The bane of nutritional supplements

Therese* is a typical millennial who grew up in the 80s and survived a decade of fish-oil supplementation because her mother, and thousands of mothers across the globe, believed in the power of omega 3 and 6 in building immunity.

Therese’s mother would stand at the front door with her bottle and teaspoon as Therese and her two brothers filed out on the way to school. There was no escape. They had to open up and swallow the distasteful sticky substance before they could be let through the front door. This was believed to protect them from getting random infections in childhood.

It was a huge relief for Therese when she finally went to high school and was able to avoid the daily prescription. However, this was just a temporary reprieve. In her late 20s, Therese was back where she started; only this time, it was self-driven and self-administered. She had turned into her mother!

At 27, Therese was expecting her first born baby. Her discipline was amazing. Through thick and thin, she stuck to her pregnancy supplements, even when they made her nauseous and uncomfortable. She endured every single pill prescribed; the multivitamins, the calcium tablets and the iron syrup. Therese was committed to having a healthy baby irrespective of what it took.

She stared at me incredulously when I suggested that the supplements were not for the baby, but for herself. Babies in the womb are the most efficient parasites ever. They do not depend on us to give them what they need; they take what they need, irrespective of whether we offer it or not. It doesn’t even matter whether we have enough to begin with. If they were to depend on the generosity of their mothers, the human race would likely be on the brink of extinction.

Therefore, with regard to this basic principle, it means that if mum does not have enough nutrients for both herself and the growing foetus, she is the one who bears the brunt of the insufficiency. She will be the one getting anaemic when the iron she has is inadequate for both herself and the baby; and, she is the one who ends up with an increased risk of pre-eclampsia when her calcium levels are low.

To this end, pregnancy supplements are liberally dished out to all mothers, even when they may not always be needed. The sad bit is that the pregnant women who need the supplements in pregnancy are the ones who are least likely to access them, while those accessing them are likely to be the ones who do not really need them much. 

As if pregnancy is not enough, now we have a new cohort of women who are literally living on supplements; the women in menopause. The culture of routine supplementation to women in the premenopausal age is taking a life of its own. Women are popping an average of five to eight pills a day as part of routine daily care.

This is despite the fact that a lot of these supplements come with dodgy evidence of their effectiveness. To make matters worse, most of those pills combine so many compounds, leading to the risk of multiple dosing of the same component when taking multiple pills. These supplements are touted to improve the perimenopausal symptoms, hence improved productivity; and because the components are regarded as ‘natural’, they command quite a following.

Unfortunately, unlike pharmaceutical products, supplements do not require strict approval by the regulatory bodies on order to find their way to the shelves. Now you know why there are dozens of brands in the shops, all beckoning to the woman in the prime of her life, who can afford them, to join in the fray.

Nutritional supplements are an absolute necessity for certain categories of people who struggle with inability to obtain adequate amounts through diet. These include severely anorexic of malnourished persons; those with chronic bowel irritation like Crohn’s disease; those with dietary restrictions like strict vegans; those who have undergone surgery that took away large portions of their gut, drastically reducing the surface area for absorption of these nutrients, and those with other chronic illnesses, who are not feeding well.

That said, there are specific micronutrients that are worth noting and prioritising throughout the circle of life. Iron supplementation in pregnancy is extremely crucial to both mother and unborn infant. The mother’s blood volume undergoes drastic increase throughout the second and third trimester, exerting an additional 50 per cent requirement of iron, over and above what is needed for her non-pregnant function. Additionally, the demand from the foetus is also incredible, not only in manufacturing and sustaining the foetal blood volumes, but also to store huge amounts in their liver and other organs for use in the first six months of life, when they are exclusively breastfeeding, with little external iron source.

Vitamin D deficiency is also becoming relevant, forcing health systems back to the drawing board. This vitamin that is freely synthesised by our skin on exposure to sunshine is becoming a public health concern, especially in countries like ours that have sunshine available all year round. The change in lifestyle, with reduced exposure to sunshine, poor urban planning and more sedentary lifestyles are resulting in vitamin D deficiency across all age groups; with children getting rickets and adults at increased risk of osteoporosis.

Vitamin A is abundantly available in many food items we consume freely locally, buffered by supplementation to all children, starting from the age of six months to five years. What we are more cautious about is the likelihood of the Vitamin A excess, resulting in toxicity.

For those who do not consume any animal products, they have a lifelong risk of vitamin B12 deficiency, hence require regular supplementation to prevent the associated complications. In the same vein, folic acid supplementation in pregnancy is crucial in the protection of the developing embryo, most especially in the first trimester, to protect against brain and spinal cord defects.

For the older woman on dozens of supplements, it is time to lay down that pill burden that is not adding value to your health. A lot of these supplements have been touted to relieve menopausal symptoms and improve quality of life. Sit down with your care provider and discuss with them before overloading yourself with a pile of pills that enrich the seller, at no additional value to your quality of life!

Dr Bosire is an obstetrician/ gynaecologist