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Think Twice Before Taking These Supplements

Discussion in 'Dietetics' started by Mahmoud Abudeif, Nov 23, 2019.

  1. Mahmoud Abudeif

    Mahmoud Abudeif Golden Member

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    If supplements are supposed to be good for you, then how come they resulted in approximately 23,000 emergency department visits and over 2,000 hospitalizations per year from 2004 to 2013, according to a study published in The New England Journal of Medicine

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    Dietary supplements can provide essential nutrients for certain individuals, but not everyone needs to take them. In fact, 86% of US adults take vitamins or supplements, but less than 25% have a clinically confirmed nutritional deficiency, according to a survey from the American Osteopathic Association. This finding is concerning, given that certain supplements, including those listed below, can be dangerous when taken in excess.

    Vitamin D

    Vitamin D is fat soluble, so excess levels can be stored in the body. It is found in very few non-fortified foods but is available in supplements, and also produced by ultraviolet rays of the sun interacting with skin cells.

    Vitamin D facilitates bone mineralization and prevents hypocalcemic tetany by mediating calcium absorption in the gut, as well as balancing serum calcium and phosphate concentrations. Calcium influences bone growth and remodeling via osteoblasts and osteoclasts. Along with calcium, adequate vitamin D intake can prevent osteoporosis in the elderly, while a deficiency in the vitamin can result in osteomalacia in adults.

    Harmful effects: Excessive intake of vitamin D, or hypervitaminosis D, can result in weight loss, anorexia, polyuria, and arrhythmias. This derangement can also cause blood calcium levels to heighten, resulting in vascular and tissue calcification and heart, kidney, and blood vessel damage.

    Calcium

    Calcium is required for bone health, and if you’re not getting enough calcium from food, supplements may do the trick. Calcium supplements come in two forms: carbonate and citrate. Calcium carbonate is cheap and easy to use; however, absorption requires stomach acid, so it’s best taken with food. Calcium citrate is absorbed regardless of the presence of stomach acid, and is useful in patients with achlorhydria, absorption disorders, and inflammatory bowel disease.

    The daily requirement of calcium for men aged 51-70 years is 1,000 mg, and for women in the same age group, 1,200 mg. Calcium carbonate is 40% calcium by weight, and calcium citrate is 21% calcium by weight. The amount of elemental calcium, which is used to calculate requirements, is listed on the label.

    Harmful effects: Although mostly due to hyperparathyroidism or malignancy, calcium deposition in organs and vasculature could result from very high levels of calcium intake. This deposition takes the form of calcification of the blood vessels and soft tissue, renal insufficiency, and kidney stones. Specifically, calcium supplements have been linked to heart disease and kidney stone.

    Vitamin A

    Like vitamin D, vitamin A is fat soluble and can accumulate in the body. Vitamin A, however, can be found many natural food sources, including meats, fruits, and vegetables. Vitamin A is important for vision, reproduction, immunity, and organ function. As such, it is available as a supplement (ie, beta-carotene or provitamin A) and in countless multivitamin preparations.

    Harmful effects: Hypervitaminosis A—usually secondary to increased intake of preformed vitamin A in supplements—generally results in headaches, nausea, and dizziness, but can also cause coma and death. High levels in pregnant women can lead to birth defects.

    Potassium

    Some people take potassium supplements in a bid to lower their blood pressure, which potassium does appear to do. However, the best place to get potassium is from fruits and vegetables, such as sweet potatoes, spinach, bananas, and avocado.

    Harmful effects: Because of concerns that high doses of elemental potassium could lead to arrhythmias and cardiac arrest when taken with angiotensin-converting-enzyme (ACE) inhibitors and certain diuretics, the FDA limits over-the-counter supplements to 100-mg potassium, which is a mere 2% of daily intake requirements. Nevertheless, salt substitutes often contain much more potassium chloride, and should not be taken by those at risk for hyperkalemia.

    Kava

    This member of the pepper family is endemic to the islands of the South Pacific, where it is used in traditional ceremonies for relaxation. As a supplement, kava is used for anxiety. Research on the efficacy of kava is mixed, and it may very well be mildly effective against anxiety.

    Harmful effects: The FDA issued a warning in 2002 that kava can lead to liver damage. Moreover, people who combine kava with alcohol are at even higher risk of liver damage. Heavy and long-term use of kava can lead to dry, scaly, or yellowing skin. It can also result in eye irritation and heart problems.

    St. John’s wort

    This plant with yellow flowers is found in Europe, and blooms in late June around the feast of St. John the Baptist. In the past, it has been used to treat various conditions including lung and kidney diseases. Today, St. John’s wort is most often used in supplement form for depression, but it’s also used for ADHD, OCD, and menopausal symptoms. The effects of St. John’s wort in the treatment of depression are mixed. However, researchers have shown that it doesn’t help with smoking cessation, ADHD, or irritable bowel syndrome.

    Harmful effects: St. John’s wort can be dangerous because of how it interacts with other drugs. For instance, it can trigger serotonin syndrome when taken with selective serotonin reuptake inhibitors (SSRIs). serotonin syndrome is characterized by agitation, hyperreflexia, pyrexia, sweating, tremor, diarrhea, and dilated pupils. Furthermore, St. John’s wort decreases the effect of other drugs, including warfarin, birth control pills, and cyclosporine. Lastly, this supplement has its own potential adverse effects, including hypersensitivity to sunlight, dry mouth, dizziness, anxiety, gastrointestinal symptoms, headache, fatigue, and sexual dysfunction.

    Iron

    Pregnant women, infants, and toddlers with inadequate iron intake may benefit from iron supplementation. Although the main treatment for anemia of chronic disease involves targeting the underlying cause, iron supplementation and erythropoiesis-stimulating agents are sometimes prescribed.

    Harmful effects: Ingesting more than 20 mg/kg iron from supplements, especially on an empty stomach, can result in nausea, gastric disturbance, constipation, vomiting, and faintness. Furthermore, taking supplements that are 25 mg of elemental iron or more can decrease zinc absorption. Finally, ingesting more than 60 mg/kg at once can result in organ failure, convulsions, coma, and death.

    “Moderation in all things,” as Aristotle advised, also applies to dietary supplements. Be sure to continually ask patients specifically about their vitamin and dietary supplement intake, not only to make sure that patients don’t take too many but also to avoid possible interactions with their prescription drugs.

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