Vitamin and mineral supplements



Vitamin supplements are vitamins sold with specific health claims beyond their usual physiologic function. Vitamins are micronutrients which are required in very small amounts for specific physiologic processes. Since their discovery, there has been great interest in using vitamins not just to treat deficiency diseases but also for medicinal purposes. Like everything else in natural/holistic health, the claims run the gamut of factual, scientific efficacy. A few claims are backed by scientific study, though most are simple salesmanship and a few have even been irresponsibly, dangerously extravagant.

Vitamin and mineral supplements have often been the subject of faddism. Supplements have often been promoted via advertising using a variety of logical fallacies based on fear, such as "think of the children", including implicitly with "scientific motherhood". Such fears eventually coalesced into a health freedom moral panic, resulting in a deluge of angry consumer letters to the Food and Drug Administration demanding access to dietary supplements, starting in 1973.

Despite often being touted as "natural", supplemental vitamins are actually often synthetic: vitamin pills are not often found growing from wild plants, and it might be shocking to know that prehistoric humans did not forage for bottled hyper-saturated nutrients in the bushes. This is because "our bodies appear to absorb synthetic forms as well as they do natural forms" (assuming both forms are chemically identical, no shit, Sherlock) and because vitamin manufacturers want to add the most stable form of vitamins, and these forms are not always natural. Of course, this doesn't actually have anything to do with them being good or bad; we're just noting the faulty logic of many people who espouse taking supplemental vitamins but attack things like vaccines for being "unnatural."

The consensus from medical authorities and nutrition experts is that most vitamin and mineral supplements are not needed if one eats a well-balanced diet, with the exception of folate for people able to bear children and vitamin B12 in some populations. Scientific studies have shown a correlation between regular use of some vitamin supplements and an increased risk of cancer and heart disease.

Vitamin overview
Vitamins are chemicals that are necessary for life and must be ingested, as the body is unable to produce them. In the industrialized world, vitamin-deficiency diseases are not very common, and usually related to dysfunctional diets, often associated with psychological disorders, or genetic and/or physiological disorders. You only need a certain amount of each vitamin (eating carrots will only improve your eyesight if you have a Vitamin A deficiency), and too much of some vitamins (called ) can be toxic and even lethal. Despite this, an enormous number of Americans take vitamin supplements daily, fuelling a multi-million dollar industry. The term vitamin was coined in 1911 by Casimir Funk.

This is a relatively short list, and most of these items can be found in a normal diet without much effort, the most notable exceptions being for vegetarians and vegans, as vitamin D and vitamin B12 occur primarily in animal products (which doesn't mean either type of diet is necessarily unhealthy, just that they require more care to get everything one needs).

Clearly, there are situations when vitamin supplements can be useful, and there is a thriving industry supplying such pills. However, many companies want to go further in marketing supplements, and argue that there are other chemicals that are "vitamin-like" or desirable for health. See pseudovitamin for some examples. In 1998, choline was found to be necessary for human nutrition and probably to meet the definition of a vitamin, making it the only true recent addition to the vitamin category; its actual status is still unsettled.

Other substances besides vitamins are also necessary for human nutrition. Essential chemical elements are classified as minerals, not as vitamins. Water, fats (and essential fatty acids), and proteins are also necessary, but are not vitamins because they are needed in large amounts. In general, a vitamin is an organic compound (not a single element) that is needed by the human body in small amounts, is not always synthesized by the body in sufficient amounts, and must be obtained through the diet. Vitamins D and K, although synthesized in the body, remain classified as vitamins because outside sources of these are sometimes needed.

Vitamin industry
The dietary supplement industry is quite large, and the biggest part of the industry is vitamin sales. Numbers are difficult to come by, as they are compiled and sold by marketing firms, but an estimate for 2012 was $32 billion dollars annually. There is much misinformation about the benefits of vitamins. This article will strive to help people make better decisions about vitamin supplementation, and help to sort out extravagant claims made by producers and marketers of vitamins.

