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 even a few have been irresponsibly, dangerously extravagant.

A supplement advertisement that offers to Help with Everything that Ails.
Potentially edible!
Food woo
Fabulous food!
Delectable diets!
Bodacious bods!
v - t - e

Vitamin and mineral supplements have often been the subject of faddism[1]:149 The supplements have often been promoted via advertising using a variety of logical fallacies based on fear,[1]:19-22 including "think of the children," including implicitly with "scientific motherhood".[1]:19-24 Such fears eventually coalesced into a health freedom moral panic resulting in a deluge of angry consumer letters to the Food and Drug Administration starting in 1973, demanding access to dietary supplements.[1]:142-157

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.[2] 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 mainstream 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.[3]

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 hypervitaminosisFile:Wikipedia's W.svg) can be toxic and even lethal.[note 1] 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.[4]

Vitamin nameChemical Name
Vitamin AFile:Wikipedia's W.svgRetinoids (retinol, retinoid) and carotenoids
Vitamin B1File:Wikipedia's W.svgThiamine
Vitamin B2File:Wikipedia's W.svgRiboflavin
Vitamin B3File:Wikipedia's W.svgNiacin
Vitamin B5File:Wikipedia's W.svgPantothenic acid
Vitamin B6File:Wikipedia's W.svgPyridoxine
Vitamin B7File:Wikipedia's W.svgBiotin
Vitamin B9File:Wikipedia's W.svgFolic acid
Vitamin B12File:Wikipedia's W.svgCobalamin
Vitamin CFile:Wikipedia's W.svgAscorbic acid
Vitamin DFile:Wikipedia's W.svgErgocalciferol and Cholecalciferol
Vitamin EFile:Wikipedia's W.svgTocopherol and Tocotrienol
Vitamin KFile:Wikipedia's W.svgNaphthoquinone

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 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 arguing 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 to probably meet the definition of a vitamin, making it the only true recent addition to the vitamin category; its actual status is still unsettled.

There are other substances besides vitamins 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) needed by the human body in small amounts that 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
Extravagant claims, and a free gift!

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.[5] 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.[6][7] 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.

Efficacy and safety

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.[8] 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.[9] Another recent study showed an increase in aggressive prostate cancers in men taking beta-carotene.[10]

Since Vitamin A derives from beta-carotene, a carotenoidFile:Wikipedia's W.svg pigment, massive overdoses of either substance can turn the consumer's skin yellow or orange. Also, both substances are closely related to retinoidFile:Wikipedia's W.svg 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 teratogensFile:Wikipedia's W.svg 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. Hypervitaminosis AFile:Wikipedia's W.svg). 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, neural tube defectsFile:Wikipedia's W.svg 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.[11] 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.[12] 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.[13] High homocysteineFile:Wikipedia's W.svg levels in adults are associated with heart disease, and can be reduced by adequate folate intake,[14] 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.[15]
  • 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 tryptophan,File:Wikipedia's W.svg which the body converts to niacin, can have the same effect, and there is one known genetic disorder that somewhat (though not entirely) inhibits the conversion of tryptophan to 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),[16] or pernicious anemia—is fairly rare, and when it exists, it must be treated (hence the word pernicious). 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.[17] 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."[18][19] 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.[20]
    • 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.[21]
  • Folate, B12, and B6 are sometimes recommended for memory, but studies have failed to show any benefit in non-deficient individuals.[22] "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."[19]
  • Vitamin B6 very rarely requires supplementation in the typical American diet.[23] Certain medications can cause deficiency, as can consumption of ginkgo bilobaFile:Wikipedia's W.svg seeds.

