Sunday, May 12, 2002		Fitness

Think twice before popping vitamin pills
B.K. Sharma

IN general, a balanced diet ensures an adequate intake of all the nutrients that the body needs. In case of illness this dietary intake can be supplemented by tablets and medicines. But media reports and incomplete information sometimes prompt people to take the vitamins and minerals in an unregulated manner. According to a publication nearly 30 per cent of the population in the USA takes such supplements. In our country also it has caught the fancy of many people. It can be said, however, that it is available to those who perhaps do not really need it and those who need it badly can’t afford it. We need to examine the role that such pills containing vitamins and minerals play in our nutrition.

Human body is a self-sustaining and self-regulating complex chemical factory. Nature has designed the human body in such a way that whatever we eat, after digestion and internal metabolism, is reduced to the basic components for utilisation and detoxifying enzymes and excretory systems get rid of the waste products. The basic ingredients of nutrition include carbohydrates (sugars in broad sense and not meaning refined sugar only), proteins (nitrogen compounds) and fat.

Carbohydrates are reduced to quick useable energy in the form of blood sugar. Fats are also a source of energy which can also be stored by the body to be used later and proteins form the basis of cells, enzymes and our genetic system. These three nutrients are freely available in natural food. Besides these three basic elements of nutrition, we need ingredients which are required in a very small amount but are critical to the metabolic functions of the body in the growth, cell differentiation and critical functioning of specialised organs. These include 14 vitamins, namely, A, B (9 components), C,D, E and K, 4 minerals, including calcium, phosphorus, iron and magnesium, and 3 electrolytes, including sodium, potassium and chloride. Certain elements required in a very small amount (less than 1 mg a day) are referred to as trace elements or ultra trace elements. This last group of elements include iodine, zinc, fluoride, selenium, chromium and manganese. Although there is a facility available in the body by which many of the nutrients can be converted from other nutrients, some of these must be supplied from outside. That’s why they are known as essential nutrients. These include 14 vitamins, some fatty acids, 9 essential amino acids and the trace elements.

All these vitamins serve essential functions in the body and therefore should be taken in adequate amounts. Deficiency of all these vitamins can give rise to specific symptoms and diseases which can be dramatically cured by the intake of these vitamins in the form of pills or injections. This has led to the practice of taking these vitamins on a irregular basis and sometimes in undesirable amounts. The functions of vitamins are complex but each of them has a distinct function. Vitamin A is required for the visual functions and for the integrity of skin and mucus membrane of the body. The B complex group of vitamins are required for metabolic functions required to produce energy, for the formation of blood (folic acid and B 12) and various neurological functions. Vitamin C is required for the formation of basic matrix and is required for the integrity of capillaries carrying blood and thus its deficiency can lead to bleeding in various places in the body. A lot has been written about the function of Vitamin E, including its importance in the prevention of heart and other cardiovascular diseases. Vitamins A, C and E are also credited with having the properties of acquiring certain toxic products of oxygen metabolism and that is why sometimes they are referred to as antioxidants. Vitamin D is essential for the regulation of calcium and thus helps in bone formation. Vitamin K is required for the integrity of the clotting system of the body. This ensures that after any injury bleeding stops all by itself otherwise one would bleed to death even after a small cut.

These vitamins are fairly well-distributed in nature and a person taking a balanced diet should not ordinarily suffer from vitamin deficiency. Vitamins A, D, E and K are known as fat-soluble vitamins and can be stored in the body, specially in the liver and muscles, whereas Vitamins B complex and C are water soluble and large quantities of these cannot be stored and if we ingest a large dose of these vitamins they are flushed out by the body. In general, vitamins are available in the fresh fruits and vegetables, specially in greens, sprouts, legumes, beans, meat products, milk and milk products, nuts and whole grain cereals. Vitamins A and D are specifically available in milk and nuts. Vitamin D is also manufactured by the skin with the help of sunlight. This is a very good source of Vitamin D in tropical countries like ours. Vitamin C is found in citrus fruits, tomatoes, gooseberries, potatoes and guava. Vitamin K is available in green leafy vegetables, milk and soyabean.

Apart from the unfortunate circumstances when even simple food is not available, vitamin deficiency can occur in circumstances where the supply of food is not a problem. These include infections, alcoholism, chronic diarrhoea. trauma, burns, use of certain broad spectrum antibiotics, cancer, starvation and certain psychiatric disorders. Some normal physiological conditions also need excessive amounts of vitamins and other nutrients. These include pregnancy, lactation, adolescence, excessive exercise and geriatric population. There is no doubt that under these circumstances supplementary vitamins are required. In nutrition, imbalance due to poverty and deprivation, specific therapy with vitamins and minerals is indicated. These include a good supply of Vitamin A to the children suffering from eye disorders, Vitamin D in children suffering from rickets, iodine in areas with iodine deficiency in water and soil and in general supplement of multi-vitamins in chronic diseases, alcoholism and malnutrition. These conditions form the basis of the prevailing practice of prescribing and taking vitamin pills with undisputed deficiency. A majority of people belonging to the economically well-off strata of the population ordinarily take some kinds of vitamins supplements. This may be a capsule of B-complex group of vitamins, a multi-vitamin pill, a calcium tablet or broad based pills which contain everything. Such pills are easily available in the market in some countries. In India no prescription is needed even for very complicated prescription drugs let alone vitamins and minerals.

Do we need to take vitamins as a routine I don’t think the question can be answered by a ‘yes’ or a ‘no’. There are strong opinions to support both arguments. There are people who advocate taking a large amount of vitamins and minerals to prevent any deficiency. A Nobel Laureate advocated many grams of Vitamin C every day to prevent common cold (this theory was unfounded). Other feel that with an average mixed diet there is no need to take a vitamin supplement except under certain circumstances like pregnancy, adolescence, old age and with some kind of dietary restrictions. There should be no problem if a person is taking pill of vitamins containing vitamins in doses corresponding to what is known as ‘recommended daily allowance’. But the trouble starts when he starts taking a mega dose, believing that more is better. I would like to mention here that the impression that vitamins are totally safe is not true and therein lies the purpose of this exercise. Many of the vitamins can be harmful if taken in large doses and serious toxicity can occur. Vitamin A taken in large doses over a period of time can produce serious disorders of the nervous system and skin. Vitamin D taken in large doses can paradoxically start damaging the bones which it normally protects. It can go on to produce high calcium level, formation of stones and renal failure. Vitamin C was considered to be very safe because it is water soluble but when taken in large doses it can lead to abdominal pain, nausea, diarrhoea, acidosis and increased production of oxalates and uric acid resulting in stone formation. Even the group of B complex vitamins generally considered safe have been known to produce severe allergic reactions, skin toxicity and neuropathy.

One can, therefore, conclude that vitamins and minerals are very essential and vital ingredients of our nutrition and are required for maintenance of good health. There are circumstances when supplements in the form of drugs may be required. During certain stages of life a small amount of maintenance supplements may be in order. But taking exorbitantly large doses is unnecessary and can be harmful. You should consult your doctor before getting high on vitamins.