Should we swallow it?

How high-dose supplements can help

Old-age pensioners lurking around the back of pubs, cash in hand to score illegal substances. Spotty teenagers busted in their bedrooms by customs officers for ordering outlawed pills to treat their acne over the internet. These are a couple of the more fevered scenarios being proposed at the moment as a result of an EU directive that slipped into English law almost unnoticed at the end of last month.

At first sight, the Food Supplement Directive (C5-0640/2001) couldn't appear more boring and innocuous. Concerned with harmonising the permitted levels of supplements throughout the EU, it is packed with soporific phrases such as "the maximum and minimum amounts of vitamins and minerals referred to in paragraphs 1, 2 and 3 shall be adopted in accordance with the procedure referred to in Article 13(2)". But in fact this is inflammatory stuff. If past reactions are any thing to go by, MPs' post bags will be bulging, e-mail servers will be overloading with petitions, and celebrities will be denouncing it at photo-opportunities.

The recommended daily allowance (RDA) of vitamin E for general health is 22 international units (IU). But if you are worried about your heart, at present you can act on evidence which indicates that taking 800 IU of vitamin E may reduce the risk of heart disease, and buy high-dose vitamin E capsules over the counter. Or you can buy high levels of selenium, which may be protective against cancer, or B6, which may help combat PMT and multiple sclerosis. But if the legislative train that was set in motion this month isn't derailed in some way, within three years such purchases will become illegal.

"This is an issue of freedom," says Sue Croft of Consumers For Health Choice, one of several groups campaigning on this issue. "There is no reason in health or safety to restrict the sale of these nutrients. If they are outlawed plenty of people, myself included, will keep on taking them." The campaigners, who also come from groups such as Campaign for Health Freedom (www.healthfreedommovement.com) and the magazine What Doctors Don't Tell You, have considerable experience – the battle over UK vitamins is a long-running one.

The fact that there is no legal upper limit on the levels of supplements that can be sold in the UK has long been a sore point with the Brussels bureaucracy. In most European states levels are strictly controlled, generally being set at no more than twice the RDA. This makes it hard for vitamin suppliers to sell in all member states. The stated aim of this directive is to standardise the industry and create a level playing field for trade, rather than to set a safe, healthy ceiling for the consumption of supplements. That means drastically reducing the levels allowed in the UK.

The proposal provokes remarkably strong emotions – in fact, the tone on the fringes of the campaign becomes positively evangelical. Dr Bernard Rath's organisation sells megavitamin supplements which he controversially claims are an actual cure for cancer and heart disease. He claims to have discovered a revolutionary new form of medicine called "cellular medicine".

"For the first time in history, I have proved a direct link between chronic vitamin deficiency and the development of most common health problems," he declares (www.drrath.com/new_default/new_main_ uk/def_uk.htm). Dr Rath believes that this directive is a plot against him by the pharmaceutical companies. Since his treatments will lead to the collapse of the drugs industry, he claims, they have lobbied Brussels to have his "natural, side-effect-free remedies declared illegal".

Rath's response highlights the dramatic shift in our ideas about health and medicine over the last decade. Health has become just another consumer issue. People like to shop around. Twenty per cent of adults are now estimated to take supplements in the UK; encouraging individuals to take responsibility for their health now appears to be government policy.

The internet has made the latest medical findings available to everyone, and results continue to indicate that supplements can be effective, both in preventing and treating certain disorders. Many studies also show that individuals vary widely in their requirements. Yet contrastingly, the directive clings to an older, more traditional view; it states: "An adequate and varied diet could, under normal circumstances, provide all necessary nutrients."

Setting one level for the whole continent is unhelpful when, for example, the vitamin D requirements of those in the North are inevitably greater than those of people living in the sunny South. And might not children fed on the all-too-common UK diet of high fat and refined carbohydrates have different vitamin and mineral needs from children brought up on a Mediterranean diet?

The rise in the use of supplements has been driven entirely by consumer demand. The medical profession has been at best indifferent, at worst hostile. A major factor in the increased use of supplements has been growing concern over the dangerous side effects of drug treatments. The directive asserts that "excessive intake of vitamins and minerals may result in adverse effects and therefore necessitate the setting of maximum safe levels". But campaigners point out how safe vitamins are when compared with drugs. An estimated 100,000 Americans and 6,000 Britons are killed by reaction to prescription drugs every year.

The directive, although already part of UK law, has not yet set any levels – that will be done over the next three years. It also contains a list of permitted "nutrients and nutrient sources". Anything not on the list will be banned when the directive comes into force in 2005. The existing list, according to the campaigners, omits 300 nutrients currently available in the UK. It includes, for instance, no "chelated" minerals – those which are easier to absorb because they are attached to a biological molecule. Manufacturers can submit dossiers over the next three years, putting the case to add a nutrient. But each dossier is expensive and current estimates are that resources are available to submit a total of just 14.

So what will people do when the legislation comes in? Well, they could take an awful lot of pills. Getting a gram of vitamin C, if the new levels are twice the RDA, would mean taking eight tablets. That would probably cost eight times as much as at present, since the cost of the ingredients is only a small part of the total price. When a black market inevitably emerges, controls over ingredients and quality will vanish.

Vitamin C (RDA 40mg)
Out of 38 trials, 37 found that the colds of subjects who took over 1,000mg of vitamin C a day cleared up more quickly and were less severe.

Vitamin B6 (RDA 1.2mg) and Folic acid (RDA 200mcg)
High levels of the amino acid homocysteine in the blood can indicateheart-attack risk. Taking a combination of 25mg of vitamin B6 and 400mcg of folic acid can lower homocysteine levels.

Vitamin D (RDA 200 1U)
A new study shows that African-American women in the US are likely to suffer from dangerously low levels of vitamin D.Even women who took the RDA of supplements still had low levels. The researchers recommended increasing the RDA to 1,000 IU.

Riboflavin (vitamin B2 RDA 1.2mg)
There is clinical evidence that giving schizophrenics doses of 2,000mg a day can greatly improve their condition.

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