Vitamin C
L-Ascorbic acid (Vitamin C)

Vitamin C may have the most notoriety of the commonly available vitamin supplements due to Nobel Prize-winning biochemist Linus Pauling's 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."[24]

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
See the main article on this topic: 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.[25]

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.[26] 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.[27]

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).[27]

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.[27]

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.[28] 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. Crohn's diseaseFile:Wikipedia's W.svg) 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."[29]

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

Vitamin K
Not to be confused with ketamine,File:Wikipedia's W.svg which has been referred to in slang as '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).[citation needed] 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.[30] 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.[31]

Minerals

Dietary minerals, such as phosphorus, magnesium, zinc, and kryptonite,Do You Believe That? 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,[32][33] 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
See the main article on this topic: Pseudovitamin

A number of substances are sold claiming to be vitamins but are not. These are often named using the "vitamin" naming convention, as in "Vitamin B17" (which is actually laetrile). A number of other substances were also once thought to be vitamins but later reclassified out of the vitamin category; occasionally one will run across these still 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.[34]

Megavitamin therapy

Megavitamin therapy is what Dr. Mario uses to get rid of viruses[35] 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[36] and naturopathy, but is only rarely used in regular medicine for unusual genetic diseases.[37]

The first research on megavitamin therapy begin in the 1930s: for vitamin E by Drs. Wilfrid and Evan Shute (1936),[38] for vitamin C by Claus W. Jungeblut in 1937,[39] and for vitamin B3 by W. Kaufman in 1953.[40]

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.[19] 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."[19] AIs are "established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy."[19] 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."[19] It should be noted that 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.

It should also be noted that 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.[41]

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.[42]

