A recent review study published in Nutrients aimed to summarize the knowledge about micronutrients with regard to selected neurological diseases and shed light on the possibilities of therapeutic intervention in clinical practice.
Study: The Role of Micronutrients in Neurological Disorders. Image Credit: photka/Shutterstock.com
Background
Vitamins and trace elements, collectively known as micronutrients, are vital for basic metabolic reactions in the human body. The deficiency of micronutrients or even increased amounts could lead to serious health disorders.
Research has revealed that long-term abnormal levels of micronutrients could be associated with the etiopathogenesis of some common neurological diseases. Chronic and acute alterations in micronutrient levels could also lead to serious complications in neurological diseases.
Water-soluble vitamins (B, C) are not stored in the body, but fat-soluble vitamins (A, D, E, K) are. A deficiency in fat-soluble vitamins may manifest later. Micronutrients mainly act as catalysts in enzyme systems.
Other essential roles include modulation of cellular immunity, antioxidant activity, and wound healing. Micronutrients can neutralize free radical reactive nitrogen species (RNS) and reactive oxygen species (ROS).
They modulate cellular immunity and tissue healing either directly or indirectly by using substances created through their induction.
Micronutrients in clinical practice
It is common for symptoms of micronutrient deficiency to appear after long-lasting depletion.
These symptoms range from skin manifestations and frequent infections to serious deficiencies like osteomalacia (vitamin D) and scurvy (vitamin C). Long-lasting deficiencies can manifest acutely or via lactic acidosis development.
Capillary leakage increases in pathological conditions due to the influence of released cytokines. Subsequently, the plasma level of all micronutrients decreases.
Owing to the fact that the concentration of micronutrients with antioxidant effects is highest at the site of inflammation, redistribution mechanisms are also involved.
It should be noted that there is an increase in the loss of micronutrients with drainages, urine, repeated hemodialysis, and burn victims.
The reduction in micronutrient plasma levels is a guess rather than a real detection. The levels of only a small number of micronutrients can be assessed routinely. This micronutrient dilemma raises several questions.
Micronutrient administration: To whom and how?
Administration is recommended for hospital patients admitted to the intensive care unit (ICU). Such patients have oxidative stress, redistribution, and increased usage. Patients receiving repeated hemodialysis and those with burns, exudates, and wound areas are also candidates for fortification.
In patients with home parenteral nutrition (HPN), special attention is required during substitution. The enteral route is the most natural route for administration, either in an ordinary meal or defined enteral nutrition by gastrostomy or using a nasogastric/nasojejunal tube.
In supplying micronutrients through this route, we should consider the principles of absorption of individual micronutrients. An increase in the quantity of one could preclude the absorption of a different one.
As an example, the greater intake of Iron reduces the resorption of copper (Cu) and zinc (Zn). The depletion of Copper then manifests as microcytic anemia.
Sometimes, synergies can be detected with regard to absorption. As an example, the administration of vitamin C increases the absorption of Iron. However, the limited absorption capacity of the gastrointestinal tract (Vitamin C) must be considered.
In critically ill patients and in patients with malabsorption, the whole quantity of micronutrients in a given amount of enteral nourishment is not absorbed completely.
The parenteral route is another option for the administration of micronutrients. This is particularly useful when using a range of pharmaceutical mixtures.
Monitoring and supplementation of micronutrients in some neurological disorders
In Alzheimer’s disease (AD) and Parkinson’s disease (PD), supplementation with Vitamins A, B, C, D, E, Folic Acid, Selenium, and Zinc brings about benefits proven by research. For AD, Homocysteine (Hcy), 25-OH vitamin D, Cu, and Zn should be monitored, while for PD, it is important to monitor B6, 25-OH vitamin D, vitamin E, and Hcy.
In both cases, a diet rich in antioxidants (DRA) can be used as an adjuvant therapy. In Amyotrophic lateral sclerosis (ALS), 25-OH vitamin D and vitamin E should be monitored, and supplementation with Vitamins E, D, B, and C is recommended.
In Wilson’s disease (WD), FD Zinc (Zn) should be supplemented, DRA should be used as adjuvant therapy, and Cu, Zn, and ceruloplasmin should be monitored.
For Huntington’s disease (HD), 25-OH vitamin D should be monitored, and supplements with proven benefits are Coenzyme Q10, vitamins A, D, E, C, B1, B3, biotin, Se, and Zn (pyruvate).
Vitamin D supplementation is beneficial in Myasthenia gravis (MG), and in the case of Multiple sclerosis (MS), Vitamins A, D, and E are recommended.
Other diseases analyzed in this study are Epilepsy, Ischemic stroke, Myopathy, Neuropathy, Restless leg syndrome, Injury to the central nervous system, Injury to the peripheral nervous system, and Sarcopenia.
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