Over-Supplementation

Listen to the Over-Supplementation podcast episode here. 

Feb 16, 2024

Supplements are recommended and taken to correct nutritional deficiencies and come in many forms, including tablets, capsules, powders, drinks, and gummies. It seems that over the past several years, the market for these goods has exploded. Advertisers have creatively packaged different offerings of these items for the purposes of improving physical and mental health, usually without mention of potential risks. It is apparent that many people feel like their health is not where it should or needs to be, supply is intended to meet demand, which explains why there are so many businesses boasting about how their products are essential to their customers’ health.

But too much of a good thing is most often harmful. The technical term for over-supplementation is hypervitaminosis. Before I go into the numbers, I’ll relay my own personal experience working in the healthcare field and even just conversing with friends. More than half of the people I know and even strangers I have met tell me they take at least one supplement per day and more than half of those take five or more supplements daily. Some take it for bone health or mental well-being, others believe it can cure physical ailments. Others have read or heard podcasts or advertisements about the benefits and religiously fill med planners with a variety of pills, tablets, and gummies, believing they cannot survive without them. Silently, I wonder how they manage to remember when and what to take, how their bodies are fighting to clear all these chemicals, vitamins, and minerals from their systems, and what this is doing to their nutrition levels in addition to all of the foods they eat.

During 2017 and 2018, 57.6% of adults reported taking dietary supplements in the past 30 days with intake in women being higher than men (5). Since COVID-19, more than 75% of Americans reported taking supplements to support their health and wellness, according to one survey (7). Historically, foods sold were supplemented with certain vitamins and nutrients in order to help prevent certain nutrient-deficient diseases such as goiter, rickets, beriberi, and pellagra in nations with particularly higher rates of poverty and even in the United States (1). According to the World Health Organization (WHO), fortification is the addition of previously lacking nutrients to a food, while enrichment restores nutrient levels in foods that have lost nutrients during processing, handling, and storing (1). In the 1920s, Michigan implemented a public campaign encouraging consumers to buy salt fortified with iodine, a nutrient which can be depleted in the soil as a result of flooding, heavy rainfall, and glaciation; it was suggested that iodine deficiency impairs the production of thyroid hormones in the body, leading to neck goiter and neurocognitive impairments, and the campaign was made in the interest of public health and disease prevention (1).

Other examples of fortification in global history include milk, cereals, or orange juice fortified with vitamin D to help combat rickets, a deficiency of vitamin D leading to bone deformities. Salmon, mackerel, and sardines are a naturally occurring source of vitamin D, as is sunlight, which our body uses to produce Vitamin D; however, over-exposure can lead to skin cancer, which is why individuals must be careful (1). Flour is another example of a product fortified with B vitamins to help reverse the processing of wheat into refined flour, which strips it from essential B vitamins (1). Since the American diet was heavily reliant in the 1930s on refined flours (and still is today), the American Medical Association (AMA)’s Council of Foods and Nutrition endorsed enriching foods such as breads, rice, cornmeal, and macaroni and noodle products with B vitamins, including thiamin, niacin, and riboflavin to help the public avoid deficiency (1). Deficiency of vitamin B can lead to several conditions. Niacin deficiency can lead to a condition called pellagra that is characterized by “‘the four D’s’: diarrhea, dermatitis, dementia, and death, and was widespread in southern states” (1). Thiamin deficiency was known to be associated with a neurological disorder known as beriberi, while riboflavin deficiency often presented with cracking, redness, and swelling of the mouth and tongue (1).

Vitamins are essential to our health. But the added supply of vitamins and nutrients in the foods we eat in addition to the supplements people take every day can swing the pendulum from one extreme to another. Prolonged use of and overconsumption of vitamins that are either water- or fat-soluble, can lead to accumulation and toxicity (2). Vitamins A, D, E, and K are fat-soluble and are mainly stored in the liver, while vitamin C and B complex are water-soluble, which dissolve in water and extra quantities are usually excreted in the urine (2).

While the Federal Drug Administration (FDA) monitors and regulates pharmaceutical efficacy and safety, it “does not require any documentation of efficacy for vitamins and supplements” and relies solely on the reporting of adverse events, which means that the supplements taken may or may not have any biological value and can lead to toxicity (2). That being said, even if the quality of the supplements are as advertised, excessive amounts in the body when combined with a large intake of fortified foods or pre-existing conditions affecting liver and kidney metabolism can have disastrous effects. More than 81,000 adults and children including those younger than 6 years of age have been subjected to life-threatening vitamin toxicity according to reports by poison control centers across the U.S. in 2022 (3). While mortality for older adults taking vitamin D3 supplements has been shown to be reduced, the opposite is true for well-nourished individuals taking too much of antioxidants including vitamins A and E (2).

Antioxidants are often boasted to be very good for you, promising to prevent cancer and improve overall health. However, how much do you need and how much should you take and for how long? The daily recommended dietary allowance (RDA) of vitamin A for adults 19 and older is 3,000 International Units (IU) for men and 2,333 IU for women (4). The amount of vitamin A in a capsule supplement is usually 10,000-50,000 IU; toxicity can be seen short-term with levels up to 25,000 IU/kg in the body or chronically with 4,000 IU/kg daily for 6-15 months (2). Vitamin A toxicity is actually more common in the U.S. than deficiency; since it is fat-soluble, it tends to build up and over time can lead to increased risk of bone loss and hip fractures (interfering with the benefits of vitamin D), along with vision changes and sensitivity to light, dry skin, and bone pain (4). A common supplement taken by many is cod liver oil for vitamin D, however, it is also high in vitamin A at 192% of the RDA (4).

