Living Well in Myanmar
The myth of vitamins: more doesn't necessarily mean better health
For some reason the word “vitamin” is associated with good health. It’s believed around the globe that taking daily vitamins is a beneficial behavior. People assume that they will be more energetic day-to-day and prevent illness in both the short and long term. In the United States it is estimated that 40 percent of the population takes multivitamin supplements, an industry that generates $28 billion per year.
While we don’t have vitamin usage data for Myanmar, personal experience tells me that most people who visit a local doctor or pharmacist leave with a vitamin included in the pill bundle they receive. Often this happens because patients generally expect that going to the doctor means getting prescribed medicine. Vitamins, therefore, are a colourful way for the physician to promote patient satisfaction.
But do vitamins actually promote health? The overwhelming majority of medical research says no. A recent issue of the Annals of Internal Medicine offers three articles that solidify the case against the usefulness of vitamins. The first group of researchers reviewed 27 clinical trials involving 400,000 adults and concluded there was no long-term benefit in terms of extending life or preventing against heart disease or cancer.
The second study directly followed 6000 men for 12 years and found no differences in cognitive performance or verbal memory in those who took vitamins compared to those who did not.
The third paper evaluated whether vitamins might benefit men and women who recently had a heart attack. It found no additional protective effect against further heart problems in the 1700 people enrolled in the study.
In fact over the decades there has been almost no research showing health benefits to the average person from vitamin consumption. Furthermore, some supplements, such as vitamin E, beta-carotene and possibly high doses of vitamin A actually appear to cause people to die sooner. Using vitamins as a general strategy to prevent disease is not justified, and for most people they should be avoided.
Vitamins are organic compounds that are needed in small amounts to facilitate the chemical reactions which allow the body the function. However having an oversupply doesn’t mean the body is functioning better. As an analogy, a car needs a bit of oil for it’s engine to be able to use gasoline, but adding extra oil won’t allow it to somehow function better.
Vitamins are almost exclusively obtained from food. A deficiency in a particular vitamin can cause a specific physiologic problem, but these deficiencies usually occur only in patients with diseases that impair the gastrointestinal uptake or metabolic processing of a vitamin. Most of the basic diets that are typical in much of this country provide an adequate supply.
For Myanmar, the public health implications of this research are significant. When doctors in small community clinics or township medical offices give people vitamins, they are rarely doing so because of a known vitamin deficiency in that patient (ie, testing vitamin levels in the blood is not commonly done). While some segments of the rural and urban poor are vitamin and nutrient deficient because of dietary choices or access to food, identifying and treating these groups needs to be part of a national health-screening and treatment policy. For example folic acid, a vitamin found in green vegetables, fruits, grains, nuts and meat, should be routinely given to women early in pregnancy to prevent neural tube defects. It should not however be prescribed as a response to sickness for a woman in her child bearing years.
Even vitamin c, which seems to be a cross-cultural vitamin supplement used for the common cold, has been evaluated in at least 7 high quality studies and found to be no better than placebo in reducing the severity and duration of cold symptoms. The tendency of individual doctors, both in Myanmar and abroad, to give vitamins to ill patients is at best clinically ineffective and at worst an ethical violation of the doctor-patient relationship.