“There are patients who ask me to prescribe multivitamins for no reason,” Dr Manisha Arora, a consultant on internal medicine at New Delhi-based Sri Balaji Action Medical Institute, told me.
“I don’t recommend supplements unless the report shows deficiency. Otherwise, if you follow a healthy diet, you can get all of the vitamins and minerals from food.”
Arora recounted that the fad has gotten even more pronounced post the Covid-19 outbreak. “Even healthy people ask for such capsules and syrups, assuming that it will give them immunity and maintain health.”
No wonder Indians bought over 500 crore pills of Vitamin C, Zinc, and multivitamins to battle Covid-19 in 2020. But, do we really need to consume multivitamins to keep our bodies fit and fine?
This is a common myth that is being bred since the 1970s that multivitamins should be consumed by everyone to prevent chronic diseases and to stay in the pink of health.
Before we proceed further, here is the disclaimer: This article discusses “healthy” people who have no known disease or a disease history but pop multivitamins supplements without consulting a healthcare provider. It does not include people with co-morbidities who consume such supplements on their doctor’s prescription.
Consuming a multivitamin daily to improve health and prevent diseases is a generalised misbelief among the population. It is one of people’s commonest, self-deceptive, illusions of ‘good health’.
Even then, there is no standard definition of what and how many nutrients a multivitamin tablet or syrup must contain. In fact, there is no good quality research data to suggest an intake of daily multivitamins and minerals.
Our bodies cannot absorb all the food we eat. There are physiological limits to the amount of nutrients our bodies can absorb. For example, our bodies usually can’t absorb more than 10% of the iron from a vegetarian diet and 18% of iron from the western diet, which includes animal food. Similarly, only 20-25 grams of high-quality protein is absorbed in one go. The same is true for multivitamins.
The human body cannot absorb all of them and popping extra pills puts unnecessary strain on our system, such as on the kidneys to flush them out which eventually impacts the natural harmony of the body.
In fact, a multitude of published peer-reviewed research has shown that daily multivitamins and specific vitamin use in healthy people are possibly associated with a host of diseases, including cancers.
Market in India
Multivitamins as a category had done extremely well during the Covid-19 time with demand for zinc, Vitamin C, Vitamin D preparations amongst others on the rise.
While the markets noticed a dip in term of sales, in the last few weeks, according to data by research firm Pronto Consult, there was an increase in sales of this category.
“53% of retailers saw an increase in sales of brands into Vitamin D, calcium, protein powders and zinc preparations,” said the research conducted by Pronto Consult, which specialises in doctor perception studies and pharma market insights in India and West Asia.
The increase has been witnessed across brands in supplements category. Blame long Covid-19 or post Covid-19 fatigue and related paranoia which pushes one to take care of health by all available means.
“56% of retailers have reported that customers come asking for “goli hai” for fatigue or body pain and hence, over the counter sales of such supplements is growing.”
The study found that the pick-up in sales is beyond metros in cities like Vellore, Thane, Howrah, Kota, Puri, Vizag, Guntakal among others.
Who needs what, when?
The deficiency of nutrients shows up very quickly, according to half a dozen health experts I spoke to.
Symptoms of iron deficiency anaemia or vitamin C deficiency are hard to miss by practitioners. Even B12 deficiency — which is most common among vegetarians in India — can be diagnosed by numbness and tingling of the hands.
Hence, balance is the key.
“Multivitamins may very well be useful, for example, for sportspersons. But taking anything off the shelf will not help even them,” Delhi-based health practitioner Dr Abhishek Singhal said.
Athletes competing in endurance sports such as marathons need to replenish salt and glucose while sports like football, long jump, and even javelin throw require strength in joints and cartilages. “So naturally, supplements have to be different for each of them. This is precisely the job of nutritionists and doctors specialising in sports medicine.”
Similarly, for pregnant females, the nutrition requirements rise and folic acid, as well as dietary supplements, have a proven benefit for them. But for an everyday Joe, just having a glass of milk or eating an apple or any fruit gives him or her the required amount of vitamins.
“An important vitamin that I generally prescribe elderly vegetarians is B12. So, if you are ageing and consume only a vegetarian diet, you must watch out for your B12 levels,” Dr Sumit Ray, critical care specialist at Holy Family Hospital, believes.
Where evidence falls short is in finding if such pills help people who otherwise have a relatively healthy diet and are healthy.
Stop popping multivitamins unless found deficient
Multivitamins contain fillers or excipients which are basically inert materials that do not react with or have any effect on the human body. These fillers are added along with active ingredients having a therapeutic effect.
With new research coming in, the inertness of these excipients is slowly coming into question and we need to bear it in mind while consuming anything for longer periods unless its obvious benefit weighs much higher than the probable risks.
“Most multivitamin tablets contain talc as a filler. With Johnson & Johnson already taking talc-based powders off the shelves across the globe, it is unfortunate that we are still consuming talc as filler substances in tablets, especially multivitamins,” Dr Singhal pointed out in a conversation.
Then, calcium supplements usually contain calcium carbonate. This is the same compound that is used to plaster our walls or in Hindi termed ‘choona’. The more expensive variants do contain calcium citrate but its absorption is only mildly better than carbonate salt. An overdose of calcium is harmful to the kidneys as well as to the heart.
Even those green Vitamin E capsules contain a minuscule amount of Vitamin E dissolved in a far greater quantity of undisclosed oil. So, those trying to get their cholesterol down need to be aware of this fact.
None of the multivitamin supplements has proven to prevent heart disease in the general population, but only omega-3 fatty acid supplementation has been found useful in preventing heart attacks in at-risk persons.
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 leukaemia, were observed for greater multivitamin use in men, with a higher oropharyngeal cancer risk in women,” the study found.
“We found little evidence to support a cancer-preventive role for multivitamin use, with the exception of colon cancer, in both sexes…”
It’s not a new or surprising finding. In fact, a 1994 ATBC study followed by several other studies threw mixed evidence. It found no reduction in the incidence of lung cancer among 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 may actually have harmful as well as beneficial effects,” this study found.
In a gist, Dr Cyriac Abby Philips, a specialist in hepatology and liver transplant medicine in Kerala, said: “Several highest quality research meta-analyses, authoritative reviews and expert panel consensus have conclusively found that there is overall no benefit, that is they do not prevent heart disease, reduce infections or prevent cancer, with generalised multivitamins and minerals use in healthy young or aged population.”
Philips, who has been very vocal in educating people about the scientific evidence to fight pseudoscience, advises that “the blind, un-recommended and generalized use of multivitamins for improving health, may, in fact, give one a chance to visit the hospital”.
Earlier studies showed that daily folic acid use in healthy persons may increase the growth of undiagnosed large bowel tumours.
“Folic acid at 1 mg/d does not reduce colorectal adenoma risk. Further research is needed to investigate the possibility that folic acid supplementation might increase the risk of colorectal neoplasia,” a study conducted in 2007 suggested.
The 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 assigned to take vitamin D each day found the vitamin had no effect, even among people who had low vitamin D levels or osteoporosis.
And even if there is no harm, there is no benefit as well. A 2018 study showed multivitamins had slightly substantial benefits and the review found that consumption of multivitamins, vitamin D, calcium or vitamin C, does no harm but there is no clear advantage either.
The idea of popping vitamins has been unquestioningly accepted by many in India. It’s time to question the approach.
Meanwhile, a balanced approach is needed and science-based, rational prescribing is the need of the hour when it comes to multivitamins. Neither should you outrightly reject vitamins nor should you gulp them unnecessarily without a proven cause.