Micronutrient Dietary Reference Intakes (DRI)[19][note 2] Potential adverse effects below DRI[19][note 3] Tolerable Upper Intake Level (UL)[19][note 2] Potential adverse effects above UL[19][note 3] People who have taken more than the UL and/or recommendations at/above the UL
Vitamins
Vitamin A 900 µg (M);
700 µg (F)		 Xerophthalmia, impaired embryonic development, follicular hyperkeratosis, increased risk of infectious morbidity and mortality 3000 µg Bone mineral density loss, teratogenicity, liver abnormalities, vision trouble, skin peeling off
  • Some supplements are at the UL (e.g., "GNC Vitamin A 10000 IU"[43]). 10,000 IU from fish liver oil (retinol) is 3000 µg.[44] Unless one's diet is otherwise totally devoid of vitamin A, taking this as directed will push one over the UL.
  • Scientology/Narconon's "Purification Rundown" includes of doses of vitamin A at 5,000-50,000 IU[45] Depending on the form of vitamin A, this could range from 1,500-15,000 µg to 2,750-27,500µg.[44]
  • A paleo diet book co-authored by Pete Evans titled Bubba Yum Yum: The Paleo Way for New Mums, Babies & Toddlers contains a recipe that is "10 times the maximum safe daily intake of vitamin A for babies."[46] [note 4]
Vitamin C 90 mg (M);
75 mg (F)		 Scurvy, dyspnea, edema, Sjögren's syndrome, weakness, fatigue, depression 2000 mg Gastrointestinal disturbances, increased oxalate excretion and kidney stone formation, increased uric acid excretion, excess iron absorption, lowered vitamin B12 levels, systemic conditioning, pro-oxidant effects
  • Prior to 1999, Dr. Andrew Weil recommended 2000-6000 mg, since then he only recommends 200 mg[49]
  • Linus Pauling took 18,000 mg.[49]
  • Andrew W. Saul,File:Wikipedia's W.svg a nutritionist involved in orthomolecular medicine recommends 15,000 mg or more.[50]
  • Robert F. Cathcart, M.D. recommended up to 200,000 mg/day to "provide the reducing equivalents necessary to quench almost all the free radicals generated by severe disease processes."[51]
  • Some supplements are at the UL (e.g., "GNC Vitamin C 2000 MG — Crystals"; recommended dose is 1/2 teaspoon = 2000 mg[52]). Unless one's diet is otherwise totally devoid of vitamin C, taking this as directed will push one over the UL.
  • Scientology/Narconon's "Purification Rundown" includes of doses of up to 6000 mg of vitamin C.[45]
  • It has been claimed that taking 2000 mg/day of vitamin C can reduce the duration of the common cold,[53] however vitamin C supplementation does not reduce the incidence of colds.[54] The evidence for reducing the duration of colds is based on individuals who experienced "extreme physical stress", not the general population.[54] The evidence for reducing the duration of colds was also not replicated in therapeutic trials, and the authors of the meta-analysis concluded that the "level of benefit does not justify long-term supplementation" for colds.[54]
  • CEASE therapy — a pseudoscience for treating autism
Vitamin D 15-20 µg (M);
25-20 µg (F)
= 600-800 IU		 Rickets/osteomalacia, bone fracture, inadequate calcium absorption, Colon/Prostate/Breast cancer. Diabetes Type 1 & 2, Hypertension, Glucose intolerance, Multiple Sclerosis 100 µg (M); 100 µg (F)
=4000 IU		 Hypercalcemia
  • Some supplements are at the UL (e.g., "Carlson® Vitamin D3 — 4000 IU"[55]). Unless one spend one's whole life in a basement, taking this as directed will put one over the UL.
  • Joseph Mercola's "Liposomal Vitamin D 5000 IU" is above the UL.[56]
  • Ortho Molecular Products' "Vitamin D 5,000 IU" is also above the UL[57]
  • Suzy Cohen's Vitamin D3 contains 5000 IU per serving[58]
Vitamin E 15 mg (M);
15 mg (F)		 Peripheral neuropathy, spinocerebellar ataxia, skeletal myopathy, pigmented & retinopathy, but "overt deficiency symptoms in normal individuals consuming diets low in vitamin E have never been described." 1000 mg Hemorrhagic toxicity, inhibition of blood platelet effects
  • The so-called "Shutes Protocol"[59] includes doses of up to 1600 IU (1072-1440 mg depending on the type of vitamin E).[44] Treatment at this level has been suggested for a variety of ailments, including thrombosis, angina, burns, plastic surgery, and mazoplasia.[60]
  • Scientology/Narconon's "Purification Rundown" includes of doses of up to 2400 IU of vitamin E.[45] Depending on the form of vitamin E, this would be in the range of 1610-2690 µg.[44]
Vitamin K 120 µg (M);
90 µg (F)		 Hypoprothrombinemia, increase in prothrombin time, bleeding, Arteriosclerosis none established