Claims
Because of the great interest in vitamins as medications, a great deal of research has gone into investigating their safety and efficacy. However, in the US, vitamins are regulated as dietary supplements, not medications, and there is no requirement for manufacturers to prove efficacy. By definition, vitamins are needed for health. In most cases, a basic, inexpensive, "general multivitamin supplement" is sufficient for adults to remain healthy. However, there is a growing body of evidence that multivitamins are unnecessary for those without vitamin deficiencies and could even cause harm in some isolated cases. Additionally, they are often marketed for uses far beyond their basic function and in much higher doses than typically needed.

The health claims used on the bottles are intentionally vague and non-specific (phrases such as "helps support", "promotes", or "bolsters"). With further protection from the Quack Miranda Warning, non-specific ailments can be treated in non-specific ways with non-specific results.

Vitamin A/beta-carotene
Vitamin A deficiencies can occur in developing nations and can lead to severe visual problems, among other conditions; with 200 million children affected by this deficiency (causing half a million deaths and another half a million cases of permanent blindness), this may be the most widespread deficiency. Beta-carotene (β-carotene), a common precursor to Vitamin A used as a supplement, has been studied as an "antioxidant" and cancer preventative. However, large, well-conducted studies have shown an increase in lung cancer in people taking these supplements. Smokers and others at increased risk for lung cancer saw their risk increase even more. Another recent study showed an increase in aggressive prostate cancers in men taking beta-carotene.

Excess vitamin A is stored is stored in the liver, although there is a limit. β-carotene is stored in your fat cells, and is converted to vitamin A when needed. So long as sufficient amounts existed in storage beforehand, humans can survive for several months without vitamin A before malnutrition sets in.

Since Vitamin A derives from beta-carotene, a pigment, massive overdoses of either substance can turn the consumer's skin yellow or orange. Also, both substances are closely related to pigments such as form the photosensitive component of most animal eyes. Such substances are also used in medicine to treat severe skin diseases such as disfiguring acne and ichthyosis; however, they can be due to their effect on DNA, requiring careful monitoring, especially in female patients.

Unlike beta-carotene, vitamin A in retinoid form is not water-soluble, so excesses cannot be easily excreted through the kidneys (unlike vitamin C). Thus, serious health complications can arise from taking too much of it (c.f. ). This is why you shouldn't eat polar bear liver.

B-vitamins

 * Vitamin B9, or folate, is necessary for several metabolic pathways in cells, including those involved in DNA replication. Deficency can lead to anemia, and, more critically, in fetuses, because folate deficiency interferes with proper cell division. This has led to legally-mandated folate fortification of foods in the U.S. and many other countries. Because of this risk of birth defects, the U.S. National Academy of Medicine recommends that anyone planning to become pregnant consume a minimum of 400 mcg/day from supplements or fortified foods, and consume at least 600 mcg/day during pregnancy. The American College of Obstetricians and Gynecologists recommends that all people pregnant or capable of becoming pregnant take a daily vitamin supplement that includes at least 400 mcg of B9. High  levels in adults are associated with heart disease, and can be reduced by adequate folate intake, although it has not been shown that taking folic acid reduces cardiac risk.


 * A deficiency of Vitamin B1, called "thiamine", can result in beriberi. In the developed world this is most commonly seen in people who have a long history of chronic alcohol or other substance abuse, and in places dependent on rice it can be largely prevented by eating it unpolished.


 * A deficiency of Vitamin B2, called "riboflavin", can result in ariboflavinosis. However, riboflavin deficiency is always accompanied by deficiency of other vitamins.


 * A deficiency of Vitamin B3, called "niacin", can result in pellagra (the first disease described using the modern scientific method, although it wasn't until later that they discovered the cause). A lack of which the body converts to niacin, can have the same effect; the genetic disorder  somewhat (though not entirely) inhibits the conversion of tryptophan to niacin, while  causes the body to convert abnormal amounts of tryptophan into serotonin instead of niacin. Pellagra was rampant in the South well into the 20th century, but is now exceedingly rare in the developed world thanks to vitamin fortifications (a.k.a., supplementation) in food (in the US, bread and enriched rice/flour). Although the US RDA of niacin is 20 mg per day, niacin is increasingly being prescribed at therapeutic dosage levels (upwards of 1000 mg per day) as a treatment for elevated blood triglycerides. Unfortunately, large doses of niacin can result in uncomfortable flushing episodes; these can be managed by taking aspirin half an hour before taking niacin or sometimes by just eating a meal first. "No flush" versions of niacin exist, but these have been demonstrated not to have an effect on blood triglycerides and thus kinda defeat their own purpose.