This is just one example of how easily taking supplements can lead to hypervitaminosis and adverse events. There are other examples, for instance, too much iron, which accumulates in the liver, can lead to liver disease, especially when individuals have hemochromatosis, a genetic condition that may or may not present with symptoms but often shows up as joint pain, fatigue, unexplained weight loss, abnormal bronze or gray skin coloration, and abdominal pain (8). Iron overload carries numerous other health effects particularly taxing for the gastrointestinal system.

The decision to supplement one’s diet needs to be made after consideration of several factors and consultation with a nutritionist, who is highly specialized in understanding deficiencies and how to treat them. Even though supplements are over-the-counter, they can be more dangerous than prescription medications. For those who are concerned about their nutritional levels and diet, I encourage them to reach out to Alexsol Health as there are many ways we can help through consultation with experienced nurses and physicians. For instance, one of the recommendations I would make is to request a doctor’s order either through our company or your primary care physician for a comprehensive lab panel to check vitamin levels before reaching for the next supplement on the aisle. Additionally, getting yearly check-ups and making sure there are no underlying medical conditions will help rule out potential symptoms mimicking nutritional deficiencies. Ethnicity, religion, and culture also influence one’s nutritional needs when combined with personal taste preferences and environment (5). Meeting with a nutritionist can help individuals develop a nutritional plan that includes a comprehensive review and consideration of diet, genetic makeup, and current treatments for any medical conditions and these are services Alexsol Health can coordinate for you.

The idea for this topic came from a person I met this week with whom I discussed how my patient advocacy services can help her and she shared her personal experiences and how they can potentially help others through my blog and podcast. In addition to struggling with a chronic illness, she shared her experience with taking numerous supplements in the hopes that it will benefit other physical ailments. Rather than positive outcomes, she shared concerns that varied from having to remember what supplement and when to take each one, to fears of how each chemical is affecting her body and how certain systems might be affected by having to work extra hard at clearing them from the body, to the overall mental impact and stress of the whole ordeal. She reported such exhaustion from the process that she sought medical advice on how she can slowly reduce the amount of pills she is having to take safely.

Though some supplements may sound exciting or instill security that they are fulfilling all of your nutritional needs, according to Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, it is usually “best to try to get these vitamins and minerals and nutrients from food as opposed to supplements” (9). Many of the studies that claim to fight against diseases such as cancer or Alzheimer’s and heart disease are only observational and not in a controlled environment such as the randomized controlled trials pharmaceuticals are required to pass through in order to reach the market (9). In the past, supplements such as vitamin E were reported to protect the heart, but they increased the risk of hemorrhagic or bleeding strokes; folic acid and B vitamins were also touted as heart disease and stroke preventers, however, controlled testing showed an increase risk for cancer (9).

Ultimately, loss of appetite, certain metabolic conditions, impaired digestion and absorption, limited access to a variety of necessary foods, poor quality and unbalanced diets, and lack of knowledge are all factors that play a role in leading to nutritional deficiencies. Some factors are beyond our control, whereas others are not. The most important controllable factor is knowledge and increasing our understanding of what we put into our bodies. I am sure all of us have tried a supplement at one time or another and maybe some of us take several supplements daily, but if you find yourself struggling with continued symptoms or worry about what these supplements may be doing to your body, I encourage you to reach out to me directly on my Contact page for a consultation.

— Stephanie Alexandre, Owner, Alexsol Health

References

1. Pike, A. (April 28, 2023). A Brief History of Food Fortification in the U.S. Food Insight: Your Nutrition and Food Safety Resource. Retrieved from https://foodinsight.org/is-food-fortification-necessary-a-historical-perspective/

2. Saljoughian, M. (October 15, 2021). Hypervitaminosis: A Global Concern. U.S. Pharmacist. Retrieved from https://www.uspharmacist.com/article/hypervitaminosis-a-global-concern

3. America’s Poison Control Centers. (2022). Annual Report. Retrieved from https://www.aapcc.org/annual-reports

4. Harvard T.H. Chan: School of Public Health. (March 2023). The Nutrition Source: Vitamin A. Retrieved from https://www.hsph.harvard.edu/nutritionsource/vitamin-a/

5. Kouba, J. (2005). Impact of Environment, Ethnicity, and Culture on Nutrition and Health. In: Touger-Decker, R., Sirois, D.A., Mobley, C.C. (eds) Nutrition and Oral Medicine. Nutrition and Health. Humana Press. https://doi.org/10.1385/1-59259-831-5:045.

6. Mishra S, Stierman B, Gahche JJ, Potischman N. Dietary supplement use among adults: United States, 2017–2018. NCHS Data Brief, no 399. Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://doi.org/10.15620/cdc:101131

7. CRN Newsroom. (August 20, 2020). Dietary Supplement Usage Up Dramatically During Pandemic, New Ipsos-CRN Survey Shows. Retrieved from https://www.crnusa.org/newsroom/dietary-supplement-usage-dramatically-during-pandemic-new-ipsos-crn-survey-shows

8. Upham, B. Reviewed by Breite, I.D. (rev. October 16, 2022). What is Hemochromatosis? Causes, Symptoms, and Treatment. Everyday Health. Retrieved from https://www.everydayhealth.com/liver-disease/hemochromatosis/

9. Harvard Medical School. (January 1, 2013). Dietary Supplements: Do They Help or Hurt? Retrieved from https://www.health.harvard.edu/staying-healthy/dietary-supplements-do-they-help-or-hurt