Pedi fighting me over iron supplementation

[echoecho1528]

We've been back and forth about supping iron for my 26 mo DD for the last 6 months. She tested mildly low in an in-office toe-stick (10.9) a while back and the pedi suggested starting DD on iron at that time. I was hesitant to give her iron because DD has some major constipation issues that often cause her to stop eating, making her drop in weight, etc., etc.

After a bit of research and recommendations on here, I tried giving her half a dose of Floradix Floravital w/Iron (a total of 5mg iron) per day. She almost instantly starting pooping small little black pellets. Within four days, she stopped pooping all together. So, I stopped the iron and had to give her some pretty large doses of Miralax for the next 7 days before she had a BM. I absolutely HATE giving Miralax

So, fast forward to now. (Please forgive the layman's terms) DD had some blood work done which indicates that she is still a little low (10.9 again), but she also has very low iron stores (??). The pedi said that healthy range is 20-145, and DD tested at 10. Pedi wants me to give her fer-in-sol at a daily dose of 30mg of iron!!!! Uhh... did she not hear me that not pooping is really bad??? She suggested giving a double dose of Miralax every day to offset the constipation effects! Wholly cow! Does this seem like a really stupid idea to anyone else?? I read that a healthy dose of iron for a lactating or pregnant woman is 27mg/day. How could 30mg/day be right for a constipation sensitive child?

I am certainly worried about her iron, but seriously, her constipation just triggers a whole slew of problems that I don't want to ever happen again!

Does anyone here know more about iron deficiency/supplementation/constipation/ or have any insight on how to proceed? The doc really likes to bully me and pretty much insists that I am a complete idiot for not just doing everything she says. (I am in the market for a new doc, asap, btw!)

[Violet2]

What about trying food? Liver. Spinach. Oatmeal etc...

Also, you can dose every 2 to 3 days as a compromise.

As someone whose iron levels are not great I will tell you I feel pretty crappy. So do what you can to help her out without completely ruining her poops.

I do have great luck with my toddler pooping recipes (see my siggy). I eat the muffins and cookies too and I've been pooping fine and I'm supplementing 2x a day right now. Of course I can take Slow FE that helps prevent constipation too.

V

[nicole_marie]

Try leafy greens. You can blend them into smoothies and your kiddo won't even taste them. Add a cute straw and kids suck them down. We eat very little meat, but tons of leafy greens. I know one vegan family whose parents added leafy greens, then had iron levels rechecked...their pediatrician got the results back and said "What are you feeding her? Nails??"

It can't hurt, right?

I would follow dr's orders unless you can successfully raise levels through nutrition. xo

[nicole_marie]

The green smoothies help with constipation too. I can time my BM's daily...within 30 minutes of drinking a green smoothie.

Boost that fiber and folate intake!

[echoecho1528]

Thank you both for your replies. I guess I should have given a little background though

DD doesn't eat very much in quantity or variety, so getting her to eat anything is really hit and miss. She does drink smoothies on a semi- regular basis and I have been putting a handful of spinach in them and it goes undetected.

The problem is further complicated by the condition of her teeth and her food restrictions. Her four top front teeth are decaying fast and her holistic dentist believes it is a combination of malnutrition and eating too much sugar and grains. So, she is on a moderate to low sugar intake diet and absolutely no juice/grapes/bananas/dried fruit allowed. She is also gluten intolerant. So, your delicious recipes Nicole_Marie would be outside her diet protcol as far as I can tell

We are currently supping a theraputic dose of magesium and I'm wondering if this might offset the iron's effect on her bowels?

[nicole_marie]

Oh wow...so sorry! So much to deal with...remember to take care of yourself too. You are a great mama!

Can your daughter do non-sweet fruits in a smoothie like avocado's & cucumbers, blended with celery and/or leafy greens? Any fruit would work in the smoothie! I don't use a recipe, ours are different/unpredictable every morning. My 15 month old is gluten-free, dairy-free, soy-free, egg-free, sugar-free, nut-free, etc. He can do a small amount of pears or apples every day.

He drinks green juice daily cucumber/broccoli or cucumber/kale. I add a few drops of liquid stevia to sweeten (then weaned the stevia...now he takes them without).

Today's smoothie was pear/avocado/chard. Some other combos that he loves are cucumber/avocado/kale.

Have you heard of the Body Ecology Diet?

