Iatrogenesis of Vitamins, Minerals and Herbal Supplements

Our body is a wondrous construct of multiple systems working in concert to maintain a finely balanced homeostasis, but dependent on the external environment, the food we eat and the way we use our bodies and minds.

An unbalanced homeostasis leads to disease, which could be something as simple as fever due to infection or a complex multi-organ dysfunction brought out by malnutrition or cancer.

The regulatory pathways that maintain mineral and vitamin homeostasis have evolved over hundreds of thousands of years and work well in most instances unless there is a clinical problem or a deficiency caused by a change in our environment or the food we eat.

It is important therefore that we be cognizant of what we put in our body, what we do with our body and mind, what our body and mind are exposed to externally and how they develop due to our internal genetic makeup. We have no real control over the last part (our genes) and we usually don’t have much control over the third part too, which is based upon where we live and the resources available to us. We can however control to quite some extent what we put in our body and how we handle our body and mind.

We’ve seen how the food we eat matters. A plant-based diet with nuts, fruits and vegetables, with as few ultra-processed food items as possible, goes a long way in keeping us healthy and increasing our healthspan and lifespan. Physical activity as I have mentioned ad nauseam, is the one magic pill that perhaps, even more than the food we eat, keeps our mind and body healthy.

Ivan Illich in his book “Medical Nemesis” in 1975, discusses iatrogenesis in detail…how modern medicine has produced more disease with its drugs and interventions than would have existed if people took better care of their own health themselves. He goes onto say,

“The fallacy that society is caught forever in the drug age is one of the dogmas with which medical policy-making has been encumbered: it fits industrialized man. He has learnt to purchase whatever he fancies. He gets nowhere without transportation or education; his environment has made it impossible for him to walk, to learn and to feel in control of his body. To take a drug, no matter which and for what reason - is a last chance to assert control over himself, to interfere on his own with his body rather than let others interfere. The pharmaceutical invasion leads him to medication, by himself or by others, that reduces his ability to cope with a body for which he can still care.”

This mirage of freedom leads us to try a cornucopia of supplements and medicines that we believe can improve the quality of our lives, keep us healthy and ward off disease, irrespective of whether these actually work or not. I call this a mirage, because our beliefs are also a consequence of the thoughts of our peer group, the kind of society we live in, the advertising we are exposed to and our susceptibility to the University of Whatsapp, factors that most of us often don’t really have control over or prefer not to control.

Let’s take the example of calcium supplementation. From childhood, we are led to believe that unless we supplement our food with calcium based products (Horlicks, Complan, etc in childhood and then calcium and vitamin D tablets as adults), we will be weak and unhealthy. The number of adults, especially middle and high income, even in India, who are on some form of calcium supplementation is ridiculously high, despite the fact that there is no evidence that in otherwise nutritionally adequate individuals, calcium supplements make any difference to overall health including preventing osteoporosis and fractures, as has also been endorsed by the United States Prevention Services Task Force (USPSTF).

So it is no surprise that a recent study headed by Nicholas Kassis [1] showed that those who took calcium and vitamin D supplementation had a higher rate of death from aortic stenosis (a condition where the aortic valve between the heart and the aorta narrows, usually with age). Though they don’t know the exact cause, it is postulated that calcium supplementation upsets the delicate balance of calcium homeostasis in the body with unintended harm.

“…upsets the delicate balance of…homeostasis in the body with unintended harm.” This statement can apply to a bunch of supplements that we take in the hope of preventing disease…whether these are vitamins or minerals or aged garlic or some herbs packaged into bottles and sold over the counter…you can take your pick.

I have already written about the hype and hoopla around vitamin D.  The D-Health study [2] that I referenced showed no benefit of vitamin D in improving longevity…it however did show an increased incidence of cancer and cancer mortality, which was dismissed off as a likely statistical aberration because of the way we think about vitamin D (how can vitamin D cause cancer, when it is supposed to reduce our risk of cancer). But, what if this is true? What if normal individuals don’t need additional vitamin D and what if extra vitamin D upsets the body’s homeostasis and increases our risk of cancer?

There are some concepts that seem to make intuitive sense but have absolutely no basis in science. Detoxification is a classic example…as if toxins accumulate in the body that need to be “flushed” out with some “detox” regime. The same is true of “boosting immunity”. This concept gained prominence during COVID-19, as if our immunity fluctuates and we can improve it by taking vitamins and minerals and supplements and God knows what else.

In healthy individuals without nutritional deficiencies, or chronic illnesses or malabsorption, vitamin and mineral supplements are of no use and likely can cause harm, as we have already seen with vitamin D and calcium. Similarly, unnecessary vitamin C can cause diarrhea and kidney stones [3]. Vitamin E supplementation may actually increase mortality [4]. And worse, the illusory invulnerability [5] of these vitamins and supplements may actually increase unhealthy behavior, in the belief that the supplements will offset the downside of the bad habit.

Popping multivitamin and mineral supplements has become a routine for the affluent with a trickle down effect in the rest of the population. Questioning the use of these supplements is more and more a futile exercise…however question you must…everything you put inside your body.

So what should you and I do? If you are otherwise healthy and normal, and eat sensibly, there is no reason to use any kind of mineral or vitamin or herbal supplement. Not only do they not help, they can also cause significant financial and bodily harm.

Footnotes

1. Kassis N et al. Supplemental calcium and vitamin D and long-term mortality in aortic stenosis. Heart. 2022 May 25;108(12):964-972.

2. Neale RE et al. The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality. Lancet Diabetes Endocrinol. 2022 Feb;10(2):120-128.

3. Abdullah M, Jamil RT, Attia FN. Vitamin C (Ascorbic Acid). 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29763052.

4. Guallar E, et al: Stop wasting money on vitamin and mineral supplements. Ann Intern Med. 2013 Dec 17;159(12):850-1.

5. Chiou WB et al. Ironic effects of dietary supplementation: illusory invulnerability created by taking dietary supplements licenses health-risk behaviors. Psychol Sci. 2011 Aug;22(8):1081-6.