Jeremy Laurance: What you should know before you pop a vitamin pill

Medical Life

Absolute and total health excellence, every day, forever," it says on the front of the pack of vitamin pills sitting on my desk – the latest of the free gifties from the world of PR that always brighten my day. Actually, I preferred the real thing – a fresh lemon, newly waxed and polished, that arrived beautifully packaged in a square, red cardboard box last week advertising some cold remedy. I took it home and put it in my tea – delicious.

Back to the ersatz vitamins. Scary, isn't it, that claim? Like something you might read in a Scientology leaflet – join our life course and experience total consciousness and absolute awareness of the universe for ever. It's the understatement that sets my teeth on edge.

Vitamins matter – we know that much. Go without eating fruit and vegetables for six weeks and you will develop scurvy – as sailors did until the 18th century when they learnt to suck lemons on long voyages. Supplements can be a good idea for the chronically ill or elderly, whose capacity to eat or absorb nutrients may be limited.

But for the rest of us? There is precious little evidence that vitamin supplements do anything for people eating a healthy diet – except create expensive urine (excess vitamins cannot be stored and must be excreted).

Can they be harmful? Apparently they can. Scientists from Monash University have examined the development of insulin resistance, the first stage in the development of diabetes, and found that vitamins mop up molecules known as Reactive Oxygen Species (ROS), which actually enhance insulin action, though they are harmful in other ways. It seems that the ROS molecules, which include free radicals, are beneficial in the early stages of Type 2 diabetes and shift to be being harmful in the later stages. The researchers are now trying to find out when they shift from good to bad.

The little-reported study, published in 'Cell Metabolism', has only been done in mice so far. But Professor Tony Tiganis was moved to say: "The widespread use of anti-oxidants [vitamins] by the general public as a preventative measure is something that should be discouraged, particularly if you are otherwise healthy." Type 2 diabetes is rising so rapidly across the western world it poses a severe challenge for the future. It would be remarkable if our modern obsession with popping vitamin pills was, in however limited a way, fuelling that rise.

***

I spent a couple of hours in A&E at the weekend, accompanying an elderly relative who had an infected foot. The medical care was fine, the way the doctor spoke to me was not. She was curt, abrupt and abrasive. A couple of weeks ago I saw a nurse specialist for a problem of my own. Her manner was so aggressive that at one point I called a halt to the consultation to ask if there was something wrong. She said there wasn't. A niece who has recently moved to London from the country and who has a problem that needs regular monitoring by the GP, complains that she is frightened to phone for appointments because the reception staff are "so rude". Do we need an etiquette guide for the NHS?

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