Toxic Vitamins?

April 13, 2008 6:50 PM

I think my multivitamin is/was making me sick, but I can't figure out which one so I don't repeat the problem. I need to be taking a multi but this got quite bad--anxiety like symptoms, depression, extreme fatigue and just general yuck. I'm having other causes checked out as well (I suspect there is a thyroid issue going on), but I need some help with the toxicity possibilities of some of the components.

Following is the list of what was in the vitamins I was taking. I have started feeling better since I quit taking them, so I know these were part of the problem. It's only been about a week or so that I haven't had them and I am improved. I took them one morning during the last week and had quite a bad anxiety reaction and felt bad/tired/sick for two days. I haven't had any since. Things did go progressively downhill during the month I took them.

Serving Size: 4 Soft Gels
Vitamin A as Beta-carotene 5000 IU 100%
Vitamin C Ester-C Calcium Ascorbate 60 mg 100%
Vitamin D from Fish Liver Oil 200 IU 50%
Vitamin E d-alpha tocopherol 30 IU 100%
Thiamin (B1) 1.5 mg 100%
Riboflavin (B2) 1.7 mg 100%
Niacin (B3) 20 mg 100%
Vitamin B6 Pyridoxine HCL 2 mg 100%
Folate,Folic Acid,Folacin 1000 mcg 250%
Vitamin B12 Cyanocobalamin 600 mcg 1000%
Biotin 300 mcg 100%
Pantothenic acid 10 mg 100%
Calcium Carbonate 360 mg 36%
Iron Ferrous Succinate 27 mg 150%
Magnesium Oxide 180 mg 47%
Zinc Citrate 10 mg 67%
Selenium L-selenomethionine 50 mcg 71%
Copper Sulfate 2 mg 100%
Manganese Citrate 2 mg 100%
Chromium Polnicotinate 120 mcg 100%
Molybdenum Aspartate 75 mcg 100%
Potassium Citrate 10 mg <1%
DHA from Fish 300 mg*
EPA from Fish 21 mg*
Choline Bitartrate 10 mg*
Inositol 5 mg*
Citrus Bioflavonoids 25 mg*
Ginger Oil 100 mg*
Alfalfa Leaf Powder 10 mg*

posted by pywacket to health & fitness (36 comments total)

There's plenty of stuff in there - but one other thought, could it be one of the non-vitamin ingredients -- like food coloring or the coating they have?
posted by LobsterMitten at 6:54 PM on April 13, 2008

At a glance, the one that leaps out at me is the chromium. Diabetics sometimes take this to increase their sensitivity to insulin. A lot of what you're describing could be hypoglycemia (low blood sugar).
posted by selfmedicating at 7:03 PM on April 13, 2008

Possibly, funny they are called puregels though :-) They are supposed to be a kind that doesn't have extra added badness.
posted by pywacket at 7:05 PM on April 13, 2008

Iron overload?
posted by gjc at 7:12 PM on April 13, 2008

Have you tried simply changing brands? Try a regular ol' Centrum or something.
posted by Justinian at 7:12 PM on April 13, 2008

Oh I'm absolutely not taking these anymore. I've got some regular old vitamins, but I'm giving my body a break for awhile. I really wanted to add the Omega 3s and this looked like a great all in one set up. I've got some Centrum and Basic Omega 3s to start in a month or so. I'm just really curious what could have gone so wrong. It was actually getting scary.
posted by pywacket at 7:19 PM on April 13, 2008

Assuming that you really are experiencing a system allergic reaction, the most obvious candidate in those ingredients is the alfalfa which, being a non-purified herb, contains a spectrum of potential allergans. If you are sensitive to components within Fabaceae (Legumes), that would do it. It's also possible that the alfalfa has other plant materials mixed in with it. Sensitivity to plant preparations in unregulated products is not uncommon (allergies to St John's Wort or Echinacea also being not uncommon). You should see an allergist.
posted by meehawl at 7:27 PM on April 13, 2008 [1 favorite]

