Supplements serve as a protective
and corrective tool to address nutrient deficiencies in the modern diet
and in drug-induced cases. — Filepic
Discussion about supplements is a popular topic.
A
stroll across a pharmacy, clinic or healthcare establishment will find
you faced with a stacked shelf of vitamins, minerals, herbs and
nutritional powders.
This
ubiquitous availability tends to bring up a critical and reasonable
question in the public’s mind: if we eat well enough, why then do
doctors and healthcare professionals prescribe supplements?
The
solution is not found in health fads, or on sales campaigns, but exists
within modern living, evolving dietary patterns, the escalating burden
of chronic disease and chronic medication adherence.
Supplements are not meant to replace food and the traditional diets that Malaysians take pride in.
Nutrient
deficiencies do not occur only in people who eat poorly or live in
extreme conditions; they are increasingly common even among individuals
who appear well-nourished.
Malaysia is frequently referred to as a
country rich in food, due to abundant produce but modern eating habits
have changed significantly over the past few decades.
Rapid urbanisation, long working hours, shift work and easy
access to convenience foods – all these have changed what and how we
eat.
Fast and highly processed items, sugary sweets and fried
foods, as well as large portions of refined carbohydrates now serve an
increasingly important role in urban dining patterns.
These foods provide enough calories and are satiating in nature, but they usually lack important micronutrients.
National
local surveys found that adults fail to meet the recommended intakes of
calcium, iron (especially women) and many vitamins, despite consuming
adequate, or even high, calories.
This leads to a paradox in which one may seem well-fed or even overweight but be functionally malnourished.
These
deficiencies may not lead to illness over the long term but over time
are associated with fatigue, lower immunity, bad bone health and
increased risk of chronic disease.
Impaired absorption and changing lifestyles
The gastrointestinal system is crucial for the absorption of nutrients.
Various
conditions, including irritable bowel syndrome, inflammatory bowel
disease, coeliac disease, low stomach acid and prior gastrointestinal
surgeries, can hinder the uptake of vitamins and minerals.
Additionally,
even without a formal diagnosis, elements such as chronic stress,
alcohol intake, and frequent antibiotic usage can compromise gut
integrity and disturb the balance of the microbiome, thereby diminishing
nutrient availability.
Modern lifestyles place extra demands on nutritional health.
Chronic
stress, often faced by urban professionals and those working shifts,
has been linked to an increased requirement for various nutrients,
particularly magnesium and B vitamins.
Inadequate sleep can disrupt hormonal balance and nutrient utilisation.
Alcohol
consumption hinders the absorption and metabolism of B vitamins, zinc
and magnesium, whereas smoking amplifies oxidative stress and reduces
levels of vitamin C and antioxidants.
Together, these elements
contribute to a gradual and unnoticed decline in nutrient levels,
frequently occurring well before any laboratory indicators become
evident.
Increased physiological demands
Various life stages such as pregnancy, breastfeeding, adolescence, menopause and ageing require increased nutrient intake.
In
these scenarios, relying solely on dietary consumption may not suffice
to fulfil these heightened requirements, making supplementation a viable
and evidence-supported option.
Expectant and nursing mothers need
to increase their intake of iron, folate, iodine, calcium and vitamin D
to preserve maternal well-being and facilitate the growth of the foetus
or infant.
Factors like chronic stress, infections, inflammation
and significant physical or mental exertion further increase the
turnover of nutrients.
Older adults, due to age-related digestive
changes, are often prescribed multiple long-term medications, which must
be taken cautiously to ensure adequate nutrient absorption.
The
metabolic demands for these individuals are heightened as many also have
chronic health issues such as hypertension, diabetes and heart disease,
hence require medications that can disrupt the body’s nutrient balance.
An overlooked problem
Perhaps
one of the most clinically significant yet often overlooked causes of
nutrient deficiencies is the prolonged use of medications.
These
drug-induced nutrient deficiencies (DIND) arise when drugs disrupt the
processes of digestion, absorption, metabolism, transport or excretion
of essential nutrients.
This does not suggest that medications are
detrimental or unnecessary; in fact, many are crucial for effective
disease management.
However, neglecting to consider their nutritional impacts can undermine treatment efficacy and overall health.
To
counteract deficiencies resulting from medication use, supplements are
advised, which is particularly important in Malaysia, where chronic
conditions such as diabetes and heart disease are widespread.
