Editorial about the use and abuse of food supplements in everyday practice of medicine

Singh U

Indian Journal of Physical Medicine and Rehabilitation

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(1)EditorialIJPMR April 2007; 18 (1): 1 EditorialSupplementsAt times one keeps wondering, what happened to theage old tablet of Vitamin B complex so frequently givenand looked upon by the patient as an energizer.  Threedecades ago that was one of the most commonlydispensed medicine if we may call it that way.  Witheach prescription of almost any drug, let it be an antibiotic,analgesic etc. this yellow tablet used to be a commonadjuvant.  Have we seen it being prescribed or taken bythe patient as much or with any enthusiasm.  Is it that thepatients have become more demanding or the doctorsfeel that something greater than the simpler vitamin needsto be given or is it that the technology has brought to ussomething that we feel should be a must to prescribe.Man has always thought beyond what was available tohim.  That is the way progress has been made, not satisfiedwith the existing, always looking beyond.  Now if weextend our search to look at the  food supplements broughtout in the market, it would be found that in the recentyears a number of them have found a way into thepharmaceutical industry.  The industry is pushing themvery hard into the market with a lot of pressure on thedoctors to prescribe them and creating a ‘need’ in thepatients to take them.  Good examples are various‘purified’ or ‘active’ forms of vitamins and other essentialnutrients and minerals etc.  The arguments given arethat these act faster or absorbed better or the body doesnot require processes or complicated metabolic cycles tomake it ‘available’ to the tissue or the cells where it isneeded.  For the sake of preventing a defamationallegation from the promoters of such nutrients, I wouldnot like to name them but each one of us is quite familiarwith these and would understand the meaning of my writeup as we read further.  Does the body really need these.Do we really need the refined or the active forms likethis.  It appears that ‘waves’ of some form or the otherkeep coming in the health promotion cycles.  Do werequire supplements in the normal course of our healthand fitness, if we keep taking our balanced diets, unlesswe have a specific deficiency.  If we read the literatureabout the treatment of osteoporosis or prevention ofosteoporosis the amount of calcium recommended ispretty high.  Do we give all the recommended calcium inthe form of supplements or do we take into account theamount being taken in the diet as well.  Accordingly therequirement of supplementation reduces.  In my practiceI have always done it and in my teachings I have promotedthis concept.  Finding out what is lacking in the diet andsupplementing it till required with the minimum burdenon the pocket of the patient and still getting good resultsas monitored on the follow up DEXA scans. There havebeen patients who have complained and others who havecommended prescriptions of lesser items, speciallysupplements.  One of the best remarks that reinforcesthis thought is a comment by a patient that it is rare tofind an allopathic doctor not write drugs and suggest onlydietary modifications and still get relief.  The question isthat the body knows what it has to do unless there is aninborn error of metabolism or it has got some alteredfuntioning because of a disease or the deficiency of aparticular nutritient, that is when we may resort to these.A food item available in tomatoes is now being promotedto a great extent.  If we analyze the Indian cooking useof tomotoes in the style of cooking can make availablethe nutrient to an adequate quantity that may be neededfor the body to give the protection required. I am remindedof a quote written at the end of an engineering book wherea mention was made about the inventions done andmarketed.  Man evolved from the jungles.  It used to dohunting and a lot of labor in search of food.  Now ascivilized human beings if we look at ourselves not far butjust beyond 30 years, we used to walk to our schools andwork places or cycle most of the times if not taking buses.Car was invented long ago and a need was created somuch to have a car to convenience us.  We tried to earnmore to pay for the car by putting extra labor or extrahours of work.  We lost the exercise by being more atwork and while driving the car.  We got disuse syndromeand the visits to the doctors increased with lifestylediseases after a while.  Doctors prescribed exercisesand walking.  Keeping this in view, a need was createdby the advertisers to have the best exercise over atreadmill rather than walking normally.  Many investedfurther to buy a treadmill and worked more in the officeto pay for the treadmill.  If we think and analyze forourselves what happened in the end.  There was a needfor walking but we bought the car but could not dispensewith walking but still bought a treadmill to walk becauseboth machines were promoted hard by the marketwhether really needed or not.  Let’s apply the sameprinciple to the supplements and think whether the realfood was good enough or we should have refinedsupplements. Let’s think again before prescribing anysupplement if there was an actual need or a created ‘need.’Let us not forget that the body is smart enough.Dr U SinghEditor

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