I need to be taking a multi

Really? Why? If you suspect these pills are causing you problems then please stop popping them. You can get all the vitamins you need through proper diet, unless you have a specific deficiency in which case you should target only that deficiency, or you have some sort of disorder which prevents proper intake or uptake in which case you really should be having your doctor answer this question.
posted by caddis at 7:29 PM on April 13, 2008

If it was just these pills it could also be an allergy to a specific ingredient.
posted by caddis at 7:31 PM on April 13, 2008

Slow down Caddis, I said I'm not taking them anymore, I was certainly never popping vitamins, just trying to take care of myself! I do need to be taking a multi vitamin. I try and have a good diet, but I'm not perfect--have a lot to do and a lot of people to take care of.

And I am going to a doctor, but it takes 6 weeks to see an endocrinologist, another month to see an internal medicine specialist. My regular doc is clueless-- tried her already.
posted by pywacket at 7:37 PM on April 13, 2008

Start w/ a nutritionist; it'd probably be cheaper and their advice would be able to steer you in a better direction than making assumptions to IM or endocrinology just yet.
posted by uncballzer at 7:47 PM on April 13, 2008

Unless you have been specifically diagnosed with a deficiency the jury is really out on whether you should be taking a multi. There are even some studies suggesting that it could cause as much harm as good.

A quick review of some of the first links on the google search here could make you change your mind on supplementing.
posted by Octoparrot at 7:52 PM on April 13, 2008

Ah, I have some other issues that need to be checked out by the endocrinologist (thyroid) and other issues for the other doc. The thing that has me stumped is how much better I felt when I quit taking them, and how very bad I felt on them after the first two weeks. This has has my regular doc stumped too. My doc does believe I should be taking a multi vitamin, obviously not that one though.

Interesting the dislike of multi vitamins/supplements though, I've not come across that before.
posted by pywacket at 8:00 PM on April 13, 2008

I try and have a good diet.

Then you definitely don't need to be taking vitamins. A decently healthy western diet will cover you in pretty much everything you need. (Unless you have other medical conditions). I'd stop taking all these vitamins for good. And only take supplements unless your physicians tells you are are deficient in something.
posted by ruwan at 8:41 PM on April 13, 2008

Please consider what a lot of people are pointing out, that you need to really ask yourself if you NEED to be taking these, if you eat half-decently and have no serious health problems most nutritionists will NOT recommend taking vitamin supliments. Also I suggest doing some reading on the difference between vitamins obtained through normal diet and those in supliments, they are very much not the same thing.
posted by parkerama at 8:45 PM on April 13, 2008

She's not taking them anymore. Calm down everyone.

(pywacket, I think the anti-supplement folks are more tempted to come in here and comment on it than the pro-supplement folks. So you're getting a skewed sample of views on supplementing.)

Does the package list the non-vitamin ingredients? It might be useful to post those as well.
posted by LobsterMitten at 8:56 PM on April 13, 2008

Here are the DRIs. They are pretty much the definitive guide to this subject.
posted by 517 at 9:19 PM on April 13, 2008

You could have an underlying genetic polymorphism that means you process one, some or all of those ingredients more efficiently that the general population, meaning that a normal dose for someone else would be an overdose for you. It would be very hard to pin down particularly as the full biochemical pathways for processing food components aren't yet known, so the polymorphism could be previously unknown (or at least not yet looked at). Or the pill could interacting with something else in your diet changing how one, some or all of those ingredients affect you specifically. Grapefruit juice would be the most obvious culprit assuming you ever drank it but it could be anything.

The chances are certainly higher that you're reacting to the non-vitamin or mineral ingredients, like maybe the colouring or binders used in there as well as the plant extracts. Otherwise you'd probably react to the vitamins and minerals in normal food too. Maybe start with a simpler concoction, just a few of the main vitamins and minerals and no extra stuff. If you have any idea of what type of nutrients you are missing you can often get supplements for that just that, e.g. B vitamins only or selected minerals only, and that might be another way of narrowing things down. I'd add the omega oils at a different time to the multivitamin so you'll get an idea of if they're involved, and probably avoid any plant extracts or less 'pure' supplements also.

