Professor Fatai Fehintola, consultant physician and clinical pharmacologist at the University College Hospital, Ibadan, speaks about multivitamins and mineral supplements, when they are required, and caution on their rational use for improving health, reports Nigerian Tribune.
Excerpts:
Are multivitamins necessary supplements we should be taking?
Well, multivitamins presuppose that one is dealing with a combination of various ingredients known as vitamins, including vitamins A, B, C, D, E, and maybe K as well. Iron and some other agents, like calcium, come under the so-called minerals. But multivitamins plus minerals are also regarded as a supplement to meals and so on. Well, it is not wrong. Sometimes, it is part of what can be regarded as a minimum requirement in certain circumstances.
We talk about a balanced diet, having an adequate amount of various food ‘elements’ or nutrients vis-à-vis carbohydrates, proteins, and fat, plus the various minerals and vitamins in the right quantity.
While people talk about different meals, for example, fufu or amala with soup that is garnished with pieces of meat or fish, these give those basic constituents like protein, fat, and carbohydrates.
But the micronutrients, particularly vitamins and minerals, may not necessarily be in the right quantity to meet the person’s body requirement. And that is why the use of multivitamins and minerals may become more of a necessity, as it were, for such individuals. They are expected to take it along with their meals.
Foods contain vitamins and minerals. Okra, for example, contains a significant amount of folic acid. By the time it is overcooked, some of these become denatured. Some of its mineral content is also lost. As such, adding maybe some form of supplements in terms of multivitamins and minerals may become useful for individuals.
But in all of this, it must be done with moderation. Gone are the days when a high percentage of people would pick fresh fruits, fresh tomatoes, and everything else, all on their farm, thus being able to get some of these minerals and vitamins in the right quantity within their bodies by the time they had eaten such things three to four times in a day. Many people do not even have time to do this now. So, it is not wrong, as it were, to use these multivitamins and minerals as supplements to meals in trying to ‘secure’ a balance.
Vitamin deficiencies can pose serious health consequences to the body, we are told. What are those consequences?
Individuals who have some form of mineral or vitamin deficiency cannot function optimally, and there are various ways by which such things can manifest in such individuals.
Deficiencies of some vitamins, for example, vitamin B deficiency, will not make an individual able to metabolise some drugs and some foods properly.
Such nutrient deficiency can affect the functioning of important organs in the body, like the heart, including the healing of wounds in an individual.
For instance, vitamin B12 deficiency can lead to fatigue, weakness, neurological problems, and an increased risk of cardiovascular diseases, while scurvy, impaired wound healing, and an increased risk of infectious diseases may happen due to vitamin C deficiency.
Deficiencies in minerals also have negative implications. Anaemia, fatigue, weakness, and impaired cognitive function may occur due to iron deficiency, just as weakened bones and an increased risk of fractures may be suggestive of calcium and/or vitamin D deficiencies.
Frequent muscle cramps are sometimes suggestive of magnesium deficiency, too. So, there are consequences, and primarily, it is ill health, even when the serious conditions relating to this deficiency syndrome are not so obvious.
Does it, therefore, mean that taking multivitamins can be a safety net, particularly in Nigeria, for some individuals?
Circumstances of individuals differ, so the availability and requirements of these essential minerals and vitamins also differ based on the mode of food preparation and sundry related issues.
The food might have been overcooked, the minerals might have been lost, and the vitamins are denatured. So, in circumstances like that, it may be something that will prevent the individual from falling ill or preserve the person’s health.
However, older adults may benefit more from multivitamins to help support declining nutrient levels and promote healthy ageing. Likewise, in pregnancy, women may also benefit from taking multivitamins to ensure they get essential nutrients for the unborn baby’s development as a result of demands.
Is it safe for everybody to take multivitamins and mineral supplements generally? Are there some populations that must avoid them altogether?
That is a very tricky question, but what I would say is that we need moderation in everything. For example, in the tropics, sunlight is abundant, and our skin helps us with the production of vitamin D precursors. If an individual also now chooses to take a lot of vitamin D-containing supplements, the person may be jeopardising his health. Taking water-soluble vitamins like B and C has the singular advantage of easy excretion by the healthy kidney, thus preventing excessive accumulation.
