DSMphobia?

After another wave on my facebook feed of shared articles expressing concern, derision, and even outright fear over the diagnostic criteria given in the Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its fifth edition, I feel the need to write a little something here.

The DSM is essentially not much more than a means of linking a set of pathological traits with a shorthand definition. This can be useful when communicating between different health professionals or to health insurance companies, and when gathering statistics and conducting research on mental illness. It doesn’t generate new diseases, really, just labels to quickly describe observed illnesses.

The DSM itself explains that for something to be a mental illness, well, it has to cause illness — it needs to be “associated with present distress[…]or disability[…]or with a significant increased risk of suffering.”
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In the News: Multivitamins and Other Supplements

In the news over the last couple of days there has been a certain amount of excitement over an editorial in the Annals of Internal Medicine accompanying a set of articles which, some outlets and blogs are claiming, show that “doctors say supplements don’t work and that you shouldn’t bother taking them. Ever.”

There is a huge amount of evidence that daily multivitamins are simply unhelpful and generally the “nutrition gaps” that their marketers claim to be plugging just don’t exist in the general population. (Possible exceptions include vitamin D and omega-3’s, talk to your doctor if you are concerned about these.) Vitamins and oral chelation therapy can most certainly cause harm, for the same reasons they can help when used in appropriate circumstances at appropriate doses.

You probably don’t take preventative paracetamol (tylenol) every day; you take it when the need arises. You wouldn’t get yourself monthly preventative blood transfusions; you’d only do that when you actually needed the blood product. It’d be wasteful and potentially harmful to do either of these things, but they would help you greatly if you were in a situation where you actually needed either of them.

The same goes for vitamins. They will help you… if you have a shortage of that particular natural chemical in your body. If you don’t, at best you’re wasting money, at worst, you’re putting too much in and will make yourself unwell. For example, if you have more vitamin A than you need, it can cause problems like hair loss and bone fractures. Excess vitamin C may elevate your risk of kidney stones. But a deficiency of vitamin A can cause serious vision problems, and vitamin C deficiency causes scurvy. (Yes, that thing pirates talk about; it’s entirely real, and quite nasty.)

The Annals of Internal Medicine does not deny this; those guys know what they’re on about. However, a proportion of other media outlets seem to have misunderstood what was being said.

Vitamin supplements, in appropriate doses and under appropriate circumstances, work.

Taking random vitamin cocktails (read: taking multivitamins, the thing that the article actually deals with) as part of your daily routine does not help anything, and may even give negative health outcomes.

If you have been diagnosed with low or deficient levels of a vitamin or mineral, use supplements as directed by your doctor. They are great for that.

If you THINK you might have low or deficient levels of a vitamin or mineral, speak to your doctor.

Nutrition is part of medicine. As with any other disease, if you think you have a nutritional deficiency that may need supplementation to correct, speak to your doctor or specialist dietician. If you don’t, you may be wasting your money, or you may even be doing yourself serious harm.