If you really do have a nutrient poor diet and are not able to get all the vitamins and minerals you need then that could be causing health problems on it's own. And the idea of trying to supplement just the areas you need rather than indiscriminately has some valid science behind it and isn't a fringe idea (for a start many those ingredients are interacting with each other and blocking absorption so they don't even make it into your body in the first place, they just give you expensive faeces and urine). But there are times when you can't work out what you're lacking in and it's easier to take one overall pill in the hopes that will cover it. And sometimes it works *shrug*.
posted by shelleycat at 10:36 PM on April 13, 2008

I think sensitivity to alfalfa is a very reasonable guess. Alfalfa contains the amino acid L-canavanine, which is a notorious sensitizer.

I also think there is a strong possibility you could have a vitamin B-12 malabsorption problem, which can lead to a deficiency no matter how much you take orally. When you lack the ability to absorb B-12 (which can happen for a variety of reasons, and is often correlated with a lack of stomach acid, which can in turn give rise to food sensitivities) folate can have a toxic effect. My Merck Manual says "Giving folic acid (instead of B-12) to any patient who is B12- deprived is contraindicated because it may result in fulminant neurologic deficit." I think the anxiety, depression, and fatigue you had could be a mild version of this kind of B-12 deficiency driven reaction to folate.

There are tons of anecdotal accounts which insist that B-12 deficiency can cause msg sensitivity, by the way.

I think you might want to consider asking your doctors to check your serum B-12 levels next time you go in.
posted by jamjam at 12:05 AM on April 14, 2008

I remember my ex-girlfriend taking zinc capsules to lose weight, and they made her sick as a dog.
posted by zardoz at 2:45 AM on April 14, 2008

I'm certainly not anti-multivitamin. I take one every day. But I wouldn't if I suspected it was causing any sort of health issues.
posted by grouse at 3:08 AM on April 14, 2008

First of all and again--please note I AM NOT taking them anymore!! I stopped as soon as I thought they could be the problem. SHEESH.

My doctor, which unless I miss my mark you anti supplement folks, none of you are, suggests I take a multi vitamin. I have several issues in my life which make this a good idea (just imagine a boatload of life stressors happening at once +physical health issues) I would have been ready to listen to the anti supplement side of the issue more easily if you hadn't all ran at me frothing. (and thank you Lobstermitten)

It is weird to walk face first into a controversy I didn't know existed. My doctor is stumped and looking into this. I am seeing other doctors. I thought the hive mind might see something (and the b-12 malabsorption is very interesting ( I do have an extreme MSG sensitivity). And thank you Shellycat and jamjam.

We do know part of this had to do with the vitamins, I was just curious if it had happened to others or if someone had some expertise.

The other things it in:rice bran oil, gelatin, glycerin purified water, lecithin from soy, yellow beeswax tumeric powder, annato extract.Contains:corn, fish, (anchovy, mackeral, skipjack, sardine, tuna)soy.

We eat a half vegetarian diet (that means no meat for half the meals a week) so I'm comfortable with soy.
posted by pywacket at 5:15 AM on April 14, 2008

Justinian said what I was thinking - try a different brand. Some brands of vitamins just disagree with some people's systems -- it's a fairly common occurrence, actually -- so before you launch into a huge investigation, I would just try a couple brands. If you find one that doesn't make you sick, then your problem is solved. Maybe stick with something well-known, like Centrum. Chances are you need the more common ingredients like Vitamin B and potassium more than you need the "Choline Bitartrate" and the "Alfalfa Leaf Powder," anyway, so I would start with something basic and work your way up.

