Nutraceuticals and dietary supplements are not a substitute for a healthy diet, but they serve a purpose for older adults, vegetarians, and people with erratic eating patterns who are often deficit in one or more micronutrients needed to stay healthy.
Vegetarians and people who have too much alcohol or caffeine have a slightly higher risk of iron and vitamin B12 deficiencies, while people with underlying diseases and conditions, such as intestinal infection, inflammation or surgery, prolonged use of antibiotics, pancreatitis, cystic fibrosis, Crohn’s disease, and food sensitivity such as lactose intolerance, may also need supplementation, but it should be closely monitored.
“Supplementation is essential for people with deficiencies, but the health benefits of multivitamins are negligible for healthy people till they are 60 years, when malabsorption may begin. Healthy people don’t need supplementation but with rising income and increasing health consciousness, having supplements has become a fad,” said former chief dietician of All India Institute of Medical Sciences (AIIMS), Rekha Sharma.
This fad is fuelling the market for supplements in urban India. The nutraceuticals and dietary supplements market in India was valued at 26,000 crores in 2017, and is projected to grow at a compound annual growth rate of 17 per cent over the next five years to reach 8,08,000 crores by 2023, according to Ken Research.
With an increasing number of health-conscious urban folk having multiple supplements, the cases of toxicity are also rising. “We get quite a few cases of vitamin B12 and vitamin D3 toxicity, which are fat-soluble vitamins that get stored by the body. Vitamin B12, for example, gets stored in the liver and when given in concentrated doses, can lead to dizziness, headaches, and vomiting. Injection of B12 must be administered with caution only to people who are highly deficit,” said Navin Dang, who runs Dr Dangs Lab, one of Delhi’s leading diagnostic labs.
Similarly, vitamin D3 accumulates and leads to calcium build-up in the blood (hypercalcemia), which causes nausea and vomiting, weakness, and frequent urination, followed by joint pain and kidney stones. “There is no toxicity from water-soluble vitamins like vitamin C because the body excretes the excess amount,” said Dang.
High doses of beta carotene (the body converts it into vitamin A) have been linked to a greater risk of lung cancer in smokers, vitamin E toxicity has been found to trigger stroke caused by bleeding in the brain, while vitamin K is known to interfere with the anti-clotting action of blood thinners prescribed to people with heart disease, which can lead to heart attacks.
Most supplements available over the counter come with daily recommended allowance (RDA) for each vitamin and mineral mentioned on the label. Since the dose contained in each tablet is well below the RDA, you are safe as long as you have it in the recommended dose.
“Most cases of overdose occur because of unethical physicians injecting vitamins in high concentration meant for therapeutic use. Lab follow-up after supplementation in India are rare, as is reporting of adverse drug reactions, so the known cases of toxicity are just the proverbial tip of the iceberg,” said Dang, who gets a couple of cases in his lab every week.
Vitamin D, vitamin B12, calcium, potassium and iron are the most common deficiencies and most vitamin supplements available are usually a combination of the same small group of vitamins – A, E, D and K – with or without folate, iron and magnesium. What varies between different brands is the amount each nutrient is present in and whether some extra frills have been added, such as ginseng, ginkgo, Brahmi, evening primrose oil, or green tea.
There is little scientific evidence to show that these add-ons do anything for health. Supplements are not regulated under India’s Drugs and Cosmetics Act, 1940, which means they do not undergo the same vigorous efficacy tests as medicine and can claim outcomes that are not scientifically validated, such as lowering stress, enhancing energy, minimising post menopausal symptoms, and improving brain function.
Standard multivitamin and mineral tablets are as effective and a 30-day supply can cost as little as 50 to 100, depending on the brand.
“Oral supplements are usually safe, but it’s advisable to go for a diagnostic follow-up at least once a year to identify deficiencies and stop supplementation when it is not required,” said Sharma.