Vitamins

Published on 27 September 2025 at 05:35

Photo of the week - ele therapy.

Highlight of the week: We gate-crash brunch with our friends Sel and Annie who are in South Luangwa on holiday.

Lowlight of the week: We get called away to an emergency just as we settle down to a post-brunch natter with Sel and Annie

Maximum temperature: 41 degrees Celsius

Rainfall: We heard that there was rain in Katete – 4 hours away.

Vitamins, or more correctly vitamines are organic compounds vital to life. Vitamine is a Funky word. Coined by a bloke called Funk. Casimir Funk from Poland. Dr Funk kicked off the massive 591 billion dollar nutraceutical industry in 1912. Nowadays, there are so many vested interests in the peddling of these magic bullets, that most self-respecting doctors have divorced themselves from the hype and choose to generalise about a healthy diet.

For the most part we can follow the party line of doing no harm by prescribing vitamins. They are sometimes given as a plausible placebo. Proven by science to give results. But true vitamin deficiency is uncommon in the UK. These days it’s rather frowned upon to hoodwink a patient and to give them a placebo without full disclosure. Understanding the natural history of disease could allow us to claim a cure for 80% of our patients’ recoveries with a coded prescription for coloured tablets, that at least do no harm. But our British General Medical Council would take a dim view of us peddling that type of deception en masse. Consequently, we only prescribe vitamins when the moon is blue these days.

OK so I’m overstating the case to suggest that vitamins are just placebos. Vitamin D is a favourite prescription in the dark Northern wastes that might include Middlesbrough and the like. Vitamin B12 is needed by some blood lines (I blame the parents) and those who prefer not to consume animal products. And folic acid is de rigueur during pregnancy for well-established reasons.

Aside from a confessional research article in which 97% of UK doctors admitted to occasionally prescribing placebos, it’s borderline unethical to use them. Patients generally do better when they know what’s going on. We have moved on from the days when the doctor knows best. When the doctor makes all the decisions. We can no longer give placebos without making it explicit. This red tablet is a vitamin. It will not do you any harm. In itself, it may make you feel better. But the active ingredient, vitamin C, will not cure your cold.

Today, my mind is changed. Vitamins are the panacea, not the placebo. Vitamins won’t just make you feel better. They will save your life. Your skin. Your brain. Your guts. This vitamin is the be all. Vitamin B3. Niacin - far better than Red Bull at giving you wings. The opposite of Ricin - which is the end all.

You ought to know that we have a very welcome houseguest at present. Most of our guests are uninvited and sometimes challenging. We have written about them before. https://keithandginnybirre.wixsite.com/intoafrica/post/a-bug-s-life-the-sting Keith has had to extricate 4 bats from our house this year. 3 scorpions have been dealt with more summarily. The skitters are ever present, despite copious qualities of Doom in our atmosphere. Joel - our houseguest and resident neuroscientist - does a home visit with Andrew this week. They assess James in his very humble abode. Joel describes a sorrowful situation. James is almost mute. Physically looking out of sorts. Only able to walk with support. With swollen ankles. And a rash. Joel and Andrew decide that he needs a medical overhaul. There is no pushback on the idea that he should come to clinic today. James is the focus of today’s blog and he is the focus of our full attention in clinic today.

James is a 42 year old man with epilepsy. Cared for by our epilepsy team. A team which started working in our valley in 2022. Their local lead is Andrew. A health care worker. Protocols focus their activities. Drugs are supplied to fill gaps where the government supplies fail. Providing better medicines, consistently. The international team visits regularly. Their money and expertise come from Canada and Austria. Investing in a nearby unit that will soon offer daytime support for patients with learning difficulties and epilepsy. Diagnoses are revisited. Investigations are undertaken. Brain wave recordings. Brain scans.

Some patients turn out not to have epilepsy. Correcting, de-prescribing and un-diagnosing helps some people. Just as much as starting medicines does for others. No need to keep taking drugs. No need to attend clinic. But complex disadvantaged patients are brought under protective wings. Epilepsy still has a massive stigma here. Witchcraft and bush medicine are regularly deployed to rid patients of their demons. Exorcisms that are doomed to fail. Patients are cast out. Or locked up. This project continues to work with communities. To try to sensitise them. To remove the stigma and the nonsense.

