Like other Western countries, we're a nation of vitamin pill poppers. About half of all Australians at least occasionally take vitamins, minerals or some other supplement – alone, or more commonly in multivitamin preparations.

There's not a lot of evidence they do any good, but that doesn’t stop many people. What they are really buying is not protection from illness, but a sense of wellbeing. – the illusion that we're doing a bit extra over what nature can do, and that makes us feel satisfied.

Health experts know it's all a bit of a con, but they keep fairly quiet about it – mainly because the prevailing belief is they don't do any harm, as long as the dosage is moderate, and if people want to buy the illusion of wellness in a capsule, well it's their money.

But that's about to be turned on its head after a sophisticated analysis of vitamin studies done by Danish researchers and published in the latest Journal of the American Medical Association.

These researchers looked at clinical trials involving the common antioxidant vitamins beta carotene, vitamin A, vitamin C also known as ascorbic acid, vitamin E, and selenium either singly or in combinations. They looked only at well-designed studies – ones that compared groups of people taking vitamins, single or in combinations with other vitamins – and compared them to similar groups taking a placebo or taking nothing. The researchers were looking for any evidence of an increase in death from any cause in those taking vitamins. There were 68 trials from all over the world, totaling 232,606 people – some healthy, others with specific health problems, but not seriously ill people.

They identified some trials as unreliable because of bias. Amongst the rest, the better quality studies, they found there was a significantly increased risk of death in people taking some vitamins – alone or in combinations. Vitamin A increased mortality risk by 16 per cent. Vitamin E upped the risk by four per cent and beta carotene seven per cent. Selenium and vitamin C didn't show any increased risk (and selenium actually seemed to lower the risk of death).

Cellular effects

Antioxidants mop up free radicals (byproducts of cellular metabolism which destroy sensitive structures like cell membranes and DNA). But the researchers suggest that removing free radicals could somehow interfere with other important cell processes like apoptosis, where cells grow old and self destruct to avoid becoming cancerous or phagocytosis where white blood cells gobble up bacteria.

Previous studies have shown there's a risk to health only when a person consumes large amounts of vitamin. It's known for instance that in large amounts, over longer periods of time, fat-soluble vitamins – including vitamins A, E and K – can accumulate in the liver and cause toxicity.

But the Danish researchers were looking at people who took very modest doses. They say this is a very serious situation, given that 10-20 per cent of the population of Western counties regularly take them. And while the increased risk to an individual is fairly small, when it's applied to millions of people, the number of increased deaths is large.

As you’d expect, the vitamin industry has denounced the findings, arguing the review is flawed, without being too specific about why. The deaths could be due to factors other than the vitamins, they suggest. Besides which, they argue, some people in the studies were already ill, so why blame the vitamins?  In fact the analysis showed that vitamins raised the death risk in people already ill.

Moreover, the researchers argue the problem could be actually worse than these findings suggest. That’s because there are a great many studies done on vitamins that are never published. Most vitamin studies are funded by vitamin manufacturers who tend not to publish if there are adverse findings – the researchers didn't include any unpublished studies in their review.

Try food instead

So it's a good reason to leave the pills and capsules sitting on the supermarket shelf. Go to the fresh food and dairy sections instead – there's beta carotene in yellow, red, and deep green vegetables; vitamin A in cheese, eggs, oily fish, milk, and yoghurt; and vitamin E in olive oil and nuts. Tastier, cheaper and they won't kill you.

Peter Lavelle studied medicine at Sydney University and graduated in 1983. He practiced as a GP for several years before becoming a full-time medical writer. For many years he wrote for national medical newspapers and magazines and is now working for ABC.

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