 * Vitamin B12 deficiency—usually from an improperly-managed vegetarian or vegan diet, certain intestinal diseases, heavy abuse of nitrous oxide (laughing gas/whippets/nangs), or pernicious anemia—is fairly rare, and when it exists, it must be treated. A B12 deficiency can lead to symptoms like tingling in hands or feet, difficulty walking, tongue inflammation, cognitive difficulties, fatigue, and weakness; supplements can treat this. Supplementing this vitamin in non-deficient people has not shown to have any benefit, but oral supplementation as part of a daily multivitamin may have a small effect of reducing cardiac risk in some people. Deficiency is more common in older people, as they tend to become less able to absorb vitamin B12 in foods, and some medications can interfere with its absorption. "Because 10 to 30 percent of older people may malabsorb food-bound B12, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with B12 or a supplement containing B12." B12 is only found in reliable amounts in animal foods; thus, the U.S. Academy of Nutrition and Dietetics recommends that vegetarians and vegans fulfill their nutritional requirement for B12 through consumption of supplemental B12 or foods fortified with the vitamin.


 * B12 deficiency leads to anemia, neuropathy, particularly in the hands and feet, and in severe cases cardiomyopathy, neurological symptoms, infertilty, and growth retardation in children. If you suspect a deficiency, pick up some supplements right away and then make a doctor appointment. The good news is that early treatment makes a big difference.


 * Folate, B12, and B6 are sometimes recommended for memory, but studies have failed to show any benefit in non-deficient individuals. "In view of evidence linking folate intake with neural tube defects in the fetus, it is recommended that all women capable of becoming pregnant consume 400μg from supplements or fortified foods in addition to intake of food folate from a varied diet."


 * Vitamin B6 very rarely requires supplementation in the typical American diet. Certain medications can cause deficiency, as can consumption of seeds.

Vitamin C
Vitamin C may have the most notoriety of the commonly available vitamin supplements due to Nobel Prize-winning biochemist Linus Pauling's wacko controversial assertions that large doses of vitamin C can prevent the common cold, a position that a) showed that even Nobel Prize winners can be wrong, egregiously wrong, and b) proved to be not terribly accurate when studied but very persistent in the journals of public opinion, probably due to a lack of peer review in that forum.

Vitamin C deficiency leads to scurvy (from which the name ascorbic acid derives), which was a massive problem for early sailors. In the developed world, this still needs to be accounted for when planning extended trips without access to fresh food, such as long-term submarine missions. In addition to its usual function, vitamin C is also used as a preservative for fresh fruit (especially apples, where it prevents enzymatic browning after the fruit is cut). Food scientist and cookbook author Shirley Corriher, in her 1997 kitchen science book Cookwise, also recommends adding vitamin C to some bread recipes to enhance gluten development.

Proponents of Orthomolecular medicine believe that Vitamin C supplements can cure cancer. This is not supported by clinical evidence. A 2018 review noted that "results from most clinical trials suggest that modest vitamin C supplementation alone or with other nutrients offers no benefit in the prevention of cancer."

Like vitamin D and unlike the vast majority of other woo supplements and herbs, vitamin C is a serious supplement for asymptomatic people. Having extra vitamin C is not just superfluous, it has theoretical mechanisms and even evolutionary arguments for why it should help, which is why Pauling stuck so strongly to it. In a way, the question is why taking a lot more doesn't help human health, not why it should. It's useful for conditions like pneumonia when a patient's vitamin C levels are severely depleted and has been suggested as a cheap prophylactic measure in people at high risk from pneumonia. It has been shown to help against the original SARS virus of 2002-2004 and has been tried intravenously by a New York doctor against COVID-19, who has claimed modest benefits. On the other hand, it has been tried and tried and just does not work against cancer, aging and other diseases, especially not orally and when a disease has taken hold. Whether you're an idiot for taking it as a healthy person or not is up for question but certainly when COVID-19 is hanging around it's a highly plausible supplement to take, especially if you're a vulnerable person.

Like vitamin E and beta-carotene, vitamin C is an antioxidant.