We should connect! Feel free to message me. Misery loves company.

[tanyalynn]

How long has she been GF, and/or completely grain-free, compared to the timeline of the two iron tests?

Whatever you do, consider adding in some tissue salt (cell salts), if you haven't already--I was reading in another forum, someone used that in combo with another iron supp to get their iron up fast at the very end of pregnancy--she thought it was the combination that was needed.

[Learning_Mum]

Have you tried giving her a high dose Vit C supplement with the iron? Vit C helps the iron absorb. The constipation is caused by a build up of the iron not being absorbed.

[Koalamom]

Originally Posted by tanyalynn

Whatever you do, consider adding in some tissue salt (cell salts), if you haven't already--I was reading in another forum, someone used that in combo with another iron supp to get their iron up fast at the very end of pregnancy--she thought it was the combination that was needed.

That was me!

I found that addressing the need for iron didn't always get my iron as high as needed but adding in b vitamins especially brewers yeast has helped. And I found that adding in a different iron really helped. The one I like the best is Garden of Lifes Raw Iron, all whole food sources and not constipating at all. It is in a capsule and easy to sprinkle on food for kids.

So sorry about your LO's teeth. Hopefully we can all brainstorm at how to get her nutrients in.

[sbgrace]

We struggled with iron and constipation with Andrew. And then I tried food and he got worse (I was using iron rich foods that actually block iron absorption unknown to me at the time--that includes egg, greens, grapes/prunes, beans, and basically anything except red meat).

And I found ferrochel (ferrous bis-glycinate). You can give smaller doses because it's absorbed at least 3 x's better than other forms (so 10 mg. equals 30 mg of the one your doctor recommended but I'd do 15 mg. with a child who is low).

Anyway, the yay thing about ferrochel in addition to the absorption and, therefore, faster response in correcting levels, is that it doesn't cause constipation! The constipation is because of the unabsorbed iron in other forms. Andrew really struggled and we saw nothing with ferrous bis-glycinate. We use a form from kirkman labs http://www.kirkmanlabs.com/[e-mail] but we've also used gentle iron by solgar which is easier to get at most health food stores. I like the kirkman better because it's 5 mg. per pill vs. 25 mg. in the solgar so I can control the amounts I give easier. But either will work. I think there is one liquid form too but we never did it. I just did pear sauce, iron w/vitamin C powder, pear sauce. The only key is to keep iron (any iron, not just this form) away from egg, greens, beans (including soy), dairy, bright fruits, and other mineral containing supplements. I do iron with breakfast which I keep clear of all that stuff. I used to do iron in the middle of the night (syringed in pear juice). If you can't help but serve it with blocking foods I'd avoid the biggest offenders (in order): egg, soy/dairy as much as possible. This form will still work but you might need more of it.

[Koalamom]

What about nettles and alfalfa infusions for iron and other minerals?

[sbgrace]

Originally Posted by bluebirdmama1

What about nettles and alfalfa infusions for iron and other minerals?

Greens are usually not a good choice becaues they contain either other minerals (like calcium in the case of nettles), oxalates (in spinach for example), antioxidants (one of alfalfa's problems along w/mineral content), etc.

B vitamins are shown to increase the effectiveness of iron. Riboflavin is a big one I know. I can't remember the others.

[SaoirseC]

Strange that Floradix made her constipation worse. It actually kept me regular when I was already constipated.

BTW, dental issues are also related to iron deficiency. Iron is necessary to stimulate salivation (don't remember the specifics here), and is especially important for nighttime salivation, when salivation is already very low. I learned that because my two kids both had atrocious dental problems (and of course the dentists made me feel like s***, and like it was due to neglect). We ended up taking each kid in at around 2 years and having their teeth repaired under general anesthesia using stainless steel and composite. Certainly not ideal, but they are able to eat, and the teeth that weren't capped or altered are now strong and white (neither of my kids have been to the dentist since their respective dental work was performed). Now, my oldest is starting to lose some of his damaged baby teeth. Though, I certainly understand not wanting to treat the damage from the outside, that's just not the route we went (we decided to do both, though obviously a tooth that's capped can't remineralize from the outside).

