Irrespective of their specialty, almost every doctor in India has had patients request them to prescribe &ldquo;taakat waali goli&rdquo;- the energy pill. &ldquo;I feel much better, and my body hurts less when I take these pills daily&rdquo;, says Nita, a mother of two whose blood reports show no nutritional deficiencies. &ldquo;I started taking them during the pandemic to help maintain my immunity, and I feel it has been better for my overall health. I have recently started taking another anti-ageing supplement. I don&rsquo;t get time to exercise, so these pills are an important part of my self-care routine.&rdquo; When asked if she was aware of the cases of liver toxicity associated with the use of the particular brand she was using, Nita didn&rsquo;t know about it. &ldquo;It is promoted by the Indian cricket captain. I&rsquo;m sure any issues with the pills must have been resolved.&rdquo;&nbsp;&nbsp;

Healthy living is a viable sales target- more so <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416287/">after COVID hit</a>. While the effects of Zinc, Vitamin C, and other supplements were being studied, people rushed to buy these over-the-counter products to stave off the pandemic raging worldwide. The incumbent US President <a href="https://apnews.com/article/virus-outbreak-melania-trump-archive-f1ef1f03cdd92fa83618ed34a3ea5ddb">claimed</a> that a cocktail of drugs, along with vitamins, was keeping him healthy, which led to a <a href="https://academic.oup.com/cdn/article/5/Supplement_2/207/6293090">dramatic spike</a> in sales of these medications. The multivitamin industry is now a multibillion-dollar<a href="https://www.reportsanddata.com/report-detail/multivitamins-market"> enterprise</a> grossing over <a href="https://www.thebusinessresearchcompany.com/report/multivitamin-capsules-and-tablets-global-market-report#:~:text=The%20global%20multivitamin%20capsules%20and,(CAGR)%20of%2010.3%25.">20 billion dollars worldwide</a>, with most consumers in the Asia Pacific region. In India, the sales of multivitamins have <a href="https://www.thepharmaletter.com/article/indian-companies-score-over-multinationals-in-vitamins">overtaken</a> sales of medication for diabetes and heart disease, too. The Indian market hopes to see the worth of nutraceutical products <a href="https://www.thepharmaletter.com/article/indian-companies-score-over-multinationals-in-vitamins">rise from 4 to 18 billion dollars</a> in the country by 2025.&nbsp;

History of multivitamin tablets

The discovery of vitamins was made in the early 20th century by Kazimierz Funk, and their role in preventing diseases like scurvy and beriberi was proposed. Researchers at the time proposed that <a href="https://karger.com/anm/article-abstract/57/2/85/41738/Casimir-Funk-His-Discovery-of-the-Vitamins-and?redirectedFrom=fulltext">modern methods of milling and polishing</a> food grains were responsible for dietary deficiencies of these vitamins. However, as early as 1916- even before they were isolated and understood-&nbsp; vitamins began to be touted as energizers, cure-alls, and preventives for a plethora of ailments.&nbsp;

Instead of focusing on nutritional deficiencies caused by specific diets or disease conditions, advertising and marketing all across the United States of America focused on vitamins&rsquo; alleged capacities to <a href="https://ghostsofdc.org/2014/03/07/vitamon-tablets-female-beauty-male-power/">enhance vigour, beauty, and youth</a>. As the formulations became more <a href="https://sciencehistory.org/stories/magazine/vitamins-come-to-dinner/">accessible and convenient</a> one-a-day tablets, celebrities <a href="https://youtu.be/RbGJQXjiopo">marketed</a> multivitamins as a necessary part of life.

The cure-all: why are more Indians taking multivitamins?