Thiamin (B1) 1.2 mg (M);
1.1 mg (F)		 anorexia, weight loss, apathy, decrease in short-term memory, confusion, irritability, muscle weakness, cardiovascular effects such as an enlarged heart none established
Riboflavin (B2) 1.3 mg (M);
1.1 mg (F)		 sore throat, hyperemia, edema of the pharyngeal & oral mucous membranes, cheilosis, angular stomatitis, glossitis (magenta tongue), seborrheic dermatitis, normochromic, anemia none established
Niacin (B3) 16 mg (M);
14 mg (F)		 Pellagra, vomiting, constipation or diarrhea, bright red tongue, neurological symptoms 35 mg Vasodilatory effects (flushing), gastrointestinal effects, hepatotoxicity, glucose intolerance, ocular effects
  • Scientology/Narconon's "Purification Rundown" includes of doses of niacin ranging from 100 mg up to 5000 mg.[61][45]
  • Joseph Mercola's Whole-Food Multivitamin Plus Vital Minerals is above the UL at 40 mg[62]
B6 1.3-1.7 mg (M);
1.3-1.5 mg (F)		 Seborrheic dermatitis, microcytic anemia, epileptiform convulsions, depression, confusion 100 mg Lung cancer (>20 mg), sensory neuropathy
  • Some supplements are at the UL (e.g., "Nature Made B-6 Vitamin 100 mg"[63]). Unless one's diet is otherwise totally devoid of B6, taking this as directed will push one over the UL.
  • A large prospective epidemiology study found an increased risk of lung cancer for both smoking and non-smoking men (but not women) in those groups taking the highest doses of B6 (>20 mg), but not lower dose groups.[64][65]
Folate (B9) 400 µg (M);
400 µg (F)		 Neural tube defects, other congenital anomalies, vascular disease; cancer, psychiatric and mental disorders 1000 µg Neuropathy
  • Some supplements are at the UL (e.g., "PureFormulas Methyl Folate 1,000 mcg"[66]). Unless one's diet is otherwise totally devoid of B9, taking this as directed will push one over the UL.
  • Ortho Molecular Products' Folic Acid supplement contains 5000mg of folate, well over the UL[67]
B12 2.4 µg (M);
2.4 µg (F)		 Pernicious anemia, neurological complications, gastrointestinal complaints none established Lung cancer (>55 µg)
  • A large prospective epidemiology study found an increased risk of lung cancer for both smoking and non-smoking men (but not women) in those groups taking the highest doses of B12 (>55 µg), but not lower dose groups.[64][65]
Pantothenic acid (B5) 5 mg (M);
5 mg (F)		 Irritability & restlessness; fatigue; apathy; malaise; sleep disturbances; gastrointestinal complaints; neurobiological symptoms; hypoglycemia & increased sensitivity to insulin none established
Biotin (B7) 30 µg (M);
30 µg (F)		 Dermatitis, conjunctivitis, alopecia, central nervous system abnormalities none established
Choline 550 mg (M);
425 mg (F)		 Liver dysfunction 3500 mg Body odor, sweating, and salivation; hypotension; hepatotoxicity
Minerals
Arsenic none established no justification for supplementation due to toxicity
Boron none established 20 mg/day (M);
20 mg/day (F)		 General systemic toxicity (implied by animal studies); dermatitis, alopecia, anorexia, indigestion (in humans)
Calcium 1000-1200 mg/day (M);1000-1200 mg/day (F) Reduced bone mass, osteoporosis 2000-2500 mg/day (M);
2000-2500 mg/day (F)		 kidney stone formation, hypercalcemia, renal insufficiency
  • Scientology/Narconon's "Purification Rundown" includes of doses of calcium up to 3000 mg[45]
  • Bob's Best Coral Calcium 2000 mg[68] Unless one's diet is otherwise totally devoid of calcium, taking this as directed will push one over the UL.
Chromium 30-35 µg/day (M);
20-25 µg/day (F)		 Weight loss, peripheral neuropathy, impairment of glucose utilization none established
Copper 900 µg/day (M);
900 µg/day (F)		 Liver damage 10 mg/day (M);
10 mg/day (F)		 Gastrointestinal illness
  • Scientology/Narconon's "Purification Rundown" includes of doses of copper up to 12 mg[45]
Fluoride 4 mg/day (M);
3 mg/day (F)		 Dental caries 10 mg/day (M);
10 mg/day (F)		 Enamel and skeletal fluorosis
Iodine 150 µg/day (M);
150 µg/day (F)		 Intellectual disability, hypothyroidism, goiter, cretinism, other growth and developmental abnormalities 1100 µg/day (M);
1100 µg/day (F)		 Burning of the mouth, throat, and stomach, abdominal pain, fever, nausea, vomiting, diarrhea, weak pulse, cardiac irritability, coma, cyanosis, goiter, thyroid cancer
  • Joseph Mercola's Iodine supplement is above the UL at 1500 µg[69]
  • Ortho Molecular Products' Seleno-Iodide supplement contains 3000µg of iodine[70]
