Uses, Misuses of Vitamins


 Uses, Misuses of Vitamins

Lt. Gen. Prof. Emeritus Mahmud Ahmad Akhtar
Former Surgeon General/DGMS (IS), Pakistan Army

Vitamins are most often misused in Pakistan. The name Vitamin literally denotes Vit in Mini-doses. Its needs are in very minute quantities, many in a few micrograms or a few milligrams. Further infants and children’s daily requirements are much less. It should be kept in mind that a balanced diet consisting of whole grains, vegetables, fruits, pulses, low-fat dairy products, nuts, seeds, fish, poultry, meats, oils provides far more amounts of vits than needed by the body. For poor people seeds like flax, sesame, nuts like peanuts, veggies, whole grains low cost fruits etc. can provide more than enough of vitamins needed by the body. Appropriate exposure of body parts to sun can provide enough vitamin D.

Furthermore, a balanced diet also provides calorific ingredients, fiber, minerals, antioxidants, flavonoids etc. while the artificial vits preparations contain many chemicals which on prolonged use may be deleterious to the body – date expired chemicals can be very hazardous. Furthermore human-body has enormous reserves of many vitamins like Vit B12 for 2-5 years and folic acid for six months.

Generally deficiencies of vitamins are very rare. However deficiencies can occur amongst very poor people who suffer from severe malnutrition. In addition to deficiencies of vitamins (mini-quantities) these people suffer seriously from deficiencies of other constituents of food. Therefore these people need food and vitamins in mini quantities and not in mega quantities. Unfortunately most of the vitamins in the market contain vitamins in mega quantities which not only cause waste of meager financial resources of patients who are quite often impoverished and of the country but are also very harmful. Billions in foreign exchange go down the drain. An expert opined that Pakistan's hospital sewerages are depots of wasted vitamins.

Vitamin A in high doses my cause nausea, vomiting, fissuring of tongue, liver damage, bone-cortical hyperostosis, benign intracranial hypertension, pseudo-motor cerebra etc. Vit A in high doses may cause complications during pregnancy. High doses of b-carotene cause higher incidence of lung carcinoma amongst smokers. Excessive quantities of Vit B6 contained in many preparations may cause a variety of neurological syndromes like polyneuropathy, cerebellum degeneration. In the treatment of tuberculosis, INH drug may cause its deficiency for which 10 mg B6 daily is recommended.

High doses of niacin may cause hyper-glycaemia, hyper-uricaemia, G. I upsets,liver function disturbances, skin lesions and circulatory disturbances. Patients of diabetes-mellitus and gout need precautions in using niacin. In clinical practice hazards like this are often noted.

Vitamin C in high doses may increase absorption of calcium causing kidney stones. The preps containing combinations of high doses of vitamin C and calcium are hazardous therefore should be de-registered by the “Drug Regulatory Authority”. Use of high dose of Vit E, increases incidence of carcinoma prostate and stroke (hemorrhagic) have been observed. High doses of Vit E increase bleeding - risks of patient on anticoagulant and on anti-platelet drug therapy.

There is however, genuine use of vitamins.   Babies suffering from measles of poor families may get eye and respiratory tract complications. In order to avoid those one capsule of 50 thousand units of vitamin A should be provided.

Four hundred micrograms of folic acid daily should be provided to females before conceiving and be continued during pregnancy in 1st trimester in order to prevent neural-tube defects. Vit C in small quantities may be provided to iron deficient anemic patient to increase iron absorption. The daily requirements of vitamin D can be obtained by carefully exposing parts of body to the sun from 10 AM to 4 PM and also by having diet of dairy products, egg yolk, fish, prawns, mushroom, etc.

Patient deficient in Vitamin D may be provided Vit D preparations avoiding toxicity. Vitamin B­12 is the most misused rather abused vitamin. Its daily requirement is only 2 micrograms a day while the body has 3 to 5 years reserves. Pakistani diet contains enormous amounts of Vit B12. Furthermore pernicious anemia, in which Vit B12 is not absorbed is generally not seen in Pakistan. Yet billions of rupees are wasted on this vitamin, that too on an irrational form “Methyl-cobalamin” which is not registered by any valid drug authority in the world.

Vit B12 has three analogues cyano-cobalamin which is absorbed poorly, Hydroxyl-cobalamin which has the longest half-life, used all over the World and furthermore this is the only analogue which is recommended by the WHO “Drug Expert Committee”  including the top experts of the World and by top World Regulatory authorities like BNF, PDA, European, Scandinavia’s etc.

An injection of 500 micrograms of hydroxyl-cobalamin costs rupees two per vial. The Pakistan Drug Regulatory Authority granted Rs. 160 per vial of Methylcobalamin to a firm and also registered its Methylcobalamin tablets of no value at enormous price. Not only had that, the Nexus of industry, corrupt rulers (politicians and bureaucrats) got hydroxyl-cobalamin out of the market.

Furthermore the rulers granted the company advertisement rights with claim of its value in every disease, whole of neurology, psychiatry, rheumatology, and orthopedics in fact every disorder. The companies and rulers made billions of rupees while the poor debt-ridden country on IMF bailout lost billions. That is how Pakistan’s economy and morals have been destroyed by naked corruption. Ironically the preparation containing Vit B12 1000 micrograms, Vit B 100 mg, Vit B6 50 mg are priced Rs. 12 ½. This can happen only in Pakistan – the cause of its steep downfall. This depicts Pakistan’s drug and pricing policy – anti people policy.

Conclusion: Irrational and harmful and money guzzling vitamin preparations should be deregistered. Only rational vits preps recommended by the world drug authorities contained in “Essential Drug List” should be rationally used and promoted. Essential Drug Policy should be implemented and rational drug pricing be made eliminating corrupt practices which are eroding the foundations of Pakistan.

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