Health and Medicine
The dose makes the poison… or the remedy: spotlight on vitamins and minerals

The dose makes the poison… or the remedy: spotlight on vitamins and minerals

Summary:

  • In the context of nutrition, vitamins and minerals are molecules or chemical elements required by our organism in order to perform fundamental functions.
  • The “the more the better” rule does not apply even for such (apparently) harmless substances.
  • Healthy individuals often get the required amounts of these nutrients from a balanced diet. 
  • Dietary supplements might be necessary in specific cases and should be taken after consultation with expert professionals.
The dose makes the poison… or the remedy: spotlight on vitamins and minerals

In our previous article “How much chemistry does my natural product contain?” (link), we mentioned that not only the chemical structure but also the intake amounts can make almost any substance, regardless of its origin (natural or synthetic), either bad or good for our health. The first part of today’s title is a quote from Paracelsus, effectively summarizing this concept, which we would like to address in more detail. 

A very immediate example of this are spices. Nutmeg, which is, among others, used in several culinary preparations, contains neuroactive substances that can have psychotropic effects and cause acute poisoning when used in high amounts (often for deliberate abuse [1, 2]). 5 g of nutmeg powder, corresponding to a bit less than a tablespoonful, is considered to be a toxic dose [3]. Still, we tolerate it in the lower, more commonly used amounts.

From a slightly different perspective, but still in the context of dose recommendation, it is interesting to explore the area of vitamins and minerals. Here, we focus on those by giving some examples and asking ourselves how much of these substances we actually need in order to stay healthy. We are quite used to hearing about the importance of their regular intake, so what are the recommended doses? Does the “the more the better” rule really apply in this case? Can the excess intake (through dietary supplements) cause collateral or even adverse effects?

For vitamin C, which needs to be introduced through our diet because during evolution we lost our ability to independently produce it [4, 5], the recommended daily dietary intake ranges from 40 to 200 mg [6, 7]. One average size orange already contains around 70 mg of it [8]. Especially for vitamins, acute adverse effects linked to overdoses are not very common, since the “extra”-amount is often simply eliminated through urine. However, for some of them, possible collateral effects are reported. In the case of vitamin C, high doses (above 1 g per day) can cause stomach pain and diarrhea [6].

The dose makes the poison… or the remedy: spotlight on vitamins and minerals

Another example is vitamin B3, also called niacin, which is reported to possibly become hepatotoxic, if taken for prolonged periods of time in higher amounts than those recommended [9]. Still, vitamin B3 has a number of functions in our body, it is needed for the health of our nervous system as well as for maintaining the integrity of our skin [9,10]. Like vitamin C, also niacin is an essential component of our diet, as we are not able to independently synthesize it [10]. It is primarily contained in meat, fish, eggs and wheat flour. 100 g of tuna fish, for example, contains roughly 10 mg of it [11, 10] and the recommended daily intake is 16.5 mg for men and 13.2 mg for women [9].

Concerning minerals, potassium is an example of an essential mineral (among many) that we need to introduce with our diet. The recommended daily intake is around 3-3.5 g [12, 13]: one baked potato of medium size contains around 600 mg of it, one cup of cooked lentils around 700 mg, and half a cup of raisins again around 600 mg [13]. Potassium overdose from dietary intake is considered unlikely, especially in healthy individuals [14]. However, hyperkalemia (the condition linked to higher potassium blood levels than the normal ones) can occur especially in individuals with impaired kidney function and it can in some cases cause severe symptoms like palpitations, arrhythmia, muscle pain, muscle weakness, or numbness [15, 16].

Dietary supplements of vitamins and minerals can play an important role in some specific situations. For example, vitamin D supplements can be useful or even necessary during the winter season (especially for inhabitants of northern countries) when the exposure to sunlight is substantially reduced. In fact, the chemical reaction leading to vitamin D synthesis is dependent on the UVB rays that reach our skin while being exposed to sun [17, 18, 19]. Vitamin D is required for enhancing the intestinal absorption of some minerals (e.g. calcium, magnesium, phosphate) and its deficiency, especially if occurring in young children, can lead to serious consequences, such as bone deformities [18]. At the same time, its prolonged excessive intake can cause damage to kidneys, heart and, again, bones [17]. Further examples of this kind could be listed and individual recommendations should be left to expert professionals.