Are you taking it with food? That can help a lot. I take mine with breakfast, but whatever's easiest for you is fine. Or you might try finding a smaller dose vitamin and taking it twice a day. Good luck!
posted by boomchicka at 6:09 AM on April 14, 2008

Oh - I just read that you plan to use Centrum next. I think comparing the ingredients and quantities on the two labels will help you narrow it down a lot.
posted by boomchicka at 6:14 AM on April 14, 2008

I think you are doing yourself a great disservice by characterizing people who are telling you that you should reconsider your insistence that you must have a multivitamin supplement as "frothing" anti-supplement partisans. I took a multivitamin pill this morning (and the day before that, and the day before that), so I think you would be hard-pressed to call me "anti-supplement" and I don't really see any examples of "frothing" or agitation from any of the people advising you to consider whether you really need vitamins. The only reason you have identified for it is that your primary care physician, who you elsewhere characterize as "clueless," has said it might be a good idea, without any specific reasons why.

And yeah, I know you've stopped taking them for now, but you also plan to start taking other vitamins again in a month. You could try an ad hoc approach to guess which ingredient is causing trouble, and use trial-and-error with new vitamins, running the risk that you will get the same symptoms again. You could get the advice of an allergist. Or you can decide that it isn't worth it for the vague and unarticulated benefit of multivitamin supplements.
posted by grouse at 6:30 AM on April 14, 2008

I characterized people as frothing because they started in saying "stop taking them you don't need vitamins" when I'd already stated and restated I'd STOPPED taking them. They started in on staying away from vitamins before they read through that currently was staying away from vitamins. I don't find it particularly helpful that some seemed to say that it wasn't good to take vitamins AT ALL , rather than address what could be happening in this instance--unless of course everyone who takes vitamins has this same type of reaction .

My doctor is clueless currently about what is causing the problem with the vitamins. She isn't clueless to the fact that certain issues in my life, health and otherwise, that make it possibly a good idea to take a multi vitamin. I was hoping that some folks here might have an idea about common allergans or know of strong reactions to any of the components mentioned. I did get the info about B-12 and folic acid which will be helpful and I'm grateful for that.

It would have been interesting to hear the arguments against multi vitamins but I got the sense that my question wasn't read, just a blanket anti argument thrown at it--and not even one that really addressed my current issue--even that would have been helpful.

And grouse, one person's froth may be completely innocuous to another, obviously your mileage varies.
posted by pywacket at 8:33 AM on April 14, 2008

It isn't unreasonable to suggest that you not take multivitamins even when you have already stopped, given that your clear intention is to begin again in the short term.

certain issues in my life, health and otherwise, that make it possibly a good idea to take a multi vitamin

I am unaware of any research that suggests that stress is an indication for the use of multivitamins. I don't know what your physical health issues are. It might be worth asking your physician if she could share the research that underlay her suggestion. It's your health at issue, so I think it is worth asking.

You may find that there is little such research and that it is unconvincing. A lot of the argument for some treatments of unproven efficacy is that they are unlikely to cause harm. For you, clearly that assumption is wrong, and the whole calculus has to change.
posted by grouse at 9:11 AM on April 14, 2008

"It isn't unreasonable to suggest that you not take multivitamins even when you have already stopped, given that your clear intention is to begin again in the short term."

I think we'll need to disagree about this one. It seems to me that you believe I would take the multivitamins even if they were making me sick, which is clearly not the case, since I have stopped taking the ones that were making me sick. If I were to discover that *any* vitamin was going to make me sick, do you suppose, given that I've stopped once already, that I would go ahead and take them?

It may be that the specific one I was taking made me sick and that others would not. This one had several things I hadn't had in vitamins before. They were given to me by a friend who swears by them and I liked the idea of a combination of multi vitamin and omega3s, so I switched from taking a multi and several omega 3's to just taking the one type.

As for the evidence, well I suppose more will be revealed on all sides of the equation.
posted by pywacket at 9:21 AM on April 14, 2008

It seems to me that you believe I would take the multivitamins even if they were making me sick, which is clearly not the case,

No, that is not what I believe. I believe that you are going to try other multivitamins and see if they make you sick. I'm saying that the potential gains are too ill-defined to make even this testing process worth it, even if you stop as soon as you realize something makes you sick.

