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Vitamin and mineral deficiency

Vitamin and mineral deficiency

E. Shih

Edition:РМЖ. – 2004. – Т.12. – № 23.

Although, it is customary to use the expression “vitamin or mineral deficiency”, there is no mistake in the title. As a rule, the organism of a modern man experiences deficiency not only in certain minerals and vitamins, but their certain combinations. Most frequently these are the combinations of micronutrients acting synergetically. A popular example for this is a complex deficiency of vitamins B9 (folic acid) and B12. The presence of the former one in the diet is a necessary condition for the assimilation of the latter. That’s why the deficiency of B12 may cause the deficiency of folic acid.

Biologic functions of vitamins and minerals

The majority of vitamins take part in metabolism as coenzymes, some of them are hormone precursors (vitamins A and D) or antioxidants (vitamins C and E). Therefore, the lack of vitamins causes disturbance of metabolic processes, immune reactivity, tissue growth and regeneration, reproductive function, etc.

The diagnostics of these states is, normally, complicated in view of the absence of pathognomic clinical presentation of polyhypovitaminosis and the presence of internal pathologies for some patients, which symptoms stand forth.
Minerals are as important for the human organism as vitamins. Some of them are considered to be vital – essential. These are, first of all, such macroelements (more than 0.005% of a body’s mass) as calcium, phosphorus, chlorine, sodium; micronutrients (less than 0.005% of a body’s mass) – iron, copper, iodine, selenium, etc. For the moment 32 elements have been found to be clinically important. In case of expressed decrease of their concentration in the organism there develops a more or less typical clinical presentation. Molybdenum, manganese, bromide and others belong to this kind of elements.

Participation of mineral substances (macro- and microelements) in metabolism is connected with the formation of osseous system (calcium, phosphorus), support of osmotic properties (sodium, potassium), hematosis (iron, copper). Many of them are activators and cofactors of enzymes (magnesium, copper, iron, selenium, etc.), form enzymes and so on. For instance, iodine, which is a part of thyroid hormons, produces anabolic effect, stimulates growth and formation of organs and tissues.

Vitamins and minerals can execute these specific functions provided they are properly assimilated, transferred into tissues, set into their active or inactive state, withdrawn from the organism. At the same time, synergism and antagonism of interaction of some micronutrients may show on the stage of metabolism. Thus, ascorbic acid provides transformation of folic acid into active coenzyme forms and reduction of oxidated tocopherol [1], and vitamin D is necessary for adequate assimilation and utilization of calcium [2]. There are many facts indicating antagonism of micronutrients, for example, nicotinic and ascorbic acids destroy vitamin B12 [3].

Reasons for the deficiency of vitamins and minerals

Our usual diet inevitably leads to the shortage of micronutrients. There are several reasons for that. The principal one is that demand for micronutrients developed on the basis of evolution in conditions when a person spent (and consumed) 5000 kcal, and now our average energy consumption comprises 2500 kcal – getting twice less food we lack half of the necessary amount of micronutrients.

The situation gets even worse due to bad habits (smokers need additional 35 mg of vitamin C), imperfect food technologies (80-90% of the B group vitamins are lost while processing corn into bread), pollution of the environment (increased consumption of vitamins-antioxidants), geochemical peculiaritues (low iodine content in water). A number of internal illnesses causes the decrease of vitamin concentration in the organism: Addison-Birmer disease, anacydic gastritis, diphyllobothriasis, specific malabsorbtion affects absorbtion of vitamin B12. Enteritis accompanied by the malabsorbtion syndrome even on early stages may lead to expressed reduction of vitamin B6 concentration in the organism.

Long-term ingestion of some medicines may cause the deficiency of some vitamins in the organism. The intake of oestrogen-containing contraceptives leads to the shortage of pyridoxine. The decrease in the level of the latter is also observed in case of a long-term use of some antibiotics, sulfonamides, ftivazidium, isoniazid, cycloserinum.

According to the literature, the health of our nation is mostly affected by the deficiency of vitamins А, С, Е, В1, В2, folic acid and minerals: calcium, iron, iodine, selenium [4]. In view of the fact that health authorities at present moment have practically no opportunity to examine the population for detection of the level of vitamin and microelement concentration in different regions we may conclude that this problem is much more critical than it seems at first sight.

In present conditions it’s not just a matter of deficiency prevention, but of polyhypovitaminosis treatment combined with polyhypomicroelementosis. At the same time there’s no universal and regular alternative to vitamin and mineral preparations.

Micronutrient interaction

Biochemical and physiological functions of a number of essential micronutrients have been fairly well studied by the present moment. Research proved among other things the presence of many vitamins and minerals in metabolic fates and drove the scientists to the conclusion about their interaction.

This course of research prospective both from scientific and practical points of view is far from exhaustion. However, the results of some of the investigations have already become generally recognized and are being used for formulation and production of vitamin preparations. Full reviews of the results of such investigations can be found in recently published articles [5, 6].

