People take vitamin supplements for all kinds of reasons, from maintaining general health to preventing cancer. But there’s no convincing evidence that vitamin supplementation benefits people who don’t actually have a vitamin deficiency.

For starters, clinical trials of large numbers of people in multiple locations and contexts show vitamin supplements don’t prevent cancer. Rather, there’s emerging evidence (as yet only in mouse models) that some vitamin supplements may actually slightly increase the risk of some cancers.

Still, the appeal of vitamin supplementation in the community seems to be greater than ever. And in an era where conventional therapies are being subjected to increasingly more strenuous tests of efficacy, toxicity and cost effectiveness, the vitamin industry remains outside the mainstream of therapeutic evaluation.

One cause for this mismatch may be the political and financial influence of the vitamin supplements industry. But it’s also worth considering why western society has so enthusiastically embraced dietary supplements, nutriceuticals and complementary medicine.

Four vitamin myths

Vitamin supplements appeal to an ever-increasing number of people based on what may appear to be common-sense ideas. But most people completely misunderstand the nature of vitamins and how our bodies absorb them.

Here are some common myths about vitamins and why they’re wrong.

Myth one: If vitamin deficiency causes disease, supplements must therefore prevent disease.

Put simply, if less is bad, that doesn’t mean more is good. Take profound vitamin A deficiency, which can cause abnormal cell growth in the lining of the mouth and food pipe (oesophagus). There’s no evidence that vitamin A supplements prevent such abnormalities in those at risk, such as smokers and heavy drinkers.

Now consider people who have severe vitamin B12 deficiency due to a condition called pernicious anaemia. They are at increased risk of stomach cancer but this has nothing to do with the vitamin itself. These people have an autoimmune disorder that causes inflammation and cancer in the stomach at the same time as it blocks vitamin B12 uptake in the gut.

Myth two: Low vitamin “levels” indicate deficiency.

For starters, vitamin deficiency in someone who has a normal balanced diet is extremely rare.

The current trend towards vitamin D supplementation is largely based on the idea that blood levels of the vitamin are below the “normal” range. But whether blood levels accurately reflect total body vitamin D stores in body is still contentious.

The jury is still out on the benefits of supplementation in people with low vitamin D “levels”, and there’s no evidence that routine supplementation is useful in people with normal diets and levels of sun exposure.

Myth three: Vitamins are safe.

Actually, this one is correct on the whole. But there are always extreme cases where an excess of vitamins can cause harm, such as toxicity due to the excess intake of vitamin A, particularly in children.

And when vitamins harm, they can go to town. Manifestations of vitamin A toxicity include abnormal bone growth, swelling of the brain, increases in blood calcium concentrations, hair loss, and liver damage.

What happens is because fat-soluble vitamins, such as A,D,E and K, are more difficult to excrete, they can accumulate in the body with excessive intake. Water-soluble vitamins, such as vitamins C, are safer in this regard as people with normal kidney function usually pass excess amounts in urine rather than have it stored in their body.

Myth four: Vitamins are “natural” compounds, not drugs.

First of all, it’s important to remember that natural doesn’t mean good for you. Consider the taxane family of chemotherapeutics used for treating breast cancer. Taxanes are naturally-occurring molecules extracted from the bark of the pacific yew tree that are able to kill rapidly dividing cancer cells. But they also have potentially life-threatening side effects, such as bone marrow suppression. Nonetheless, taxanes are 100% natural.

Producing supplements requires a combination of purification from natural sources or chemical synthesis – or both – in the same way as many commonly used pharmaceuticals.

Penicillin, for instance, was initially purified from a fungus with natural antibacterial activity. With the exception of an allergy and rare cases of anaphylaxis, penicillin is an extremely safe natural compound, but it’s very much a drug.

Parting thoughts

We ingest vitamins from food, or get our gut bacteria to make them for us and then absorb them. In some cases, we make our own in the liver. Either way, we constantly replenish our vitamin stores without realising it.

No one really knows whether taking large amounts of vitamins in tablet form is even the best way delivering them to the body. And even if we choose accept that vitamin supplements largely are safe but have marginal benefit, they still have an economic cost.

