Imsutola Jamir
Dietitian, CIHSR, Chümoukedima
Over-the-counter dietary supplements are big business. The Indian nutritional supplements market reached a value of INR 331 Billion in the Financial Year 2021. Looking forward, International Market Analysis Research and Consulting Group (IMARC Group) expects the market to reach INR 847 Billion by 2027. For many people, a healthy lifestyle means more than eating a good diet, and getting enough exercise; vitamins, mineral supplements, and complementary nutritional products are considered part of the healthy lifestyle plan. There is so much publicity about potential benefits of supplements, and is less awareness of their possible harmful effects. They’re sold openly and freely as food. So just like we buy some vegetables or fruits, one can buy whatever sort of supplements, botanicals, or probiotics in the stores, pharmacy, online, or from a company salesperson. This helps to create a "false impression" that food supplements cannot cause harm.
What are dietary supplements?
A dietary supplement is a manufactured product intended to supplement one's diet by taking a pill, capsule, tablet, powder, chewable gummies, bar, candies or liquid. A supplement can provide nutrients either extracted from food sources or that are synthetic in order to increase the quantity of their consumption.
Types of supplements
One way to group multivitamin and mineral supplement are as follows:
Types | Description |
Basic
| Multivitamin and Mineral Supplement taken once a day that contain all or most vitamins and minerals, most in amounts that do not exceed the Daily Values (DVs), Recommended Dietary Allowances (RDAs), or Adequate Intakes (AIs) for these nutrients. |
High potency
| Some Multivitamin and Mineral Supplement contain amounts of some vitamins and minerals that are substantially higher than the Daily Value, RDA, AI, or even, in some cases, the established Tolerable Upper Intake Level (UL). These Multivitamin and Mineral Supplement might also include other nutrients and botanical ingredients like Aloe Vera, Bitter Orange, Black Cohosh, Ephedra, Ginkgo Biloba, Ginseng, Goldenseal, Green Tea Extract, Gum Guggul, Kava Kava, Milk Thistle, Senna, Usnea Lichen, Vinpocetine, Black Cohosh, Echinacea Purpurea, Garcinia Cambogia, Valerian Root etc |
Specialized | Multivitamin and Mineral Supplement such as those for energy, enhanced athletic performance, weight control, improved immune function or eye health—often combine several vitamins and minerals with botanical ingredients ingredients like Aloe Vera, Bitter Orange, Black Cohosh, Ephedra, Ginkgo Biloba, Ginseng, Goldenseal, Green Tea Extract, Gum Guggul, Kava Kava, Milk Thistle, Senna, Usnea Lichen, Vinpocetine, Black Cohosh, Echinacea Purpurea, Garcinia Cambogia, Valerian Root etc and specialty ingredients, such as coenzyme Q10, probiotics, or glucosamine etc. Some of these products might contain amounts of nutrients that are substantially above the DV, RDA, AI, or even UL. These Multivitamin and Mineral Supplement are condition specific. |
Above figure: National Institutes of Health, Office of Dietary Supplements. Dietary Supplement Fact Sheet for Health Professionals, Multivitamin/mineral Supplements – Health Professionals.
Some benefits of taking supplements.
Some dietary supplements have been linked to a decreased risk of some conditions and to improvements in health. For example:
• Folic acid intake to a lower risk of fetal development issues.
• The omega-3 fatty acids in fish oil are with improved heart health.
• Calcium and vitamin D can help bone loss.
• Vitamins A, C, and E intake improve to eye health.
• Multiple common herbs, including St. John’s wort and rosemary, have anti-bacterial properties.
• Probiotics for their ability to support digestion and the immune system.
• Magnesium for sleep and healthy digestion.
Supplements on Cancer
The evidence regarding multivitamin and mineral supplements, antioxidant supplements use and cancer risk is mixed. Some studies suggest no effect on cancer risk, while others link multivitamin use to increased cancer risk. Herbal supplements are postulated to interfere with cancer treatment. It is recommended to consult the treating oncologist, before recommending supplementation. Random high doses of nutrients supplement are not recommended unless specific nutrient deficiency is established. If food intake is inadequate, oral nutrition supplements can be provided after evaluating the patient’s nutrition status and food intake.
Current evidence does not support a role of vitamin and mineral supplements in reducing cancer risk, with some evidence suggesting potential harm.