Modern science proved more than 20 facts of vitamin and mineral interaction both positive (synergism) and negative (antagonism). Synergism of micronutrients was first considered in vitamin medicines of directive effect, for example, for the treatment of osteoporosis (calcium and vitamin D), in antioxidative complexes (vitamins A and C), etc.

In preventive polyvitamin products containing the full set of vitamins and essencial microelements, i.e. consisting of dozens components it is important to take into consideration antagonistic interactions. Particularly, there are many competitive or antagonistic interactions as regards minerals. For instance, it is not recommended to combine medical antianemic iron-containing remedies with calcium-containing preparations. For the same reason one shouldn’t drink milk with such preparations [7].

It is necessary to take into account such recommendations when formulating polyvitamin complexes designed for preventive use in risk groups as it has been proved that assimilation of iron from a polyvitamin may reduce twice if the same product contains calcium. Unfortunately, very often women of childbearing age are recommended such vitamins specifically for iron replacement.

The practical result of scientific research devoted to the interaction of vitamins and minerals appeared to be the division of the daily dose of components necessary to the organism. Thus, synergic substances are united in one tablet, whereas antagonists are separated into different ones, which prevents their opposition in a medicine during storage. Separate intake of tablets with the interval of several hours excludes any possibility of antagonistic interaction on the stage of releasing active principle of the tablet, in the process of its absorbtion, distribution and withdrawal from the organism.

Such approach to formulating preventive vitamin and mineral complexes allows to take into consideration all the known correlations between micronutrients in the process of their production and storage, assimilation in gastrointestinal tract, inclusion in metabolic processes of the organism and to get maximum possible clinical effect from the use of such preparations.

Vitamin preventive health care

It hasn’t been long since the scientists realized the importance of interactions that take place between the ingredients of polyvitamin products. However, this new approach has already been successfully actualized by the manufacturers who aim at creating the most rational vitamin and mineral complexes.

Wide-spread vitamin preventive health care is a result of development of vitamin science. This trend thrived in the XX-th century and brought to its researchers four Nobel prizes. There were only two vitamins known in 1920: A and B (vitamin B stood for watersoluble vitamins). In 1955 the structure of the last vitamins from those generally recognized nowadays (B12) was found, though its production started only in 1973.

Thus, the wide application of vitamin complexes began only in the last quarter of the XX-th century. At present time, according to the data of “Comcon-Pharma” research company, 30 million Russian citizens take vitamins (20% of the population). Most unfortunately, the number of vitamin users hasn’t been growing for the past few years. Only one third of these 30 million people uses full value vitamin and mineral complexes, others keep taking either monopreparations (vitamin C) or cheap unbalanced complexes, moreover, their intake being limited to a cold season.

In present conditions, when micronutrient deficiency is characterized as associated deficiency and appears, practically, in all population groups and in all regions and doesn’t get weaker in the summer period, the efficiency of such prevention gets close to zero. Obviously, the main reason for using out of date products is an economic one. However, awareness of both specialists and patients plays a great role as well. For many people “vitamin” and “vitamin C” are understood as synonyms. Some people still believe that if you eat several kilos of fruit from your garden you’ll “charge” yourself with vitamins for several months.

It is very hard to break this kind of stereotypes. According to “Comcon-Pharma” the number of users of full value products increases 1 million per year. If this tendency persists it will take 20 years to drive old-fashioned products from the market.

Modern polyvitamin products

Modern complexes, normally, contain all the 13 generally recognized vitamins and basic microelements dosated to satisfy phisiological needs.

In 2004 a document “Recommended consumption standards of food and bioactive substances” came into effect [8]. In its methodologic recommendations, apart from adequate consumption standards of vitamins and minerals, maximum permissible standards were set. According to the above-mentioned recommendations maximum permissible standards for all micronutrients exceed adequate standards several times. This means that the possibility of an overdose when using modern complex preparations at a lenghty period is insignificant. Thus, a myth about the threat of hypervitaminosis when using polyvitamins due to supposedly sufficient influx of essential micronutrients with food taken for granted even by some of the doctors up to the present moment is discredited.

According to multiple research, which included long-term supervision of people taking vitamins and minerals in therapeutic doses, no adverse clinical effects were found.

It is now time to pass over from discussing the reasons and consequences of hypovitaminosis to the problem of choosing the most effective preparations where complex character of vitamin and mineral deficiency for a specific region is considered.

There is no doubt that the preference here should be given to remedies created with the consideration of components interaction and consist of several tablets, which do not contain antagonistic pairs of micronutrients. At the same time, micronutrients forming synergic combinations must be united in one tablet and, consequently, enter the organism simultaneously. This principle enables adequate assimilation and maximum activity of all bioactive components of the preparation.