Studies have shown that Indians believe that <a href="https://d1wqtxts1xzle7.cloudfront.net/75051653/8804-libre.pdf?1637695014=&amp;response-content-disposition=inline%3B+filename%3DAwareness_Perception_and_Usage_of_Nutrac.pdf&amp;Expires=1693763630&amp;Signature=FAz7P1Hh5ABDbkKrKr-EOG88tJMCecjvo3fruv~6k~hOJrN76M0-Qrvag6LtbVj5nA6zfirw3auHjcCXhUKR0oj2u81QVvdtwgoZsO257vXbMvqJB8A6OzwQS9d36f4Q-mRvMEehC3Rdgwb7SzAi-OHCiMEI0tPNsqUOa-fcnfxbKKXtgRXMaFGvJU1bKPGFz5SDLqMB23w8H~dSnpu~kfBUgJHrTgUXhoCIzSL1KLEpmy-pOG9NDn9YfMVDiXc6fJyR2SWJbUiA70EUqoNmuy4CON4bd53x2B32mjKToV3WtGZ7w5VkeCA5HGY8~Fm6lOrDCSsR7YtK0GPOo~QjLQ__&amp;Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA">supplements</a> make them healthier, stronger, and feel better. Almost half the population in studies <a href="https://deliverypdf.ssrn.com/delivery.php?ID=051126078111096020126125081070096014120023010055065000089099126025125075098107109106054039055107041010048091000088106018113071059040012021004023064107127097118081077052083033089096068124000082008002022101093126071080125066017122100030109089003105099013&amp;EXT=pdf&amp;INDEX=TRUE">believe</a> that our diets don&rsquo;t contain all the nutrients we require and believe supplements are important. However, awareness about the content of supplements, and possible side effects, is consistently low.

&ldquo;It&rsquo;s just a vitamin, no,&rdquo; a patient tells me. &ldquo;It is like a boost-up for the entire body, that&rsquo;s it. My skin looks better, my energy stays up. It can only do good.&rdquo; Health and wellness are obvious human concerns, but the pandemic magnified them greatly. The search volume of terms like &ldquo;immunity boosting&rdquo; in India saw a sharp rise, as did the use of vitamin C and zinc supplements. Recent sales indicate that this concern with immunity has been associated with<a href="https://timesofindia.indiatimes.com/city/ahmedabad/viral-infections-sales-of-immunity-boosters-up-by-20-in-gujarat/articleshow/98679412.cms?from=mdr"> increased purchases</a> of multivitamins, despite no evidence to support the same. Multivitamins are found in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9846909/">more than half</a> of all prescriptions in India, even when <a href="https://www.sciencedirect.com/science/article/abs/pii/0277953687902334">unnecessary</a>. &ldquo;We have to give them something,&rdquo; seems to be the unwritten law of the land.

Content of multivitamins

Several studies on the content of multivitamin tablets in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660877/">India</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5267296/">abroad</a> have shown that they often exceed the required daily allowance of specific vitamins. What this means is that following the &ldquo;one-a-day&rdquo; rule for such medication can result in harm from the presence of unnecessarily high amounts of these vitamins in our body. The overdose of vitamins can be dangerous, and current regulations on the multivitamin market do not hold them accountable. Vitamins <a href="https://www.ncbi.nlm.nih.gov/books/NBK557876/">D</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK564373/#:~:text=Vitamin%20E%20toxicity%20occurs%20due,on%20anticoagulation%20or%20antiplatelet%20therapy.">E</a> in large doses, especially <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852574/">the formulations</a> widely used in India, can have harmful health effects that people may not be aware of. <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01614-8">These</a> can be life-threatening, given their free over-the-counter sales and daily use.&nbsp;

Nutritional supplements that contain multivitamins and plant extracts have been <a href="https://www.journal-of-hepatology.eu/article/S0168-8278(07)00406-0/pdf">associated</a> with several well-documented <a href="https://www.sciencedirect.com/science/article/abs/pii/S0168827807003674">cases</a> of liver damage and liver failure. However, these brands continue to thrive and are popularized by celebrities all over the world. A recent study on lung cancer even showed that <a href="https://www.jci.org/articles/view/169671/pdf">antioxidants</a>- such as vitamin C- can actually increase the growth of cancer by encouraging small blood vessel growth. The authors of the paper confirmed that dietary antioxidants aren&rsquo;t harmful- but additional doses may be. Most of us don&rsquo;t really need vitamin supplements- our diets often suffice.&nbsp;

