Stop popping the pill

One needs to eat well,they say,and insist on a diversified diet which comprises lean protein,whole grain and a variety of fruits and vegetables.

Its really a package deal that mother nature has given us. So,why does one need pills when a balanced,traditional diet offers us our daily dose of iron,calcium and zinc? Healthy food combined with adequate physical activity is the key to prevent diseases, says Dr Umesh Kapil,professor of public health nutrition at the All India Institute of Medical Sciences,New Delhi.

Goa-based Dr Vikram Patel,who is also a professor at the London School of Tropical Hygiene,says that studies reported in medical journal Lancet show that vitamin supplementation in adults may not be effective.

A latest research published in journal Psychological Science also indicates that those who pop pills are lulled into a false sense of security.

New deficiencies,more pills

Traditionally,nutritional deficiencies pertain to iron,iodine and folate.

In recent years,however,there are reports about Vitamin B-12,Vitamin D and zinc being listed among nutritional deficiencies. Now,while the bodys daily requirement of Vitamin B-12 is just 2 mcg,the smallest Vitamin B-12 tablet in the market is packed with 15 mcg. This is where over-the-counter availability of high-powered vitamin supplements pose a problem, says Dr C S Yajnik,diabetologist and director of the Diabetes Research Centre at KEM hospital Pune.

Importantly,B-12 deficiency is related to the growth of a foetus in the womb and Yajniks research published in various journals underline a babys tendency to become obese in later life and risk of diabetes owing to its deficiency.

The impact of B-12 deficiency is also marked among people who have normal or high folate levels. Indians predominantly have a vegetarian diet,which,again,predisposes them to B-12 deficiency.

Obstetricians,however,prescribe large doses of folic acid to prevent neural tube defect and pregnancy-related problems. The neural tube defect is linked to the deficiency of B-12.

The national anaemia programme,on the other hand,prescribes only iron and folic acid to adolescent girls and pregnant mothers.

Dr Kapil points out that excess iron medication,in the absence of overall dietary improvement,can lower zinc-related nutritional status. The addition of Vitamin C improves the absorption of iron. What one needs is food of good nutritive value,not a capsule of select synthetic nutrients. We must understand that nutrient-nutrient interactions can be both positive and negative,and we still do not have adequate scientific data on this subject, he says.

Prescription drugs abound

What is alarming is that the use of such vitamins is unrestricted,says Dr Vikram Patel of Goa.

In a recent survey by us,published in Journal of Postgraduate Medicine,we found that 40 per cent of the prescriptions presented at pharmacies in Goa included a vitamin or tonic preparation,for which there were only a few specific medical indications. While researchers and scientists clearly back a diversified diet,doctors do feel that they are at times compelled to advise their patients to take some vitamins, he says.

These findings are similar to studies from other parts of India.

For example,in one study of 2,400 prescriptions,antibiotics were widely and inappropriately used,and food supplements and tonics of dubious nutritional and pharmacological value made up a high proportion of the total drugs bill, Dr Patel pointed out.

A study of 2,953 prescriptions from public primary health centres in south India revealed that vitamins,antibiotics,analgesics and antihistamines were commonly used accounting for more than 80 per cent of the drugs prescribed,says Dr Patel.

Need to fortify diet

So,while the best source of micronutrients is food,there is every chance that one may not be eating well every day. According to Dr K Madhavan Nair,a scientist involved with micronutrient research at the National Institute of Nutrition,Hyderabad,a simple meal of rice with pickle will definitely not offer ones daily dose of vitamins.

Periodical surveys by the National Nutrition Monitoring Board has shown that micronutrient malnutrition continues to be a major public health concern in India and that the most vulnerable segments of the population are children,adolescents,pregnant women and lactating mothers. We suggest food fortification for them, says Dr Nair.

It is,however,essential that such food fortification is limited only to the people who need it,he added.

Diabetologist Dr C S Yajnik points out that there is a move to fortify many ready food items and flour with multiple micronutrients to cover a large section of people in developed countries.

This policy has led to the supplementation of a substantial section of society who do not need it. It has generated a controversy in some countries where concern is now being raised that excess folic acid in fortified flour leads to added anaemia and brain dysfunction, he says.

The take-home message is very simple. According to Dr Kamala Krishnaswamy,former Director of National Institute of Nutrition,multi-vitamins and other supplements are safe only for a short period and it is important not to get swayed by their tall claims.