Sometimes, there is antagonism or competition for absorption between different nutrients, such as copper and zinc, or in utilization, for example, iron and vitamin E. However, these are usually not sufficient to be a serious concern when taking large doses of supplements.

There are some exceptions to this rule. For example, some of the amino acids are better utilized for specific purposes when taken separately from foods. (See Chapter 8.) My recommendation is not to worry too much about such combinations; they are minor, and worrying about them makes supplement programs confusing and inconvenient. If you do not remember to take things, they are not going to do you any good.

You may have concerns about swallowing so many pills if you are on many different supplements. If you have difficulty, it is easiest to take them with a thicker liquid, such as tomato juice or a blended fruit and yogurt smoothee. This usually makes it easy to open the throat for swallowing and coats the pills, making it easier for them to go down. After you are able to take them this way, it becomes easy to swallow many pills at one time, even with plain water, but be careful. (One of my patients uses this trickÑjust before taking the liquid for the pills she says to herself, "I am really thirsty." She says it helps the pills go down.)

What About Pregnancy?
Most pregnant women need extra nutrition, and most physicians will recommend at least some dietary supplements. As stated before, folic acid is essential for the prevention of some birth defects, and other nutrients are helpful in preventing toxemia of pregnancy (see B6 and magnesium). Some supplements are helpful in reducing morning sickness of pregnancy, especially pyridoxine (vitamin B6).

Most of the nutrients on basic supplement programs are helpful during pregnancy and are often recommended by obstetricians. Extra iron and calcium are useful additions to a routine supplement program. The only caution is taking too much vitamin A during the first 3 months. Anything above 10,000 IU may be too much, but this only applies to preformed vitamin A, not to beta-carotene.

How to Store Supplements
You do not need to take special precautions when storing most dietary supplements. It is usually sufficient to keep them on a shelf in a pantry or on the kitchen counter. Most of the products are quite stable if kept in dry, room- temperature conditions. As with any food, do not leave them for prolonged periods in a hot car or in a closed carrier out in the sun, where they will easily get overheated.

Sometimes people are tempted to put their supplements in the refrigerator, but this is not a good idea. Every time you open a bottle of cold supplement pills in a warm external environment, there will be some condensation on the surface of the pills that remain in the bottle. Eventually, they will become wet and sticky, or they will actually begin to dissolve, depending on how much they attract moisture. An exception is some supplements of intestinal flora (lactobacilli or bifidobacteria), which sometimes keep better in the cold.

For the same reason, do not keep your supplements in the bathroom (not that you were really tempted to do so). It gets too humid with all the showering to keep them dry and fresh. The best place for storage is probably the kitchen, since it is usually dry, and it is convenient, since you will mostly take your supplements with meals.

How Long Do They Keep?
It is not a good idea to keep supplements for a long time after they have been opened. Although some are quite stable in a dry environment, there is inevitably some oxidation and loss of potency. The amount of loss depends on the particular nutrient. Many of the supplements are quite stable, and last for years if kept cool and dry. Minerals do not deteriorate with time.