Pop goes your health
City folk often skip meals in favour of dietary supplements, but nutrition experts warn that overdosing can do permanent damage, writes Patsy Moy
EVERYONE HAS their own version of a healthy breakfast: eight-treasure congee, soy milk, wholemeal toast and fruit - the list goes on. For advertising agent Simmy S.M. Yim, the standard menu is one tablet each of vitamin C and calcium chased with a cup of antioxidant green-tea essence, washed down with a bowl of grain-based meal replacement.
Yim, 40, is a great believer in dietary supplements and often substitutes them for regular meals, for instance eating a packaged 'energy' porridge for lunch. She says regular food is prone to contamination and is less nutritious. 'That's why we need additional nutrients from different supplements to maintain good health,' she says.
The health-conscious Yim is among an estimated 22.8 per cent of adults in Hong Kong who take health supplements regularly. But dietitians and physicians say many people overrate their value, and are consuming so much it's becoming a health problem. Their concern was highlighted by the sudden death last month of a 30-year-old financial consultant who skipped proper meals and relied instead on dietary supplements.
One in four people who sought diet consultations at the Chinese University over the past year was found to have overused health supplements, says Mandy Sea Man-mei, manager of the university's centre for nutritional studies. That's more than double the rate registered six years ago, when 10 per cent of patients were consuming excessive amounts. Almost all were women.
One patient went to such extremes she took more than 10 mineral, vitamin and herbal capsules every morning to replace breakfast, says Sea. 'Besides vitamins and minerals, she also took lingzhi pills, omega-3 and flaxseed oils, as well as garlic, gingko and blueberry extracts, which she believed would help her stay young and healthy.'
But health supplements are generally superfluous in an affluent city like Hong Kong, says Sea. Healthy people can get all the nutrients they need in a balanced diet.
It's people who can't absorb enough nourishment from regular meals - mostly chronic patients, those recovering from major surgery, mothers-to-be and people on weight-loss programmes - who may require supplements. Even then, says Sea, they should seek advice from doctors or dieticians on the proper dosage.
Greater health awareness following the 2003 Sars outbreak and the city's ageing population have led to a growing market for dietary supplements. Some retailers are even enjoying double-digit growth, the Health Food Association reports. According to census surveys, half of their customers gobble vitamins (53.2 per cent) and one-fifth consume Chinese herbs (21 per cent). Other popular items include calcium (15.1 per cent), cod liver oil (12.5 per cent), products for boosting the immune system (10.6 per cent), and 'instant bird nest' (8.6 per cent).
Pharmacy chain Watson's sells more than 10,000 health products at its 170 outlets across the city. Besides vitamins and calcium, best-sellers include joint-support tablets and extracts of Chinese herbs such as lingzhi and cordyceps.
With a small bottle costing several hundred dollars, dietary supplements don't come cheap. But besides lightening the wallet, overdosing can bring permanent health damage. Surgeon Lo Chung-mau cites the case of two teenage girls who suffered severe liver damage after their mother fed them with massive daily doses of vitamins A and D.
'Relatives and friends told the mother that the vitamins could alleviate her daughters' asthma,' says Lo, a professor at the University of Hong Kong. 'She thought the more, the better, and gave the children 10 times the normal dosage every day for years.'
By the time they were admitted for examination, the girls were struggling to breathe because the liver cirrhosis also affected their lungs. The sisters are now awaiting liver transplants. 'But even if there are suitable donors, their lungs are so weak it will present the surgeon with added difficulty,' says Lo.
Tragic as the sisters' plight is, Lo says such cases aren't uncommon. A number of his patients suffered severe liver disease because they overdosed on health supplements and meal replacements.
'Dietary supplements such as fish liver oil were helpful in the old days when people didn't have enough food and suffered from malnutrition,' says Lo.
'But our major challenge nowadays is over-nutrition.'
Census findings show consumer awareness of health supplements comes from two main sources: advertisements (47 per cent) and others' recommendations (72.1 per cent). However, medical experts and the Consumer Council blame the obsession with dietary supplements on misleading labelling and exaggerated product claims.
The power of advertising is reflected in the way unwarranted consumption is most acute for calcium and vitamins C and E, says Sea. 'The functions of those nutrients are most heavily promoted in television commercials and magazine ads as ways to prevent flu, wrinkles and osteoporosis.'
'Most products emphasise their nutritional and health values without detailing possible health risks. Some even don't state the intake limit,' says Brian Cheng Yeuk-nin, the Consumer Council's chief research and trade practices officer.
The council received 135 complaints on dietary supplements last year and 154 in 2005, mostly over the effectiveness of products.
The Undesirable Medical Advertisement Ordinance covers treatments for only certain ailments, while claims for other conditions fall into a grey area.
This allows supplement companies to get away with extravagant claims with skilful phrasing, says the council, which wants legal restrictions on ads about slimming, boosting immunity and detoxification.
The president of the Health Food Association, Angela Lau Ming-yan, insists the industry can regulate itself, adding that the group has issued a good-practices guide to its 30 member companies.
Critics say misuse is likely as dietary supplements are widely sold in pharmacies and supermarkets, but Lau blames the problem on consumers' failure to follow instructions. Health supplements have a role even in healthy families, Lau says, because many people don't have time to cook proper meals or exercise regularly.
Customers such as Yim certainly find the products handy. 'I know tonic soups made with lingzhi and other Chinese herbs are beneficial for health, but I don't have the time or skill to prepare them,' she says. 'Making instant health porridge and soups from powder is easy - and it allows me to sleep in for an extra 30 minutes in the morning.'
However, deputy chief executive of the Consumer Council Connie Lau Yin-Hing urges consumers to be more critical rather than rely on manufacturers' claims.
'People may be aware of the issue for a brief period after we announce our test results [on health foods]. But they soon forget our warnings and are lured by the new marketing tactics,' she says. 'Traders have a duty to honestly disclose relevant product information while consumers should learn to protect their health and rights.' She says the government should make a greater effort to change public perception on health - which should be gained through a healthy lifestyle instead of relying on health supplements.
Medical experts say supplement makers are undermining the fundamental tenets for good health - regular exercise and a balanced diet - by advertising the idea of short cuts and instant solutions. They argue the health risk from dietary supplements is likely to be far greater if there is any contamination of raw ingredients because the extraction process will also concentrate toxins.
'The risk from whole foods is relatively low as you need to eat a large amount of the same food over a long period of time to be poisoned,' says Sea. 'You can easily get enough vitamins by following the two plus three principle [of eating two portions of fruit and three of vegetables everyday]. Natural food is tasty and cheap, so why spend money on tablets?'