Vitamin D
Vitamin D is especially important for bones. There is evidence that people who live in cooler, cloudier climates, where sun exposure is less, benefit from some supplementation. Without adequate vitamin D, the body absorbs no more than 10%-15% of dietary calcium. In the vitamin D–sufficient state, calcium absorption increases to 30% to 40%.

Recent studies have also shown that Vitamin D also works as a hormone to help regulate important functions of the body. One study showed an association between excessive daytime sleepiness and low levels of Vitamin D. New research suggests that Vitamin D may play a significant role in the prevention and treatment of type 1 and type 2 diabetes, hypertension, glucose intolerance, multiple sclerosis, and other medical conditions.

The Endocrine Society 2011 clinical guidelines for vitamin D, states that that to maximize effect on calcium, bone, and muscle metabolism the desirable serum concentration of 25(OH)D is >75 nmol/L (>30 ng/ml).

Vitamin D is fat-soluble; the body stores it in liver and fat tissue. Serum 25(OH)D levels increase in response to increased vitamin D intake, but however the relationship is non-linear, so that increasing serum 25(OH)D to >50 nmol/L requires much more vitamin D than increasing levels from a baseline <50 nmol/L.

Vitamin E
According to the first edition of Harold McGee's seminal kitchen-science book On Food and Cooking, Vitamin E deficiencies are not especially common in the Western diet. Almost all cases in the developed world are completely unrelated to quality of food intake and mostly occur in very small and premature infants, people with a specific genetic disorder that severely inhibits Vitamin E absorption, and people who have various metabolic or gastrointestinal disorders (e.g. ) which result in difficulty absorbing fat from their diets. However, supplements are sold and sometimes used as skin care lotions. Vitamin E is also sometimes used as a preservative for whole grain products.

Note: "… researchers from the Cleveland Clinic found that men who took vitamin E had an increased risk of prostate cancer." The US Preventive Services Task Force issued a statement in 2022 recommending against the use of beta carotene and vitamin E supplements for the prevention of cardiovascular disease or cancer. Vitamin E is sometimes suggested to treat Peyronie's Disease and Dupuytren's disease, though studies differ on their effectiveness.

Like vitamin C and beta-carotene, vitamin E is an antioxidant.

Vitamin K
Vitamin K (from the German Koagulationsvitamin) is used in the human body's blood clotting system and calcium deposition. Most people get a sufficient amount of it from bacteria in the colon and from virtually any leafy vegetable such as spinach or kale, and it is not widely available as a standalone supplement for adults. Insufficient Vitamin K can lead to arteriosclerosis (i.e. calcium being deposited not in the bones but instead in the walls of arteries in the heart and lungs). It is contraindicated for those on long-term anticoagulant therapy (warfarin or similar drugs) and is useful in the treatment of rat poison (warfarin) ingestion.

Because babies are born low in vitamin K — it does not cross the placenta well, it is not significantly present in breastmilk, and newborns do not have much of a gut microbiome — babies in developed countries routinely receive vitamin K injections shortly after birth to reduce the risk of hemorrhages, e.g. into the GI tract or brain. Comporting with their general chemophobia and terror of anything that comes in a syringe misplaced suspicion of proven-safe public health measures, anti-vaxxers and some figures in alternative medicine have begun fearmongering about these injections as well, with the predictable sequelae of parents refusing them and newborns getting hurt.

Minerals
Dietary minerals, such as phosphorus, magnesium, zinc, and kryptonite,🇱🇮 aren't classified as vitamins. However, many multivitamin supplements also include some minerals.

Several snake oil salesmen over the years have pushed mineral supplements. Sales pitches such as the audio/video/book Dead Doctors Don't Lie, colloidal silver, and more recently, Miracle Mineral Supplement, tout their mineral supplements as the cure for everything from aging to prostate cancer. Generally these high-priced mineral supplements are in some form you can't get from your local drugstore, such as colloidal suspensions, accompanied by claims that their form is much better absorbed than the normal pills are. At best, these mineral supplements will give you very expensive urine. At worst, they can cause serious side effects in sufficient quantities. For example, colloidal silver can cause the skin to become blue-gray, and excessive zinc supplementation can cause copper deficiency.

