avoid taking calcium supplements at the same time as iron — these compete for absorption

    • Take calcium in divided doses of 500-600mg at a time for best absorption

  Getting nutrients through a healthy and balanced diet is always recommended before reaching for the pill form of specific nutrients. However, sometimes supplementation is necessary. As with all dietary supplements, check with your healthcare provider to ensure they are safe for you and do not interfere with any of your prescribed medications. You can also find out more through the NIH Office of Dietary Supplements at https://ods.od.nih.gov/.

Jamie Libera, RD, LD, CCTD, is a clinical dietitian within the Providence health system. She works closely with the heart programs in offering consultations for heart failure patients, cardiac rehab patients, and serves as the nutrition consultant for Basecamp Prevention + Wellness. Jamie offers monthly nutrition-based classes and a monthly heart-healthy recipe as part of Basecamp’s free community programming.