Vitamins and minerals aren’t risk-free. Here are 6 ways they can cause harm

Shutterstock

Geraldine Moses, The University of QueenslandOne reason dietary supplements are so popular is the perception they’re harmless.

But like all drugs, there are many potential dangers from taking vitamins and minerals.

The problem is that, unlike conventional medicines, dietary supplements aren’t required to provide warnings to consumers of their potential risks.

Nor are they required to submit extensive documentation of their risks to Australia’s drug regulator, the Therapeutic Goods Administration (TGA), when they’re licensed for marketing, leaving us all uninformed.

This week, I published a paper in Australian Prescriber identifying six possible harms of taking vitamin and mineral supplements.

What do we mean by supplements?

Dietary supplements are natural health products such as vitamins, minerals, amino acids, enzymes, plant extracts, and algae used to augment people’s diets rather than treat disease.

Although these products are more commonly referred to as complementary medicines in Australia, particularly by the TGA, the term “dietary supplement” is frequently used by consumers and in the research literature.

Dietary supplements dominate the complementary medicines industry in Australia.

Sales reached A$4.9 billion in 2017, having doubled over the preceding ten years.

Complementary medicines are widely used in Australia. A national survey published in 2018 showed 63% of people use them regularly.

Supplements containing vitamins and minerals were the most popular type of complementary medicine, reportedly used by 47% of respondents. Examples include vitamin D, vitamin C, calcium, magnesium and vitamin A.

---

Read more:
Thinking about trying collagen supplements for your skin? A healthy diet is better value for money

---

6 potential harms of dietary supplements

People often say they’ve never heard of harms of dietary supplements. This isn’t surprising, given their marketing is largely based on benefits with little, if any, mention of potential harms.

What’s more, consumer information leaflets are never provided, and few products carry warnings on their packaging of potential serious effects.

Nonetheless, there are well-recognised harms from the ingredients of dietary supplements, which anyone who has studied pharmacology would know, especially when these substances are consumed in high doses.

For these reasons, some higher-dose vitamin A and selenium products are legally regulated by the TGA as Schedule 2 (pharmacy only), Schedule 3 (pharmacist only) and Schedule 4 medicines (prescription only) products.

When contemplating the possible harms that could arise with dietary supplements, most people just think of side effects.

However, as with any medicine, there are at least six types of harm that can occur which I identified in my research:

• Side effects. Side effects from vitamins and minerals can occur from short- or long-term use. Typically side effects emerge from doses that are too high, but not always. They can also cause new disease or upset existing conditions. There are risks from certain supplements during pregnancy and breastfeeding too
• Drug interactions. Interactions with other drugs, certain foods, and some diseases can make other drugs more toxic or less effective
• Cost. The cost of dietary supplements can impact on people’s finances and their ability to afford treatment or other essential items
• Delay more effective therapy. Time spent taking ineffective products may delay more effective interventions, waste valuable time and allow a disease to progress
• False hope or fraud. Falling for fraudulent claims offering false hope can be demoralising and depressing, which for some can make the difference between continuing to manage a health condition and giving up
• Medication burden. As the number of medicines and supplements increases, so too does the chance of something going wrong. This includes the risk of side effects, drug interactions, or making a mistake.

The key to safety is the dose

Many dietary supplements are used safely for medical purposes. Women are prescribed folic acid and iodine in pregnancy, for example, or vitamin and minerals supplements are given for deficiencies, such as iron.

The key to using them safely is the dose, which is determined from research demonstrating the benefits outweigh the risks.

This isn’t the case when people self-medicate with products purchased on the open market. Consumers rarely consider the effective or safe dose and often just take the dose recommended on the label – which could be useless – or whatever they guess is right.

Many people neglect the risk of overdosing on the same ingredient such as vitamin B6 or vitamin A, which is most likley when taken via multiple products.

---

Read more:
New vitamin supplement study finds they may do more harm than good

---

For people to make informed decisions about using dietary supplements, details about the benefits and harms should be evidence-based and readily available. People need to know not only where to look for this information, but also how to critique it.

Health professionals can assist people by openly discussing the risks and benefits of dietary supplements, explain why dose is important for both efficacy and safety, and direct them where to go for good quality information that goes beyond what’s on the manufacturer’s label.

Manufacturers should be required to make this information more readily available.

When assessing the potential benefits and risks of supplements, it’s vital to look beyond the main or well-known ingredient. Identify the exact product being used, all its ingredients, the dose being taken, and the potential for cumulative overdose from repeated ingredients in multiple products.

As with all medicines, if you have any side effects or problems after taking dietary supplements, report them to the TGA.

Geraldine Moses, Adjunct Associate Professor, School of Pharmacy, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health Check: should I take vitamin C or other supplements for my cold?