Pseudovitamins
A number of substances are sold with a false claim to be vitamins. These are often named using the "vitamin" naming convention, as in "Vitamin B17" (which is actually laetrile). A number of substances were once thought to be vitamins but later reclassified out of the vitamin category; occasionally one will still run across these being referred to using their old (generally pre-World War II) vitamin name, such as "Vitamin F" and "Vitamin B4". "Vitamin F" was the old name for essential fatty acids, which are essential for human nutrition but do not meet the definition of a vitamin any more than water does. "Vitamin B4" is adenine, which is no longer considered a vitamin as it is not necessary for human nutrition, although it is synthesized in the body and binds with other B vitamins. Taking any of these supplements is a waste of money, and in the case of "B17"/laetrile, can be hazardous to your health.

National bans on vitamin supplements
Denmark bans the sale of products with excessive amounts of vitamins, believing them to be a health risk.

Megavitamin therapy
Megavitamin therapy is what Dr. Mario uses to get rid of viruses the use of large doses of vitamins (or minerals), exceeding the recommended dose range, and even exceeding maximum safe dose, dose levels that have been created by scientific consensus. As such, megavitamin therapy usually falls into the realms of quackery and alternative medicine, and only rarely in the realm of experimental medicine. Megavitamin therapy is common in orthomolecular medicine and naturopathy, but is only rarely used in regular medicine for unusual genetic diseases.

The first research on megavitamin therapy begin in the 1930s: for vitamin E by Drs. Wilfrid and Evan Shute (1936), for vitamin C by Claus W. Jungeblut in 1937, and for vitamin B3 by W. Kaufman in 1953.

The Dietary Reference Intakes (DRIs) and Tolerable Upper Intake Level (ULs) below are per day for adult males (M) and non-pregnant, non-lactating adult females (F). These values and adverse effects are taken from the Nutrient Recommendations: Dietary Reference Intakes. See the original document for children's and other adult females' levels.

Depending on the vitamin, DRIs are either Recommended Dietary Allowances (RDAs) or Adequate Intakes (AIs). RDAs are the "average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people." AIs are "established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy." The Tolerable Upper Intake Level (UL) "is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects in almost all individuals." These levels are the total intake from all sources (except for magnesium, as noted in the table): dietary, Sun exposure (for vitamin D), and nutritional supplements.

Just because there is a UL for a given nutrient, it does not mean that there is necessarily any benefit in consuming at or near that amount. High dose antioxidant pills appear to be worse than useless (and some vitamins are antioxidants). Yes, that's right, antioxidants can hinder muscle strength. This appears to be because muscles require a certain level of oxidative stress in order to build over time.

It should be of particular concern for users of megadose mineral supplements that the consumption of mineral supplements was correlated with higher doses of minerals from food sources, particularly for calcium and magnesium.

Searching for my mainline
Physician John A. Myers started injecting some of his patients with vitamin cocktails (the "Myers's Cocktail") in the 1960s to treat patients with asthma, migraines and fibromyalgia. There is no evidence that the cocktail is effective for any of these ailments. Worse yet, no one knows what Myers' formulation was. There are very specific reasons why injection of vitamins might be medically advisable (e.g., for premature babies). However, careless medical use of vitamin injections under medical supervision has resulted in patient deaths and in disciplinary action against the physician involved. The potential risks with no known benefit make non-medically supervised injections highly inadvisable. In 2018, vitamin injection started getting popularized by celebrities Chrissy Teigen and usual suspect Gwyneth Paltrow.

Resources
If you need to take a vitamin supplement it's worth remembering that there are degrees of how good a product is. So, always err on the side of caution. With that in mind, the following is a list of websites which monitor the quality of supplements (including vitamin supplements) and the claims of their makers.
 * The American Journal of Clinical Nutrition: (http://www.ajcn.org)
 * Consumer Lab: (https://www.consumerlab.com)
 * Food and Drug Administration: (http://www.fda.gov/Food/DietarySupplements/)
 * Institute of Food Technologies: (https://www.ift.org/)
 * Medline Database: (https://www.nlm.nih.gov/medlineplus/)
 * National Institutes of Health, Office of Dietary Supplements: (https://ods.od.nih.gov/)
 * Supplement Watch: (http://www.supplementwatch.info/Vitamins/ListOfVitamins.html)
 * Vox's supplement database (http://www.vox.com/a/supplements)