Vitamin and Mineral Deficiency

Vitamin and mineral deficiency

N. Korovina

According to the data of Nutrition Science and Research Institute, 80-90% of the population appear to have vitamin C deficiency, 40-60% have vitamins A, B1, B2, B6 level reduced, the majority of the popukation are found to have mineral deficiency (iron, iodine, etc.) [1]. Everyone is aware of hazardous consequences of the deficiency. But what are they caused by?

Basic reasons for deficiency

Let’s discuss the daily diet of an adult and the content of some micronutrients in it (including % from physiological standard).

The diet is balanced, it has 2600 Kcal (97.5 g proteins, 91.4 g lipids, 343.8 g carbohydrates), but amount of vitamins and minerals is insufficient (table 1).
Bad habits may aggravate the deficiency (smokers need 35 mg of vitamin C additionally), imperfect technologies (the loss of 80-90% of the B group vitamins while processing corn into bread), environment pollution (increased consumption of antioxidants), geochemical peculiarities (low iodine content in water) [1, 2].
Average diet of the Russian residents is considerably inferior to the above-indicated one in terms of quality. That’s why it is so strange to read in mass media recommendations of some dietitians to achieve the adequate level of micronutrient consumption solely by means of diet (fruit, fish, etc.).
In present conditions it is not just the matter of deficiency prevention, it is a question of polyhypovitaminosis treatment combined with polyhypomicroelementosis, where there is no alternative to using complex vitamin and mineral products on a regular basis. In view of this there may arise the following question:

May excessive consumption of micronutrients become a hazard?

According to the results of numerous and continuous supervision of people taking vitamin and mineral preparations in medical doses, overdose is very improbable and does not pose any hazard (e.g. see "Safe levels of vitamins and minerals" report of the English Food Standards Bureau on
Vitamin and mineral complexes normally contain 100% of physiological needs in micronutrients from the standards recommended by the Health Ministry. The probability of hypervitaminosis is so insignificant that it is offically allowed in case of bioactive food supplements to exceed the vitamin contents three times as compared to that level, and ten times – for vitamins C and E [1].

Quality of vitamin and mineral complexes

At present time many different multivitamins – products that contain, practically, the full set of mecessary micronutrients – are being sold. However, sometimes it is hard to choose something definite as most of them have similar contents (10-15 vitamins and vitamin-like substances, 5-15 minerals) and similar preparative product form (big tablet). Moreover, active substances (pure vitamins, metal salts) for the production of multivitamins are purchased from one and the same major suppliers (transnational chemical concerns).
The substances manufacturers’ authority is very high and there are no doubts about the quality of a product’s components. However, there exists a popular, but false opinion that vitamins derived synthetically or with the help of biotechnologies can not fully substitute the vitamins that people get from food. Nevertheless, artificial vitamins are more effective than natural ones thanks to deeper purification and choosing more active forms.
Besides, according to the words of Nutrition Science and Research Institute vice-director Baturin A.K., before a synthesized vitamin is recommended as a preventive remedy, it should pass multiple examinations, which can prove its absolute identity to its natural prototype both in terms of structure and effect [3].
Actually, the quality of multivitamins is defined by the balance of its contents and efficiency of their active components assimilation. Specifically, the product’s composition must take into account the components interaction in the process of production, storage and assimilation in gastrointestinal tract, when actualizing their biochemical role in the organism.

