If you take a vitamin or mineral supplement as part of your wellness routine, making healthy lifestyle choices is likely a priority for you.
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But when it comes to certain supplements, what you're putting into your body might actually stir up your gastrointestinal tract, leading to diarrhea.
Osmotic diarrhea occurs when you consume something that prevents proper water and electrolyte absorption, according to Clinical Methods: The History, Physical, and Laboratory Examinations.
This type of diarrhea is most commonly associated with things we ingest, like certain supplements, Dr. Caroline Renee Jouhourian, MD, a gastroenterology specialist in North Chelmsford, Massachusetts says.
While it's not uncommon for people to experience a bout of diarrhea that subsides after a couple of days, even brief episodes of diarrhea can result in dehydration. That's why it's important to pinpoint what might be causing GI distress — such as these common vitamin supplements that cause diarrhea — and take steps to prevent it.
Is Your Diet Missing Certain Nutrients?
1. Vitamin C
Vitamin C is a water-soluble nutrient, which means it can't be stored in the body for later use, and it's important to meet your daily recommended amount for it, per the National Cancer Institute. For adults, it's recommended to get 65 milligrams to 90 milligrams per day, according to the Mayo Clinic.
The upper limit, or the maximum amount you should have in any given day, is 2,000 milligrams. Megadoses of C can cause diarrhea as well as vomiting, cramps, nausea and other symptoms. But it's rare to get that much vitamin C through diet alone, Dr. Jouhourian says.
Research suggests that zinc might play a role in immune function, including promoting normal development and immune cell function, and preventing inflammation, according to a May 2008 paper in Molecular Medicine.
The recommended intakes for people assigned female and male are 8 milligrams and 11 milligrams, respectively, according to the National Institutes of Health (NIH). While zinc is found in almost all multivitamin supplements, most people get what they need from foods, including oysters, red meat, fortified cereals, beans, nuts, whole grains and some dairy products, according to the NIH.
Getting too much zinc can bring excess water into the intestine, contributing to diarrhea, Dr. Jouhourian says.
But like with vitamin C, most people are getting adequate amounts, she says. "But that may change if more people take zinc to fight infection like COVID-19," Dr. Jouhourian says, noting there isn't research to suggest zinc protects against the coronavirus.
3. Fish Oil
Omega-3 fatty acids — found in fatty fish — are associated with heart health, reduced inflammation and improved cognition, according to the NIH. But when it comes to reaping those benefits from a fish oil supplement, the results are mixed.
For example, researchers did not find that omega-3 supplements reduced heart attacks, strokes or deaths in people without known risk factors, according to a November 2018 paper in the New England Journal of Medicine. But researchers also found that those who didn't eat fish but took a supplement might reduce their risk of heart disease, according to Harvard Health Publishing.
That said, people who take a fish oil supplement may experience "slippery" poop, and in some cases, diarrhea, Jouhourian says. That's because fish oil contains a lot of fat, which essentially serves as a lubricant in the GI tract.
"Fish oil is similar to a stool softener, but it doesn't necessarily soften it — it's like a slip and slide." And if you take too much, it could lead to diarrhea, she says.
Fish oil is basically a concentrated form of fat. Consuming a high amount of fat in a short period can disrupt your digestive tract, leaving you with gas, bloating and possibly diarrhea as your body attempts to deal with the fatty overload.
Your system might get used to the fish oil so you stop having episodes of diarrhea, but if you continue to experience loose, watery stools for more than a day or two, it's time to discuss alternative options with your health care professional.
You might be able to minimize the incidence of diarrhea you experience from fish oil supplements. Rather than taking oil by the spoonful or a basic fish oil capsule, look for a brand that is a time-release preparation.
These encapsulated formulas don't start breaking down until they reach your small intestine and are designed to break down gradually, minimizing gastrointestinal irritation
Magnesium is a crucial nutrient for protein synthesis, muscle and nerve function and blood pressure regulation, according to the NIH. Magnesium is found in leafy green vegetables (think: spinach, kale and chard), legumes, nuts, seeds and whole grains.
The recommended daily intake is 320 milligrams for people assigned female at birth and 420 milligrams for people assigned male at birth, according to the NIH. And more often than not, people can hit those amounts from their diet.
"A lot of people might take magnesium for their immune system or cardiovascular health," Dr. Jouhourian says. And for those who have a cardiac arrhythmia and are taking magnesium, for example, diarrhea might be an issue, she says. Their doctors might prescribe an anti-diarrhea medication like Imodium.
Antacids with magnesium might also cause diarrhea, according to the U.S. National Library of Medicine.
This might go without saying: Laxatives are designed to cause diarrhea. Laxatives work by pulling water into the gut or causing the intestinal muscle to contract, according to the U.S. National Library of Medicine.
There are times when doctors might recommend a laxative, Dr. Jouhourian says, for reasons like constipation relief.
"It's OK to take a laxative here and there," Dr. Jouhourian says. "But they shouldn't be taken every day and should be taken under the guidance of a doctor." What can be dangerous and never recommended, she says, is taking a laxative for weight loss.
