Vitamin. Its derivation is VITal AMINe or Vital amine – an amine essential to life. An amine is a biochemical substance and not all vitamins are in fact amines. But that doesn’t matter – the dictionary definition is “an organic compound essential to life”. So if something is essential to life we need lots of it, right? It is good for us, therefore it is something a bit magic, and gives us a lift or an edge on those people who don’t have it, who are going to suffer from all sorts of maladies, doesn’t it?
People spend lots of their hard earned cash on buying vitamins. “Which” magazine recently estimated costs¹  for some of the common vitamins consumed – £300 per year seemed to be an average cost of a product. Advertising campaigns are everywhere, and there is always a “glow” about them – vitamins, healthy, good, good, good.

There is only a grain of truth in all this hype. Yes, vitamins are essential to life. But only people who are actually sick – enough to see a doctor and get diagnosed properly and then get prescribed them – need to take them, because almost all vitamins are either already present in a normal diet, or can be made by the bacteria that live in our gut (so arguably aren’t really vitamins at all). Vitamin D, which needs sunlight to be synthesised in the skin, is an exception and I cover this later. Other common nutrients – iron, zinc, magnesium and so on, are also present in more than adequate amounts in a good normal diet. There are groups of people who are at risk of vitamin deficiencies – pregnant women and the foetus, children, some old people and those in poor and disadvantaged groups, but surely we shouldn’t be encouraging healthy adults, especially those who are short of money, to buy these expensive artificially produced additives?

We need an education campaign to tell people that the best way to get any vitamin is by eating it – in fresh food. So why is all this money wasted on gimmicks? Fresh food can be expensive, but surely not that expensive and is far more enjoyable, and if you eat the right food you can stay healthy and hopefully slim. (There is another argument raging at the moment about fat and sugar; see previous blog). The problem seems to me that people have been brainwashed into thinking that if they are feeling below par or tired and lacking in motivation, then all they need is a vitamin fix. And it will be proved by the placebo response, that well known fact that 30% people will feel better after taking something they believe will help them, even if it is actually proved to be useless – and even in some cases if you know it is a placebo! ²

Instead, we seem to be in the middle of yet another advertising campaign to encourage us to worry about vitamins and nutrients, supported by no less a person than England’s Chief Medical Officer, Dr Sally Davies. She calls for NICE, the Clinical Excellence body, to examine the cost-effectiveness of offering vitamins A, C and D to all children under five. ³ Of course, children are a very important special group; they are growing quickly and so are likely to need a good supply of vitamins. The report highlights that in many families – often those on low incomes – the quality of children’s diets is restricted, and children often spend long periods indoors. Vitamin D deficiency is a big concern because the lack of sunlight in most of the northern hemisphere means it is difficult for the body to make enough vitamin D. Rickets, characterised by soft and deformed bones and general ill health, has now returned in parts of the UK. It is indeed a disgrace for it to be occurring in 21st century UK. But what a cop out! Instead of ensuring that healthy food is cheap enough for families to buy, and that children are encouraged to play outdoors, we are thinking of giving vitamin supplements to everybody, including children who don’t need it, which is most of them. This is in spite of the fact that it is free right now to disadvantaged families, and the children most at risk – those in families which are too disorganized to take daily tablets – are still going to miss out.

A better way, if vitamin D is really needed, might be food supplementation – the vast majority of liquid milk in the United States is fortified with vitamin D at a level of 10 mcg/quart. Surprisingly, there is very little vitamin D naturally occurring in milk, and the US have had a proactive milk fortification policy since the early 1990’s, even though 49 of the US states are south of the UK and have higher year-round UVB levels than we do. At least it would get us away from the idea that we can take pills instead of eating a good diet.

For adults the marketing gimmick is to customize the vitamin packs you should buy –for male or female, or old age. It is easy to do and there is some science behind the campaigns. Women having periods lose a lot of iron; folic acid is essential to prevent neural tube abnormalities, and the package includes 24 vitamins and nutrients altogether. It sounds so plausible, as if the manufacturers really have our interests at heart, but they don’t. They are misleading us into thinking we need something when we don’t.

The recommendation of the government at present is for all pregnant women, and those intending to get pregnant, to take supplements of folic acid and vitamin D, to reflect the great needs of the growing foetus. Without enough folic acid stores in early pregnancy, babies can be born with spina bifida, which was common in the past, so this is absolutely essential. But you don’t have to pay for them – all these vitamins are of course free on the NHS when prescribed to these groups.

For the over 65’s, vitamin D is indeed essential to prevent osteoporosis and muscle wasting, which can result in fractures after only light trauma, and it is recommended that all people over 65 should supplement with vitamin D tablets. (Free on the NHS of course). But a recent article indicated that taking vitamin D supplements to prevent osteoporosis is not justified in healthy adults. The research (a meta-analysis), funded by the Health Research Council of New Zealand, included 23 randomised controlled trials comprising 4000 participants with an average age of 59, found very little evidence of an overall benefit in terms of bone density of vitamin D supplementation ^4. Also it appears that bone density measurement – by Dexa scan – does not necessarily correlate well with the risk of fractures. It is another surrogate measure – you would need to measure the fracture rate in these people to be sure the intervention is  effective.⁵  It is sound advice to take supplementation, which will be prescribed by your doctor (10 micrograms a day), if you are immobile and don’t go out, but for active healthy over 65’s it is probably not necessary.

It is even more true for all the other vitamins, that people are wasting their money. The “Which?” report is clear, and I hope it has at least some effect in counteracting all the hype about the need for extra vitamins. I have written about vitamins in detail in in my book ⁶, giving some of the science behind them, and the effects of problems with lack of vitamins and nutrients when people are ill.

But for adults on a healthy diet, it is wasting money. I would like to get away from pill popping in any shape or form, unless it is proved by clinical evidence to be necessary in your case. In the case of vitamins, the amount you need is usually tiny, and any more will not do you any good at all. Excess in some cases can definitely harm you. If you are not feeling well, you need a proper diagnosis, and if nothing shows up, you will need to think of lifestyle factors and your diet rather than resorting to pills, which are no more than quack remedies.

1. Which? September 2013 “Pills Popped”
2. Ted J Kaptchuk PLoS ONE, December 22, 2010, online publication
“Placebos without deception: A randomized controlled trial in irritable bowel syndrome”
3. Annual Report of the Chief Medical Officer 2012; Our Children Deserve Better: Prevention Pays

Click to access 33571_2901304_CMO_All.pdf

4. Reid I, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta analysis. Lancet 11 Oct 2013, doi:10.1016/S0140-6736(13) 61647-5.
5. Clifford J Rosen, of the Maine Medical Center Research Institute, Published Online October 11, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)61721-3p
6. A Sceptical GP, Elen Samuel, Rheafield Publishing, May 2013