Interaction of components

All the vitamins and the majority of necessary minerals are present in food in microdoses, they do not perform as buliding material or energy source in the organism. They play the role of accessory factors in biochemical processes, i.e. they show their activity by means of interaction with other biologically active substances. They interact with one another as well, i.e. they react chemically during the process of their production and storage, impede or foster one another’s assimilation in gastrointestinal tract (GIT), act as synergists or antagonists in internal environment.
During storage and production usually measures are taken to prevent direct contact of reacting components (granulation, microencapsulation, etc.). However, it is not always possible to eliminate chemical reactions with the help of techological methods, for example, 10-30% of vitamin B is oxidated by vitamin C in such products [4].
It is even more difficalt to eliminate inhibition of assimilation and competition in GIT at combined intake. Women often use iron as a part of vitamin and mineral tablets (with a wide set of minerals) for the prevention of anemia, though calcium carbonate and magnesium oxide inhibit iron assimilation in these products [5]. Here’s another example: iron, copper, zinc, vitamins B3 and C reduce vitamin B2 absorption [6]. Specifically, there are many such examples in case of minerals. This is not surprising as far as they are applied in the form of chemically similar oxides or salts and often use common mechanism of active transport into internal environment.
There also exist many facts that prove the positive influence of some of micronutrients on the assimilation of the other ones, for example, calcium helps assimilate vitamin B12 [7].
Antagonism of micronutrients in internal environment may declare itself in a very unpleasant way, for instance, vitamin B12 may intensify allergic reactions caused by vitamin B1 [8]. However, in most cases vitamins and minerals do not compete when performing their biological function in internal environment, but cooperate. The most popular examples of positive interaction in internal environment are reduction of vitamin E oxidized form by vitamin C and support of calcium and phosphorus homeostasis by vitamin D [10].
We managed to find a great number of facts dealing with antagonism and synergism of micronutrients that usually form multivitamins [11].
When evaluating the quality of multivitamins it is natural to proceed from two medical criteria: safety ("don’t harm") and efficiency ("cure or safeguard"). Some combinations of micronutrients may affect the safety of the product, for example, due to chemical reactions with the formation of hazardous substances, other combinations may reduce efficiency, interfering with assimilation and reducing the influx of active substances to the organism. At the same time there exist useful combinations from this point of view.
It is natural that synergic micronutrients should be taken together and antagonistiv ones should be taken separately. Antagonists should be taken at different time. The interval must comprise 4-6 hours, so that by the moment antagonist had got into GIT the first dose would have already been assimilated. This may be achieved by dividing all the components of vitamin and mineral complex into several tablets. This principle of formulating and using vitamin and mineral complexes provides the better quality of multivitamins.
Below you’ll find the most popular and bright examples of positive and negative interactions between micronutrients, which may affect safety and efficiency of a product.

Increase of safety

First of all, safety can be increased by taking into consideration the interactions of vitamin B12 with vitamins C and B1, iron and copper minerals.
Despite the fact that the need of the organism in vitamin B12 is very insignificant (1-3 mcg), its deficiency is pretty common and vey dangerous: disturbance of hematosis, digestion, nervous system. The shortage of vitamin B12 in the diet can be determined by the fact that it is not present in vegetable food (products containing this vitamin are vital for vegetarians) and for its adequate absorption from animal food the GIT must have the so-called "Castle intrinsic factor" – a special glycoproteid synthesized by stomach cells [1]. Besides, assimilation of vitamin B12 is impeded in case of protein digestion derangements, which is typical of elderly people.
Vitamin C, especially in the presence of iron, copper, vitamin B1 may oxidize vitamin B12 and transform it into its useless or antagonistic analogues. One of negative effects of these analogues is decomposition of IF, therefore, the incorrect way of taking vitamin B12 (together with vitamin C) is harmful for the organism [4,12,13].
In the famous M.D. Mashkovsky reference-book [8] there is information that vitamin B1 may cause allergic reactions, and not just in case of parenteral introduction, but in case of intake of usual preventive doses for people vulnerable to allergies, women during their menopause and premenopausal period, alcoholics. It also says that vitamin B12 may aggravate allergic effect of vitamin B1. Ignoring these facts results in decrease of the product’s safety.
Thus, it is necessary to take vitamin B12 separately from vitamin C, it is also recommended to take vitamin C at a different time from iron, copper and vitamin B1. At separate intake (elements are contained in different tablets) the maximum concentrations of these antagonists are reached at different time periods, which makes the development of adverse reactions less probable.
The simultaneous use of some minerals is potentially dangerous. If a polyvitamin product is used to eliminate iron deficiency it is necessary to separate the intake of iron from the intake of calcium and magnesium, which interfere with iron assimilation and may aggravate the deficiency. The product containing these three minerals together may produce a reverse effect to the expected one.

Increase of efficiency

Vitamins B3 or C, as well as copper, zinc or iron when united together with vitamin B2 in one tablet may reduce the assimilation of the latter. In this case the real consumption of the indicated amount of vitamin B2 can not be guaranteed. The mechanism of this negative effect is described in the work and presumes the ability of the indicated substances to form chelate complexes with vitamin B2, which reduces its bioavailability [6].
As it has already been mentioned, many facts of antagonism werefound for minerals. That’s why, calcium, iron and zinc in particular, should be contained in different tablets.
At the same time high quality product must keep all the principal positive (synergic) interactions, long and well-known in medicine:

• vitamin D provides assimilation and support of calcium homeostasis [1,10], i.e. these two micronutrients must occur in one tablet of the product;
• vitamin C reduces the activity of vitamin E Е [9] – these vitamins should be taken together as well;
• calcium intensifies assimilation of vitamin B12 [7] – it is not recommendable to separate these substances.