Taking a laxative for weight loss can lead to severe health issues, according to the National Eating Disorders Association (NEDA), such as:
- Electrolyte and mineral imbalances, which can cause organ dysfunction
- Severe dehydration, which can lead to kidney damage, tremors, weakness, fainting and, in some cases, death
- Laxative dependency, which happens when the colon stops reacting to recommended doses of laxatives and requires larger amounts to produce bowel movements
- Internal organ damage
- Increased risk of colon cancer
If you or someone you know is struggling with an eating disorder or disordered eating, help is available. Please visit the National Eating Disorder Association for resources.
6. Vitamin D
Vitamin D works together with calcium to help build strong and healthy bones; adults aged 19 to 50 years need 600 international units of vitamin D per day.
Taking too much vitamin D can cause diarrhea, constipation or stomach pain. Scientists don't all agree on how much vitamin D is too much, but the NIH has set the maximum upper tolerable limit at 4,000 IU for anyone over the age of nine.
Research around vitamin D and diarrhea finds that vitamin D toxicity (also called hypervitaminosis D) is rare, but occurs in cases where too much vitamin D is ingested, per a July 2015 study in Clinical Endocrinology.
Eating foods rich in vitamin D will not increase your vitamin D levels too high, per the Mayo Clinic. Vitamin D toxicity is also not possible from too much sun exposure.
However, if you take high doses of vitamin D supplements, it is possible to overdose. Consult your doctor to determine the proper dosage.
7. Calcium Supplements
Calcium pills usually do not cause any problems, but some digestive effects are plausible, according to the Mayo Clinic.
It's possible that calcium supplements may increase the incidence of constipation, diarrhea, bloating and abdominal pain, per November 2018 research in Clinical Interventions in Aging.
Rather than causing diarrhea, calcium is more likely to lead to constipation and excess intestinal gas. Adding more fiber to your diet and drinking more water usually gets rid of these effects, but you might need to cut back on the supplements if you still have problems.
All varieties of calcium supplements are better absorbed when taken in small doses (500 mg or less) at mealtimes, per the Mayo Clinic.
Take no more than 500 mg of calcium per day if the pills affect your bowel movements, and gradually raise the amount to a full dose after a week of taking the reduced amount.
Tips to Avoid Diarrhea from Supplements
If your supplement is sending you running for the bathroom, there are measures you can take to mitigate those effects.
1. Split Your Supplement Doses in Half
Spreading out your supplement dose 6. can help ease any diarrhea you may be experiencing.
For example, you might try splitting your pill in half and taking one in the morning and one in the evening, Dr. Jouhourian says.
2. Take Your Supplement After Exercise
People who exercise are probably no stranger to the effects movement can take on their GI tracts. In fact, some 30 to 50 percent of athletes experience intestinal problems related to exercise, according to a May 2014 review in Sports Medicine.
"Exercise notoriously gets things going," Dr. Jouhourian says. She recommends taking a supplement after a workout, and perhaps more importantly, while eating, which can help settle the stomach.
3. Avoid Fake Sugars
Regardless of whether you're taking a supplement that might cause diarrhea, fake sugars — osmotic stimulants — can lead to or worsen diarrhea, Dr. Jouhourian says. It's best to read labels and avoid polyols or sugar alcohols.
"The key with diarrhea is [avoiding] the culprit," she says.
4. Focus On Fiber
Fiber can be a little tricky, Dr. Jouhourian says. Eating the right amount — 25 grams to 38 grams per day, according to the Academy of Nutrition and Dietetics — will keep your GI tract regular. But too much or too little fiber can lead to constipation or diarrhea.
In addition to eating enough fiber, make sure to stay hydrated. Dr. Jouhourian recommends drinking 64 ounces a day and more if you're physically active.
- Clinical Methods: The History, Physical, and Laboratory Examinations: "Diarrhea"
- Mayo Clinic: "Is it Possible to Take Too Much Vitamin C?"
- National Institutes of Health: "Zinc"
- Medline Plus: "Drug-induced Diarrhea"
- National Eating Disorder Association: "Laxative Abuse"
- National Cancer Institute: "Water-soluble Vitamins"
- Molecular Medicine: "Zinc in Human Health: Effect of Zinc on Immune Cells"
- National Institutes of Health: "Omega-3 Fatty Acids"
- New England Journal of Medicine: "Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer"
- Harvard Health Publishing: "Fish Oil: Friend or Foe?"
- National Institutes of Health: "Magnesium"
- Sports Medicine: "Gastrointestinal Complaints During Exercise: Prevalence, Etiology, and Nutritional Recommendations"
- Academy of Nutrition and Dietetics: "Easy Ways to Boost Fiber in Your Daily Diet"
- Clinical Endocrinology: "Vitamin D toxicity resulting from overzealous correction of vitamin D deficiency"
- Mayo Clinic: "What is vitamin D toxicity? Should I be worried about taking supplements?"
- Clinical Interventions in Aging: "The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health"
- Mayo Clinic: "Calcium and calcium supplements: Achieving the right balance"