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09 December 2015

Vitamin drips are not 'magic bullets' Part II

In small quantities vitamins are vital for survival and good health, but in larger doses they can be quite dangerous. DietDoc explains the effects of overdosing on water-soluble vitamins.

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Last week we discussed the new trend among the rich and famous to indulge in vitamin drips whenever they feel hung over, tired, or just plain bored.

Ironically, in tiny quantities vitamins are vital for survival and good health, but in larger doses they can be quite dangerous – a fact that most people tend to ignore.  

When are vitamin drips necessary?

People who have suffered from certain illnesses (e.g. beri-beri caused by alcohol abuse and malnutrition), or those who have developed serious vitamin deficiencies, may require infusions of specific vitamins via a drip to rapidly avoid the potential damage of such deficiencies. Patients suffering from severe malnutrition, eating disorders such as anorexia nervosa and organ failure may benefit from receiving a fast replenishment of the missing nutrients while being carefully monitored by their treating physicians.

Read: Can vitamins boost your memory?

But the rest of us certainly do not need vitamin overloads force-fed into our veins.

Water-soluble vitamins

Last week we discussed the negative effects that excessive intakes of the fat-soluble vitamins A, D, E and K may have on the human body. This week we look at the water-soluble vitamins (i.e. vitamin B complex and vitamin C) in terms of overdosing.

The saving grace of many of these vitamins is that because they are water-soluble, any excess the body does not need, is excreted by the kidneys via the urine. Also, if most of the vitamins in the drip are just going to be voided through the kidneys, it seems stupid to spend up to R3,000 on a single drip. 

1) The B vitamins:

a) B vitamins which are generally not harmful even if abused:

The following B vitamins are generally regarded as non-toxic when used in excess (the NRVs [Nutrient Reference Values] are listed after each vitamin; all NRVs used in South Africa are specified for persons older than 4 years of age):

- Riboflavin or vitamin B2 - NRV: 1,3 mg/day

- Pantothenic acid - NRV: 5 mg/day

- Vitamin B6 or pyridoxine - NRV: 1,7 mg/day

- Vitamin B12 or cyanocobalamin - NRV: 2,4 mcg (microgram)/day

- Biotin - NRV: 30 mcg/day

b) Thiamin or vitamin B1

This vitamin is also not regarded as a threat under normal circumstances, but Mahan and her co-authors, state that “Parenteral doses of thiamin at 100 times the recommended levels have produced headache, convulsions, muscular weakness, cardiac arrhythmia and allergic reactions.” Parenteral doses are doses that are administered via other channels than through the gastrointestinal tract, namely through intramuscular, intravenous or subcutaneous routes. A drip is such an intravenous route.

NRV: 1,2 mg/day.

c) Niacin, nicotinamide or nicotinic acid:

Niacin is sometimes used at very high doses of 1 to 2 g per day to lower cholesterol levels, which have been linked to a release of histamine that causes flushing and may be detrimental to patients with asthma or peptic ulcers. It is important that the treating doctor uses the nicotinamide form of niacin for such treatment and not the nicotinic acid form. It should also be kept in mind that excessively high niacin doses are toxic to the liver. In other words, at high doses this vitamin no longer acts as a nutrient, but as a drug.

NRV: 16 mg/day

d) Folate or folic acid:

Generally not toxic in high doses, but having too high an intake of folic acid/folate may mask vitamin B12 deficiencies that could be present.

NRV: 400 microgram/day

2) Vitamin C / Ascorbic acid

Thanks to Linus Pauling, double Noble Laureate, who recommended the use of 1,000 mg of Vitamin C in 1970 to prevent and cure colds and ‘flu, this is probably the most popular vitamin when it comes to overdosing. Pauling’s recommendation is still followed faithfully today by thousands of pill popping enthusiasts. The fact that humans, guinea pigs, Coho salmon and fruit bats are the only species on earth unable to synthesise vitamin C in our own bodies, makes the argument that we need to boost our vitamin C intake to scary levels, even more plausible.

Read: Could vitamin C therapy cure a cold?

But while it is necessary to obtain vitamin C from our diets, we do not need to go overboard, and in fact there are indications that overdosing on vitamin C may be just as harmful as suffering from a deficiency (i.e. scurvy). Too much oral vitamin C can cause diarrhoea and stomach upsets, while doses ingested via any method can cause kidney stones.

The latter very painful condition is linked to excessive vitamin C intakes because vitamin C is broken down to oxalate which is one of the components of oxalate kidney stones. The jury is also still out in relation to the use of vitamin C in high doses for the treatment of different types of cancer.

Generally speaking, most cancer organisations recommend that patients should obtain their vitamins and minerals from a healthy, balanced diet and natural, whole foods rather than from supplements. In cases where patients are not able to ingest whole foods, supplementation must be monitored by your dietitian or physician.

NRV: 100 mg/day.

The latter message also applies to the general public – don’t be fanatic about vitamin supplements and only accept vitamins via a drip if this has been prescribed for you by your medical doctor.

Keep in mind that too much of a good thing can be bad for you, and even fatal in extreme cases!

Read more:

Vitamin drips are not 'magic bullets' Part I

The problem with vitamins

The vitamins you need

References:

- Cancer Research UK (2015). The safety of vitamins and diet supplements

- Child, K (2015). Wealthy hooked on treatment that drips with controversy. The Times published 25 November 2015, page 6.

- Government Gazette (2010). Nutrient Reference Values (NRVs) for Individuals of 4 Years & Older. Regulations relating to the labelling & advertising of foodstuffs, No. R. 146, Foodstuffs, Cosmetics & Disinfectants Act, 1972 (Act 54 of 1972). Government Gazette, published on 1 March 2010.

- Mahan K L et al (2012). Krause’s Food & the Nutrition Care Process. Elsevier Publishers, USA.

Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry. She believes that "we are what we eat" and offers free nutrition and weight loss advice via her DietDoc service on Health24.com. Read more of her articles.

 
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