EXPLAlNER: Potential harms of taking unprescribed dietary supplements, multivitamins

Snagging the second position in the top ten countries with low life expectancy, Nigeria’s healthcare system has continued to raise concerns among stakeholders. 

In most cases, Nigerians are advised to maintain an overall healthy lifestyle — physically or even mentally- to prolong their lives and avoid chronic diseases. In a report by The Lancet, the Nigerian health system is ill-prepared to deal with the increased prominence of non-communicable diseases and the surge in deaths.

This has made many in the country resort to alternatives, which are often dangerous, to keep themselves healthy. 

In recent times, the Nigerian social media space has been awash with the benefits attached to the use of multivitamins and food supplements because they are considered generally safe to use. 

However, health experts have argued that food supplements are not risk-free.

Quoting Euromonitor, a report in the New Zealand Medical Journal showed that the value of global retail sales of non-prescribed supplements increased by 105% between 2007 and 2021, with a particular emphasis on preventive health at the start of the pandemic in 2020.

A study by BMC Geriatrics examining the effect of unprescribed use of vitamin D described how publicity boosts the acquisition of vitamins for different purposes, increasing consumption with no professional advice or supervision.

What are multivitamins? 

Multivitamins are a combination of many different vitamins that are normally found in foods and other natural sources. 

According to Healthline, most people taking multivitamins often do so to improve their health, protect themselves against nutrient deficiencies, or compensate for the odd nutrient gap in their diet. 

Another report by the National Institutes of Health warned that supplements cannot replace the variety of foods important to a healthy eating routine.

However, it corroborated the claim that dietary supplements can improve overall health and help manage some health conditions. For instance, Calcium and vitamin D help keep bones strong and reduce bone loss; folic acid decreases the risk of certain birth defects; Omega-3 fatty acids from fish oils might help some people with heart disease, among others.  

However, there are potential dangers attached to taking unprescribed supplements, particularly over a long period without a proper prescription.

The NIH report explained that some supplements can increase the risk of bleeding or, if taken before surgery, can change the body’s response to anaesthesia. 

“Supplements can also interact with some medicines in ways that might cause problems… Antioxidant supplements, such as vitamins C and E, might reduce the effectiveness of some types of cancer chemotherapy.”

Also, the study noted that taking vitamins arbitrarily might raise the risk of side effects. For example, too much vitamin A can cause headaches and liver damage, reduce bone strength, and cause birth defects. Excess iron causes nausea and vomiting and may damage the liver and other organs.

The BMC Geriatrics study cited above showed how indiscriminate use of Vitamin D can disrupt calcium metabolism, creating aggressive hypercalcemia, which causes many adverse effects in almost every body system. 

It further noted that “Hypervitaminosis D can lead to clinical signs such as persistent vomiting, weight loss, dehydration, psychiatric disorders and, at levels generally greater than 150 ng/ml, hypercalcemic crisis with difficult to control hypertension and acute kidney injury, setting a medical emergency that can lead to death.”

In an interview with DUBAWA, a medical expert at the University of Lagos (UNILAG), Francis Agbaraolorunpo, explained that the system in Nigeria aids the unprescribed use of multivitamins among citizens. 

He said vitamins naturally ought to come from meals. Still, some of those meals are expensive and unaffordable for a vast majority of the population, making people resort to food/dietary supplements. 

He further explained that some people use multivitamins when needed and would instead not consult a doctor considering waiting time and resources to be spent, adding that the period of use may not portend any form of danger. 

“Generally, multivitamins are required by women and girls because of their menstrual cycle. They lose blood during their cycle. They lose iron, as it were, so there would be a need to rebuild it, but naturally, the body can rebuild it, so some women would not take iron supplements, but some women will feel symptoms that they’ve lost blood. It is the symptom that makes them to self-medicate in that aspect. 

“Pregnant, lactating women are sharing their vitamins with their babies, and a lot of them may not eat the nutrients required, and most of them, because of consultation fees or whatnot, they may go for the multivitamin but even the period they will use it may not pose a serious problem.”

To further clarify the issue, Mr Agbaraolorunpo said those who abuse fat-soluble vitamins are likely to develop hypervitaminosis, which may have specific implications on some body organs. 

He also cautioned against the use of food supplements for an extended period.

“Let me explain; vitamins are divided into two groups. There are water-soluble vitamins and fat-soluble vitamins. The fat-soluble vitamins, vitamins A, K, D and E. In our body, anything that is fat soluble can be kept in the fat in the body, which can become toxic to the body because it’s not just going to disappear. If a person takes or abuses the fat-soluble vitamins, such a person can develop a condition called hypervitaminosis, and some of them may have implications on the body’s organs. 

“Most times, some branded supplements will only have some of these compositions of vitamins in small proportions but be it as it may, it is not good to use it for prolonged periods like six months.”

Meanwhile, he noted that some people who take multivitamins/supplements instead of deriving the vitamins in the food, who believe the supplements will alternate with the real natural vitamins, may fall into the danger of fat-soluble vitamins that may poison the system. 

With specific reference to the need for multivitamins in aged people, the doctor said their demand for some vitamins increases when they age. He, however, noted that self-medication is not advised in such cases because of the danger attached to it. 

Mr Agbaraolorunpo explained that some people might have iron overload while using multivitamins, which can damage the liver and affect some other organs. 

He also noted that while it is not a bad idea to purchase supplements occasionally without a doctor’s prescription, some potentially dangerous vitamins should be taken under doctors’ attention.

“In fact, one of my patients was allergic to some vitamins, so we had to check the medical history. Some are allergic to even the best of the food supplements, their body does not tolerate it because they have enough, and some may resist the extra you’re trying to give them.”

He added that precautions must be taken while prescribing supplements to aged persons, and organ function tests on vital organs of the body, such as the liver, and kidney, among others, are required, the doctor explained. Mr Agbaraolorunpo said this is because with ageing, the organs age too, and these are the organs that clear the drug.

“Drugs do not stay permanently in the body. With aged persons, you must be careful with the dosage and duration you give the patient a particular drug. Multivitamins should not be abused. For instance, if an aged person complains of leg pain, you should not think of calcium immediately. It may be some degenerative disease. If you’re loading the person with calcium, it seems like you’re loading him with cement. What doctors do is measure what is in the system; if it is adequate, you don’t try to augment again. 

“Drugs that are abused in this regard are minerals and vitamins and sometimes some antioxidants sold by big companies. The individuality, based on the genetic information in the body, the gene may not be able to tolerate such.”

The medical expert explained that the best thing generally is to see a doctor, who may prescribe for a maximum period of three months but who will also counsel on a positive lifestyle. He, however, mentioned that the ineffectiveness of the health insurance policy in the country might be a problem for most people who would rather self-medicate. 

“Seeing a medical practitioner shouldn’t be too expensive or hard. I guess that’s why we have this health insurance policy, but to be candid, not many Nigerians can access medical facilities and practitioners like that. With health insurance, people should be able to visit the doctor. Even when they’re not sick, the doctor may still prescribe the multivitamins. The doctor will counsel on a positive lifestyle and prescribe multivitamins for three months maximum. It’s better to see doctors, but occasionally, individuals may want to take multivitamins for one-month maximum.”

He further said the challenge lies with those who combine multivitamins that might have the same compositions, which results in “overloading” of the body system. 

Mr Agbaraolorunpo also said there are other natural ways to boost immunity, a primary reason for using multivitamins. These include: eating food adequately, getting enough rest and eating fruits and vegetables. He also noted that a significant challenge with using supplements is the fake ones in the market, hence the need for caution.

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