If they were regulated as therapeutic products, vitamins would certainly not receive government subsidies since there’s no evidence they work, or that they are cost-effective.

Since people pay for supplements themselves, it’s important they re-evaluate whether the cost of vitamins is really worth it. Based on all the available evidence, a healthy diet and lots of exercise are a much better way to promote good health.

Most of the salt consumed in Australia is already hidden in processed foods and meals, but there are some simple steps you can take to avoid eating too much of this palatable seasoning.

High salt intake is implicated in a variety of health problems, most importantly, in raising people’s blood pressure. High blood pressure is a leading risk factor for cardiovascular and kidney disease.

Salt may also play a role in other health problems, such as osteoarthritis, cancer, asthma, Ménière’s disease and obesity. Lowering your salt intake will improve your health and reduce your risk of experiencing these problems.

Hidden sources

The average salt intake for Australians is around nine grams each per day, well in excess of the one or two grams per day required for good health and the World Health Organization’s (WHO) target of five grams a day.

Current Australian guidelines include a suggested dietary target of four grams and an upper limit of six grams. This is less than one teaspoon of salt a day and it means the majority of us need to cut consumption by at least half.

But you need to be aware of more than just the salt added to food during cooking. Around 75% of the salt we eat is already in the foods we buy, and it’s not always obvious where it’s hiding.

People are often unaware, for instance, that bread is one of the biggest culprits for their high salt intake. Recent studies have shown that around 19% of salt in the Australian diet comes from bread; and the bread and cereals group together contribute 32.5%.

For no particular reason, Australian bread products are saltier than those found in the United Kingdom and New Zealand.

Other major sources of salt are processed meat products such as salami, sliced sandwich meats and canned meats (14.4%) and convenience meals, such as pizzas, sandwiches or stir-fry dishes (8.4%). And be careful if you pass on the salt but pour on the sauce – many sauces and condiments contain a lot of salt.

A weak initiative

Recognising the high contribution of processed foods to Australians’ dietary salt intake, the federal government established the Food and Health Dialogue in 2009 to improve the food supply.

So far, the dialogue has developed targets for the maximum levels of sodium that food manufacturers should aim to achieve in bread, ready-to-eat breakfast cereals, simmer sauces, processed meats, soups, savoury pies, savoury crackers, and savoury snacks.

But the initiative has attracted criticism from public health groups because of its slowness and lack of accountability. Despite other countries, such as the United Kingdom and the United States, setting salt reduction targets for more than 80 categories of food in a relatively short time frame, only 17 targets have been set in Australia since the dialogue was established over five years ago.

What’s more, existing evidence suggests that adequate reductions are not being made. Previous studies on changes in salt levels in bread, ready meals and pasta sauces, show little evidence of systematic reductions.

And even if all pasta sauce manufacturers meet the dialogue’s voluntary commitment by the end of 2014, average salt levels in Australian pasta sauce products would still be above other international targets. While this demonstrates a clear need for government to ramp up its efforts, individuals can also make simple changes to cut the salt from their diets.

What you can do

The easiest way to lower dietary salt intake is to eat fresh, unprocessed foods and limit your intake of processed snacks and treats.

Click to enlarge

Nutrition labels in Australia indicate how much sodium (the unhealthy part of salt) a product contains. To calculate the salt content of a product, you need to mulitply the sodium content by two and a half.

A low-sodium food contains less than 120 milligrams of sodium per 100 grams (or 100 millilitres) of food, while a high-sodium food has more than 600 milligrams per 100 grams (or 100 millilitres).

Eating less salt doesn’t mean what you eat will be less tasty. A lot of people who move to a low-salt diet discover they prefer the wide variety of flavours that salt used to mask.

Taste buds adjust very quickly so after only a few weeks eating less salt, you’ll become more sensitive to the salt in food, and won’t even notice a difference. But it will make a difference to your long-tern health.

The World Health Organisation (WHO) has been consulting on draft sugar intake guidelines that propose revising the recommended daily intake downwards to address obesity and dental disease. The body says it’s particularly concerned about the increasing global consumption of sugar-sweetened drinks, including soft drinks and sports drinks.

