Preeya Alexander: Norman, I have a quick quiz for you. 

Norman Swan: Okay, okay, I hate quizzes, particularly when there’s several hundred thousand people listening to it.

Preeya Alexander: I think you’re the perfect candidate for this, though. How well do you know the dietary guidelines? Can you picture the wheel of what you’re meant to eat day to day? 

Norman Swan: Look, I’m still old-school, I imagine the pyramid. I never got the wheel. The wheel is too complicated for my little brain, so I’ve still got the pyramid, you know, where there are lots of vegetables at the bottom, and then you slowly get to a small amount of red meat at the top. That’s how I think about it. The wheel just makes me dizzy. 

Preeya Alexander: The pyramid is a while ago.

Norman Swan: You’re new-school, that’s why you’re presenting the Health Report. 

Preeya Alexander: But the pyramid gives you that beautiful pie cut up and, as you said, it’s lots of whole grains, fruit, veggies. And then it says ‘sometimes foods’, which are the processed things. But interestingly, if you look at the wheel, and I often talk about it with patients, I have that wheel in my room, there’s a lot of processed foods on there, ultra-processed foods.

Norman Swan: Such as?

Preeya Alexander: Well, cereals.

Norman Swan: You mean like a breakfast cereal?

Preeya Alexander: That’s right, which are considered processed foods.

Norman Swan: Yeah, and that’s part of the labelling of foods, the check and so on. Do they really consider how processed the food is before they give it the tick or whatever? In fact, it’s an active debate at the moment. But it turns out that you could be following the dietary guidelines perfectly, but, as you say, if you just choose the ultra-processed part of the wheel or the pyramid, you might not be doing yourself as much good, even though the guidelines are being met. 

Preeya Alexander: That’s coming up on the Health Report; wheels, not pyramids. I’m Preeya Alexander on Wurundjeri land.

Norman Swan: And I’m Norman Swan, old-school, on Gadigal land.

Preeya Alexander: Also on the show, women are often told they’re not in perimenopause because their periods haven’t changed. But a new study suggests the onset may be earlier than traditionally thought. 

Norman Swan: The benefit of psilocybin (and we’ve talked about it many times in the Health Report in the past, that’s the psychedelic compound found in magic mushrooms) may well have been overstated when it comes to the treatment of depression, and it’s due to the way the research has been done, but I’ll explain more later.

Preeya Alexander: But first in the news, there’s been two studies come out around Covid vaccines, their safety and how much of an impact they’ve had on saving lives globally.

Norman Swan: Yeah, and this, this has currency. You know, just recently, in the last week or two, the US has removed $500 million in grants and funding for mRNA vaccine technology and research. And so a really good epidemiologist, John Ioannidis, who’s Greek but works in the United States and we’ve had on the Health Report before and is also a very conservative epidemiologist, doesn’t like overstating the situation. So he’s done a pretty conservative study looking at pre-Omicron and post-Omicron eras, trying to balance what may have happened in terms of infection rates, exposure across the world, and also representative sample of what they call the age pyramid. We talked about the food pyramid, they haven’t turned it into an age circle yet, an age wheel, it sometimes feels like the wheel of life, but an age pyramid and taking into account vaccine effectiveness in terms of reducing deaths, and also vaccine effectiveness in terms of adding years of life. They call them life years. So in other words, if you take the vaccine, how many more years of life did you get? 

And bottom line, vaccinations (a pretty well conducted study) averted about 2.5 million deaths between 2020 and 2024. It could have been as many as 4 million and as few as 1.4 and the mid-range there is about 2.5 million. And about 15 million life years saved, and it could have been as high as 24 million life years or as low as seven, but again, the mid-range was about 15. So, pretty good results there, mostly in people aged over 60, but about 20% of the benefit was in people in their mid-life, and not very much of those benefits accrued in terms of lives saved, years gained in young people and children. So effectively from about 50 on was where you got the major benefits there, but showing clear benefits. 

And the second study is of the safety of the JN1 vaccine using Danish data, because they’ve got very good health records, this is really looking at a more modern version of the COVID-19 vaccine, mRNA vaccine. And they looked at 29 different adverse effects, and effectively there was no statistically increased risk of any of these 29 adverse events in terms of whether or not they actually got into hospital, and that includes things like myocarditis. Caveat here is that the recommendation in Denmark is mostly focused on people aged over 65 but it does emphasise the safety in that group. So, good news there.

Preeya Alexander: It is good news, and it confirms what we know, which is that older people tend to have the most benefit with the Covid vaccine, and that it does reduce your risk of death and going to hospital. So are you needing a booster, is the big question.

Norman Swan: And B6 is not out of the news.

