Usage Pattern of Multivitamin Preparations

By - 10/02/2006

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DR. N. Udupa

Dr. N. Udupa

Chronic diseases like diabetes, Tuberculosis, hypertension, arthritis are
major health challenges for the population around the world. While tackling
these challenges it is necessary to give more emphasis on new methods for
preventing it, now it is time to balance the scales with little common sense.

Scientists, healthcare professionals and experts agree that a multivitamin
is an excellent tool in the quest for good nutrition and better health, and
they also suggest that multivitamin supplement play important role in preventing
chronic diseases like diabetes, TB, and hypertension.

Role of Multivitamins in Diabetes Mellitus

Studies revealed there is potential
connection between the level of glycemia and the development of long-term
complications of diabetes. The glucose hypothesis says that hyperglycemia is
either directly or indirectly related to the development or progression of
diabetes specific complications, including retinopathy, nephropathy and
neuropathy. Atherosclerosis and other micro vascular diseases are the leading
cause of morbidity and mortality of diabetes mellitus patients. Oxygen free
radicals and reactive oxygen species have been shown to be involved in the
pathogenesis of diabetes and its complications.

Antioxidants such as ascorbic acid and tocopherol (Vitamin E) inhibit glucose
auto-oxidation and protein glycation. Thus they may prevent the formation
of advanced glycation and products (AGE) and LDL oxidation. Thus antioxidants
can arrest the progression or development of diabetic complications. Vitamin
B complex and trace elements also play supportive role since they are the
constituents of different metabolic reactions and enzyme systerns.

Role of Multivitamins in Hypertension

Hypertension has been associated with low
levels of antioxidant vitamins, particularly ascorbic acid, and supplementation
of antioxidants to hypertensive patients can reduce blood pressure. The
potential benefit of antioxidants is also supported by studies linking
hypertension to vasodilatation by the superoxide radical.

Some antihypertensive agents like captopril, β-blockers, and certain calcium
antagonists are acknowledged as free radical scavenging agents’ invitro,
but their low circulating concentrations (nanomolar) make them insignificant
in comparison with endogenous antioxidants (micromolar). Normal endogenous
vasodilators like acetylcholine mediate vasodilatation due to release of Endothelium
Derived Relaxing Factor (EFRF), which was subsequently established as Nitric
Oxide (NO).

Nitric oxide is inactivated by mainly the free radical like superoxide effecting
into vasoconstriction endothelial thickening, which can manifest as hypertension.
Interaction of NO with superoxide may generate the potent tissue – damaging
moiety, peroxynitrate (ONOO-) Antioxidant supplementation of selenium vitamin
E and Vitamin C leads to strengthening of endogenous free radical scavenging
systems like glutathione. The detrimental effects of the oxygen radicals in
the pathophysiology of hypertension may be prevented by this mechanism.

Role of Multivitamins in Tuberculosis

Still today TB is considered to be one of the killer
infectious diseases, which is taking the toll of millions of lives around the
world. It is evident from the studies
that nutritional status may be associated with poor outcomes in TB patients.
Several observations and limited intervention studies support the hypothesis
that nutritional supplements may be beneficial in the treatment in TB.

The long-term treatment for TB is harmful to the patient’s health. Multivitamins
with combination of antioxidants, vitamin, mineral and trace element, helps
to improve the immunosystem of the patient. These antioxidants, can act by
catalysing the reduction of the oxidants inside the cell. It helps in protecting
the body in long term treatment regimen condition. This 6 month and 9 month
long term treatment may results in several adverse effects like, hepatitis,
optic neuritis, arthralgia, anorexia, and rearly photosensitivity resulting
in bright red-brown discoloration. Pellagra-like symptoms including stomatitis
and diarrhoea have been reported in few cases. In this chronic illness and
adverse conditions an antioxidant, minerals, and trace elements, which are
present in multivitamin can help patients.

Role of Multivitamins in Hyperpyrexia and Infections

Hyperpyrexia may occur in response to
infection, inflammation, or by unknown cause. Exogenous agents like bacteria,
virus and fungi, which can produce fever through activation of phagocytes in
bone marrow to release a fever-inducing hormone and endogenous pyrogen. This pyrogen,
in turn, is believed to induce synthesis of prostaglandins which act as
mediators for fever by influencing the thermoregulatory center in
hypothalamus.

Increase in body metabolic rate, decreases in glycogen stores and adipose tissue,
increased catabolism of proteins and oxidative stress, increased loss of sodium
potassium and body waste are some of the metabolic effects of fever in human
body. Fever apparently increases the requirements for vitamins like ascorbic
acid and B-complex.

Infection may have significant effects on nutritional status. Nutrient needs
are generally increased during infection by some of these mechanisms-

The stress
reaction induces a catabolism which results in increased loss of magnesium
zinc, phosphate etc.
In severe
infections with fever the energy needs are increased.
Anorexia
decreases nutrient intake.
Malabsorption
in enteric infections.

Individuals with marginal nutritional status
with regard to vitamins are at increased risk for deficiencies of vitamins.

Conclusion

Today, use of multivitamins in healthcare is
not confined only as a nutrient supplement. Its curing potential of several
chronic diseases has been proved. Its role in managing the diseases like Diabetes
Mellitus, Hypertension, Tuberculosis, Hyperpyrexia, Infections and Inflammation
is important and it needs detail study to reveal more scientific information on
its applications in other chronic and deadly diseases.

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About Authors

Ajay Pise, Virendra Ligade, Laxmidhar Naik, D. Sreedhar, Manthan
Janodia, N. Udupa*

Department of Pharmacy Management, Manipal College of Pharmaceutical Sciences,
Manipal

Ajay Pise

Ajay Pise

First Author (Ajay Pise) completed his B. Pharmacy from
Institute of Pharmaceutical Education and Research Centre, Wardha (Maharashtra)
in 2002, and have completed his M. Pharm (Pharmaceutical Marketing) from Manipal
College of Pharmaceutical Sciences, Manipal (Karnataka) in 2004. Presently
working as a lecturer in Department of Pharma Management, Manipal College
of Pharmaceutical Sciences, Manipal. He has presented good number of papers
in the conferences and his papers are published in reputed journals.

Virendra Ligade

Virendra Ligade

Virendra Ligade completed his B. Pharmacy from K.L.E’s College of Pharmacy,
Hubli, and has completed his M. Pharm (Pharmaceutical Marketing and Administration)
from Manipal College of Pharmaceutical Sciences, Manipal (Karnataka) in 2002.
Presently working as a lecturer in Department of Pharma Management, Manipal
College of Pharmaceutical Sciences, Manipal. His papers were published in
reputed journals and have presented many papers in the conferences.

D. Sreedhar

D. Sreedhar

First author D. Sreedhar did B.Pharm from Roland Institute
of Pharmaceutical Sciences, Berhempur, Orissa, M.Pharm (Pharmaceutical Marketing
and Administration) from Manipal
College of Pharmaceutical Sciences, Manipal, Karnataka and presently working
as lecturer in the Department of Pharmacy Management and is registered for PhD
under the guidance of Dr
N. Udupa, HOD(Department of Pharmacy Management) and Principal, Manipal
College of Pharmaceutical Sciences. Papers were published in the reputed
national journals.

*Corresponding Author