The
high prevalence of diabetes often necessitates long-term medication,
potentially leading to unintended malnutrition and associated public
health concerns.
DIND can occur as medications impede nutrient
absorption or metabolism, frequently going unnoticed since symptoms like
fatigue or cognitive issues are commonly attributed to ageing or stress
instead of nutrient shortages.
Common medications
Proton pump inhibitors e.g. omeprazole and pantoprazole are widely used for gastric pain, acid reflux and ulcer disease.
By
reducing stomach acid, these drugs reduce symptoms and encourage
healing, but stomach acid also plays a key role in the absorption of
critical nutrients.
Persistent application of proton pump
inhibitors has been linked with impaired absorption of vitamin B12,
magnesium, calcium and iron in the long term.
This could lead to
anaemia, nerve symptoms, muscle cramps and a higher risk of fractures
over time, especially in elderly people.
Metformin, which is the most prescribed drug of choice for type 2 diabetes, is another well-established example.
Long-term
use of metformin has been well-established to decrease vitamin B12
absorption, leading to fatigue, tingling or numbness in the hands and
feet, memory and concentration problems, and further peripheral
neuropathy.
Vitamin B12 is not regularly monitored or
supplemented, which leads to symptoms attributed solely to diabetes
itself, and leaves the deficiency untreated.
Statins, often prescribed to lower cholesterol and the risk of cardiovascular diseases, present nutritional problems too.
Such
medicines suppress cholesterol production by blocking a metabolic
pathway that also produces coenzyme Q10, a key ingredient for the
formation of energy in muscular cells.
Lower levels of coenzyme
Q10 can give rise to muscle pain, weakness and fatigue – effects that
can also cause people to stop their medications without medical
guidance.
The use of hormonal contraceptives utilised by women,
has been linked to lower levels of several nutrients such as vitamin B6,
vitamin B12, folate, magnesium and zinc.
Not all users are affected but chronic use may affect mood, energy level and tolerance for stress in high-risk individuals.
Diuretics,
which are the medications commonly used for conditions including
hypertension and heart disease, raise urinary potassium, magnesium and
zinc losses.
Deficiencies in these nutrients are observed as
muscle cramps, weakness or abnormal heart rates, especially among
elderly patients.
Corticosteroids, like prednisolone, which are
administered against asthma and immune-mediated diseases, inflammation
or inflammatory disease disrupt the metabolism of calcium and vitamin D,
leading to calcium deficiency and bone-wasting.
Osteoporosis is becoming a growing problem among older Malaysians.
Meanwhile,
the prolonged or frequent use of antibiotics can disturb the gut
microbiome, which is essential for the synthesis of various vitamins,
such as vitamin K and several B vitamins.
This imbalance, known as
dysbiosis, may negatively affect digestion, immune system
functionality, and the absorption of nutrients even after the completion
of antibiotic treatment.
DIND are frequently observed yet frequently go unrecognised in clinical settings, despite their widespread nature.
The
symptoms associated with these deficiencies are often vague, routine
blood tests may yield normal results, and the onset of deficiencies
progresses gradually.
Additionally, consultations with healthcare
providers tend to focus on disease management rather than evaluating
nutritional health.
As a result, numerous individuals experience
persistent symptoms that could be alleviated and prevented through
proper nutritional intake.
The role of supplementation
Supplementation,
when applied correctly, serves as a strategy for correction and
prevention rather than a substitute for evidence-based medicine.
Its
objective is to restore physiological equilibrium, assist metabolic
processes, mitigate the long-term impacts of diseases and the side
effects of medications.
It is crucial that supplementation is
tailored to the individual, taking into account clinical evaluations,
medication history, dietary habits and when necessary, laboratory
assessments.
In short, supplements are not lavish goods but serve
as protective or corrective tools, especially for people with chronic
diseases.
Supplementation should be subject to regular review and used alongside, not replace medical treatment and a healthy diet
When
used wisely and correctly, supplements help support the body so that
medical treatments can work more effectively and overall health is
preserved.
Datuk Dr Nor Ashikin Mokhtar is a consultant
obstetrician and gynaecologist, and a functional medicine practitioner.
For further information, email starhealth@thestar.com.my. The
information provided is for educational and communication purposes only,
and it should not be construed as personal medical advice. Information
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