A 60-year-old gentleman came to consult me for his loss of appetite. During the interrogation, he showed me a list of 17 supplements (written on a worn piece of paper) that he took. These ranged from vitamins, hormones and even steroids. He said he just wanted to live longer than others by consuming these “energy supplements”. Investigations revealed shredded liver (elevated liver enzymes indicating liver damage) while urine showed lots of protein (indicating kidney damage). I said to him: “By consuming this dangerous cocktail of supplements and hormones, you can live less long than the others. I stopped all of her supplements and her liver and kidneys gradually healed.
Another patient came to me with very high calcium levels causing kidney failure. When asked, he said: “I had heard that we were all deficient in vitamin D, so I started taking it daily.” He bought it over the counter and, without a doctor’s advice, took one sachet of 60,000 units of vitamin D daily for three months (intended to be taken once a week for a limited time in people with vitamin D deficiency). He had to be hospitalized and we were able to gradually lower his calcium level. And his kidney function has improved.
Do you really need vitamins and supplements?
Both cases were examples of the types of vitamin and supplement abuse. The lesson is that you don’t need vitamins and minerals if you’re not sick. Exercising regularly and eating a nutritious diet, including plenty of fruits and vegetables, should be enough. Sufficient vitamins/minerals can be acquired from the following sources: vitamin D from exposure to sunlight, calcium from milk, curds, cheese, etc., B12 from liver and seafood, while Protein can come from non-vegetarian sources, soy, milk, nuts, bengal gram, lentils, and flax seeds.
Dietary supplements are available in pure forms (eg vitamin B12, fish oil, vitamin D, whey protein, etc.) and blended (multivitamins contain from a few to 30 or more vitamins and minerals together). The latter is widely consumed.
When do you need supplements?
A patient should be guided by a doctor or nutritionist. When food absorption is decreased in the intestine (malabsorption, inflammation of the pancreas or intestinal surgery), several vitamins become deficient. Patients who have lost a lot of weight (cancer, liver disease, etc.) will need vitamin and protein supplements. Those who consume a considerable amount of alcohol for long periods of time become deficient in vitamins. Those with weak bones and thin muscles need vitamin, calcium and protein supplements. Iron supplements are necessary in several conditions: heavy periods in women, intestinal ulcers, worm infestations, etc.
Remember that multiple vitamin and protein deficiencies can occur after any acute infection (viral, bacterial) and have been observed in severe cases in people infected with COVID-19. Pregnant women clearly need vitamins to prevent the occurrence of birth defects in their offspring. Some vegetarians may suffer from vitamin B12 and protein deficiency. For those going through the process of alcohol withdrawal, thiamine supplementation becomes necessary.
Diabetic patients are often prescribed multivitamins. Those taking the commonly prescribed medication metformin will need vitamin B12. People with long-standing diabetes, who are frail, and have poor appetite or bowel muscle dysfunction (due to severe nerve damage) will need multivitamin and vitamin D supplements. Protein supplements should be administered with great caution to patients with renal dysfunction. Diabetic patients often have high blood lipids (“triglycerides”) and these could be effectively treated with fish oil capsules (made from oils of salmon and other fatty fish).
The gym alert
Young men who want to build muscle are given protein supplements at gyms. These can help. However, the total protein intake dose should be calculated correctly based on body weight. Other additions such as bodybuilding hormones (anabolic steroids) should be avoided. These supplements are given in many gyms by unqualified people.
Like excess vitamin D (see patient two above) and calcium, intake of certain other vitamins can also be harmful. Avoid beta-carotene (in pill form, but fine with natural foods) if you’re a smoker/ex-smoker, and vitamin A if you’re pregnant. Excess vitamin E taken for long periods may increase the risk of prostate cancer.
A multivitamin won’t help
Some people think that if they take a multivitamin tablet they will get enough vitamins and minerals. It’s not true. Specific vitamin/mineral deficiencies (vitamin B12, folate, calcium, iron, vitamin D, etc.) should be treated with pure specific vitamins/minerals (tailored therapy) which are given in 5-10 times higher doses than those found in a multivitamin capsule/tablet. In case of severe deficiency, injectable vitamins should be administered.
Finally, there is a misconception that taking vitamins and minerals daily will prevent heart disease or cancer. There is no evidence that this will happen in those who eat a variety of healthy diets, fruits and vegetables, and go out in the sun for aerobic exercise. Obviously, a daily multivitamin cannot replace a healthy diet and exercise.
(The author is a Padma Shree award winner and author of the book “Diabetes with Delight”)
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