  • Alex Jones' InfoWars site sells "Survival Shield X-2 — Nascent Iodine", a liquid, with a serving size of 3 drops that gives 1950 µg of iodine,[71][72] nearly double the UL. The Edgar Cayce-inspired iodine treatment is supposed to combat water fluoridation (actually quite safe) as well as water disinfection byproducts (very safe compared to the effects of not disinfecting) with an ineffective but potentially-toxic dose of iodine.[72][73][74]
  • Detoxadine also has a serving size of 1950 µg.[75]
  • Iodine tablets are sometimes recommended to prevent thyroid cancer from nuclear accidents. A small study on 8 volunteers showed effectiveness in preventing radioactive iodine uptake when the volunteers took 32,000 µg/day for 3 months.[76] The volunteers had temporarily increased thyroid size but no evidence of hyperthyroidism nor hypothyroidism.[76]
Iron 8 mg/day (M);
8-18 mg/day (F)		 Reduced physical work capacity, delayed psychomotor development in infants, impaired cognitive function, anemia 45 mg/day (M);
45 mg/day (M)		 Vomiting, diarrhea, constipation
  • Scientology/Narconon's "Purification Rundown" includes of doses of iron up to 108 mg[45]
  • Puritan's Pride: High Potency Slow Release Iron 45 mg[77] Unless one's diet is otherwise totally devoid of iron, taking this as directed will push one over the UL.
Magnesium 400-420 mg/day (M);
310-320 mg/day (F)		 Hypocalcemia, neuromuscular hyperexcitability 350 mg/day (M);
350 mg/day (F)[note 5]		 Diarrhea, nausea, abdominal cramping
  • Joseph Mercola's Magnesium L-Threonate supplement is at well above the UL at >2000 mg[78]
  • Scientology/Narconon's "Purification Rundown" includes of doses of magnesium up to 1500 mg[45]
  • Global Healing Center's Oxy-Powder (sold as "Advanced Liver Cleanse Pack" on InfoWars) contains 1537 mg per serving[79]
  • Carlson® Magnesium 350 mg[80]Unless one's diet is otherwise totally devoid of magnesium, taking this as directed will push one over the UL for women.
Manganese 2.3 mg/day (M);
1.8 mg/day (F)		 Impaired growth, impaired reproductive function, impaired glucose tolerance (based on animal studies) 11 mg/day (M);
11 mg/day (F)		 Neurotoxicity
  • Scientology/Narconon's "Purification Rundown" includes of doses of manganese up to 24 mg[45]
Molybdenum 45 µg/day (M);
45 µg/day (F)		 Molybdenum deficiency has not been observed in healthy people. 2000 µg/day (M);
2000 µg/day (F)		 Reduced growth or weight loss, renal failure, skeletal abnormalities, infertility, anemia, diarrhea, and thyroid injury (based on animal studies)
Nickel none established 1 mg/day (M);
1 mg/day (F)		 Reduced growth, weight loss, renal failure, skeletal abnormalities, infertility, anemia, diarrhea, and thyroid injury
Phosphorus 45 mg/day (M);
45 mg/day (F)		 Hypophosphatemia 4000 mg/day;
4000 mg/day		 Hyperphosphatemia
Selenium 55 µg/day (M);
55 µg/day (F)		 Keshan disease, Kashin-Beck disease 400 µg/day (M);
400 µg/day (F)		 Chronic selenosis
  • Good State Liquid Ionic Selenium Minerals Supplement, (96 days at 400mcg.)[81] Unless one's diet is otherwise totally devoid of selenium, taking this as directed will push one over the UL.
  • An unidentified selenium supplement was reported to have 200 times the labeled amount, causing acute selenium poisoning (median daily ingestion was 41.6 mg/day).[82]
Silicon none established none established
Vanadium none established 1.8 mg/day (M);
1.8 mg/day (F)		 "Although vanadium in food has not been shown to cause adverse effects in humans, there is no justification for adding vanadium to food, and vanadium supplements should be used with caution."
Zinc 11 mg/day (M);
8 mg/day (F)		 Diverse symptoms 40 mg/day (M);
40 mg/day (F)		 Epigastric pain, nausea, vomiting, loss of appetite, abdominal cramps, diarrhea, headaches
  • Scientology/Narconon's "Purification Rundown" includes of doses of zinc up to 90 mg[45]
  • Mason Natural Zinc, 100mg, Tablets[83]
  • Ortho Molecular Products' Reacted Zinc supplement contains 54mg of zinc[84]
Potassium 4700 mg/day (M);
4700 mg/day (F)		 Hypokalemia, high blood pressure, cardiovascular disease, bone demineralization, kidney stones none established
Sodium 1300-1500 mg/day (M);
1200-1500 mg/day (F)		 Adverse effects on blood lipids, insulin resistance 2300 mg/day (M);
2300 mg/day (F)		 Increased blood pressure, cardiovascular disease
Chloride 1800-2300 mg/day (M);
1800-2300 mg/day (F)		 correlated with sodium 3600 mg/day (M);
3600 mg/day (F)		 correlated with sodium