Current WHO guidelines (published in 2002) recommend sugars should make up no more than 10% of daily total energy intake. The new draft guidelines suggest revising this to 5% – the equivalent of around six teaspoons of sugar a day for an average adult. It highlights the role of “hidden” sugars in obesity and how sugar leads to the development of dental disease.

The WHO describes dental diseases as the most prevalent non-communicable diseases globally. More than 90% of Australian adults have experienced tooth decay and almost 60% of 14-year-olds have decay in their permanent teeth. In 2010-11, more than 23,000 Australian children were hospitalised for dental treatment under general anaesthetic – mostly for treatment of tooth decay.

Sweet tooth

Sugar feeds the bacteria that live on the surface of everyone’s teeth, enabling them to rapidly produce acids that dissolve tooth enamel. Known as “demineralisation”, this process weakens the tooth structure through loss of minerals.

High-frequency sugar intake, coupled with bacterial acids not being removed regularly and properly, will lead to demineralisation to the point of creating cavities. Indeed, it’s an eye-opener to see just how quickly sugar damages teeth.

In unpublished laboratory experiments we’ve done with colleagues, teeth were given a ten-minute dose of sucrose solution four times a day, without the benefits of tooth brushing or drinking water. It took less than two weeks for cavities to begin to form. More frequent sucrose doses led to cavities appearing sooner.

Even though we have ways to treat cavities, through fillings and tooth removal when necessary, treatments don’t eliminate the underlying cause of tooth decay. And too many filled or removed teeth increases a person’s risk of future oral health problems, such as difficulty eating effectively when teeth are lost and an ongoing need for more complex fillings.

Tooth-rotting drinks and food

Most Australians know how to avoid dental cavities. If nothing else, they know sugar is bad for teeth and brushing is good. But people are generally not well informed about the sugar content of what they eat and drink.

In many cases, they’re not aware that drinks they believe to be healthy are actually damaging to their oral health. Scientists comparing the cavity-creating potential of a number of soy milks to cows’ milk, for instance, found the former produced decay-causing acid at five to six times the rate of cows’ milk – a damaging recipe for teeth.

Many soft drinks and sports drinks not only contain sugar but also food acids (citric and phosphoric acids) that can cause erosion of tooth enamel when consumed frequently. These food acids are also found in the sugar-free versions of these drinks, so sugar-free soft and sports drinks are not necessarily better for your teeth.

Compounding the problem of the increasing popularity of sweet beverages is the fact that people often drink these instead of plain water. Water is much better for your teeth because it helps rinse away food, liquids, sugar and acids.

More than 90% of Australians have access to fluoridated tap water, which helps to protect teeth against demineralisation, but note that most bottled water has only low levels of fluoride.

Not normal

The ubiquity of dental decay may create the impression that oral disease is inevitable and not of serious public concern. But that’s not the case. Although most dental disease is preventable, treatment costs the Australian economy $8.4 billion a year.

The cost to individuals is measured in lost teeth, in the inability to maintain a healthy diet into older age, and in the social disadvantage arising from the stigma and embarrassment caused by poor teeth.

There are ways to prevent this beyond the level of the individual. The State of California, for instance, is considering legislation that would make it the first jurisdiction to require warning labels on sugary drinks. Under the proposed bill, beverages with added sweeteners over a certain limit would read:

STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay.

We can reduce the prevalence of cavities in Australia. The proposed recommendation by the World Health Organisation will provide solid grounds for calling for better community understanding of the amount and forms of sugar we’re consuming.

Eating good food promotes overall health and well-being, but what you eat may also impact how you feel. Research suggests that not only can the food you eat affect your mood, but that your mood may influence the foods you choose to consume.

Enjoying a wide variety of vegetables, fruits, nuts, seeds, wholegrain cereals, legumes, low-fat dairy, lean meat and oily fish, for instance, is associated with reductions in mood swings, depression and anxiety.

And the opposite holds for a diet based on foods high in refined sugar (think lollies), one that combines high levels of sugar and fat (cakes, for instance, or pastries), or involves high intakes of caffeine or alcohol.

