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Vitamin check

Not-so-vital vitamins

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A multi-vitamin in the morning. A couple of vitamin C tablets to ward off the cold that's going around. A fish oil supplement before going to bed. Countless urban Indians are picking up vitamins sold over the counter like they would purchase almonds or flax seeds as a health-fix. What many don't realise is that they may be doing themselves more harm than good.

Sheebani Banga isn't ill, but she pops a multi-vitamin pill without fail every morning. "When I am not taking the pill, my legs ache and I feel weak. I think everyone needs a multi-vitamin after 40, " says the 50-year-old homemaker, adding that her kitty circle and building friends take supplements, too.

While post-menopausal women like Banga do need calcium daily, do they need any of the 23 other vitamins and minerals, be it copper or magnesium, that the pill contains? Not unless there is a deficiency, say doctors. But most people don't bother consulting a doctor or going through any tests.

A slew of recent studies has questioned the benefits of taking vitamin supplements after trials showed that people taking them are no healthier than those who don't. Sample this: A 19-year-old study of 38, 000 Iowa women led by the University of Minnesota showed that women who took multi-vitamins, vitamin B6, folic acid, magnesium, zinc, copper, and especially iron, died at a higher rate compared to those who didn't use supplements. French researchers analysed the health of 8, 000 people over four years and found that those taking supplements were just as likely to have developed cancer or heart disease as those who took a dummy pill.

But it seems the scary headlines - one even said 'Your multi-vitamin may be killing you' - have not deterred the 'worried well' who are more influenced by their favourite batsman Yuvraj Singh urging them to 'Jeeo jee bhar ke' with a multivitamin. They also swallow the numerous studies, many sponsored by pharmaceutical companies, that talk about wonder vitamin X or Y preventing cancer or strokes.

Doctors say this is a dangerous trend. "Vitamin supplements are overused and abused in India, " says Dr Sandeep Budhiraja, director of the Max Institute of Internal Medicine. Dr Urmila Thatte, who heads the pharmacology department at KEM Hospital in Mumbai, says the trend of popping vitamins is "fashionable, not rational". Dr Surendra Shastri, head of preventive oncology at Tata Memorial Hospital, Mumbai, agrees. "Vitamin supplements play no role unless you have a deficiency, " he says. But what about the surge in energy levels and other benefits that consumers like Banga notice? "That's just a placebo effect, " says Shastri adding that while vitamins A and E contain anti-oxidants that can prevent cancer, they are beneficial only when derived from natural sources. "Vitamins from manufactured sources are not useful. People should eat red and yellow fruits to get vitamin A rather than take a pill, " he says.

TOO MUCH IS TOXIC


Not only are many 'healthy' people wasting money on supplements - a pack with 60 capsules can cost anywhere between Rs 250 and Rs 950 - doctors say they could be inviting trouble as vitamins or minerals can cause various side effects and toxicity if taken in excess. Many consumers believe that one can't go wrong with vitamins because the body just flushes out what it doesn't need, but this is not true. "Vitamins B and C are water soluble and are passed out in urine, but all other vitamins, including A, D and E, are fat soluble. They accumulate in the body and there is well-documented evidence of their toxicity, " says Buddhiraja.

He has come across several cases of severe liver toxicity due to excess intake of vitamin A, D and E pills. "I have seen girls suffering because they have taken vitamin A for too long. Dermatologists prescribe the pills for acne treatment, but sometimes girls continue to take it on their own", says Buddhiraja, adding that overuse causes nausea, loss of appetite, jaundice and blood pressure problems.

While minerals like iron, for example, can be life-saving for an anaemic patient, they can cause liver, kidney and heart damage if used chronically by someone who already has a normal level, say doctors. "Poor Indians have multiple mineral deficiencies so there is no danger of an overdose, but the rich have adequate food so there is no need to supplement, " says Shastri. "One should especially avoid multi-vitamins. Even if your doctor prescribes them, ask him the reason. "

Considering their potential for harm, Budhiraja feels all vitamin and mineral supplements should be considered medicines and taken only if prescribed by a doctor.

LITTLE SUNSHINE IN VITAMIN D


Perhaps no vitamin has garnered as much fame in recent years as vitamin D. It has been conferred the title of a 'nutritional superstar' that can prevent a host of ailments, be it cancer, depresssion or osteoporosis. At the same time, it has been reported that more than 80 per cent of people have a deficiency of this sunshine vitamin, even in sunny India, sending the sales of the vitamin's tests and supplements soaring. But two reviews - published recently in the Annals of Internal Medicine - which looked at hundreds of previous studies concluded that the vitamin may be a 'dud' as there is little evidence that it protects against cancer, heart disease or even fractures if taken alone.

Worse still, an excess of vitamin D is toxic. In March 2011, the Sheri Kashmir Institute of Medical Sciences published a paper documenting the cases of ten patients who had developed hypercalcemia - excess of calcium - and resulting kidney dysfunction due to vitamin D overdoses. The researchers reported that while the Kashmir valley has a high prevalence of vitamin D deficiency and physicians often treat patients with vitamin D for various ailments, the doses sometimes exceed the requirements. The same applies to Vitamin E. A large-scale study published in the Journal of the American Medical Association in October revealed that the vitamin, which was long touted as a 'wonder drug' that protects against heart disease and dementia as well as a 'fountain of youth', increases the risk of prostate cancer among middle-aged men.

TO FORTIFY OR NOT TO FORTIFY


If pharma companies pushing pills down our throats wasn't enough, now many packacged foods, be it the humble dahi or biscuits, are also being pumped with supplements to woo the health conscious. In a recent television commercial for a milk additive, one mother questions another about what she is doing to ensure her son gets calcium and insists that two glasses of milk are not enough if she is not adding the additive which contains Vitamin D. Not long ago, the rival brand had boasted about containing Docosahexaenoic acid or DHA, an omega-3 fatty acid that supports brain development. The ad for the top cornflakes also tells viewers that it has 'iron shakti' that 'recharges' children. Not wanting to take any chances with their wards' health, parents often make a beeline for the products.

But a majority of children don't need these supplements, say doctors. "Most children living in urban areas are eating adequate food. They don't need any supplements. In fact, they would benefit from cutting down on junk and monitoring quantity. It is the poor children who don't get proper meals who could benefit from Bournvita or Horlicks, but it is out of their reach, " says Dr Rahul Nagpal, head of paediatrics at Max Healthcare. The doctor added that there is little or no research to prove that fortified foods or drinks are beneficial for children. "Only pre-term babies, babies born to malnourished mothers and those who are not eating or are sick may benefit from supplementation, " he adds.

"Parents should not go by advertisements. They should educate themselves about healthy eating and give their children home-cooked, well-balanced meals. " Dr Buddhiraja, however, felt that fortifying foods with vitamin D may be beneficial considering its deficiency is widespread. "These foods could be helpful. But one should follow the path of moderation and take medical advice, " he says.

WHO NEEDS WHAT. . .


Calcium |

Post menopausal women

Folic acid |


Pregnant women, especially those who are poor

B vitamins |


People suffering from neurological conditions

Iron |


Women who are menstruating, pregnant or breastfeeding as well as people who have absorption problems in their gastro-intestinal tract or those who are recovering from a surgery/major treatment

Vitamin D |


People who have no direct sun exposure and whose tests have shown insufficient level.

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