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.

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gollark: Shut up you idiot.
gollark: It's bloated and verbose.
gollark: Why Java? WHY?
gollark: I'm just adding lorem ipsum support to potatOS.

See also

Notes
  1. The reasoning goes something like: "Vitamin C is essential for health, so lots of vitamin C should be even better!" The fallaciousness of this can be demonstrated with the statement: "Vitamin A is essential for health, so lots of vitamin A is even better!" (Vitamin A causes liver damage in high doses.) Or, to frame it in terms of something commonly known by CAM believers, "Sodium is essential for health, so lots of sodium is even better!"
  2. When a range of values is given, it means that different DRIs are given for different adult age ranges
  3. This is not necessarily an exhaustive list.
  4. Pan Macmillan Australia originally planned to publish the book (ISBN 1743537042), but completely dropped Evans as an author after he posted a cartoon on Facebook showing an ancient Sonnenrad symbolFile:Wikipedia's W.svg that has been coopted by neo-Nazis (Evans is a Trump supporter, so connect the dots).[47] An earlier edition of the book was self-published by one of the co-authors.[48]
  5. Unlike the other values in the table, the UL for magnesium is for supplementation only, hence a comparable UL for magnesium would be the DRI plus the stated UL.

References
  1. Vitamania: Vitamins in American Culture by Rima D. Apple (1996) Rutgers University Press. ISBN 0813522781.
  2. Do vitamins in pills differ from those in food? by Christine Rosenbloom & Luke Bucci (2003) Scientific American.
  3. The Vitamin Myth: Why We Think We Need Supplements
  4. http://www.nobelprize.org/nobel_prizes/themes/medicine/carpenter/
  5. Nutritional Supplements Flexing Muscles As Growth Industry by David Lariviere (Apr 18, 2013 @ 07:09 PM) Forbes.
  6. More evidence that routine multivitamin use should be avoided by Scott Gavura (December 19, 2013) Science-Based Medicine.
  7. The Case Against Multivitamins Grows Stronger by Nancy Shute ( December 17, 201312:37 PM ET) NPR.
  8. WHO on Vitamin A deficiency
  9. Risk Factors for Lung Cancer and for Intervention Effects in CARET, the Beta-Carotene and Retinol Efficacy Trial by Gilbert S. Omenn et al. (1996). Journal of the National Cancer Institute 88(21):1550-1559.
  10. Serum Lycopene, Other Carotenoids, and Prostate Cancer Risk: a Nested Case-Control Study in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial by Ulrike Peters et al. (2007) Cancer Epidemiol. Biomarkers Prev. 16: 962-968 doi: 10.1158/1055-9965.EPI-06-0861
  11. Knowledge and Use of Folic Acid by Women of Childbearing Age — United States, 1995 MMWR Weekly September 29, 1995 / 44(38);716-8.
  12. "Fact Sheet for Health Professionals – Folate". National Institutes of Health.
  13. FAQ, The American College of Obstetricians and Gynecologists
  14. Homocysteine and atherothrombosis by G.N. Welch & J. Loscalzo (1998) N. Engl. J. Med. 338:1042-1050.
  15. Nutritional Biochemistry by Tom Brody (1998). Academic Press, 2nd ed. ISBN 0121348369.
  16. Edigin E, Ajiboye O, Nathani A (August 06, 2019) Nitrous Oxide-induced B12 Deficiency Presenting With Myeloneuropathy. Cureus 11(8): e5331. doi:10.7759/cureus.5331
  17. Vitamin B12 deficiency can be sneaky, harmful - Harvard Medical School
  18. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population by J. Selhub et al. JAMA 1993;270:2693-2698
  19. Nutrient Recommendations: Dietary Reference Intakes (DRI) National Institutes of Health Office of Dietary Supplements (2011).