ANYWAY... I agree with you. Doesn't her ped realize that she needs other nutrients besides iron? How is she supposed to absorb any of this if she's constantly taking laxatives? And how is that going to help her bouts of constipation, when it's only making her bowels weaker?? magnesium sounds like a good idea, have you had any other nutrient testing? it definitely sounds like her intestines are suffering from something (the constipation and iron deficiency are probably just symptoms of whatever is going on in her gut).

FWIW, he's probably prescribing 30 mg of iron because he knows that barely any of it is actually absorbed. Another FWIW, vitamin C is only necessary when taking a vegetarian source of iron. Non-heme iron comes from vegetable sources, heme iron comes from animal sources. Vitamin C is necessary to convert non-heme iron into heme iron. So, there's no need to drink orange juice with your steak, but do take it if you decide to put her back on Floradix or use nettle leaf (or whatever). I also agree that iron from animal sources are much more readily absorbed, I wouldn't waste my time on teas or spinach.

[echoecho1528]

Originally Posted by nicole_marie

Oh wow...so sorry! So much to deal with...remember to take care of yourself too. You are a great mama!

Can your daughter do non-sweet fruits in a smoothie like avocado's & cucumbers, blended with celery and/or leafy greens? Any fruit would work in the smoothie! I don't use a recipe, ours are different/unpredictable every morning. My 15 month old is gluten-free, dairy-free, soy-free, egg-free, sugar-free, nut-free, etc. He can do a small amount of pears or apples every day.

He drinks green juice daily cucumber/broccoli or cucumber/kale. I add a few drops of liquid stevia to sweeten (then weaned the stevia...now he takes them without).

Today's smoothie was pear/avocado/chard. Some other combos that he loves are cucumber/avocado/kale.

Have you heard of the Body Ecology Diet?

We should connect! Feel free to message me. Misery loves company.

Thanks for the suggestions on smoothies. I have been hiding spinach in berry smoothies for a while now, but it seems as though she tastes it (when I can't) and often won't drink much of it when it is heavy on the spinach . She is a SUPER picky eater and as a general rule will not eat anything green...
Never heard of the Body Ecology Diet - I will google it

Originally Posted by tanyalynn

How long has she been GF, and/or completely grain-free, compared to the timeline of the two iron tests?


Whatever you do, consider adding in some tissue salt (cell salts), if you haven't already--I was reading in another forum, someone used that in combo with another iron supp to get their iron up fast at the very end of pregnancy--she thought it was the combination that was needed.

She has had only one comprehensive iron panel done, where they actually drew blood and at the time we were doing a gluten trial for the first time in over 15 months. The heel sticks in the doctor's office happened when she had been GF for over a year.
We have been doing cell salts (calc phos, calc fluor, silica) for about two weeks now. Which cell salts are necessary for iron absorption?

Originally Posted by bluebirdmama1

That was me!

I found that addressing the need for iron didn't always get my iron as high as needed but adding in b vitamins especially brewers yeast has helped. And I found that adding in a different iron really helped. The one I like the best is Garden of Lifes Raw Iron, all whole food sources and not constipating at all. It is in a capsule and easy to sprinkle on food for kids.

So sorry about your LO's teeth. Hopefully we can all brainstorm at how to get her nutrients in.

Her multi vitamin is pretty high in b vitamins (GI ProHealth powder) but I have trouble getting it into her. I tried mixing it in with strong cherry juice, orange juice and water, but it's a no go. The only thing that works at least a little bit is mixing it with her old vitamin - a very strong smelling orange/mango flavored one, but I'm not sure if that is really a good idea. So I have yet to get a full dose in her since starting the new vitamin two weeks or so ago.
I'm not sure about sprinkling something into/onto her food, as I am afraid to make anything taste bad. She barely eats anything and I don't want to cause a food aversion due to taste.

Originally Posted by sbgrace

We struggled with iron and constipation with Andrew. And then I tried food and he got worse (I was using iron rich foods that actually block iron absorption unknown to me at the time--that includes egg, greens, grapes/prunes, beans, and basically anything except red meat).

And I found ferrochel (ferrous bis-glycinate). You can give smaller doses because it's absorbed at least 3 x's better than other forms (so 10 mg. equals 30 mg of the one your doctor recommended but I'd do 15 mg. with a child who is low).

