Do supplements really add up?

Dr Manisha Arora, director of internal medicine at CK Birla Hospital, Delhi, says, “The number of dietary supplements available to consumers has skyrocketed, resulting in both positive and negative outcomes. In vulnerable populations, for example, supplements can help treat nutritional deficiencies, such as iron, vitamin D, vitamin B12, and folic acid.” However, she adds that due to the sheer volume of products in the market, many people are using them indiscriminately. She says that most of these products lack sufficient clinical evidence to support their claims. “So, even though supplements are helpful, when used correctly, the widespread and uncontrolled proliferation of supplements has caused considerable harm as well,” she says.

“A significant number of people self-prescribe based on advertisements, social media posts, or what a friend recommended,” says Dr BA Chaurasia, consultant, internal medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai. The fallout from taking supplements without proper guidance can look very different from person to person. “For some, it’s nothing more than an upset stomach or a lingering headache. For others, it can spiral into something far more serious, liver damage, kidney stress, or a dangerous clash with a medication they are already taking. In extreme cases, certain supplements taken in high doses can even be fatal,” adds Dr Chaurasia

“The focus has shifted from addressing real needs to promoting general ‘wellness’ or quick solutions,” says Dr Suranjit Chatterjee, senior consultant, internal medicine, Indraprastha Apollo Hospital, Delhi. “This can lead to misinformation, unnecessary consumption, and potential harm. ”

Speaking of the range of supplements and their sheer volume available in the market, Dr Anshu Makkar, group medical director at Park Hospitals, elaborates, “Today, there are supplements for vitamins (vitamin A, B-complex, vitamin C, vitamin D, vitamin E, vitamin K), minerals (iron, calcium, zinc, magnesium), protein, omega-3, and probiotics, among others. They are used to address deficiencies such as anaemia (iron, vitamin B12), bone deficiency (calcium, vitamin D), boost the immune system (vitamin C, zinc), and malnutrition generally. Other specialised supplements include supplements that promote growth during pregnancy (folic acid) and supplements for the aging process (multi-vitamins) and athletes (protein, creatine).”

She also notes that taking supplements when there is no deficiency can cause harm. In a recent event in Mumbai last month, Pritee Chaudhury, regional director, western region, Food Safety and Standards Authority of India, shared that the Indian nutraceutical industry, which currently holds 2% of the global market, could surpass pharmaceuticals by at least tenfold in the near future.

Consume with caution

Quite often, people tend to abuse supplements, driven by advertising, recommendations of friends, or online communities. According to research, a considerable percentage of city inhabitants’ resort to the use of vitamins, minerals, or herbs without consulting their doctors. “This behaviour leads to severe consequences, including the toxic effect, for example hypervitaminosis D and A, negative interactions between drugs and supplements, inability to identify the problem, and delay in treatment,” says Dr Makkar.  “High doses of iron, for instance, cause liver, kidney, and bone damage, and certain herbals affect the action of drugs.”

In addition, she warns that excessive intake of calcium might increase the chances of developing kidney stones, whereas an intake of too much vitamin C may result in digestive issues. “Estimates suggest that as many as 60-70% of people will use a supplement without consulting their physician prior to use,” says Dr Arora, “Furthermore, many consumers may use a supplement, which may mask more serious health problems that could delay the diagnosis or treatment of the underlying issue or issues,” he says.

Dr Arora says, “Examples of vitamin D overdose from taking too many high doses of vitamin D are on the rise, and this is seen in clinical practice with patients having elevated calcium levels due to vitamin D overdose, causing kidney failure. Additionally, there are also many cases of liver dysfunction due to the consumption of herbal supplements or natural supplements, and kidney stones due to excessive calcium consumption.”

“Some people genuinely need to tread carefully, particularly pregnant and breastfeeding women, children, older adults, and those managing chronic health conditions. For these groups, a conversation with a doctor before starting anything new isn’t just advisable, it’s essential,” says Dr Chaurasia “When patients report starting a supplement due to social media recommendations, the consistent medical advice is that a social media endorsement is not a replacement for a proven lack of a nutrient or a doctor’s guidance. It may seem like a harmless decision, but that difference between well-informed medical advice and online influence is one that can lead to very real health problems,” says Dr Chatterjee.

What not to take

Several of the most commonly used supplements in India have little to no reliable scientific proof that they work, says Dr Chatterjee of Indraprastha Apollo Hospital. “’Detox’ and ‘cleanse’ supplements are perhaps the clearest example of something bad; the liver and kidneys naturally and constantly clean the body, and no supplement can copy or improve this natural cleaning. ‘Immune-boosting’ supplements grew rapidly during Covid-19, yet the body’s defence system cannot be specifically boosted by taking supplements, and most such claims are not supported by facts.”

Biotin is heavily promoted in India for hair and nail growth, but there is no proof of benefit unless there’s a proven lack of the nutrient, and large amounts can interfere with diagnostic blood tests, says Dr Chatterjee. “Collagen supplements are also promoted without strong proof of benefit for people who are not lacking it.”

Dr Chatterjee surmises that since FSSAI does not allow claims that supplements can treat diseases but also doesn’t require proof that they work before being sold, many products reach Indian consumers based on marketing claims alone. “Many people experience unexpected side effects, sometimes quite severe, from products they believe are harmless. These can range from allergic reactions to more serious complications affecting vital organs,” he warns.

Dr Makkar of Park Hospitals says, “The reality shows that many patients, especially in a private practice, are influenced by marketing campaigns much more than by their understanding of medical facts. As a rule, a high percentage of customers does not understand the content, composition, dosage, and possible consequences of taking a certain type of supplement.”  She says, “Such marketing concepts as ‘natural’, ‘herbal’, or ‘immunity-boosting’ give a feeling of security, but in most cases, the patient cannot recognize the active substances and his/her need for taking such supplements.” “A lot of what’s out there is built on big promises and very little proof. Products that claim they will help you shed weight fast, flush out toxins overnight, or turn back the clock on aging tend to crumble the moment you look at the actual evidence behind them,” says Dr Chaurasia.

Label literacy

“It is observed that Indian patients are regularly influenced by packaging, celebrity endorsements, and social media content rather than by scientific proof or medical advice. This is the main way many young Indians find out about and buy supplements, and brands spend a lot on fitness influencers and wellness creators to push these choices,” says Dr Chatterjee. “Greater health awareness, increasingly sedentary lifestyles, rising rates of chronic disease, and the influence of digital media have all played a role (in the gaining popularity of supplements and nutraceuticals). The pandemic gave it another big push, with people rushing toward anything labelled ‘immunity-boosting’,” adds Dr Chaurasia