  20. "Position of the Academy of Nutrition and Dietetics: Vegetarian Diets". J Acad Nutr Diet 116 (12): 1970–1980. 2016. doiFile:Wikipedia's W.svg:10.1016/j.jand.2016.09.025. PMID 27886704.
  21. What are the symptoms of vitamin B-12 deficiency? - Medical News Today
  22. Vitamin B6, B12 and folic acid supplementation and cognitive function: a systematic review of randomized trials by E. M. Balk et al. Archives of Internal Medicine. 167(1):21-30, 2007 Jan 8.
  23. What Vitamins Should I Be Taking, Doctor? Willett WC, Stampfer MJ. N. Engl. J. Med. 345:1819, December 20, 2001.
  24. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
  25. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N. Engl. J. Med. 1998;338:777-783.
  26. Vitamin D, Race, and Excessive Daytime Sleepiness by David E. McCarty et al. (2012) Journal of Clinical Sleep Medicine 8(6):693-697.
  27. Vitamin D Fact Sheet for Health Professionals
  28. 'On Food and Cooking by Harold McGee (1997). Scribner. 1st ed. ISBN 0684843285. p. 539
  29. National Study Finds Vitamin E Supplement May Increase Prostate Cancer Risk (October 11, 2011) Cleveland Clinic.
  30. Protect Your Baby From Bleeds — Talk to Your Healthcare Provider about Vitamin K (December 26, 2019) Centers for Disease Control and Prevention.
  31. Anti-Vaxxers Turn on Vitamins, Too (April 14, 2017) The Daily Beast.
  32. Joel D. Wallach, the "mineral doctor" The Skeptic's Dictionary
  33. Dead Doctors Don't Lie by Joel D. Wallach (2004) Wellness Publications, 2nd ed. ISBN 0974858102.
  34. Extra Vitamins? A Great Idea, Except in Denmark (Jun 16, 2011) New York Times.
  35. Dr. Mario Instruction Booklet Nintendo. Warning: this does not work in the real world.
  36. Orthomolecular therapy: its history and applicability to psychiatric disorders by F. J. Menolascino et al. (1988). Child Psychiatry Hum. Dev. 18 (3): 133–50. doi:10.1007/BF00709727.
  37. High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms1-3 by B. N. Ames et al. (2002). Am. J. Clin. Nutr. 75 (4): 616–58. PMID 11916749.
  38. The Vitamin E Story DoctorYourself.com
  39. Vitamin C therapy and prophylaxis in experimental poliomyelitis by Claus W. Jungeblut (1937) Journal of Experimental Medicine 66(1):127.
  40. Niacinamide therapy for joint mobility; therapeutic reversal of a common clinical manifestation of the normal aging process by W. Kaufman (1953) Conn. State Med. J. 17(7):584-9.
  41. For athletes, antioxidant pills may not help performance: Some supplements can blunt the positive effects of exercise training by Laura Beil (February 24, 2015) Science News.
  42. Dietary supplement use is associated with higher intakes of minerals from food sources by Regan L. Bailey et al. Am. J. Clin. Nutr. 2011 Nov; 94(5): 1376–1381. Published online 2011 Sep 28. doi: 10.3945/ajcn.111.020289.
  43. Vitamin A 10000 IU GNC
  44. RFA Vitamin Conversion Chart Robert Forbes and Associates Regulatory Affairs
  45. Is Narconon Safe? Dangerous detoxification by Chris Owen (5 November 2002) Narconon Exposed.
  46. Pete Evans paleo for kids cookbook put on hold amid health concerns: Public Health Association president says recipe in book co-authored by celebrity chef has 10 times safe daily intake of vitamin A for babies by Melissa Davey (12 Mar 2015 01.37 EDT) The Guardian.
  47. Pan Macmillan Drops Pete Evans Amid Neo-Nazi Scandal, As 10 Boots Him from I'm a Celeb Line-up (17 November, 2020)B&T Magazine.
  48. Bubba Yum Yum: The Paleo Way for New Mums, Babies & Toddlers by Charlotte Carr, Helen Padarin, and Pete Evans (2015) Charlotte Carr. ISBN 0994326408.
