Health Matters | Stop wasting money on multivitamins. The science around their health benefits is still hazy

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“Multivitamin pills are not a shortcut to better health” – so many doctors across India tell their patients who insist on prescribing supplements.

“There are patients who ask me to prescribe multivitamins for no reason,” Dr. Manisha Arora, an internal medicine consultant at Sri Balaji Action Medical Institute in New Delhi, told me.

“I don’t recommend supplements unless the report shows a deficiency. Otherwise, if you eat a healthy diet, you can get all the vitamins and minerals from food.

Arora said the fashion became even more pronounced after the Covid-19 outbreak. “Even healthy people ask for such capsules and syrups, assuming that it will give them immunity and maintain their health.”

No wonder Indians bought more than 500 crore of vitamin C, zinc and multivitamin pills to fight Covid-19 in 2020. But do we really need to consume multivitamin to keep our body fit and fit ?

It’s been a common myth since the 1970s that multivitamins should be consumed by everyone to prevent chronic disease and stay in the pink of health.

Before we go any further, here’s the disclaimer: This article is about “healthy” people who have no known disease or history of disease, but take multivitamin supplements without consulting a health care provider. It does not include people with comorbidities who take such supplements on prescription from their doctor.

Consuming a multivitamin daily to improve health and prevent disease is a common misconception among the population. This is one of the most common delusions of “good health” among people.

Even then, there is no standard definition of what a multivitamin tablet or syrup should contain and how many nutrients it should contain. In fact, there is no good quality research data suggesting a daily intake of multivitamins and minerals.

Our body cannot absorb all the food we eat. There are physiological limits to the amount of nutrients our bodies can absorb. For example, our bodies generally cannot absorb more than 10% of the iron from a vegetarian diet and 18% of the iron from the Western diet, which includes animal foods. Likewise, only 20-25 grams of high-quality protein is absorbed at one time. The same is true for multivitamins.

The human body cannot absorb them all and taking extra pills puts unnecessary pressure on our system like the kidneys to eliminate them, which ends up affecting the natural harmony of the body.

In fact, a wealth of published, peer-reviewed research has shown that daily multivitamins and the use of specific vitamins in healthy people may be associated with a host of diseases, including cancers.

Who needs what, when?

Nutrient deficiency shows up very quickly, according to half a dozen health experts I spoke to.

Symptoms of iron deficiency anemia or vitamin C deficiency are hard to miss by practitioners. Even a B12 deficiency – which is most common among vegetarians in India – can be diagnosed by numbness and tingling in the hands.

Therefore, balance is key.

“Multivitamins can very well be useful, for example, for athletes. But taking anything off the shelf won’t even help them,” said Delhi-based health practitioner Dr. Abhishek Singhal.

Athletes who participate in endurance sports such as marathons need to be replenished with salt and glucose, while sports such as football, long jump and even javelin throwing require strength in the joints and the cartilages. “So naturally the supplements have to be different for each of them. This is precisely the job of nutritionists and doctors specializing in sports medicine.

Likewise, for pregnant women, the nutritional needs increase and folic acid, as well as food supplements, have a proven benefit for them. But for an everyday Joe, just drinking a glass of milk or eating an apple or fruit gives him the required amount of vitamins.

“An important vitamin that I usually prescribe to elderly vegetarians is B12. So if you get older and only follow a vegetarian diet, you need to watch your vitamin B12 levels,” says Dr. Sumit Ray, a specialist in intensive care at Holy Family Hospital.

Where the evidence is lacking is in whether these pills help people who otherwise have relatively healthy diets and are in good health.

Stop taking multivitamins unless deficient

Multivitamins contain fillers or excipients which are essentially inert materials that do not react with or have any effect on the human body. These fillers are added with active ingredients that have a therapeutic effect.

With the arrival of new research, the inertia of these excipients is slowly being questioned and we must take this into account while consuming anything for longer periods of time, unless its obvious benefits outweigh the probable risks.

“Most multivitamin tablets contain talc as a filler. While Johnson & Johnson is already removing talc-based powders from shelves around the world, it is unfortunate that we are still consuming talc as a filler in tablets, especially multivitamins,” Dr Singhal pointed out during a presentation. ‘a conversation.

Next, calcium supplements usually contain calcium carbonate. This is the same compound that is used to coat our walls or in Hindi called ‘choona’. The more expensive variants contain calcium citrate, but its absorption is only slightly better than the carbonate salt. An overdose of calcium is harmful to the kidneys as well as the heart.

Even these green vitamin E capsules contain a tiny amount of vitamin E dissolved in a much larger amount of undisclosed oil. So, those who are trying to lower their cholesterol should be aware of this fact.

None of the multivitamin supplements have been shown to be effective in preventing heart disease in the general population, but only omega-3 fatty acid supplementation has been shown to be useful in preventing heart attacks in those at risk.

Let’s dive deep into the available evidence

Last year, a study published in a peer-reviewed Journal of Nutrition found that daily multivitamin supplementation is associated with a “slightly” higher risk of cancer.

“Slightly higher risks of overall, prostate and lung cancer, as well as leukemia, were observed for greater multivitamin use in men, with a higher risk of oropharyngeal cancer in women. “, revealed the study.

“We found little evidence to support a cancer prevention role for multivitamin use, with the exception of colon cancer, in either sex…”

This is not a new or surprising discovery. In fact, a 1994 ATBC study followed by several other studies threw up mixed evidence. He found no reduction in the incidence of lung cancer in male smokers after five to eight years of dietary supplementation with alpha-tocopherol or beta-carotene (ATBC) – powerful antioxidants synthesized in plants.

“In fact, this trial raises the possibility that these supplements actually have both harmful and beneficial effects,” the study found.

In the gist, Dr. Cyriac Abby Philips, a specialist in hepatology and liver transplant medicine in Kerala, said, “Multiple highest quality research meta-analyses, authoritative reviews and group consensus of experts have conclusively concluded that there is no overall benefit i.e. they do not prevent heart disease, reduce infections or prevent cancer, with a widespread use of multivitamins and minerals in a healthy young or elderly population.

Philips, who has been very active in educating people about the scientific evidence to combat pseudoscience, advises that “the indiscriminate, non-recommended and widespread use of multivitamins to improve health may, in fact, give a chance to visit the hospital. .

Previous studies have shown that daily use of folic acid in healthy people may increase the growth of undiagnosed large bowel tumors.

“Folic acid at 1 mg/day does not reduce the risk of colorectal adenoma. Further research is needed to investigate the possibility that folic acid supplementation may increase the risk of colorectal neoplasia,” a 2007 study suggested.

Emerging evidence shows that vitamin D pills taken with or without calcium have no effect on bone fracture rates.

The latest study of nearly 26,000 people – published on July 26 – who were required to take vitamin D every day found that the vitamin had no effect, even in people with low vitamin D or vitamin D levels. osteoporosis.

And while there is no harm, there is no benefit either. A 2018 study showed that multivitamins had slightly substantial benefits and the review found that consuming multivitamins, vitamin D, calcium or vitamin C, does no harm, but there is no more clear advantage.

The idea of ​​popping vitamins has undoubtedly been accepted by many in India. It’s time to question the approach.

Meanwhile, a balanced approach is needed and rational, science-based prescribing is the need of the hour when it comes to multivitamins. You should also not reject vitamins outright or swallow them unnecessarily without a proven cause.

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