Moreover, with this approach the possibility of development and degree of manifestation of some reactions of “allergic type” (individual intolerance), which are more evident at synchronous intake of two certain micronutrients [9]. One more way to fight with possible adverse reactions is using less “dangerous” in this respect forms of vitamins (e.g. nicotinamide instead of nicotinic acid) [10].

Synthetic vitamins constituting vitamin products are absolutely identical to their natural analogues found in food products as regards their chemical structure. At the same time, synthetic analogues don’t just compare well with natural ones in terms physiological effect on the organism (which has been proved by multiple research), but als have many advantages. Thanks to a high degree of purification and the use of modern technologies in production they are less allergenic. A number of researches proved that bioavailability of vitamin E synthetic analogues is much higher [11].

Pharmacoeconomic aspects of vitamin preventive health care

As far as present popularity of ineffective preventive remedies can be explained mostly by the reasons of economy, it is significant to mention some words about the summands of price and quality of polyvitamins.

Today on the market you can find some major western chemicopharmaceutical companies, which having big yields may provide producers of polyvitamins with high quality ingredients at a low price. The majority of domestic and foreign polyvitamin producers use these substances.

At the same time the cost of active substances constitutes only 5-10% from the prices of such products and none of manufacturers try to save money using cheap and low quality sunstances. Therefore, the majority of polyvitamins that are on sale are fairly similar as regards their structure and quality. The price difference is due to different production, packaging, promotion and distribution expenses.

Only the latest complex preparations created with the consideration of principle of components interaction have considerable advantages for consumers (better efficiency, less probability of adverse reactions). Assimilability of some vitamins and minerals from one-tablet products is 30-50% lower, than from the complexes having several preparation forms. It is ncesessary to mention that the loss of activity for all the components united in one tablet is different and hard to predict.

Different attempts to solve this problem by dividing the daily dose into several intakes (tablets with identical but reduced contents of all the components) or taking vitamins separately from minerals (one tablet has vitamins, another one has minerals) are inconsistent. In the first case the components interaction is not considered at all, as for the second one all the antagonistic pairs of vitamin-mineral and mineral-mineral types aren’t taken into account. As it has been mentioned above, there has been found especially many of antagonistic interactions for minerals, which accounts for some of them having common traffic mechanismsm and, therefore, competition for assimilation. A distinctive trait of vitamin and mineral complexes optimized in terms of assimilation and activity is applying the principle of components compatibility – uniting in each tablet of the complex only “friendly” vitamins and minerals, whereas antagonists go to different tablets.

Appearing of such vitamin and mineral complexes as ALFAVIT and Vitamineral where the daily dose of necessary micro- and macroelements is divided into different tablets on the market allows to solve the problem of “separately or together” in a way of reasonable compromise.

The right choice of preparation, its dosage, food influence on the components availability, length of treatment, chronopharmacological aspects, possibility of using it together with other medicines is a subject of serious reflection of a specialist prior to the beginning of vitamin therapy, which performs not only as a powerful instrument in providing vital activity to a sick person, but also in improving life quality of a healthy person.


  1. Baturin А.К. Medical journal, 2001, January, №5.
  2. Korovina N.А., Zaharova I.N., Zaplatnikov А.L., Obinochnaya Е.G. Children’s vitamin and microelement deficiency: modern approaches to correction. Manual. Medical Practices -М, 2004.
  3. Mashkovsky М.D. Medical remedies. 14-th edition, volume 2. – М.: New wave, 2000.
  4. Recommended consumption standards of food and bioactive substances. Methodic recommendations МR 2.3.1. 1915-04 (approved on July 2, 2004.). Moscow, 2004.
  5. Tuteljan V.А., Spirichev V.B., Sukhanov B.P., Kudasheva V.A. Micronutrients in the diets of a healthy and a sick person. – М.: Kolos, 2002.
  6. Shikh Е.V. Rational vitamin therapy in terms of interactions. Pharmaceutical herald, 2004, №11(332), с.8-9.
  7. Arnaud C.D. Calcium homeostasis: regulatory elements and their integration. Federation Proceedings, 1978, 37:2557-2560.
  8. Mrocheck J.E., Jolley R.L., Young D.S., Turner W.J. Metabolic response of humans to ingestion of nicotinic acid and nicotinamid. Clinical Chemistry, 1976, 22:1821-1827.
  9. Shrimpton D.H. Nutritional implications of micronutrients interactions. Chemist and Druggist, 2004, 15 May, pp 38-41.
  10. Sokol R.J. Vitamin E. In Ziegel E.E. and Filer L.J. (eds), Present knowledge in nutrition, 7th ed, 1996. ILSI Press, Washington, DC, pp 130-136.
  11. Yip R., Dallman P.R. Iron. In Ziegel E.E. and Filer L.J. (eds), Present knowledge in nutrition, 7th ed, 1996. ILSI Press, Washington, DC, pp 277-292.