Supplements on Type 2 diabetes mellitus
Current research does not support the use of supplements with vitamins C or E, Vitamin A, or fish oil to reduce the risk of type 2 diabetes.
Supplements on Heart Diseases
There is insufficient evidence to claim the presence or absence of benefits from use of multivitamin and mineral supplements to prevent heart diseases. While some experts believe that taking Multivitamin and mineral supplements can help prevent heart disease but, research doesn’t seem to support it conclusively. Some studies suggest that multivitamins correlated to a reduced risk of heart attacks and death, while others show no effects.
The Physicians’ Health Study II investigated the effects of daily multivitamin use in over 14,000 middle-aged male doctors for over a decade and found no reductions in heart attacks, strokes, or mortality.
What are the Health Risks?
There are in fact many ways in which a supplement of an essential nutrient can produce an adverse effect. The risk of side effects increases if many supplements together or if taken in high doses. Since many dietary supplements add to the nutrients from foods, it can be easy to take an overly high dose without knowing.
Possible side effects of dietary supplements include:
• nausea
• vomiting
• headache
• constipation
• excessive sleepiness
Supplements can also have long-term complications and risks such as:
• liver or other organ damage
• reduced bone strength
• fetal development abnormalities
• increased risk of bleeding
• changes in your response to anesthesia
• reduced effectiveness of chemotherapy
• nervous system damage
Additionally, some supplements can interact with prescribed medications. Some side effects are specific to certain supplements or to the combination of certain supplements and medications.
Supplementing with large doses of certain nutrients can have harmful effects to health. This is more likely to occur if one takes a high-potency multivitamin on top of a nutrient-dense diet. Dosage is an essential factor to consider when taking multivitamins.
Our body flushes out excess amounts of water-soluble vitamins through your urine. Since our body has no easy way to get rid of fat-soluble vitamins, excess amounts may accumulate in the liver.
Smokers should avoid multivitamins with large amounts of beta carotene or vitamin A, as these nutrients may increase your risk of lung cancer. High doses of certain minerals, such as iron, can lead to stomach upset, constipation, vomiting, and fainting. Iron can also limit the body’s ability to absorb zinc. Particularly, men should be mindful of their iron consumption, as they tend to store more of it than women do. If not mindful, it leads to a buildup of toxic levels of the mineral and may cause liver cirrhosis, liver cancer, and heart disease. Another risk is faulty manufacturing processes, which may cause multivitamins to harbor much larger amounts of nutrients than intended.
Who can take supplements?
Individuals, including older adults, vegetarians, and vegans, may need higher amounts of certain vitamins or minerals. A varied diet generally provides enough of each vitamin and mineral. However, some people may need supplements to correct vitamin or mineral deficiencies. Vegetarians, vegans, crash dieters, strict dieters, pregnant women, breastfeeding women, illegal drug addicts, older adults, chronically ill people, women with heavy periods, people with food allergies and those with malabsorption problems such as diarrhea, coeliac disease, cystic fibrosis or pancreatitis may need supplements to correct vitamin or mineral deficiencies. Individuals, including vegetarians, vegans, and strict dieters need to make sure they're getting enough vitamin B12, calcium, iron, and zinc from their natural diet. Suppose if they don’t get the recommended amounts of certain vitamins or minerals from their diet, multivitamin and mineral supplements may help them obtain those nutrients.
A caution to keep in mind: consuming a healthy, balanced diet with multivitamin and mineral supplements, could exceed the recommended daily intake of many nutrients.
Takeaway message
Most people should get all the nutrients they need by having a varied and balanced diet, although some people including vegetarians, vegans, and strict dieters may need to take dietary supplements. Taking a multivitamin mineral supplement is not a substitute for a balanced, healthful diet. No supplements can beat the nutrient power of a healthy diet. Supplements should never be used in place of real food. Supplements are not a shortcut to better health and the prevention of chronic diseases. With limited regulation and oversight, it's also difficult to know for certain that the supplement contains the ingredients on the label and is free of contaminants. For a healthy adult, if supplements are used, they should generally be taken at levels close to the Recommended Dietary Allowance.
High-dose supplements should not be taken unless recommended under medical advice. Vitamin and mineral supplements can also interfere with prescription medicines and medical treatments. It is important to speak with a Doctor or a Dietitian before taking any supplements because a supplement’s effectiveness and safety may depend on individual situation and health.