However, it is not the same with fat-soluble vitamins like vitamins D, E, and A. It is for this reason that multivitamin and mineral supplements should be taken in moderation. And it is for individuals, for example, who don’t have time for proper meals or feed on junk. Such individuals may be encouraged to take some kind of supplement, but again, and I keep saying it, it must be done in moderation.
It is said that water-soluble vitamins are best absorbed on an empty stomach and that fat-soluble vitamins are better absorbed with food. So, when do you suggest is the right time to take these mineral and vitamin supplements?
The first and most important action is to get the adequate quantity. And the way to get an adequate quantity is, fortunately for us, natural sources of these multivitamins and minerals abound. Individuals who cannot access natural sources are advised to take a ‘regulated’ amount through ‘supplements’. Whether on an empty stomach or with a full stomach, it does not matter for individuals on the fringes trying to maintain normal levels of minerals and vitamins in their body system. The timing is not significant in such individuals.
However, if the multivitamin and mineral supplements are for therapeutic purposes, clear instructions would have to be given as to when to take them, and then they would even be monitored to be able to determine whether the person has achieved the therapeutic goal or otherwise.
How can individuals get appropriate multivitamins for use? Is it safe to buy such things online?
That would be a bit of a tough question to answer, because recently in the news, there was a report on very unscrupulous individuals changing labels of drugs. The drugs had expired; they were putting new labels with forged expiry dates. I refer to that because whether we use online or direct purchase, to some extent, we are just purchasing blindly.
But even then, how do you know that even when you go there physically, you are still buying what you are supposed to buy? Therefore, the key thing to note is the outlet itself.
Take, for example, University College Hospital, which has a pharmacy. You can be sure that they would have done due diligence vis-à-vis where these drugs are obtained, who is in charge, and the regulatory agency like NAFDAC would have certified such drugs and that kind of thing.
So the chances of falling prey to an adulterated, fake, or counterfeit medication or supplement are likely to be reduced. Of course, some pharmacies are quite ethical in their practice outside the shores of the public facility, like this one.
Some manufacturers specify that their product is for an age group. Are multivitamin and mineral supplements age-specific?
Yes, because there are some physiological demands when it comes to certain minerals or vitamins in our food, depending on the demands of the body. For example, a very young child that is still growing requires much more energy and protein than an adult who merely, maybe, requires this for body maintenance. It is the same in someone who is ill; such an individual also requires more to replenish what has been used in trying to fight the illness. In the case of an illness, these micronutrients are used up at a faster rate.
So, if its intake is not increasing at the same rate to ensure that the basic concentration is maintained, then there may be dysfunction.
Yes, multivitamin and mineral supplement manufacturers may tag some as age-specific; essentially, they are just trying to sell their wares. So they can put all sorts of embellishments on it.
How about combining multivitamin and mineral supplements with other medications, say for other conditions like hypertension and diabetes, which is often the case in older persons?
Yes, the use of multiple medications is not necessarily an evil. What matters most is whether there is a rational use of medication.
Don’t get me wrong. I’m not saying that polypharmacy is good. I’m only saying that it may be imposed by conditions. Like you have just mentioned, somebody has hypertension and has diabetes or osteoarthritis. All of those things are common in relatively older generations or old people. They will have to meet these conditions.
If the same individual now also has the flu or comes down with malaria, he will also need to use a medication that contains two different drug ingredients. So, it may be imposed in certain circumstances.
But again, like I said, the key thing is the rationality. Are they the right drugs? Are they used at the right time or the right quantity for the right period, and so on?
So, once all of those are taken into consideration, then one knows why some of these things are being done. And therefore, it is not to be condemned. And by extension, if an adult requires taking some supplement, there’s nothing that says that such an adult cannot take the vitamin supplement because he’s taking some other medication. So again, what is important is the rational use of not just the supplement but also the other drugs that the person was taking before. But note that some multivitamins can ‘interact’ with other medications, such as blood thinners or diabetes medications.
What do you mean by rational use?
Rational use involves the use of the right drugs at the right time, for the right reason, for the right period, for the right purpose, and for the right duration. So everything must be right. There must be a rational basis for giving any drug to anybody at any particular time for any particular purpose.
Even with multivitamin and mineral supplements, it may be used as a safety net in certain circumstances. But some other people don’t require it. So if such a person who doesn’t require it takes it, then it is not rational. That is not a rational use of medication.
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