James has an epilepsy syndrome. His childhood was blighted by marked learning difficulties. He can barely function as an adult. He lives with his family, with his sister’s support. But over the past 6 months, he has been spiralling downwards. Losing weight. His appetite sparrow-like. His speech dwindling to nothing. His mobility appalling.

But at least his epilepsy is pretty well controlled, with no seizures since July. Consistent carbamazepine keeps his seizures away. As his general decline proceeds apace, he gets diarrhoea and a rash. The hospital team are baffled. His extensive notes detail his recent visit to hospital. James is unable to corroborate this. He is practically mute now. His medication list is as long as anybody’s arm. Antibiotics. Antifungals. Multivitamins. There is a rabbit away, and the hospital docs are using a blunderbuss approach. But the rabbit is still on the run.

James is not able to tell us how he feels. He staggers into the room with support. And sits mute in the chair. Looking thin. He has some dry skin on his face and on his arms. He has swollen ankles. I press my thumb gently into the swelling and leave a deep dimple. His blood pressure is low. Otherwise his vitals are OK. I ask some questions about his diet. He eats a bit. Nshima mostly. Maize made into a thick porridge. It fills him up. Occasionally he gets some sauce with it. But there is little good stuff in here. Just carbohydrate. We scratch our heads. His diet is dreadful. He is on the thick end of a wedge. Nshima is provided in wedges in Zambia. But these wedges are deficient in everything except quick release carbs.

I’m going to clamber down from my soapbox now. I need to think about how we can help James. His symptoms are setting off a pinball reaction. I was listening intently in this particular lecture, back in the day. Dermatitis. Diarrhoea. Dementia. There are 4 Ds in this sequence - but at least James is not dead yet. The 4 Ds of niacin, or nicotinamide, deficiency would complete the set. We have no time to lose. James needs niacin urgently. Niacin deficiency is also known as pellagra. It’s not every day that I make a once in a lifetime diagnosis. This is going to need a bit of triangulation. Professor Google backs me up. Carbamazepine also plays a part.

Whilst studying for my diploma in tropical medicine, I learnt about an epidemic of pellagra. Caused by a lack of nixtamalisation. A fancy word for a fancy production process. As maize is prepared, dried kernels are soaked in an alkaline solution. Cooking in an alkaline solution alters the maize. One of its main effects is that it increases the bioavailability of niacin. This process is widely used in the Americas. But nixtamalisation is alien to Zambia. This means that our staple food is lacking in niacin. Despite this, most people in Zambia do not have pellagra, as they just about get enough niacin. From meat, poultry, fish and eggs.

A man cannot survive on nshima alone. I won’t mention here about its tendency to mainline to central adipose deposits. Nor how it nudges big people into a state of hyperglycaemia and sleep apnoeic induced torpor. But nshima is deficient for sure in niacin. Big time. And James’ pellagra is the product of nshima synergistically combined with carbamazepine.

We remove the blunderbuss of James’ over-treatment. His antibiotics and antifungals are returned to the pharmacy. We need a laser to treat James. And it needs to be pointed in the right direction. Two or three hundred milligrams of niacin daily will be needed for the next few weeks. His multivitamins are a very token effort. Containing only 7.5mg per tablet. We counsel that he take 10 a day until we can sharpen our pencils and focus our laser beams. Friday may bring a better plan.

Patrick’s pharmacy is like Aladdin’s cave. And Patrick has oft been our saviour, when we are in a tight spot. He passes Keith a box from a back shelf with a flourish. Ten vials of Vitamin B compound. Each jab sports 200mg of niacin. When administered it is given through a sharp needle into a big thigh muscle. With laser beam accuracy. Hitting the spot.

But even before this, ten daily tablets of multivitamins have a magical effect. Friday sees Andrew and Joel visiting James at home, to administer his first injection. But ten daily tablets have already cleared James’ mind. Andrew and James ask James’ family how James has been. But an unmuted voice pipes up: I’m much better thanks!

Friday sees the beginning of the end of James’ Demise. The Ds are dissolved one by one. Deficiency defeated.

The 4 Ds are deleted: Dermatitis disappears. Diarrhoea dumped. Delirium dismissed. And oh yes: Death defied. Vitamins not just a placebo.

Funky.