Highs and lows

Basically, the nutrients found in healthy foods appear to work together to cause the brain to produce the “feel-good hormone” serotonin, which is associated with improved mood and feelings of relaxation.

And eating foods that maintain a steady blood-sugar level within the appropriate range, such as wholegrain cereals, helps to stabilise mood. But how does your mood affect the foods you select?

Results of research on the connection between food selection and poor mood are reasonably consistent − people in a negative frame of mind are more likely to choose sugary, fatty or salty – indulgence or comfort – foods rather than nutritious ones.

Indulgence foods may boost energy and improve mood in the short term but these positive effects are usually fleeting. For some people, such effects can often be followed by guilt (because we know those foods aren’t good for us) and a consequent drop in mood. This can trigger more bad eating and set up a vicious circle.

Better ways of overcoming negative thoughts include exercising, which has been shown to improve mood by reducing anxiety and stress, or doing fun things such as watching a film, listening to music or visiting friends. Such activities not only enhance mood, but also assist with controlling indulgence food intake.

The right frame of mind

The connection between food selection and positive mood (if there is one) is still unclear.

Research suggests people in a good mood are more likely to prefer nutritious foods that are low in sugar, salt, and fat, and to focus on the long-term benefits of these healthy foods. But other studies point to the potential for people in a good mood consuming comfort foods, or overeating.

There’s also evidence suggesting some people in a positive mood are more likely to choose healthy foods if they feel their good mood is going to last. If not, they may be more likely to choose indulgence foods to sustain positive feelings.

Other research indicates that regardless of mood, long-term, future-focused thinking can lead to healthier food choices. And there’s evidence for gender differences in the effects of mood on consumption of comfort foods.

One study found that women are more likely to eat indulgence foods when they’re feeling depressed, lonely or guilty. While men are more likely to turn to soups, pasta and steaks as a reward when they’re feeling upbeat.

In the driver’s seat

Clearly, these relationships are complicated but which is likely to be the stronger driver – mood or food? In other words, does the consumption of particular foods lead to mood changes, or is our mood generally the predominant factor in determining the food we choose to eat?

Research suggests the foods we consume may be of paramount importance, and that what’s eaten today may affect mood a couple of days later.

This association was stronger for negative moods, so consumption of excessive energy (kilojoules), saturated fat, and sodium was associated with a worse mood two days later.

The association between eating fruits and vegetables one day and being in a positive mood the next day was stronger for men, but mood was lifted in both men and women after they ate vegetables.

What, then, can we conclude from the current evidence about the relationship between food and mood?

Well, research has highlighted some interesting (and complex!) relationships that we’re only now starting to tease out. What we can say with confidence is that eating a well-balanced diet may confer not only physical health benefits, but also better mental health through improved mood.

Adherence to the Mediterranean Diet is Associated With Lower Likelihood of Breast Cancer: A Case-Control Study.

PMID:

24847911

[PubMed – as supplied by publisher]

3 June 2014, 6.25am AEST

Listen up hypochondriacs, how do you want to be remembered?

We all worry about our health from time to time, at least to some degree, but some people worry excessively about catastrophic consequences of seemingly benign symptoms. They’re known as hypochondriacs.

This is the sort of process hypochondriacs go through: what’s that? A benign lump or malignant bump on your face, breast or rump? Adrenaline rush, heart pumping, sweating, and light-headedness follow, confirming the gravity of the terminal self-diagnosis.

Thoughts racing and images of a foreshortened future, orphaned children, and opportunities missed. Overwhelming distress. Must plan the epitaph – see, I told you I was sick!

Our future and physical health are inherently uncertain. But people with hypochondriasis (or, since the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, somatic symptom disorder) immediately resolve any uncertainty about novel physical sensations and symptoms on the side of catastrophe.

Seeking symptoms

The body is constantly in a state of flux. The heart pumps, blood flows, muscles twitch, lungs inflate, and bowels contract. Strange symptoms come and go. And most pass without conscious awareness as we focus on daily tasks.