Anyway, the yay thing about ferrochel in addition to the absorption and, therefore, faster response in correcting levels, is that it doesn't cause constipation! The constipation is because of the unabsorbed iron in other forms. Andrew really struggled and we saw nothing with ferrous bis-glycinate. We use a form from kirkman labs http://www.kirkmanlabs.com/[e-mail] but we've also used gentle iron by solgar which is easier to get at most health food stores. I like the kirkman better because it's 5 mg. per pill vs. 25 mg. in the solgar so I can control the amounts I give easier. But either will work. I think there is one liquid form too but we never did it. I just did pear sauce, iron w/vitamin C powder, pear sauce. The only key is to keep iron (any iron, not just this form) away from egg, greens, beans (including soy), dairy, bright fruits, and other mineral containing supplements. I do iron with breakfast which I keep clear of all that stuff. I used to do iron in the middle of the night (syringed in pear juice). If you can't help but serve it with blocking foods I'd avoid the biggest offenders (in order): egg, soy/dairy as much as possible. This form will still work but you might need more of it.

Can you look at THIS and let me know if it is what you are talking about?

Originally Posted by SaoirseC

Strange that Floradix made her constipation worse. It actually kept me regular when I was already constipated.

BTW, dental issues are also related to iron deficiency. Iron is necessary to stimulate salivation (don't remember the specifics here), and is especially important for nighttime salivation, when salivation is already very low. I learned that because my two kids both had atrocious dental problems (and of course the dentists made me feel like s***, and like it was due to neglect). We ended up taking each kid in at around 2 years and having their teeth repaired under general anesthesia using stainless steel and composite. Certainly not ideal, but they are able to eat, and the teeth that weren't capped or altered are now strong and white (neither of my kids have been to the dentist since their respective dental work was performed). Now, my oldest is starting to lose some of his damaged baby teeth. Though, I certainly understand not wanting to treat the damage from the outside, that's just not the route we went (we decided to do both, though obviously a tooth that's capped can't remineralize from the outside).

ANYWAY... I agree with you. Doesn't her ped realize that she needs other nutrients besides iron? How is she supposed to absorb any of this if she's constantly taking laxatives? And how is that going to help her bouts of constipation, when it's only making her bowels weaker?? magnesium sounds like a good idea, have you had any other nutrient testing? it definitely sounds like her intestines are suffering from something (the constipation and iron deficiency are probably just symptoms of whatever is going on in her gut).

FWIW, he's probably prescribing 30 mg of iron because he knows that barely any of it is actually absorbed. Another FWIW, vitamin C is only necessary when taking a vegetarian source of iron. Non-heme iron comes from vegetable sources, heme iron comes from animal sources. Vitamin C is necessary to convert non-heme iron into heme iron. So, there's no need to drink orange juice with your steak, but do take it if you decide to put her back on Floradix or use nettle leaf (or whatever). I also agree that iron from animal sources are much more readily absorbed, I wouldn't waste my time on teas or spinach.

You've basically summed up all of my frustrations Thanks for the info on Vit C & Iron.

Okay, so it looks like I need to plan out a supp & food schedule to make sure no food or other supps is blocking absorption of the nutrients she needs... I need help. My mind spins with the maze that is supplements

This is what she takes:

Multi-vitamin - split into two doses
Magnesium 150mg - 1tsp 2x/day
Zinc 7.5mg - 1tsp 1x/day
Cell salts (calc fluor, calc phos, silica) - 2 pellets each 3x/day
Iron (currently ferrous sulfate - looking to change???) - 2x/day
x-factor butter/fermented clo - 1tsp/day

[Koalamom]

Originally Posted by sbgrace

Greens are usually not a good choice becaues they contain either other minerals (like calcium in the case of nettles), oxalates (in spinach for example), antioxidants (one of alfalfa's problems along w/mineral content), etc.

B vitamins are shown to increase the effectiveness of iron. Riboflavin is a big one I know. I can't remember the others.

This may sound silly to ask, but what is wrong with antioxidants?

[sbgrace]

Originally Posted by bluebirdmama1

This may sound silly to ask, but what is wrong with antioxidants?

Antioxidants are good for us. They also interact with iron (inhibit absorption and I think some research has shown iron reduces anti-oxidant potency too). There's lots of stuff out there about this (I think this is widely known compared to, say, eggs being an iron inhibitor).
http://pubs.acs.org/doi/abs/10.1021/jf025832q

In contrast, the red grape juice and prune juice had profound inhibitory effects on iron bioavailability. These inhibitory effects were likely due to high levels of polyphenolic compounds that bind and thereby prevent absorption of soluble Fe. These inhibitory compounds appeared to counteract the promotional effects of ascorbic acid.