  49. Overloading on Vitamin C? (March 16, 2009) Weil.
  50. Dr. Andrew Saul: The MegaVitamin Man, High-Dose Vitamin C, & DIY Health interview with Abel James (Last Updated: October 26, 2015) Fat-Burning Man.
  51. The Third Face of Vitamin C by Robert F. Cathcart, Journal of Orthomolecular Medicine, 7:4;197-200, 1993.
  52. GNC Vitamin C 2000 MG — Crystals GNC
  53. Vitamin C Examine.com
  54. Vitamin C for preventing and treating the common cold by Harri Hemilä & Elizabeth Chalker (2013). Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD000980. DOI:10.1002/14651858.CD000980.pub4.
  55. Carlson® Vitamin D3 — 4000 IU GNC (archived from February 27, 2017)
  56. Liposomal Vitamin D 5000 IU (30 per bottle): 30 Day Supply Dr. Mercola Premium Products
  57. Vitamin D 5,000 IU Ortho Molecular Products
  58. Vitamin D3 in EVOO (Suzy Cohen) (archived from June 7, 2017)
  59. Some medical uses of vitamin E by A. Vogelsang, E. Shute & W. Shute (1948) Med. World 161(2):83-9.
  60. Shute Vitamin E Treatment Protocol DoctorYourself.com
  61. The Rundown on Scientology's Purification Rundown: What Scientologists aren't telling you about their detox program (June 6,2007) New York Press (archived copy from July 12, 2009).
  62. Whole-Food Multivitamin Plus Vital Minerals Dr. Mercola Premium Products
  63. Nature Made B-6 Vitamin 100 mg Target
  64. Long-Term, High-Dose Vitamin B6/B12 Use Associated With Increased Lung Cancer Risk Among Men (August 22, 2017) Ohio State University Comprehensive Cancer Center
  65. Long-Term, Supplemental, One-Carbon Metabolism–Related Vitamin B Use in Relation to Lung Cancer Risk in the Vitamins and Lifestyle (VITAL) Cohort by Theodore M. Brasky et al. (2017) Journal of Clinical Oncology JCO.2017.72.773 DOI: 10.1200/JCO.2017.72.7735
  66. PureFormulas Methyl Folate 1,000 mcg PureFormulas
  67. Folic Acid Ortho Molecular Products
  68. Bob's Best Coral Calcium 2000 mg Robert Barefoot (archived from February 26, 2017)
  69. Iodine (30 per bottle): 30 Day Supply Dr. Mercola Premium Products
  70. Seleno-Iodide Ortho Molecular Products
  71. Survival Shield X-2 Infowars Store (archived from March 3, 2017)
  72. The Online Store Where Preppers Buy Their Bulls**t Cure-Alls by Ashley Feinberg (Feb 18, 2015, 10:30am) Gizmodo.
  73. How Alex Jones Uses Fear of the Government to Sell Diet Supplements by Spenser Davis (Jul 22 2016, 6:00am) Motherboard Vice.
  74. Fluoride: Poison On Tap Documentary: Fluoride exposure can have serious health consequences by Edward Group (November 17, 2015) Infowars (archived from February 4, 2016).
  75. Detoxadine® Nascent Iodine Supplement Global Healing Center.
  76. Thyroid adaptation to chronic tetraglycine hydroperiodide water purification tablet use by H. J. LeMar et al. (1995) J. Clin. Endocrinol. Metab. 80(1): 220-223.
  77. High Potency Slow Release Iron 45 mg Puritan's Pride (archived from February 27, 2017)
  78. Magnesium L-Threonate (90 per bottle): 30 Day Supply Dr. Mercola Premium Products
  79. Advanced Liver Cleanse Pack InfoWars
  80. Carlson® Magnesium 350 mg GNC (archived from February 27, 2017)
  81. Good State Liquid Ionic Selenium Minerals Supplement Amazon.com (archived from February 27, 2017)
  82. Acute Selenium Toxicity Associated With a Dietary Supplement by Jennifer K. MacFarquhar et al. Arch. Intern. Med. 2010 Feb 8; 170(3): 256–261. doi:10.1001/archinternmed.2009.495.
  83. Mason Natural Zinc, 100mg, Tablets Amazon.com (archived from February 27, 2017)
  84. Reacted Zinc Ortho Molecular Products
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