You previously withheld the information that you had previously been taking other multivitamins. At the very least this would have helped in narrowing down the potential ingredients that could cause the problem. It's worth noting that Centrum also contains folate, although half the amount, although all of these label amounts are notoriously inaccurate anyway. It would also have reduced some of the advice to stay away from multivitamins as people would have known you had taken others before without incident.
posted by grouse at 9:40 AM on April 14, 2008

I didn't withhold grouse, I forgot to mention! I certainly didn't expect, since I didn't know there was a vitamin controversy, that the answers would veer off in that direction.

Also, I do not, thus far, believe that the potential gains are too ill defined. Perhaps that will change with further research perhaps not.
posted by pywacket at 10:59 AM on April 14, 2008

If your doctor recommends taking a multivitamin, well, that's obviously more valuable than any "advice" you'll get here. Reading some of this nonsense makes me angry. Research is mentioned is a lot.. care to share some pubmed links?

Vitamin A,D,E,K can be toxic in excess. Have you been eating bear liver lately? (I doubt it, but it's not a joke) Too much Niacin can be unpleasant. Check out this site for lots of good info on vitamins, minerals and trace elements. It might be a bit over-the-top, I don't know.

For the record, B12 deficiency does not cause Folate toxicity. B12 deficiency and Folate deficiency share many of the same mechanisms and clinical manifestations, except that B12 deficiency can also result in neurological damage. The reason Folate isn't given to someone with those clinical manifestations is that it's possible they have a B12 deficiency (similar signs/symptoms). If Folate is given the patient may feel better, but the neurological damage due to B12 will continue. That's why B12 is always tried first.

If your old vitamins worked.. why not just switch back?
posted by sero_venientibus_ossa at 11:50 AM on April 14, 2008

I do not, thus far, believe that the potential gains are too ill defined.

In that case, can you articulate what you believe you will gain from your multivitamin use?

As for support of what I have generally been saying, you may want to look to the statement of the National Institutes of Health State-of-the-Science Panel on Multivitamin/Mineral Supplements and Chronic Disease Prevention. An excerpt from their conclusions:

In systematically evaluating the effectiveness and safety of MVMs in relation to chronic disease prevention, we found few rigorous studies on which to base clear conclusions and recommendations. Most of the studies we examined do not provide strong evidence for beneficial health-related effects of supplements... Within some studies or subgroups of the study populations, there is encouraging evidence of health benefits, such as increased bone mineral density and decreased fractures in postmenopausal women who use calcium and vitamin D supplements. However, several other studies also provide disturbing evidence of risk, such as increased lung cancer risk with ß-carotene use among smokers.

The current level of public assurance of the safety and quality of MVMs is inadequate, given the fact that manufacturers of these products are not required to report adverse events and the FDA has no regulatory authority to require labeling changes or to help inform the public of these issues and concerns...

Finally, the present evidence is insufficient to recommend either for or against the use of MVMs by the American public to prevent chronic disease.

posted by grouse at 12:36 PM on April 14, 2008

I usually take a generic of Centrum, as well as fish oil capsules and a few other supplements that I have read up on and determined that I might get some sort of benefit from. I've had some trouble (sneezing and generally feeling like my hay fever's kicking up) when I tried a family member's multivitamin that had various herbs in it, including alfalfa. Just take the ones you were on before and add separate fish oil capsules if you want to go that route. Might be a good idea to take some calcium supplements too.

As far as the anti-vitamin argument, if you have one that gives you no bad effects and possible good effects, and you believe strongly that vitamins will help your health (recommended by your doctor, after all!), even if vitamins were shown not to have any effect greater than placebos (do note that I am not saying they don't), the placebo effect has a very real impact on people's health.