This doesn't mean anti-oxidants are wrong though. It's like zinc. It's not wrong or bad for us (good for us) but it doesn't "play well" with iron. So you don't give them together. If you're trying to correct iron deficiency you'd keep it away from anti-oxidant rich foods.

[sbgrace]

Originally Posted by echoecho1528

Can you look at THIS and let me know if it is what you are talking about?


You've basically summed up all of my frustrations Thanks for the info on Vit C & Iron.

Okay, so it looks like I need to plan out a supp & food schedule to make sure no food or other supps is blocking absorption of the nutrients she needs... I need help. My mind spins with the maze that is supplements

This is what she takes:

Multi-vitamin - split into two doses
Magnesium 150mg - 1tsp 2x/day
Zinc 7.5mg - 1tsp 1x/day
Cell salts (calc fluor, calc phos, silica) - 2 pellets each 3x/day
Iron (currently ferrous sulfate - looking to change???) - 2x/day
x-factor butter/fermented clo - 1tsp/day

http://www.koshervitamins.com/shop/s...zmap=MXS-17608 Your link didn't work but this is the right form of iron and, I imagine, what you had linked?

I don't think you can make this work with those supplements as you're doing them now because you need at least two and preferably three hours between minerals. I don't see how to do it with dosing that many mineral products that often.
Here is what I would do in your situation..I don't know how much she sleeps but you want at least two hours between all the minerals (before and after) so you may need to work around naps.

breakfast--iron and vitamin C..keep stuff that inhibits iron away from this. I dosed small doses of irons every half hour for a couple of hours so I split the doses some that way. You do what you can though. In studies this form corrected dosed just once. B vitamins would be good here...but you can't do your multi w/iron because of the other minerals so you'd need an individual b supplement and drop that multi. I do iodine in this morning here with B's and iron and vitamin C.

Three hours (if possible) after your iron do another mineral set (this might be zinc or your calcium containing salts with magnesium (combine those). You can do the butter in there too if you'd like. You can't keep up dosing calcium containing stuff three times per day. I don't see it as at all necessary either. Calcium is absorbed about 500 mg. at a time. If you're under that do it all at once. If you're not I''ll put below how I dose my kid.

Two or three hours later you do the other mineral combo (say zinc here).


If you've got more time in the day two hours later you can do the multi and another dose of magnesium. If you don't I'd drop that multi and put the important things in on their own.

This is how I run Andrew (he takes extra stuff too but I'm mentioning the typical things). He no longer naps and that makes it easier than it used to be however he sleeps 13 plus hours a night so I'm not likely dealing with much more wake time than you. He has to do calcium foods/supplements twice now as he needs more than 500 mg. In case it might be helpful this is how we do it:

Breakfast (and over the next hour or two) iron supplements and vitamin C. He takes b vitamins and iodine with breakfast too (and other stuff particular to him).

Lunch (this is at least two hours after his last iron dose):
magnesium, calcium containing foods, some select b vitamins individually, other minerals I'm giving

Dinner (afternoon) (three hours after those lunch things):
zinc

Before bed snack:
magnesium, vitamin K, vitamin D, CLO, calcium (all his calcium stuff goes here).

[KimPM]

I'd like to second what Rachelle (sbgrace) said about ferrous bisglycinate. I've had similar problems with ferrous sulfate and other forms of iron, while the bisglycinate form works fine for me, not constipating at all.

Also, have you considered if she has any food sensitivites that may cause constipation as well? If the problem is JUST when you give the iron, and otherwise she's normal, then it's probably the iron (or one of the "other ingredients" in it). If she generally seems on the consitpated side, and gets worse with the iron, then you might consider food sensitivities. When I eat my offending foods, I get inflamed inside, which causes constipation.

