During my residency days I was under the impression that the head of my department was a tyrant (I now believe that residents are supposed to feel that way) but as the years go by there are so many instances when I remember him with gratitude. My carelessness at certain tasks would not escape his observant gaze….from misspelling I’s and e’s in prescriptions to answers I gave from hearsay without actually reading my textbook. One busy day in the OPD he told me that I had prescribed multivitamins to twelve children and asked me for the reason.” Nothing major sir,” I said spiritlessly (by then I had learnt that honesty was my only defence) “their mothers were not happy with their appetite and nothing was really wrong with the children…”. “Dr Krishna,” he said sincerely, “you should know that you are accountable for everything you do…how many prescriptions would you actually have written if the parents concerned could not afford to buy the medicine?” I think the answer was two. Since then I have always thought twice before prescribing anything.
Vitamins are undoubtedly essential for synchronised body functioning (for enzymes to digest food, for blood to clot, for the strengthening of bones and cartilage, for nerves to transmit impulses, for hormones to be secreted, for wounds to heal, for immunity and for the eyes to see) and not just for growth. Since they cannot be manufactured in sufficient amounts by the body, and must be taken in from the environment. With the exception of vitamin D, which is manufactured by the body in response to sunlight exposure (wherein research says that 15 minutes a week of such exposure is all that is needed), all the others are naturally supplemented by a balanced diet. Vitamins occurring in their natural forms are the easiest for the body to use, and accompanied by important related compounds enabling their absorption and assimilation by the body. So are we over prescribing and overrating commercial nutritional supplements? Well, the answer is a tricky one.
Let me first list out the conditions when vitamin supplementation is mandatory.
Vitamins A, D, E, and K are called fat-soluble vitamins and are stored in the fatty tissues of the body and in the liver. They wait around in your body and when it’s time for them to be used, special carrier proteins take them to where they’re needed. So overloading on them can have toxic effects on the body. Water-soluble vitamins (vitamin C and the B complex as they are usually called) don’t get stored as much and travel through the bloodstream. Whatever is in excess is flushed out by the kidneys. So a child with a liver disease, a kidney disorder or a malabsorption syndrome (a condition where dietary nutrients do not enter the bloodstream) will need vitamins in doses above the RDA (Recommended Dietary Allowance, or the amount needed every day) for prolonged periods.