Preeya Alexander: It’s not out of the news. It feels like it’s been in the news for a long time now. But in case people have been living under a rock, B6 has been…

Norman Swan: Or a pile of supplement pills.

Preeya Alexander: Well, that’s the other thing, you could be living in a pile of those, and I think many people might be. But there have been a lot of people experiencing vitamin B6 toxicity, which is essentially neurological symptoms. So people are getting numbness, tingling, some weakness potentially. And it’s suggested that vitamin B6 in supplements is a big problem.

Norman Swan: And this can be permanent. It can permanently damage the so-called peripheral nerves, and that’s why you’re getting the problem.

Preeya Alexander: That’s right. And in 2022 the TGA actually started to alert people for potential neuropathy symptoms if they were taking vitamin B6. They started to put a warning label on medications that had 10 milligrams equivalent to vitamin B6 …

Norman Swan: So they are not really medications, they’re supplements. 

Preeya Alexander: This is the thing, they are supplements. So I think people might be aware that there’s been an issue with supplements containing higher levels of vitamin B6. They might be taking a magnesium supplement, not being aware that there’s vitamin B6 in there. And people have been having more than the 1.3 to 1.7 milligrams that’s needed daily for adults. 

Norman Swan: And now there’s a new product.

Preeya Alexander: Energy drinks. And that’s been the big thing in the news this week, that Red Bull, for instance, a 250ml can has five milligrams of vitamin B6, well over the recommended daily intake. 

Norman Swan: And they’re not the only one, to be fair.

Preeya Alexander: They’re not the only ones, no, I’ve just used one, but there are others there that are readily available anywhere you go, really any shop you go to. I think though, Norman, that people are not aware that…two things, vitamin B6 is in a lot of things; protein bars, cereals, breads, whatever supplement you’re taking. Secondly, that supplements, just because they are readily available doesn’t necessarily mean that they’re safe, and they’re regulated very differently by the TGA, and I went into a wormhole…

Norman Swan: So just to explain, the TGA is the Therapeutic Goods Administration. They are supposed to regulate drugs and supplements, and in fact they do. And before you’re allowed to put a supplement on the market, the TGA has got to put its stamp on it. But you might be shocked to discover what you’ve just discovered.

Preeya Alexander: Yes, I was shocked, you’re right, that is the word. For low-risk medicines, of which vitamins and supplements are considered low risk, most of them, the TGA (and this is taken directly from their site) does not evaluate the sponsor’s evidence of product efficacy before the product goes onto the market, nor do we examine the final product and its label. So as long as the product contains these pre-approved, low risk ingredients…

Norman Swan: But they don’t know that, because they don’t test it. They occasionally randomly test products, but it’s not systematic.

Preeya Alexander: And also, the RACGP, the Royal Australian College of GPs, has said they want the TGA to go even further here. They’ve started to introduce some interim reclassification of supplements. So they’re saying anything over 200 milligrams of vitamin B6 needs to be prescription only, 50 to 200 milligrams needs to be pharmacist sold, under 50 milligrams can be on the supermarket. What the RACGP has said is that’s a good step, but actually there needs to be a real step up in regulating the claims that these supplement companies are making.

Norman Swan: And they’re not low risk. The TGA would say, well, we’ve only had 176 reports on this, but that’s just the tip of the iceberg. Most people are almost certainly not reporting themselves to the TGA. So it’s big.

Preeya Alexander: I think it’s also important to point out, Norman, that most people (and this can come as a shock) don’t actually require any additional supplements. So if you’re eating a varied diet and you don’t have an underlying medical condition, most people don’t need an additional supplement. I don’t take anything additional. Do you?

Norman Swan: Nope. Two of my favourite sort of things to say here…’favourite’ is the wrong word…

Preeya Alexander: Tell us, we want to hear them.

Norman Swan: Well, Australians have the most expensive urine in the world. Secondly, when you take a supplement, two things prevail. One is you’re not taking the supplement in a natural dose, you’re taking it as a drug, it’s a drug-like dose. And when you take a drug, drugs have side effects. So don’t think you’re taking something natural, you’re taking a drug. And you’re also taking it isolated from food, and it has a very different effect on the body when you take an isolated vitamin rather than when it’s in food, where all the other stuff in food enhances and modifies its activity and also makes other things in food more available to you. So, take it in your food, not from a bottle.

Preeya Alexander: And of course some people do need supplements. If you are deficient in iron, if you’re planning a pregnancy or preconception, folic acid, iodine is recommended. And for some people, you might go, ‘Well, I still want to take it,’ but just be careful, read what’s in the product. And vitamin B6 might be in more things than what you realise. 

On ABC Radio National, you’re with the Health Report.