[echoecho1528]

Originally Posted by sbgrace

http://www.koshervitamins.com/shop/s...zmap=MXS-17608 Your link didn't work but this is the right form of iron and, I imagine, what you had linked?
Yes, that is it.
I don't think you can make this work with those supplements as you're doing them now because you need at least two and preferably three hours between minerals. I don't see how to do it with dosing that many mineral products that often.
Here is what I would do in your situation..I don't know how much she sleeps but you want at least two hours between all the minerals (before and after) so you may need to work around naps.

breakfast--iron and vitamin C..keep stuff that inhibits iron away from this. I dosed small doses of irons every half hour for a couple of hours so I split the doses some that way. You do what you can though. In studies this form corrected dosed just once. B vitamins would be good here...but you can't do your multi w/iron because of the other minerals so you'd need an individual b supplement and drop that multi. I do iodine in this morning here with B's and iron and vitamin C.

Three hours (if possible) after your iron do another mineral set (this might be zinc or your calcium containing salts with magnesium (combine those). You can do the butter in there too if you'd like. You can't keep up dosing calcium containing stuff three times per day. I don't see it as at all necessary either. Calcium is absorbed about 500 mg. at a time. If you're under that do it all at once. If you're not I''ll put below how I dose my kid.

Well, the cell salts have been suggested for her dental health and help in remineralizing her teeth. The recommended dosage for them is 2 pellets 3-4x/day

Two or three hours later you do the other mineral combo (say zinc here).


If you've got more time in the day two hours later you can do the multi and another dose of magnesium. If you don't I'd drop that multi and put the important things in on their own.

This is how I run Andrew (he takes extra stuff too but I'm mentioning the typical things). He no longer naps and that makes it easier than it used to be however he sleeps 13 plus hours a night so I'm not likely dealing with much more wake time than you. He has to do calcium foods/supplements twice now as he needs more than 500 mg. In case it might be helpful this is how we do it:

Breakfast (and over the next hour or two) iron supplements and vitamin C. He takes b vitamins and iodine with breakfast too (and other stuff particular to him).

Lunch (this is at least two hours after his last iron dose):
magnesium, calcium containing foods, some select b vitamins individually, other minerals I'm giving

Dinner (afternoon) (three hours after those lunch things):
zinc

Before bed snack:
magnesium, vitamin K, vitamin D, CLO, calcium (all his calcium stuff goes here).

Hmm... a lot of your advice goes to the contrary of what how I have been advised in other threads
I have been told that magnesium and calcium compete for absorption and to keep the two apart. And, I understand that minerals need to be taken separately, but she needs everything I've listed, so I'm not sure how to go from there.
The tentative schedule I made is below:
w/breakfast - Multi, cell salts
w/morn snack - magnesium
w/lunch - cell salts, multi, CLO
w/afternoon snack - zinc
w/dinner - magnesium
before bed - iron

So, I haven't been able to work in the last dose of cell salts. But, that is as close as I can get.

Thank you for your suggestions, I'm just unsure about the magnesium/calcium thing.

Originally Posted by KimPM

I'd like to second what Rachelle (sbgrace) said about ferrous bisglycinate. I've had similar problems with ferrous sulfate and other forms of iron, while the bisglycinate form works fine for me, not constipating at all.

Also, have you considered if she has any food sensitivites that may cause constipation as well? If the problem is JUST when you give the iron, and otherwise she's normal, then it's probably the iron (or one of the "other ingredients" in it). If she generally seems on the consitpated side, and gets worse with the iron, then you might consider food sensitivities. When I eat my offending foods, I get inflamed inside, which causes constipation.

Yes, I've considered food and she is gluten-free, and super low in dairy b/c only straight milk products seem to be troubling for her. I've done a TED in the past with no results, but I'm considering doing a one-by-one elimination in the near future.
Thanks for the help

[sbgrace]

I don't think there is a way to do it all perfectly. That's the (frustrating) conclusion I've come to with my kid. But the effort you make is better than none at all. I prioritize the areas of concern (in his case iron since he often runs low has to be my top and I prioritize zinc as well). I think your plan looks solid (though...how much does she sleep...that's a large spread to get into the day...you could dose something in the night w/a syringe/I did that when my son was younger).

My only question is why you are attached to that multi enough to want to do it twice a day? I say that because it's got all minerals all mixed up and that makes them pretty much useless and I'd be concerned they are affecting your cell salt absorption too which is important to you (right?). What are you trying to get out of the multi and can you give whatever that is on it's own? If you're doing it for b vitamins or iodine or the like why not give them on their own since vitamins don't (usually/generally) have nearly the issues w/inhibition interactions that minerals have. If it's trace/other minerals I'd do them on their own (that's what I do actually at our mid-morning snack time not on that list I gave).