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Uses and misuses of vitamins and minerals.

"Food is the best source of vitamins and minerals. A balanced diet contains far more vitamins and minerals than the daily need of an individual. Intake of too much of vitamins is not only useless but can be harmful". It is better to have a balanced diet which provides vitamins and minerals in adequate quantities and in natural forms. Amongst the fruits guava is the richest source of vitamin C followed by mangos and citrus fruits and bers. Amongst the vegetables, turnip tops, mustard green and gram leaves are richest in vitamin C. Watermelon is the richest source of carotene (vit. A) and carrots also contain it in large quantities.

Different vitamin and mineral preparations are widely prescribed and used. It is common to see prescriptions from qualified doctors containing one or more than one such preparations. As a result of aggressive and unethical promotion by the pharmaceutical companies and common prescriptions by the doctors, people use these preparations to improve their general state of health, to treat general weakness and body aches and pains. Another very common practice is to use vitamin and mineral preparations concomitantly with antibiotics. Strangely enough, this belief is promoted and reinforced by the doctors through their prescriptions.

One indication of the wide use of these "tonics" is that in public sector a huge share from the National Drug Bills is consumed on purchase of vitamins. The national pharmaceutical statistics of Pakistan show that vitamins are the second largest group of drugs consumed. In the year 1977, ninety million rupees and in 1986 over 400 million rupees were spent on their purchase. In private sector there is even more waste. This is despite of the fact that a clinician in this country rarely comes across cases of primary vitamin deficiencies like rickets, scurvy, hypo-prothrombinaemia and megaloblastic anaemia etc. Secondary deficiencies are also rare.

What is the rationale behind manufacturing, registering, prescribing and using all these preparations? One way of answering this question is to review and appreciate the specific indications for the use of different vitamins and minerals and their recommended doses in these indications vis a vis their normal daily requirement.

Vitamin deficiency diseases are quite rare in Pakistan as is evident from the hospital sickness returns, so the large scale use of vitamins is generally a misuse. In order to rectify this situation, there is a need to rationalize the vitamin formulations so that the waste could be minimized. The formulations based on the daily requirements, as mentioned in Table-I are thus recommended. Market is littered with very expensive, useless and harmful preparations of vitamins and minerals in the form of tablets, capsules, syrups and injections. Some even contain hormones which may cause dangerous consequences. Many of these are even imported e.g. a calcium preparation "Ossopan" costing Rs. 4.50 per tab is imported. Isn't it an absolute waste of national resources?

"Food is the best source of vitamins and minerals. A balanced diet contains far more vitamins and minerals than the daily need of an individual. Intake of too much of vitamins is not only useless but can be harmful". It is better to have a balanced diet which provides vitamins and minerals in adequate quantities and in natural forms. Amongst the fruits guava is the richest source of vitamin C followed by mangos and citrus fruits and bers. Amongst the vegetables, turnip tops, mustard green and gram leaves are richest in vitamin C. Watermelon is the richest source of carotene (vit. A) and carrots also contain it in large quantities.

The human body has vitamin reserves e.g. folic acid is stored for six months and vit B12 for two or three years. Primary deficiencies of vitamins are rare, however, secondary deficiencies occur in conditions like malabsorption syndrome. It is reasonable to prescribe vitamin supplements based on the estimated daily requirements (which are very small), when a patient is unable to take enough food because of gastro-intestinal disturbances.

Use of massive doses of vitamins like vitamin A for osteoarthritis and neuropsychiatric disorders, vitamin D for osteoporosis, vitamin C for prevention of colds and influenza, vitamin B for neuritis, myalgia and sprains, vitamin K for all types of hemorrhages, vitamin B12 for weakness and for all types of neurological disorders, vitamin E for sterility and coronary heart disease are conspicuous examples of innumerable misuses of vitamins being practiced since long. Use of pseudo-vitamin B17 (Laetrile) for cancer is a more recent example of this kind.

All objective studies have concluded that vitamin B12 has no appelite-stimulating properties and no role in neurological disorders other than subacute combined degeneration occurring in pernicious anaemia or other forms of vitamins B12 deficiency (Herbert, 1977) yet it is pathetic to note that vitamin B12 (Methycobal) is imported in Pakistan, wasting precious foreign exchange and promoted with information for all sorts of conditions including every type of neuropathy, weakness, anorexia and lethargy.

At present, there is a concern about vitamin A deficiency (xerophthalmia, keratomalacia etc.) and its contribution in the high rate of IMR by increasing the severity-and the risk of the three main health threats facing children in low social-economic communities in some countries; diarrhoeal diseases, measles and pneumonia. However, at the same time one should be aware of the consequences of the overdosage of vitamin A. Hypervitaminosis A is a well-described paediatricentity: The most common clinical manifestation of which includes bone pain and tenderness, occasionally associated with subcutaneous induration. This is accompanied by roentgenographic findings of critical hyperostosis. Anorexia, irritability and fissuring of tongue are frequently reported. More rarely, hepatic fatty infiltration with hepatomegaly, abnormal results of liver function tests and pathologic evidence of hepatocellular damage can be found. Benign intracranial hypertension and pseudotumour cerebri also appear as a complication. In young children, administration of low doses, of 20,000 to 60,000 units per day for a period of one to three months has resulted in vitamin A intoxication. The more commonly used higher doses of vitamin A upto 500,000 units per day when ingested for more than six months can produce toxic symptoms. Of course a few doses of vitamin A may be prescribed to children suffering from measles belonging to under-privileged communities.

Vitamin C in excessive doses may increase absorption of oxaluria and cause renal stones. High doses of vitamin C can destroy substantial amount of vitamin B12 when indigested with food. Excessive quantity of vitamin B6 (pyridoxine) may cause a variety of neurological syndromes e.g. polyneuropathy. Large doses of vitamin B1 may cause peripheral circulatory collapse. Anaphylactic reactions due to vitamin B complex injections are known to occur. The author has a knowledge of death of a girl due to misuse of injection B complex. There is no reason at all to give injections of vitamins to patients who can absorb easily by G. I. tract and expose them to hazards of dangerous infections like HIV, viral hepatitis etc. Toxicity due to megadoses of niacin which includes hyperglycemia, hyperuricemia, liver function disturbances, G.I. upsets, skin lesions and circulatory disturbances, is well-known. Toxic effects due to overuse of other vitamins are also being increasingly reported in the medical literature

In addition to the to indiscriminate use of vitamin wastes significant amount of money which is badly needed for buying food and essential drugs. It is pity to see large urban hospitals spending so much on these wasteful preparations while life saving drugs are not available in the rural areas and even in these hospitals for the poor patients. It will be correct to say that sewerage of these hospitals are depots of wasted vitamins. Inositol, biotin, choline, calcium pantothenate, glycerophosphates and lecithin are included in various multivitamin preparations though there is no evidence of their value. Likewise liver extract is obsolete but still included in some preparations.

The situation can be improved if the physicians do not allow themselves to be misled by the disinformation of the pharmaceutical industry. Public has also to be generally educated about the complications of vitamin misuse. It is a fashion with the higher socio-economic class to use vitamins as tonics. It must be stressed that the daily requirements of vitamins are very small and an average meal contains more than enough. Furthermore, the medical profession must be reminded that if `Vita' in word vitamin stands for life, min means minimum. At administrative level, the restriction of sale of preparations containing high doses of vitamins will undoubtedly be a helpful step in achieving the desired goal.
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Author:Akhtar, Mahmud Ahmad; Mirza, Zafar
Publication:Economic Review
Date:Sep 1, 1994
Words:1413
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