Nutritional Supplements or a Suckers Delight?

Nutritional supplements (multivitamins and minerals) have been a personal ire of mine ever since I started practicing medicine. It is overprescribed and nearly always asked for by patients.

As the COVID 19 pandemic hit, the demand for ‘immune-boosting’ supplements and vitamin pills got (even) higher. This is not to say that they are entirely useless- they are essential in some scenarios (more on that later), but when more than half of the population is on some supplement, it begets a think-and-pause.

Do we really need these supplements that have been described as ‘pricey pee’, or these are just sucker’s delight, as I like to call it?

What does the evidence say?

There is a general consensus that supplements are important when the requirements are not met by diet alone. But what if the diet is adequate to prevent a nutrient deficiency? Will taking supplements reduce your chances for certain diseases and increase your life span?

A comprehensive meta-analysis published in Circulation: Cardiovascular Quality and Outcomes in 2018 states that there is no scientific evidence that multivitamin and mineral supplements promote cardiovascular health and recommends against the routine use of MVM (multivitamins minerals) supplements for the purpose of CVD prevention in the general population.

Fortmann and colleagues conducted a sysyetmic review to assist the United States Preventive Services Task Force (USPSTS) in updating the 2003 on use of vitamin supplements for prevention of coronary vascular diseases (CVD) and cancer in adults with no nutritional deficiencies. After a review of 3 trial of multivitamin and 3 trials of single or paired vitamins randomly assigned across more than 400,000 participants, they concluded that there is no evidence that the use of supplements has a beneficial effect on cancer, cardiovascular disesase, or all-cause mortality.

Grodstein and colleagues in a study titled, ‘Long-term multivitamin supplementation and cognitive function in men: a randomized trial’ that was conducted over 12 years on 5967 physicians 65 years and older concluded that use of daily multivitamins did not provide cognitive benefits like improvement in memory loss or slowed-down thinking.

This succint study publised in 2016 reviewed multiple databases and assessed studies which were published from 1993 through 2015‏. The studies were reviewed for vitamins E,A,C,D, and folic acid.
The study concluded that ‘Taking supplements of vitamin E, A, C, D, and folic acid for prevention of disease or cancer is not always effective, and can even be harmful to health. So, it would be rational to limit these supplements consumption to those having deficiencies of the mentioned vitamins.’

These are amongst the very few studies- a quick internet search will reveal numerous studies that have tried to answer this question.

Who potentially benefits from supplementation?

1. Drug-induced nutrient depletions (e.g., Folic acid depletion induced by anti-cancer or Rheumatic arthritis medication, calcium depletion by long-term steroid use, B12 by long-term use of certain anti-acidity drugs)
2. Vegans whose diets are limited in calcium and B12.
3. Certain communities like Jains from India follow a pure vegetarian diet with added restrictions that may result in iron and B12 deficiency.
4. During high-demand periods like pregnancy, breastfeeding, and illness recovery.
5. Individuals with malabsorption syndrome (Inflammatory bowel diseases, pancreatic insufficiency, celiac disease, or post certain surgeries like gastric bypass and Whipple)
6. Vitamin D for the sun-deprived.
7. The elderly- B12 due to reduced absorption.

The above list is not exhaustive, and you will need the help of your physician to determine if you need any.

Who is not for?

Anyone trying to find a replacement for a healthful, balanced diet. Nutritional supplements are meant to fill the nutritional gaps. They are not intended to be your only source of one.
However, multivitamins can play an important role when nutritional requirements are not met through diet alone.

Even if they are ineffective, are they harmful?

1. You may not be getting what the label states. For something that does not undergo scrutiny, as it is not labeled as a drug, many prescription drugs have been found in them. This is a good database to determine if the supplement you are taking or plan to has made it to the lamentable list.
2. Some dietary supplements may react with your essential medicines and render them less effective. For e.g., mixing the prescription drug thinner warfarin with ginkgo and vitamin E supplements can thin the blood further and increase the risk of internal bleeding.
3. Supplements have been reported to cause liver damage which has even led to liver failures requiring a
   Transplant. These are mostly supplements used for bodybuilding and weight loss.
4. Large doses of vitamin C can cause diarrhea, abdomen cramps, fatigue, kidney stones, and even interfere with the results of certain lab tests like for diabetes.
5. High levels of vitamin B6 lead to nerve damage.
6. High doses of vitamin A may cause birth defects and central nervous system, liver, bone, and skin disorders.
7. High-dose vitamin E supplements have been linked to higher early death rates.
8. Very large doses of fish oil can lead to reduced blood clotting, especially if you are already on medicines for thinning the blood.

Supplements cannot be just dismissed in their entirety. All that is needed is judicious usage.
But if you think that your overpriced, USDA certified, ethically sourced, 100% natural ingredients pill can give you glowing skin and shiny hair instead of hitting the gym and eating healthy…boy, you are in for a surprise. These do not compensate for poor eating habits and lack of exercise.

Takeaway

• Vitamins and minerals are essential nutrients, the deficiency of which can result in deleterious health consequences.
• Always aim for a varied and balanced diet to meet your requirements.
• If you plan to conceive, are already pregnant, have a health issue, or have dietary restrictions, consider supplementation under medical guidance.
• Nutritional supplements are not regulated, and you need to exercise caution.
• They may also react with medicines that you are on.
• Always seek medical consultation before starting supplementation.

Trivia

The term ‘vitamin’ was coined by Polish American Biochemist Dr. Kazimierz (Casimir) Funk (1884-1967). He recognized that certain food-based factors were needed to prevent nutrition-based diseases, like beriberi (vitamin B 1 deficiency), scurvy (vitamin C deficiency), pellagra ( niacin deficiency), and rickets ( vitamin D deficiency). These unidentified substances were all in a class of organic compounds called ‘amines’, which are vital to life, so he named them vitamines (vital amines). He later confirmed the existence of the vitamins B 1, B 2, C, and D.