Once you have a cold, taking vitamin C supplements won’t do anything.
From shutterstock.com

Clare Collins, University of Newcastle

Last week I had a shocking cold. Blocked nose, sore throat, and feeling poorly. This made me think about the countless vitamins and supplements on the market that promise to ease symptoms of a cold, help you recover faster, and reduce your chance of getting another cold.

When it comes to the common cold (also called upper respiratory tract infections) there is no magic cure (I wish) but some supplements may deliver very minor improvements. Here is what the latest research evidence says.

---

Read more:
Health Check: can you treat the common cold?

---

Vitamin C

For the average person, taking vitamin C does not reduce the number of colds you get, or the severity of your cold.

In terms of how long your cold lasts, some studies have looked at people taking vitamin C every day, while others have focused on participants taking it once they develop a cold.

In 30 studies comparing the length of colds in people regularly taking at least 200 milligrams of vitamin C daily, there was a consistent reduction in the duration of common cold symptoms.

However, the effect was small and equates to about half a day less in adults, and half to one day less in children. These types of studies also found a very minor reduction in the amount of time needed off work or school.

Among studies where vitamin C was only started once a cold had developed, there was no difference in duration or severity of a cold.

There are some risks to taking vitamin C supplements. They can increase the risk of kidney stones in men, and shouldn’t be taken by people with the iron storage disease haemochromatosis, as vitamin C increases iron absorption.

---

Read more:
Feeling worn out? You could have iron overload

---

Special considerations

Although in the general population vitamin C has no impact on the number of colds people get, there is an exception. For people who are very physically active – such as marathon runners, skiers and soldiers exercising in very cold conditions – vitamin C halved their chance of getting a cold.

Many people take vitamin C supplements in hope it will treat their cold.
From shutterstock.com

A few studies have also found some benefit from vitamin C supplements of at least 200 milligrams a day for preventing colds among those with pneumonia.

However, taking vitamin E supplements in combination with a high intake of vitamin C from food markedly increased the risk of pneumonia.

Zinc

A review of studies testing zinc supplements in healthy adults found starting daily supplements of at least 75 milligrams within 24 hours of the onset of a cold shortened the duration by up to two days or by about one-third. It made no difference to the severity of the cold.

There was some variability in the results across trials, with insufficient evidence related to preventing colds. Researchers suggested that for some people, the side effects such as nausea or a bad taste from zinc lozenges might outweigh the benefits.

Take care to stop zinc supplements as soon as your cold resolves because taking too much zinc can trigger a copper deficiency leading to anaemia, low white blood cell count, and memory problems.

Garlic

Only one study has tested the impact of garlic on the common cold. Researchers asked 146 people to take garlic supplements or a placebo daily for 12 weeks. They then tallied the number and duration of their colds.

The group that took garlic reported fewer colds than those who took the placebo. The duration of colds was the same in both groups, but some people had an adverse reaction to the garlic, such as a rash, or found the garlic odour unpleasant.

Because there is only one trial, we need to be cautious about recommending garlic to prevent or treat colds. We also need to be cautious about interpreting the results because the colds were tracked using self-report, which could be biased.

---

Read more:
Science or Snake Oil: will horseradish and garlic really ease a cold?

---

Probiotics

In a review of 13 trials of probiotic supplements that included more than 3,700 children, adults and older adults, those taking supplements were less likely to get a cold.

Their colds were also likely to be of shorter duration and less severe, in terms of the number of school or work days missed.

There is some evidence that probiotics, which can be found in yoghurt, may reduce the incidence of colds.
From shutterstock.com

Most supplements were milk-based products such as yoghurt. Only three studies used powders, while two used capsules.

The quality of the all the probiotic studies, however, was very poor, with bias and limitations. This means the results need to be interpreted with caution.

Echinacea

Echinacea is a group of flowering plants commonly found in North America. These days you can buy echinacea products in capsules, tablets or drops.

A review of echinacea products found they provide no benefit in treating colds. However, the authors indicated some echinacea products may possibly have a weak benefit, and further research is needed.

Chicken soup

Yep, I’ve saved the best until last.

In a novel experiment on 15 healthy adults, researchers measured the participants’ nasal mucus flow velocity – our ability to break down and expel mucus to breathe more clearly. They tested how runny participants’ noses were after sipping either hot water, hot chicken soup or cold water, or sucking them through a straw.

Sipping hot water or chicken soup made participants’ noses run more than cold water, but sipping chicken soup worked the best. The researchers attributed this to the chicken soup stimulating smell and/or taste receptors, which then increased nasal mucus flow.

Another study on chicken soup found it can help fight infection and recovery from respiratory tract infections.

Other researchers have shown comfort foods, such as chicken soup, can help us feel better.

Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle

This article was originally published on The Conversation. Read the original article.

Vitamin Supplements

After Fatwa, Pastor in Pakistan Beaten with Bricks

Convert, a former fighter in Afghanistan, had protested Islamic attack.