One of my anti-vitamin relatives, who eats a very varied diet of home cooked meals, recently had to go on Fosamax due to bone loss from not getting enough calcium.
posted by yohko at 12:41 PM on April 14, 2008

Thank you sero_venientibus_ossa that is a helpful site. I will likely be switching back to my old vitamins until new ones are prescribed by yet another doctor at some point in the future. Right now I'm staying off of everything for about a month then re-assessing.

Grouse, you and I have reached an impasse. I don't find your tone conducive to further discussion. Suffice it to say that when I have taken vitamins in the past I have felt better, had more energy, had an improved mood (omega3s) and experienced no ill affects. This is why I take vitamins and why I will likely continue to do so. And as I've said several times, I have certain issues that make it advisable. I do not feel comfortable discussing them in this forum. You are also *not* addressing the issue raised by this question in my opinion, so let's cut our losses.

And yohko you are right, the placebo effect can be beneficial. Whether it is this effect or not, I have noted an improved mood with omega3s--my husband noted this as well. My energy and clarity are improved with a multi vitamin. I just tried these because they combined a multi vitamin and omega 3s in one bottle/pill. Just look at where my desire for simplicity got me!
posted by pywacket at 1:59 PM on April 14, 2008

It seems to me that you believe I would take the multivitamins even if they were making me sick, which is clearly not the case, since I have stopped taking the ones that were making me sick.

Actually, the main point of the anti-multivitamin argument is that it's pretty much an expensive waste of time. You're flushing a large proportion of what's in those pills and the main reason companies make them is the huge profits. As I already said there is a lot of science to back this up, it's not some weird controversy put forward by frothing advocates. If you could figure out what was in there making you feel better and just take that then you'd be saving a lot of money and quite probably increasing the efficacy of what you're taking.

For example, if you're iron deficient then a multivitamin is pointless. The calcium, manganese and folate (and probably others) are all excellent at blocking iron absorption, to the point I doubt you're getting any crossing the intestine into your body. Whereas if you took a straight iron + vitamin C pill (which costs about half as much as the multi and don't need to be taken every day) you'd be getting full benefit of that iron and actually treating the deficiency. Obviously you're not iron deficient as you're getting some benefit from the multi, but this doesn't make taking a multi better than actually figuring out what you're deficient in.

And yeah, I'm not a doctor. But I am a biochemist working in a nutrition related area and have studied iron absorption specifically in the past. I quite likely know more about this than your actual doctor and agree with other posters that if your diet is really that shit then you need to see a nutritionist (who, in turn, will know way more about it then I do).

Since you've taken a multi vitamin before then it's even more likely that you're reacting to one of the plant extracts. Go back to your more basic pill, avoid anything that isn't a pure chemical (e.g. manganese citrate good, ginger oil bad) and put some effort into finding out what it is you actually need rather than taking a messy mixture and hoping.
posted by shelleycat at 3:43 PM on April 14, 2008

Shellycat I wasn't saying the main point of the anti vitamin arguement was to stop taking vitamins that are making you sick--I was saying that was Grouse's seeming argument. I realize the anti vitamin people think it's a waste of money and quite possibly bad for you.

It isn't possible to take the time right now to figure out anything more complicated than taking a multi vitamin and an omega 3. Trust me it really isn't. This is the last day I'll have unoccupied for the foreseeable future and is the first I've had in months. I'm glad I got some pointers in some interesting directions that I can discuss with my doctor(s)and I'll stay away from boutique vitamins.

The reasons for my diet being shit (or being unable to eat at times,) are real and unlikely to change in the near future either unless I can clone myself and suddenly work miracles. When/if these particulars change then maybe a leisurely stroll down supplement discovery lane will be possible . Until then I'll know to file this conversational gambit with breastfeeding and circumcision. I honestly had no clue what a can of worms this was, I just wanted to know if anything in the vitamins I was taking had caused anyone any problems like I'd had.
posted by pywacket at 4:16 PM on April 14, 2008