Don’t pop in too many A, B, Cs....

In Sri Lanka, one of the most misused drugs is vitamins which can be bought over the counter. The majority of Sri Lankan doctors prescribe (unnecessary) vitamins and iron pills to their patients. A large number of healthy normal people especially those living in the urban areas swallow vitamins daily as they believe that daily intake of vitamins helps them to improve quality of their lives, prolong life and prevent certain chronic diseases.

Most of the vitamin pills doctors prescribe to their patients are highly unnecessary and excessive intake of certain vitamins such as vitamin A, vitamin D and vitamin K can give rise to chronic health problems both in adults and in children.

"Because nutrition operates as an infinitely complex biochemical system involving thousands of chemicals and thousands of effects on your health, it makes little or no sense that isolated nutrients taken as supplements can substitute for whole food. Supplements will not lead to lasting health and may cause unforeseen side-effects. The danger of Western diets cannot be overcome by consuming nutrient pills" (T. Colin Campbell and Thomas M. Campbell).

In Sri Lanka, thousands of healthy patients swallow vitamin pills daily. Most of them take multivitamin and B-complex tablets and some of them take iron pills. Most of the vitamins doctors prescribe to their patients are highly unnecessary and self medication with fat-soluble vitamins can be dangerous. The common vitamins doctors prescribe to their patients are multivitamins and vitamin C; multivitamin tablets containing iron can rarely lead to heart disease.

Vitamin A is prescribed by doctors to patients suffering from vitamin A deficiency which is a rare disease nowadays due to improvement in public health services unlike the days before 1970 when I served in an outstation provincial hospital as a relieving house officer, when I used to see, children with eye complications of vitamin A deficiency in paediatric wards and in the eye clinic. I saw the most number of patients with xeropthalmia when I clerked under (late) Professor C.C. de Silva at Lady Ridgeway Hospital in 1961. I understand from my colleagues that it is not common to see malnourished children with vitamin A deficiencies in the paediatric wards nowadays.

Overdose of vitamin A can cause rough skin, dry hair and raised sedimentation rate (high E.S.R.) and raised alkaline phosphatase. Vitamin A supplements should not be prescribed to females who might become pregnant and those attending antenatal clinics, as high blood levels of vitamin A can cause birth defects. Pregnant mothers should not eat liver and liver sausages which are rich in vitamin A.

We Sri Lankans are fortunate that we don't have diseases due to vitamin D deficiency as we get exposed to sunlight. I used to see a fair number of children with rickets when I did paediatric appointments in 1961, but I have never seen any adult cases with vitamin D deficiency (osteomalacca) in Sri Lanka. I saw a few cases of osteomalacia in the Metabolic Unit, Manchester Royal Infirmary when I used to join the Professional Teaching rounds in 1972 at Royal Infirmary. I understand that rickets is rare in Sri Lanka now.

You should never self-medicate with vitamin D tablets as you may get symptoms of vitamin D overdosage which include loss of appetite, lassitude, nausea, vomiting, diarhoea, weight loss, increased urine output, sweating, headache, thirst and giddiness.

Some women self-medicate with vitamin E as they have a misconception that taking vitamin E capsules and hair lotions containing vitamin E prevent fall of hair. Very often beauticians advise their customers to take vitamin E as far as I am aware vitamin E is not useful for females with loss of hair.

About 30 years ago, doctors used to prescribe vitamin E to heart patients in the belief that vitamin E prevents heart attacks. All the clinical trials done todate have shown that vitamin E does not prevent heart attacks. I frequently prescribe vitamin E to my patients who are on "water tablets" (diuretics) such as Frusemide and spironolactone, for prevention nocturnal cramps.

Deficiency of B-Complex vitamins is rare. Out of B vitamins, folic acid is commonly prescribed by obstetricians to pregnant mothers to prevent neural tube defects in the foetus. Folic acid is commonly prescribed by physicians to patients with megaloblastic anaemia (due to folate deficiency). Folic acid is known to prevent carcinoma of breast in females and is commonly prescribed to heart patients to prevent heart attacks although there is no scientific evidence so far to show that routine folic acid intake prevents heart attacks.

If you eat a well-balanced diet you don't have to swallow vitamins. Randomized clinical trials of vitamin supplements have been disappointing including those with vitamin E and beta-carotene and even folic acid for prevention of heart attacks. According to some randomized clinical trials, there are risks with increased doses of beta-carotene.

According to Dean Ornish (best selling author) at least 1000 protective substances are found in certain foods such as fruits, vegetables, whole grains, legumes and soya products and above foods have anti-cancer, anti-aging and anti-heart disease properties. When you eat more healthfully, you are going to look good, feel good, lose weight and gain health. Joy of living is a much better motivation than fear of dying.

Diet and lifestyle changes can be more powerful than drugs. I don't think the majority of Sri Lankans who swallow multivitamin, vitamin C and iron tablets are deficient in vitamins and iron. For those who take Western diets and for those who take a lot of junk food, and who don't take sufficient fruits and vegetables and whole grains, it is advisable to take some vitamins such as multivitamin and vitamin C tablets. For patients who are deficient in vitamins, their physicians will prescribe vitamins. When normal healthy people swallow vitamins, you are prone to get side-effects.

Taking too much of iron pills and syrups containing iron can cause iron overload. When you take too much of iron your bad cholesterol (LDL) will get oxidized and oxidized LDL is more toxic than unoxidized LDL and will end up in arteries and contribute to development of coronary heart disease (heart attacks).

Females don't have to worry about iron overload problems during child-bearing period and excess of iron is lost during menstrual cycles. But taking iron pills after menopause is not advisable and may cause iron overload.

You don't have to worry about vitamins and other nutrients as long as you take enough fruits, vegetables, soya and other legumes and whole grains. Only when we consume nutrients as food and not as supplements that it is useful. According to the New York Times, April 29, 2003 (science section) there are no proved health benefits of consuming nutrient supplements (Kolata G).

Vitamin supplements are not a panacea for good health and taking too much of vitamins and other nutrients including iron can be dangerous. You don't have to worry about vitamins and other nutrients as long as you take a healthful diet containing fruits, vegetables, soya products, legumes and whole grains. Avoid consumption of transfats commonly found in margarine and vegetable oils.