SARGODHA, Pakistan, November 5 (CDN) — Muslim extremists in Islamabad on Monday (Nov. 1) beat with bricks and hockey sticks a Christian clergyman who is the subject of a fatwa demanding his death.  

The Rev. Dr. Suleman Nasri Khan, a former fighter in Afghanistan before his conversion to Christianity in 2000, suffered a serious head injury, a hairline fracture in his arm and a broken bone in his left ankle in the assault by 10 Muslim extremists; he was able to identify two of them as Allama Atta-Ullah Attari and Allama Masaud Hussain.

The attack in Chashma, near Iqbal Town in Islamabad, followed Islamic scholar Allama Nawazish Ali’s Oct. 25th fatwa (religious ruling) to kill Khan, pastor of Power of the Healing God’s Church in the Kalupura area of Gujrat city. A mufti (Islamic scholar) and member of Dawat-e-Islami, which organizes studies of the Quran and Sunnah (sayings and deeds of Muhammad), Ali is authorized to issue fatwas.

Khan, 34, had relocated to a rented apartment in Islamabad after fleeing his home in Gujrat because of death threats against him and his family, he said. The fatwa, a religious order to be obeyed by all Muslims, was issued after Khan protested anti-Christian violence in Kalupura last month.

Muslim extremists who learned of his conversion had first attacked Khan in 2008 – killing his first child, 3-month old Sana Nasri Khan. He and wife Aster Nasri Khan escaped.

“During the Kalupura Christian colony attacks, once again it came into the attention of Muslim men that I was a converted Christian who had recanted Islam, deemed as humiliation of Islam by them,” Khan said.  

In this week’s attack, Khan also sustained minor rib injuries and several minor cuts and bruises. He said the Muslim radicals pelted him with stones and bricks while others kicked him in the chest and stomach. They also tried to force him to recite Islam’s creed for conversion; he refused.

On Monday night (Nov. 1) Khan had gone out to buy milk for a daughter born on July 19 – named after the daughter who was killed in 2008, Sana Nasri Khan – when during the wee hours of the night five unidentified Muslim extremists began kicking and pounding on the door.

“When my wife asked who they were, they replied, ‘We have learned that you have disgraced Islam by recanting, therefore we will set your house on fire,” Khan told Compass. “When my wife told them that I was not at home, they left a letter threatening to torch the house and kill my whole family and ordered me to recant Christianity and embrace Islam.”

Khan had sold some of his clothes at a pawnshop in order to buy milk for the baby, as he has been financially supporting six Christian families from his congregation who are on a Muslim extremist hit list. Islamic militants have cordoned off parts of Kalupura, patrolling the area to find and kill the families of Allah Rakha Masih, Boota Masih, Khalid Rehmat, Murad Masih Gill, Tariq Murad Gill and Rashid Masih.

Often feeding her 5-month-old daughter water mixed with salt and sugar instead of milk or other supplements, Aster Nasri Khan said she was ready to die of starvation for the sake of Jesus and His church. Before her beaten husband was found, she said she had heard from neighbors that some Muslim men had left him unconscious on a roadside, thinking he was dead.

The Rev. Arif Masih of Power of the Healing God’s Church in Islamabad told Compass that he was stunned to find Khan unconscious in a pool of blood on the roadside. Saying he couldn’t go to police or a hospital out of fear that Muslims would level apostasy charges against Khan, Masih said he took him to the nearby private clinic of Dr. Naeem Iqbal Masih. Khan received medical treatment there while remaining unconscious for almost four hours, Masih said.  

Born into a Muslim family, Khan had joined the now-defunct Islamic militant group Harkat-ul-Mujahideen, which later emerged as Jaish-e-Muhammad, fighting with them for eight and half years in Kashmir and Afghanistan.

While fighting in Afghanistan’s civil war in 2000, he said, he found a New Testament lying on the battlefield. He immediately threw it away, but a divine voice seemed to be extending an invitation to him, he said. When he later embraced Christ, he began preaching and studying – ending up with a doctorate in biblical theology from Punjab Theological Seminary in Kasur in 2005.

Upon learning of the Oct. 25 fatwa against him, Khan immediately left Gujrat for Islamabad, he said. He was living in hiding in Chashma near Iqbal Town when Muslims paid his landlord, Munir Masih, to reveal to them that Khan was living at his house as a tenant, he said. A young Christian whose name is withheld for security reasons informed Khan of the danger on Oct. 29, he said.

The young Christian told him that Munir Masih revealed his whereabouts to Allama Atta-Ullah Attari, a member of Dawat-e-Islami.

Khan said he confided to Christian friends about the dangers before him, and they devised a plan to hide his family in Bara Koh, a small town near Islamabad.

“But as I had sold and spent everything to help out Kalupura Christians,” he said, “I was penniless and therefore failed to move on and rent a house there.”

Report from Compass Direct News