The newest kids on the nutraceutical block, multivitamin gummies and &ldquo;energizer drinks&rdquo; actually do more harm than good. They contain large amounts of sugar- <a href="https://www.nebraskamed.com/primary-care/are-gummy-vitamins-good-for-you#:~:text=Often%20there%20are%203%20to,20%25%20of%20your%20daily%20sugar!">large enough</a> to tilt the scales of your daily intake towards unhealthy. The fact that these items are <a href="https://newsroom.unsw.edu.au/news/health/kids%E2%80%99-vitamin-gummies-unhealthy-poorly-regulated-and-exploitative">geared towards children</a> blurs the line between &ldquo;health food&rdquo; and &ldquo;marketable product&rdquo; even further. Even sugarless ones tend to give you an <a href="https://www.onemedical.com/blog/eat-well/vitamin-drinks/">overdose</a> of unnecessary goodness and cost a <a href="https://www.google.com/search?q=sugarfree+vitamin+drink+india&amp;oq=sugarfree+vitamin+drink+india&amp;aqs=chrome..69i57j0i10i512l5j0i10i22i30i625j0i22i30l3.4564j0j7&amp;sourceid=chrome&amp;ie=UTF-8">bomb</a>.

But what if the diet lacks the required nutrients?&nbsp;

&ldquo;My company&rsquo;s annual full-body panel showed that I had severe vitamin D deficiency,&rdquo; says a young IT professional. &ldquo;I started multivitamins right after that. It has a lot of things including vitamin D.&rdquo;&nbsp;

In such cases, it is better to opt for targeted supplementation towards the specific nutrient deficient in the diet. People with dietary restrictions, for instance, may require lifelong supplementation. Vegetarians are often deficient in vitamin B12, but a multivitamin tablet a day will most likely not meet their requirements and may end up over-supplementing other vitamins and minerals they don&rsquo;t need. It would be much better if they took single vitamin B12 doses.&nbsp;

Do multivitamins prevent disease?

While people often use multivitamins to <a href="https://ejhm.journals.ekb.eg/article_16737_a9abb8a7d07b860e086b03289997d7e8.pdf">prevent </a>hair fall, stay active, and maintain energy levels, most studies show that they have <a href="https://jamanetwork.com/journals/jama/fullarticle/2793446">no observable benefits</a> in healthy populations. Multivitamins have not been seen to decrease the risk of cardiovascular disease, cognitive functions, and cancers in several studies. In fact, the <a href="https://jamanetwork.com/journals/jama/fullarticle/2793446">only sustained significant improvement</a>- the decrease in risk of fractures and improvement in bone density- is seen among women after menopause, who are often naturally deficient in calcium&ndash; and would benefit more from targeted calcium/vitamin D therapy. Studies that claim the direct benefits of multivitamins to health are often <a href="https://www.tandfonline.com/doi/abs/10.3109/19390211.2013.783661">misleading</a> and overstate their findings in order to convince us to use supplements.

Even the prevalent use of Biotin, or Vitamin B7, for reducing hair fall and improving hair growth/length/quality, is not based on actual evidence. The only improvements noted have been in cases with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582478/">rare genetic diseases</a> of the skin and nails, mostly with documentation of faulty metabolism causing the biotin deficiency.

In fact, self-reported wellness has been found to be <a href="https://bmjopen.bmj.com/content/10/11/e039119">consistently higher</a> than actual wellness derived from multivitamins. This says a lot about the real use of multivitamins: it is a tool of self-placation, a reassurance that we are doing enough to stay healthy, to prevent disease, and that great equalizer we all hate to think of.&nbsp;

For most of us, there is no replacement for a good lifestyle- but this isn&rsquo;t something we like to hear. Unfortunately, the nutraceutical industry knows this, too. It is easy to market the idea of a state of health and well-being, achieved by a daily pill. It&rsquo;s even easier to believe in this idea.

Healthcare workers and beneficiaries must both unlearn the false reassurance we have placed upon multivitamins. The real problem isn&rsquo;t our pills, but what&rsquo;s on our plates. As we over-refine our foods, we begin to depend on food fortification and supplementation to make up for the nutrients lost in processing. No multivitamins can cancel out the harm done by years of high-calorie, high-fat, low-fiber ultra-processed foods. They can also probably never replicate the benefits of a decent balanced diet.&nbsp;

Edited by Parth Sharma.

Image by Janvi Bokoliya.

Multivitamins are prescribed for any and every disease and most often even without any disease. What is wrong with this approach to good health?

Marketing Magic Or Life Elixir: The Truth Behind Multivitamins

Radhikaa&nbsp;Sharma&nbsp;is a physician, writer and the Associate Editor at Nivarana.

Radhikaa Sharma is a physician, writer and the Associate Editor at Nivarana.

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Radhikaa Sharma

Radhikaa Sharma

Marketing Magic Or Life Elixir: The Truth Behind Multivitamins

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