But try this. Hold your hand upwards, so that your palm and fingertips face the sky. Focus all your attention on the tips of your fingers and wait …and wait …until you notice some sensations. Tingling, temperature changes, or just an awareness of the sensations on your skin.

Here’s an even simpler task. As you read this, shift your attention on to the sensations of the ground or chair pushing up against your body. Chances are you were unaware of all these sensations just moments ago.

Attention, you see, is the microscope of the mind. It can filter in or out any of your internal or external experiences.

Now imagine becoming hypervigilant to all the physical changes naturally occurring in your body. Try it. Just focus on all the sensations in your body for a minute. Amazing, isn’t it? Itchy toes, tense jaw, mild headache, numbness, and so on. All the normal workings of a healthy body.

People with somatic symptom disorder are experts at searching for and noticing normal bodily changes. They’re also experts at interpreting these in potentially catastrophic ways – fatigue is leukemia; a lump on the arm is cancer.

The number one enemy of someone with the disorder is Dr Google (“cyberchondria”). Indeed, the only thing more catastrophically creative than a hypochondriac’s mind is Google’s 2.42 million webpages on the causes of cancer. Every possible symptom can be linked to every possible diagnosis, by at least one disreputable source or another.

The hypochondriac is searching not for information, but for confirmation of their imminent demise. If they’re unlucky, they might come across contradictory information or additional ailments they hadn’t yet considered.

Their intense worry and anxiety feel intolerable and must be neutralised. Seeking out a sympathetic doctor or other source of reassurance, or avoiding the health section of the newspaper all provide temporary relief until the next physical symptom is perceived.

Moving forward from health anxiety

So what are some things that keep hypochondriacs worrying?

Belief: worrying will help me catch something early.

No, it won’t. Worrying will just keep you miserable until you’re old enough to find out how you will shuffle off this mortal coil (unless, of course, your demise is a blissfully brief surprise). Worry itself will not get you any closer to predicting, preventing, or planning for your death.

Belief: I can get certainty about my health.

Nope, can’t get that either. No amount of checking, doctor visits, Googling, reassurance-seeking will guarantee with 100% certainty that you’re well. I can, however, guarantee that the unrelenting pursuit of certainty will make you miserable.

So, how can you manage health anxiety?

First, develop some healthy guidelines for monitoring your health and stick to them.

Based on your past experience, how long do benign symptoms typically last? One day, two days, one week? Decide how long you will wait before seeking any form of certainty or reassurance (from the internet, friends, family, or medical practitioners) the next time you notice a symptom, especially ones you’ve worried about in the past.

Once this time expires (no pun intended), make a decision about whether you need to get the symptom checked or whether you can wait another little while before doing so. Follow guidelines from reputable sources about the recommended frequency of body checking.

And, be willing to sit with uncertainty about your health. None of us ever have certainty about our health. I could have a brain tumour as I write these words. I am willing to accept this possibility and shift my attention onto the next paragraph.

Think about it this way: if I offered you a $2 million insurance policy for your house, even if I promised to build you a gold-plated replacement if it were destroyed, you would likely consider it far too expensive.

So, how much are you willing to pay to prevent any possibility of illness? Are you willing to give up your capacity to work, time you would otherwise spend with friends and family, and ultimately your happiness? This is a very high price to pay.

Spend energy on things you truly value, rather than wasting it on a false insurance policy. Learn to accept uncertainty about your health. Revel in not knowing when or how the end will come. Focus instead on the time between now and then.

Ultimately, what you have to decide is which epitaph you would prefer when your inevitable end arrives: “lived decades in misery and fear of death”, or “didn’t see that coming but my life was far richer for it.”

For more information about how to manage health anxiety, see the Helping Health Anxiety modules here.

For many of us, alcohol is an enjoyable backdrop to life: wine with dinner, beers with friends, a glass of bubbly to celebrate a special occasion, or nip of something heavier to unwind after a long day.

But alcohol is the fourth-largest cause of disease in Australia after excess weight, smoking and high blood pressure. So, how do you decide whether – or how much – to drink?

Unfortunately, the answer is far from simple and falls into the murky realm of “it depends”. Let’s consider what the science says about the positive and negative effects of alcohol.

