Micronutrient Supplementation: Need or Producing Costly Urine

Vitamins are dynamic micronutrients that cannot be created within our system or in inadequate quantities, and the fundamental resources by which we get Vitamins are across our balanced diet.[1] Trace elements (or trace metals) are minerals required in minute quantities in breathing tissues. Some minerals are recognised as nutritionally indispensable, others perhaps critically necessary and the remaining minerals are cogitated to be dispensable (additional).[2] Micronutrients are Vitamins and minerals that are obligatory for maintaining physiology in minimal amounts. However, their impact on a body’s health is critical, and any deficiency can cause severe and even life-threatening conditions.[3] Excess consumption of formulated micronutrients as drugs can promote adverse drug reactions (ADRs).[4] It has been reported that 70% of people in the United States of America (USA) consume dietary supplements and spend over US$ 28 billion.[5] The Congress of the USA demarcated the turn of phrase ‘dietary supplement’ in the Dietary Supplement Health and Education Act of 1994. A dietary complement is a medicine (drug) envisioned for consumption that, amongst other dietary and nutritional necessities, comprises a ‘dietary ingredient’ we wish to add to our diet practice.[6,7] The International Olympic Committee Consensus Statement expressed dietary supplements as ‘a food, food component, nutrient, or non-food compound that is purposefully ingested in addition to the habitually consumed diet to achieve a specific health and/or performance benefit’[8] and the National Institutes of Health, of the USA, explains dietary supplements as, ‘a product that is intended to supplement the diet; A dietary supplement contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids and other substances) or their components; is intended to be taken by mouth as a pill, capsule, tablet, or liquid; and is identified on the front label of the product as being a dietary supplement’.[9] The FDA controls dietary add-ons in an evidently diverse way compared to regular medicines. The pharmaceutical industry must produce documentary evidence regarding pharmacodynamic potential and ADRs profile for any medicine with the application for approval. The industry is not required to show proof of dietary supplement efficacy and ADRs.[10,11] However, pharmaceutical industries are not permitted to claim this dietary supplement is effective against a particular disease, either preventive or curative. Moreover, the pharmaceutical industry must encrypt on the product: ‘The FDA has not evaluated this statement. This product is not intended to diagnose, treat, cure, or prevent any disease’.[5,10] Therefore, dietary supplements are not ineludible and beneficial for one or all.[5] The policy of the FDA before 15 October 1994, was easy-going for manufacturers in marketing dietary supplements. The policy was amended in 1994, and currently, the pharma industry must produce rational evidence supplements are safe for human use.[10–13] Multiple studies reported that currently, people around the globe, including US nationals, are selecting add-on meals (unacceptable diet) to substitute for and ignore whole meal foods (balanced diet).[14–16] Therefore, FDA policies and guidelines must be considerably escalated to improve and accentuate dietary supplements’ safety issues.[14] Lentjes 2019 reported that ‘Vitamins and minerals were used to cure deficiency diseases’.[17] On the contrary, British dietary supplement consumers had positive opinions, for example, ‘Help me to be healthy’, ‘Stop me getting ill’, ‘Not do me any harm’ and ‘Be the best I can do for myself’.[18] de Jong et al. in 2003 reported that of the people of The Netherlands who consume supplements, 48% considered it ‘an easy way to stay healthy’ and 61% thought there were ‘sufficiently proven’ health benefits.[19] Another study in the USA described reasons for consuming supplements that possess potential pharmacological properties to prevent and cure disease and supplement the diet.[20] The national guidelines of the UK,[21,22] the USA[13,23,24] and The Netherlands[25,26] do not recommend regular intake of dietary supplements in healthy subjects. These guidelines revealed that supplements largely possess no benefit amongst healthy adults[27–29] besides specific deficiency disorders. Nevertheless, the National Health Service promotes Vitamin D supplementation amongst those suffering from Vitamin D deficiency risk.[18] It has been recommended that essential physiological needs of vitamins and minerals be met through a balanced (wholesome) diet.[4,30,31] Knapik et al. in 2022[32] reported that approximately 50% and 70% consume dietary supplements of Americans and US Army communities, respectively. Overall, amongst these individuals, 18% suffer from ADRs. Nonetheless, those who take combinations of dietary supplements had a higher (20%) rate of ADRs. Reported ADRs include ‘palpitation, nausea, vomiting, diarrhoea, abdominal pain, muscle cramps, pain, weakness, sleep disturbances, insomnia, dizziness, confusion, lightheadedness, tingling, numbness, seizures, convulsions, tremors’.[32] FDA reported that consumption of dietary supplements causes ADRs, for example, rashes, dyspnoea, diarrhoea, severe joint or muscle pain, slurred speech and haematuria. These ADRs could vary from inconsequential to a deathly illness.