To conclude, the “the more the better” rule does not apply even for (apparently) harmless substances like vitamins and minerals. Provided that dietary supplements of some of these nutrients can be required in specific cases and periods of our life (following competent recommendations), we often already get the required amounts from a healthy, balanced diet and, in the best-case scenario, we just eliminate the excess intake through urine.

References:

  1. Bernard C. Sangalli, Mr. Bernard Sangalli & William Chiang (2000) Toxicology of Nutmeg Abuse, Journal of Toxicology: Clinical Toxicology, 38:6, 671-678, DOI: 10.1081/ CLT-100102020
  2. Forrester MB. Nutmeg intoxication in Texas, 1998-2004. Hum Exp Toxicol. 2005 Nov;24(11):563-6. doi: 10.1191/0960327105ht567oa. PMID: 16323572.
  3. ab. rahman, nur ain & Fazilah, A. & Mohd Esah, Effarizah. (2015). Toxicity of Nutmeg (Myristicin): A Review. International Journal on Advanced Science, Engineering and Information Technology. 5. 10.18517/ijaseit.5.3.518.
  4. Yi Li, Herb E. Schellhorn “New Developments and Novel Therapeutic Perspectives for Vitamin C” The Journal of Nutrition (2007)
  5. Morimitsu Nishikimi, Takuya Koshizaka, Takayuki Ozawa, Kunio Yagi “Occurrence in humans and guinea pigs of the gene related to their missing enzyme l-gulono-γ-lactone oxidase” Archives of Biochemistry and Biophysics (1988)
  6. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-c/
  7. Hemilä H. Vitamin C and Infections. Nutrients. 2017 Mar 29;9(4):339. doi: 10.3390/nu9040339. PMID: 28353648; PMCID: PMC5409678.
  8. https://fdc.nal.usda.gov/fdc-app.html#/food-details/169097/nutrients
  9. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/
  10. Stipanuk, Martha H.; Caudill, Marie A. (2013). Biochemical, Physiological, and Molecular Aspects of Human Nutrition – E-Book. Elsevier Health Sciences. p. 541. ISBN 9780323266956. Vitamin B3… potentially includes three different molecular forms: nicotinic acid, niacinamide, and nicotinamide riboside
  11. https://fdc.nal.usda.gov/fdc-app.html#/food-details/334194/nutrients
  12. https://www.nhs.uk/conditions/vitamins-and-minerals/others/
  13. https://ods.od.nih.gov/factsheets/Potassium-HealthProfessional/#en11
  14. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review the Dietary Reference Intakes for Sodium and Potassium; Oria M, Harrison M, Stallings VA, editors. Dietary Reference Intakes for Sodium and Potassium. Washington (DC): National Academies Press (US); 2019 Mar 5. 5, Potassium: Dietary Reference Intakes for Toxicity.Available from: https://www.ncbi.nlm.nih.gov/books/NBK545424/
  15. Lehnhardt, A; Kemper, MJ (March 2011). “Pathogenesis, diagnosis and management of hyperkalemia”. Pediatric Nephrology (Berlin, Germany). 26(3): 377–84. doi:10.1007/s00467-010-1699-3
  16. McDonald, TJ; Oram, RA; Vaidya, B (20 October 2015). “Investigating hyperkalaemia in adults”. BMJ (Clinical Research Ed.). 351: h4762. doi:10.1136/bmj.h4762
  17. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
  18. https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/ 
  19. Holick MF, MacLaughlin JA, Clark MB, Holick SA, Potts JT Jr, Anderson RR, Blank IH, Parrish JA, Elias P. Photosynthesis of previtamin D3 in human skin and the physiologic consequences. Science. 1980 Oct 10;210(4466):203-5. doi: 10.1126/science.6251551. PMID: 6251551.