Book review

Review by Ursula arens writer; nutrition & dietetics

the VitAmin ComPlex our obsessive quest for nutritional perfection

by caTherine price oneworld pUblicaTions, 2015 isbn 978-1-78074-346-2 price: £11.99

if you are in a hurry, the conclusion of this review is, a muSt read book for dietitians.

Ursula has spent most of her career in industry as a company nutritionist for a food retailer and a pharmaceutical company. She was also a nutrition scientist at the british Nutrition Foundation for seven years. Ursula guides the NHD features agenda as well as contributing features and reviews But perhaps you have time to linger and consider further why this is such an excellent book. The hugely annoying factor is just that Catherine Price is not a nutrition professional, but has managed to dig deeper, consider wider, communicate more clearly and conclude more pragmatically than many colleagues who are more learned in this terrain. She is a disciple of Michael Pollen who is well known as a prolific and influential food policy communicator, but Catherine Price has steered more into the sciency-bit of food debate (the home of dietetics).

Catherine discusses the history of vitamins, the economic and policy debates of vitamins, the latest health research on vitamins, the confusions both planted and accidental around vitamins, the industry and consumer pushes and pulls around supplementation and the legislative and political inputs on vitamin use. There is massive interweaving of all of these aspects and all contribute to the high alertness of consumers and industry to these ‘magic bullets’ that promise health and wellbeing, to counter the damages of sedentary lives and conveniencedriven food choice. Catherine is always cool and rational in her discussions and yet there is enough pepper and spice in the illustrations she selects, to make this a very exciting read. The topics are all well known to dietitians and yet there are so many new and astonishing aspects to Catherine’s insights on vitamins, that a huge ‘fortification’ of understanding is guaranteed.

For a tiny taster of the contents of this book, let’s start at the very beginning: with the letter A. Vitamin A is widely available from many natural and fortified food sources in the UK diet, but deficiency is still a global problem causing blindness and fatal outcomes from impaired immune responses to diseases such as measles. Night blindness precedes dry-eye and ulceration of the cornea and, yet, even if it never develops to the severe stages, it is a major handicap in societies without the illumination provided by electricity. Seeing children become fully dependent on others after sunset - estimated to affect more than 130 million preschool children and it is common enough to be considered a normal part of late pregnancy in some poorer communities - estimated to affect more than six million pregnant women annually. Historical descriptions of sailors’ blindness were evidently due to vitamin A deficiency, but were tagged to causes as random as homesickness or humidity or masturbation. Treatments forafflictedsailorswerebizarre,although being locked in a dark closet, ‘to give the eyes a rest’, was perhaps less painful than other common maritime remedies for ill health.

. . . I give this a 10/10 rating and urge dietitians to put aside ‘140-character reading’, and read the 380 pages of this book.

Catherine interviewed vitamin A expert Alfred Sommer about his battles to combat deficiency in Indonesia. His initial suggestions to dose vitamin A orally were mocked by WHO experts, who supported the evidence-based strategy of injections. The critics said that children would spit out capsules, and that, ‘patients liked injections’. The strong associations between night blindness and mortality rates led Sommer to consider that it was a late rather than an early indicator of vitamin A deficiency, and his study of 26 thousand children published in 1986, demonstrated that giving one vitamin A capsule every six months resulted in the 34% reduction in death rates in deficient children. Catherine describes Alfred Sommer as a feisty expletivefilled New Yorker, who can now take ‘I-toldyou-so delight’ that vitamin A supplementation programmes are viewed as the single most costeffective intervention in modern medicine and are being funded by UNICEF in more than 70 countries.

Shipping pills between and around countries cannot be the solution to vitamin A deficient populations (although the DSM-funded Sight and Life vitamin A supplementation programme deserves high praise). Beta-carotene to vitamin A conversion rates have been re-assessed in the last two decades, with dramatic changes for policy. Pure beta-carotene in oil has a conversion rate to vitamin A of about two to three, but assessments for typical American diet rates were increased from six to about 12; Sommer estimates that conversion rates in typical Indonesian diets are lower still at about 24, half those in typical American diets. The lower conversion rates explained the greater vitamin A deficiency rates observed in some populations, where theoretical diet calculations predicted adequacy. New focus on food-first strategies has led to developmentsofbiofortificationand,specifically, genetic-modification. The story of ‘Golden Rice’ is for now, just a story. The insertions of daffodil genes into rice that made it a beta-carotene source was announced in 1999 and there was excitement that this was the first genetically engineered crop that offered direct benefits to consumers rather than only farmers. But there was opposition. A huge amount of golden rice would need to be consumed to meet daily vitamin A requirements, and the involvement of the biotech company Syngenta increased opposition from food activists. Fifteen years later, field test trials of an even higher carotene variant of golden rice were successful and Syngenta declared ‘free use’ of the product to farmers whose direct annual profits from rice were less than 10,000 US dollars. But there is still not a single grain of commercially produced golden rice on the market because of fundamental opposition to the technology. Catherine observes huge hypocrisy and ‘nutritional blindness’ from the well-fed supplement-taking populations of the US in relation to a technology that could contribute dramatically to reducing vitamin A deficiency in suffering populations. On this topic, Catherine has given a “yes” to a strategy that she feels can challenge the 500 thousand vitamin A-deficient children going blind each year.

Many of the descriptions in this book are based on the American marketing and legislative developments of vitamin use. There is a whole sorry chapter on how the Food and Drug Administration (FDA) was humiliated and politically outmanoeuvred in relation to the ‘Dietary Supplement Health and Education Act (DSHEA)’ passed in 1994 - for fear of being thought even more bizarre. I will not reveal that this was my favourite chapter.

I could go on and on presenting cherries of detail from this information feast of a book. But rather, I give this a 10/10 rating and urge dietitians to put aside ‘140-character reading’, and read the 380 pages of this book. It is a deeply satisfying masterpiece of nutrition science writing.