August 2014

The Medicine

Crazy pills

By Karen Hitchcock
Our obsession with vitamins is getting out of hand

Last summer I was swimming at my local pool. It was almost midday and I knew I should get out and under cover to protect my skin, but the cool water and warm sun felt good, and I reasoned that I could probably do with a dose of vitamin D. I saw a woman in a full-body wetsuit make her way to the edge of the pool. She was also wearing socks, mittens and a mask, which left only a small circle of her face exposed. She adjusted her gloves and I heard her say to the woman beside her, “I wouldn’t wear this if I didn’t have to, for medical reasons.” I was dying to ask her what the medical reasons were. I looked down at my freckles and got out of the pool.

The following week, a patient told me that a GP–naturopath had put her on something called “The Marshall Protocol”. She asked for my opinion, and I said I’d never heard of it. She looked at me as if I were a child. “It’s about vitamin D,” she said. I started to sweat: was it one of those things I was supposed to know but could never remember, like the difference between anti-Ro and anti-La antibodies? The protocol dictated that she protect herself from sunlight for an indeterminate period – maybe more than a year – and avoid all foods containing vitamin D; apparently this would starve her bacteria and repair her immune system. “I’ve been trapped in my house with the blinds down,” she said.

Right now, vitamin D is being promoted with religious fervour. Vitamin C had a moment like this in the 1980s. For a while it could cure everything – cancer, influenza, heart attacks, HIV – and make us live to 150. When we were kids, my brother and I benefitted greatly from this craze. The experts were saying that sugar caused hyperactivity but vitamin C was healthy. We’d bully our mother into buying those mega jars of tangy orange tablets that tasted just like giant Tic Tacs, and then we’d sit in front of the TV and eat them by the handful. To us, vitamin C was an endless supply of legitimate lollies.

In times of famine or in severe malabsorptive states, vitamin deficiencies cause real disease: lack of vitamin C causes scurvy, lack of B1 causes heart failure and neuropathy, lack of B12 causes anaemia and neurological damage. The ancient Egyptians knew that night-blindness (a result of vitamin A deficiency) could be cured by eating liver. Rickets, where bones grow weak, soft and deformed, is mainly caused by extreme vitamin D deficiency. In the 18th century, rickets was treated with a pottage of snail, worm and beer.

We get vitamin D from egg yolks, offal and oily fish, but the main source is produced in our body when sunlight hits our skin. Apparently we’re all a little vitamin D deficient because we spend too much time indoors: working, playing, hiding from the sun. This mild deficiency has been linked to everything from broken bones and falls to depression, cancer and heart attacks. Vitamin D tablets are the latest miracle cure-all. Go to a hospital or visit your GP and it’s more than likely that someone will test your level of vitamin D. In Australia we spend 150 million Medicare dollars a year on 4 million vitamin D tests. We argue about the magic level. Is it 50, 70 or 100 nanomols per litre of serum?

Vitamins and other supplements are big business – for the pharmaceutical companies that make them, the chemists that flog them (with sales worldwide estimated at $68 billion a year) and the labs that test the levels in our blood.

For about a grand you can get megadoses of vitamin D pumped directly into your veins by an alternative health practitioner, while their colleague may claim it’s just food for bacteria. On the fringes, they’re saturating or starving you. Doctors meander somewhere in the middle, mostly recommending small doses for those with low levels.

True vitamin deficiencies are rare in the average, ambulant citizen of the developed world, yet more than a third of the population take some form of vitamin supplement – convinced something is missing.

The evidence is mounting that these supplements, taken in the absence of true deficiency, may cause harm: more cancer, more heart attacks, more broken bones. Too much vitamin D (hyper-vitaminosis D) causes dangerously high calcium levels in the blood, which leads to confusion, muscle weakness, vomiting, kidney stones, bone demineralisation and pain. Too little and your bones grow thin. But it is not yet clear whether or not low vitamin D causes other kinds of disease. Many observational studies have shown that people with poor health have low levels of vitamin D, but there’s no hard evidence to prove the low levels cause the poor health. If you’re sick, you tend to stay indoors and have lower levels of vitamin D. It won’t be until 2017 that we start to see the results of the first large randomised controlled trials of vitamin D supplements versus placebo on all kinds of non-skeletal health outcomes. Maybe a small supplement will prove beneficial for the great Western goal of health-tweaking. But megadoses or extreme deprivation cure nothing and cause real harm.

Vitamins are good, but if you have access to adequate amounts of real food and a bit of sun, you’ll likely get all the vitamins your body needs. There is no pill to cancel out smoking, inactivity or drinking a bottle of whisky a day. Fresh produce drenches your cells in things we can’t bottle. The truth is pedestrian: if you want to live well and long, be born in the right place and time, cross your fingers, eat lots of vegetables, and go for a walk. The miracle cures almost always turn out to be lollies or poison.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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