A 60-year-old gentleman came to me for consultation on his loss of appetite. On questioning, he showed me a list of 17 supplements (written on a scrap of worn out paper) that he was taking. These ranged from vitamins, hormones and even steroids. He said that he just wanted to live longer than others by consuming these “energy giving supplements.” Investigations revealed a frayed liver (high liver enzymes indicating liver damage) while urine showed plenty of proteins (indicating kidney damage). I told him, “By consuming this dangerous cocktail of supplements and hormones, you may live shorter than others.” I stopped all his supplements and his liver and kidneys gradually healed.

Another patient came to me with very high calcium levels, causing kidney failure. On questioning he said, “I had heard that all of us have vitamin D deficiency, so I started taking it daily.” He bought it over the counter, and without a physician’s advice, took one sachet of 60,000 units of vitamin D daily for three months (meant to be taken once weekly for a limited time in those with vitamin D deficiency). He had to be admitted and we were able to bring down his calcium levels gradually. And his kidney function improved.

Do you really need vitamins and supplements?

Both cases were examples of the kinds of misuse of vitamins and supplements. The lesson is, you do not need vitamins and minerals if you are without any disease. Exercising regularly and taking nutritious diets, including plenty of fruits and vegetables, should suffice. Enough vitamins/minerals can be acquired from the following sources: vitamin D from sunshine exposure, calcium from milk, curds, cheese and so on, B12 from liver and seafood while protein can be sourced from non-vegetarian sources, soybean, milk, nuts, Bengal gram, lentils and flaxseeds. Dietary supplements are available in pure forms (e.g., vitamin B12, fish oil, vitamin D, Whey protein etc) and mixed together (multi-vitamins include few to 30 or more vitamins and minerals together). The latter is consumed widely.

When do you need supplements?

A patient should be guided by a doctor or nutritionist. When food absorption is decreased in the intestine (malabsorption, pancreatic inflammation, or intestinal surgery), several vitamins become deficient. Patients who have lost a lot of weight (cancer, liver disease etc) will require vitamin and protein supplements. Those who take a considerable amount of alcohol for long periods become deficient in vitamins. Those with fragile bones and thin muscles require vitamins, calcium, and protein supplements. Iron supplements are needed in several conditions: heavy periods in women, intestinal ulcers, worm infestations and so on.

Remember, multiple deficiencies of vitamin and protein may occur after any acute infections (viral, bacterial) and have been seen to occur in severe manner in those with COVID-19 infections. Pregnant women clearly need vitamins to prevent birth defects from occurring in offspring. Some vegetarian people may suffer from vitamin B12 and protein deficiency. For those going through the process of alcohol withdrawal, thiamine supplementation becomes necessary.

Patients with diabetes are often prescribed multivitamins. Those on commonly prescribed drugs, metformin, will need vitamin B12. Those with long-standing diabetes, who are frail, and have poor appetite or intestinal muscle dysfunction (due to severe nerve damage) will need multivitamin and vitamin D supplements. Protein supplements should be given with great care in patients having kidney dysfunction. Patients with diabetes often have high blood fats (“triglycerides”) and these could be effectively treated by fish oil capsules (made from oils of salmon and other fatty fishes).

Young men who want to build their muscles are given protein supplements in gyms. These may help. However, the dose of total protein intake needs to be calculated properly according to body weight. Other additions such as body building hormones (anabolic steroids) should be avoided. These supplements are given in many gyms by unqualified people.

Like excess vitamin D (refer to second patient above) and calcium, intake of some other vitamins may also cause harm. Avoid beta-carotene (from pills, but it is fine from natural foods) if you are a smoker/ex-smoker, and vitamin A if you are pregnant. Excess vitamin E taken for long periods may increase the risk for prostate cancer.

A multivitamin won’t serve the purpose

Some people think that if they are taking one tablet of multivitamin, they will have enough of all vitamins and minerals. That is not true. Specific vitamin/mineral deficiencies (Vitamin B12, folate, calcium, iron, vitamin D etc) need to be treated with pure specific vitamins/minerals (tailored therapy) which are given in 5-10 times higher doses than found in a multivitamin capsule/tablet. In severe deficiency, injectable vitamins need to be given.

Finally, there is a misconception that taking daily vitamins/minerals will prevent heart disease or cancer. There is no evidence that this will take place in those who are taking a variety of healthy diets, fruits, and vegetables, and going out in sunlight to do aerobic exercises. Clearly, a multivitamin a day cannot replace a healthy diet and exercise.

(The author is Padma Shree awardee and author of the book “Diabetes with Delight”)

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Dr Anoop MisraDr Anoop Misra is the Chairman, Fortis CDOC Center for Diabetes... read more