As a neurologist, I want to do everything I can to help my patients prevent Alzheimer’s disease. For this reason, I am into supplements both for them and for myself. Fish oil, flaxseed, coenzyme-Q10, to mention a few. Personally, I have noticed a certain anxiety every morning since I nearly choked on the 1,000 milligram capsule of fish oil that an hour later came back to haunt me with a terrible regurgitation of fowl fish taste and smell. The problem is that the fish oil football I tried to swallow each morning is smaller than the cannon ball flax seed oil and coenzyme-Q10 capsules I take right after. Only the 500 milligram chewable vitamin C tablets cause no problem. I don’t know about you but I have found size counts. And when it comes to supplements, too big is bad.

The problem I found wasn’t new to my patients. I surveyed 100 patients, up to 70% had some anxiety or issue with swallowing their supplement pills. 25% simply stopped taking these mega behemoths. The problem seemed to stem from two characteristics of the pill and the method they used to sallow them.

The negative characteristics were: (1) the size of the pill (half inch or greater), (2) its consistency (hard with sharp edges), and (3) the method they used to swallow these millstones.

I found the best tolerated pills were small, roughly a centimeter, a little more than a third of an inch, football shaped and in soft capsule form. Giant pills such as 1,000 milligram fish oil, flax seed oil or coenzyme-Q10were often a problem.

The next difficulty I found is many patients thought that throwing their head back and swallowing would improve their ability to down these mega pills, as birds do. However, what maybe good for birds is not for humans. Throwing back one’s head increases the likelihood of choking. Instead keeping the head in a neutral position, then placing the pill in the middle of the tongue while swallowing the liquid, and tucking one’s chin down about 50% of the way to the chest is optimal. Try sipping water out of the palm of your hand as an example of the correct head position. Using a straw with the head tilted down is best as drinking from a cup often causes one to lift the chin and places our swallowing mechanism in a suboptimal position.

Other tips are using a denser fluid such as milk or a smoothie. Others place them in yogurt and still others coat them with a small amount of olive oil to pass the pill.

Fish oil pills are often a particular problem, usually large in size and not infrequently cause a very distasteful regurgitation later on. This distasteful regurgitation can be avoided by keeping the fish oil bottle in the freezer, eating them with food or buying fish oil capsules that are enteric coded which dissolve in the small intestine. Buying fish oil capsules that are 500 milligrams reduces the size. Some such as proDHA are flavored and of the proper size.

Attitude is important. Enjoy the supplements, don’t regard them as medicine. I advise taking some of them with 8 to 10 ounces of fluids. It helps stem one’s appetite.

Remember size does matter when it comes to taking supplements. Like Goldilocks, find the pill that’s “just right” for you.