Injury

Drinking alcohol increases your risk of accidents and injury. Only tobacco outranks alcohol as the leading preventable cause of drug-related death and hospitalisation in Australia.

Between 1992 and 2001, more than 31,000 deaths were attributed to risky or high-risk alcohol consumption. And between 1993–94 and 2000–01, half a million people were admitted to hospital for alcohol-related injuries.

Cancer

The more you drink, the higher your risk of cancer – and this is a steep exponential curve. So, with each incremental increase in your drinking, there is a marked increase in your risk.

The World Health Organization’s International Agency for Research on Cancer has concluded there is “sufficient evidence” that alcohol causes cancers of the oral cavity, pharynx, larynx, oesophagus, liver, colorectum and female breast.

Unfortunately there is no evidence of a safe threshold; as soon as you start drinking your risk of cancer increases. This includes a 12% increase in the risk of breast cancer with each additional unit of alcohol per day.

Heart disease

The evidence is mounting for a “J- or U-shaped” link between drinking alcohol and developing cardiovascular disease (heart disease, stroke and other blood vessel disease). This means light to moderate drinkers have a lower risk of cardiovascular disease compared with those who drink nothing and those who drink a lot.

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Heart disease is the most common cause of death in Australia, which makes the evidence on light to moderate alcohol consumption more relevant than it otherwise might be.

Weighing up the risk

So, how do you weigh up alcohol’s role in cancer, injury and other risks with its beneficial effects on heart disease?

This is where things get tricky. We need to consider the balance of risk and how it might apply to individual populations. What, for example, is my likelihood of first getting cancer, compared with my risk of liver disease, having an accident, being injured or developing cardiovascular disease? The answer will be different for everyone.

In younger men, accidents and injuries are leading causes of death and cardiovascular disease is relatively uncommon. Drinking, therefore, poses a greater threat to them overall than the benefits it might afford. So they really should limit their consumption, or, ideally, avoid alcohol altogether.

The same is true for younger and middle-aged women, whose risk of breast cancer is higher than their risk of cardiovascular disease.

However, the cardiovascular health benefits of drinking are likely to be more pronounced in older people, particularly those aged in their 60s or above. It is interesting to note that cardiovascular benefits don’t seem to differ according to the type of alcohol – wine, beer or spirits.

A moderate tipple

So if you are an older adult, and in an industrialised country, the current evidence suggests the beneficial effects of light to moderate alcohol consumption on cardiovascular disease are likely to exceed your risk of cancer and other conditions increased by alcohol. This means a moderate tipple is likely to help in increasing your overall longevity.

But if cancer is the thing you are most concerned about, the “don’t drink at all” message should apply to you. And if you have an alcohol dependency and an alcohol-related condition, it’s clear that cutting out drinking is the path you should take.

These messages are a hard sell. In many other areas of health advice there is happy alignment between health organisations: obesity and smoking being obvious examples. But in the case of alcohol, what protects you against cancer is not necessarily best for your heart.

This means people have to negotiate this tricky path without clear signposts. It’s no wonder some people find it all too hard. Here it’s worth returning to the alcohol advice from the National Health and Medical Research Council on reducing the risk of disease:

• Don’t drink more than two standard drinks a day
• Don’t drink more than four standard drinks on one occasion
• Don’t drink while pregnant or breastfeeding
• Don’t drink if you are under 15. And if you’re 15 to 17, delay your first drink for as long as possible.

This advice is population-based, so any individual risk has to be overlaid on top of it. But it is a good start point for guidance.

Reducing death

Finally, the question of how much alcohol would minimise the overall risk of dying prematurely is different to asking what role alcohol plays in the development of disease.

Most public health advice about alcohol, including that outlined above, recommends upper limits of alcohol consumption but does not actually encourage drinking. But the evidence, in fact, goes a bit further. Taking individual risks and priorities into account, it indicates that for people in industrialised countries who have reached a later stage in their life, drinking at least some alcohol (but not too much) is likely to minimise the overall risk of premature death.

Although it’s difficult to make decisions about the health effects of alcohol, we can be heartened by the fact that we have large body of evidence to guide us