[33] Felix et al. in 2015[34] revealed that elderly communities or those cases with multiple prescription medicines had an increased possibility of the devolvement of ADRs because drug interactions subsist with drugs metabolising enzymes,[34–36] for example, cytochrome P450 enzyme induction and inhibition. ADRs were more complicated when combining dietary supplements altered with another brand; one component is responsible for harmful effects, and under-reporting remains another issue for supplement-induced adverse health impact and management. Felix et al.’s study additionally revealed that supplement-provoked ADRs frequently and rapidly resolve amongst younger people with stoppage of the scurrilous supplement.[34] Vitamin A, iron, iodine, folate, zinc and Vitamin D are common micronutrient deficient in women and children in many low- and middle-income countries (LMICs)[37,38] and observed amongst marginalised communities of high-income countries.[38,39] These micronutrients deficiency frequently co-exists because of poor dietary practice, unhygienic sanitation, scarce dietary consumption, shortage of obtainability of food, unfair dispersal of food inside the same home, inadequate knowledge regarding the need for dietary diversity and repeated episodes of infectious diseases and no or pitiable access to health care.[40–45] The World Health Organization (WHO) reported multiple micronutrient (MMN) deficiencies, principally LMICs.[46] The scarcity of micronutrients is primarily foods that contain higher nutritional value, usually costly or overpriced and the ordinary population unable to access these diets, such as fresh fruit, raw and green leafy vegetables, nuts, seeds, beans, peas, oily fish, eggs and animal products. Moreover, fortified foods are regularly not locally unavailable.[46–49] Tam et al. in 2020, in their systematic review and meta-analysis, reported that lone iron or iron + folic acid, MMNs, micronutrient powders (MNPs) supplementation, fortification-based nutritional deficiency amongst high-risk populations and complementing one or more critical nutrients to extensively and consistently consumed foods during processing minimise the risk of iron deficiency anaemia. Lipid-based nutrient supplementation (LNS) improves amongst paediatric cases of growth retardation and underweight. Nonetheless, MMN strategies likewise marginally enhanced ‘length-for-age z-scores’.[50] Vitamin A add-on with a regular diet is expected to cut down all-cause fatal outcomes, whereas zinc reduces diarrhoeal-related adverse outcomes. Notably, this study[50] additionally reported that various potential properties of LNS and MNPs were detained when pooling data regarding the strategies’ positive impact in improving nutritional deficiencies.[50] Keats et al. in 2019[37] conducted another systematic review and meta-analysis regarding micronutrient deficiency in LMICs. Large-scale food fortification (LSFF) raised serum vitamin and mineral levels in various populations of LMICs and exhibited an optimistic influence on physiological activity.[37] The improvements include 34%, 74% and 41% in minimising anaemia, the odds of goitre and the odds of neural tube defects, respectively. In addition, this study revealed that LSFF supplementation of Vitamin A increases the possibility of saving practically 3 million paediatric cases per year from the atrocities of Vitamin A insufficiency.[37] Although worldwide, LSFF strategies in managing nutritional deficiency in LMICs are considered to be a practical approach. Nonetheless, hitherto, efficacious data regarding LSFF are very minimal; hence, more research is required, and careful consideration of the local context, both regional and national, needs to be made.[37] Another study revealed an urgent need to build competence amongst all stakeholders to approach the challenges of micronutrient insufficiency and supplementation programmes in designing, accomplishing and keeping under surveillance to evaluate the outcome on the population.[51] Still, dietary alteration towards healthy diet consumption remains the best choice.[37] The principal findings of this paper are illustrated in Figure 1.Figure 1: The principal findings of this paper.Image Credit: Fatimah Zahra Binti Mohamad RomConsent for publication The author reviewed and approved the final version and has agreed to be accountable for all aspects of the work, including any accuracy or integrity issues. Disclosure The author declares that they do not have any financial involvement or affiliations with any organisation, association or entity directly or indirectly related to the subject matter or materials presented in this editorial. This includes honoraria, expert testimony, employment, ownership of stocks or options, patents or grants received or pending royalties. Data availability Information is taken from freely available sources for this editorial. Authorship contribution All authors contributed significantly to the work, whether in the conception, design, utilisation, collection, analysis and interpretation of data or all these areas. They also participated in the paper’s drafting, revision or critical review, gave their final approval for the version that would be published, decided on the journal to which the article would be submitted, and made the responsible decision to be held accountable for all aspects of the work.