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 published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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