Consideration of components interaction in vitamin products

Synergism of components has long and successfully been used by the manufacturers of vitamin products for special use. Antioxidative complexes (e.g. Triovit KRKA – selenium, vitamins A, C, E) and products for osteoprosis prevention (e.g. Calcium - D3 Nicomed – calcium and vitamin D) usually contain the set of synergists.
Some multivitamins use the principle of uniting synergists and separating antagonists as well: american Three a day, domestic – Alfavit and Vitamineral. They contain recommended daily doses of all the vitamins and the majority of minerals, where the antagonistic substances are put into different tablets and synergists are united in one tablet. Sequential intake of tablets with the interval of 4-6 hours (which exceeds the time of assimilation) guarantees that antagonists "won’t meet" and synergists "won’t part". In Three a day and Alfavit products they managed to achieve it having divided 13 vitamina and 10 minerals into 3 tablets, whereas in Vitamineral thanks to eliminating 2 minerals from the structure – into two tablets.
In fact, Three a day and Alfavit can be considered complexes that consist of three balanced products, containing sybergic micronutrients. The order of intake of tablets from a separated multivitamin is any one convenient to the consumer, however, it is recommended to observe the interval. Actually, all the tablets of a separated preparation can be taken simultaneously. In this case it’s not worse than any complex with similar structure.
Products that combine all the vitamins and minerals in one tablet are easier to produce (one, thoigh rather big tablet a day instead of three or more as is the case of separated products). However, the price for the "convenience" is the loss of the part of biological activity, for some of the vitamins reaching 30%. It is significant to note, that such losses are unequal and unpredictable, which means that such products can not be defined as balanced.

Sources:

1. Tutelian V.A., Spirichev V.B., Sukhanov B.P., Kudasheva V.A. Micronutrients in the diet of a healthy and a sick person”. – Moscow, Kolos, 2002.
2. Skalny A.V. "Human microlelementoses (diagnostics and treatment)", Moscow, KMK publishing house, 1999.
3. Medical journal №5, January 2001
4. Herbert V., Drivas G., Foscaldi R., et al (1982) Мultivitamin/mineral food supplements containing vitamin B12 may also contain analogues of vitamin B12. N Engl J Med 299:307: 255–256.
5. Babior B.M., Peters W.A., Briden P.M., Cetrulo C.I. (1985)Pregnant women’s absorptions of iron from prenatal supplements. J Reprod Med 30: 355–357.
6. Jusco W.J., Levy G. (1975) Absorption, protein binding and elimination of riboflavin. In Rivlin R.S. (ed), Riboflavin. Plenum Press, N.Y.
7. Shaw S., Jayatilleke E., Bawman W., et al (1993). Mechanism of B12 malabsorption and depletion due to metformin discovered by using serial serum holo–transcobalamin II (holoTCII) (B12 on TCII) as surrogate for serial Shilling tests [abstact]. Blood 82(suppl1): 432A.
8. Mashkovsky M.D. "Medical remedies" 14-th edition, volume 2 – Moscow, New wave, 2000.
9. Sokol R.J. (1996) Vitamin E. In Ziegel E.E., Filer L.J. (eds), Present knowledge in nutrition, 7th ed, ILSI Press, Washington, DC.
10. Arnaud C.D. (1978) Calcium homeostasis: regulatory elements and their integration. Fed proc 37:2557–2560/
11. Korovina N.A., Zakharova I.N., Zaplatnikov A.L., Obinochnaya E.G. "Children vitamin and microelement deficiency: modern approaches". Manual. RMAPO (in print).
12. Kondo H., Binder M.J., Kolhouse J.F., et al (1982) Presence and formation of cobalamin analogues in vitamin–mineral pills. J Сlin Invest 70:889–898.
13. Herbert V., Shaw S., Jayatilleke E., Kasdan T.S. (1994) Most free–radical injury is iron–related: it is promoted by, iron, hemin, holofeppitin and vitamin C, and inhibited by desferoxamine and apoferritin. Stem Cells 12:289–303.

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