Esha Rafique ( 4th Year MBBS Student, Jinnah Sindh Medical University, Karachi, Pakistan. )
Usama Memon ( 4th Year MBBS Student, Jinnah Sindh Medical University, Karachi, Pakistan. )
Muhammad Adil Obaid ( 4th Year MBBS Student, Jinnah Sindh Medical University, Karachi, Pakistan. )
Madam, Dietary supplements (DS) are pharmaceutical dosage forms composed of one or more vital nutrients, vitamins, and minerals. They work as a supplement to the routine diet to serve a therapeutic agent or for general well-being. They may also be used as nutritional aid in high endurance athletics or as prophylactic to disease.1 Studies in the United States have noted a prevalence of DS consumption at a staggering 49% in adults, of which 44% was reported in males and 53% in females.2 One primary reason is their easy over-the-counter (OTC) availability.
However, excessive use of supplements has been linked to more physiological harm than benefit, as shown by two rare cases reported in Pakistan recently in 2018. The first case report showed how a 7-month-old infant developed Vitamin D intoxication through breastmilk of a mother who was Vitamin D sufficient, which went unchecked, the additional quantity he received through formula milk.3 The second case report portrays the fatal consequences of excessive dietary supplement usage in which the Weight-loss supplements, another commonly used DS, caused disrupting arrhythmias leading to sudden cardiac arrest in an otherwise healthy woman. After ruling out all other possibilities, the cause of this was linked to the consumption of 2 weight-loss pills.4 For the most part, Pakistan witnessed an increased misuse of nutritional supplements, particularly during the COVID-19 pandemic. DS was a small part of values sales in Pakistan until the pandemic hit when it soared to massive value growth in Pakistan in 2020 and following years. Consumers mainly purchase Vitamin C to strengthen their immune system and fight off infection. Likewise, as always Vitamin D, stays at the top of consumer demand in Pakistan.
Bearing in mind the consequences of excessive and unnecessary use of DS in Pakistan, it calls for immediate action by Pakistani drug authorities to regulate the sales of such compounds and make them less easily available over-the-counter for the general public to mitigate such health hazards. This also highlights a physician's role emphasising on taking good drug history from patients to rule out any possibilities of drug-induced complications and treat them accordingly. Proper patient counselling is crucial in ensuring patients understand the risks of misusing a supplement, which, if taken in standard recommended doses, can serve its intended therapeutic purpose.
Submission completion date: 12-05-2022
Acceptance date: 14-07-2022
Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Disclosure: None to declare.
1. What you need to know about dietary supplements [Internet]. 2022 Feb. Available from: URL: https://www.fda.gov/food/buy-store-serve-safe-food/what-you-need-know-about-dietary-supplements. page not found
2. Bailey RL, Gahche JJ, Lentino CV, Dwyer JT, Engel JS, Thomas PR, et al. Dietary supplement use in the United States, 2003-2006. J Nutr. 2011; 141:261-6. doi: 10.3945/jn.110.133025.
3. Waheed N, Cheema HA, Saeed A, Alvi MA, Fayyaz Z, Anjum N, et al. Vitamin D Intoxication In 7-Month-Old Infant With Recommended Daily Intake Of Vitamin D. J Ayub Med Coll Abbottabad. 2018; 30:S673-5.
4. Inayat F, Majeed CN, Ali NS, Hayat M, Vasim I. The risky side of weight-loss dietary supplements: disrupting arrhythmias causing sudden cardiac arrest. BMJ Case Rep. 2018;11:227531. doi: 10.1136/bcr-2018-227531.