Bucharest - Deficiency symptoms resulting from a lack of vitamins, minerals and trace elements are often overlooked and underestimated in everyday clinical practice. Even so, their occurrence is not infrequent among risk groups and can promote metabolic and neurological diseases, among others, in such groups. The importance of biofactors in the prevention and treatment of these diseases was discussed by renowned scientists and physicians from Romania, Hungary and Germany on September 8, 2016, at an international symposium which was organised by the Society for Biofactors (GfB) in cooperation with the Foundation of the Society for the Study of Neuroprotection and Neuroplasticity in Bucharest.
"According to most nutrition experts, a varied and balanced diet also covers the supply of all biofactors; however, this applies only to a population which is otherwise healthy,", the Chairman of the GfB, Prof. Hans-Georg Classen from Stuttgart-Hohenheim (Germany), pointed out. This is particularly important for patients suffering from metabolic diseases and/or those being treated with drugs affecting enteral absorption, metabolic availability or the excretion of biofactors. This also applied to many pregnant women or people who had an unbalanced diet, such as vegans or those on a weight-loss diet.
Although it is one of the main fundamental aspects of medicine that vitamins and minerals are essential for the normal physiological functions of the nervous system, the problem of deficiency is often underestimated. "Recent (but not only recent) data underlines the role of biofactors in some neurological conditions," emphasised Prof. Tudor Lupescu, Chair of the Neurological Department at the Prof. Dr. Agrippa Ionescu-Emergency Clinical Hospital in Bucharest, Romania. The neurologist issued a reminder of the importance of the B vitamins in diabetic neuropathy and Wernicke's encephalopathy. In addition, a clear correlation has been observed between vitamin D deficiency and multiple sclerosis.
Every deficit becomes a limiting factor on health
"A chain is as strong as its weakest link." - This also applies to the supply of biofactors, as Prof. Classen made clear: There must be no deficiency in any essential biofactor, as these were involved in complex reciprocal relationships. For example, the standard treatment of alcohol-related Wernicke-Korsakoff encephalopathy with vitamin B1 (thiamine) might remain unsuccessful if there were a simultaneous deficiency of magnesium. Because the key enzyme that had to be activated, i.e. transketolase, needed not only thiamine, but also magnesium as a cofactor. Magnesium deficiency was often associated with hypocalcaemia, even though sufficient quantities of calcium and vitamin D were being supplied. Because the magnesium deficiency negatively affects the vitamin D metabolism and calcium absorption. A deficiency in the supply of the mineral also resulted in secondary electrolyte imbalances in the cell, such as intracellular potassium deficiency as well as sodium and calcium overload, thereby promoting hypertension and spasms, according to the magnesium researcher Classen.
Magnesium in Cardiovascular Diseases
When used in a targeted manner, biofactors can have not only preventative, but also therapeutic effects. For instance, the cardiologist Prof. Joseph Borbola from Budapest (Hungary) pointed out the importance of magnesium in cardiovascular diseases: Various studies have shown that a high magnesium intake in the diet plays a protective role not only with respect to cardiovascular risk factors, but also in sudden cardiac death (by arrhythmias) and coronary heart diseases. Prof. Borbola referred to the special characteristics of magnesium orotate: The orotate ions it contains have a positive influence on the intracellular magnesium status and are also important cofactors for uridine, DNA and RNA synthesis. The compound was therefore used both for the treatment of magnesium deficiency and as an adjuvant therapeutic agent for cardiovascular diseases such as hypertension, arrhythmias, coronary heart diseases and cardiac insufficiency. Magnesium orotate was a unique, tried and tested magnesium therapy in cardiovascular medicine, explained Prof. Borbola in summary.
Benfotiamine: Treatment Option for Diabetic Complications
Biofactors can also have therapeutic effects in diabetes: "Beyond improving blood glucose control, pathogenetically oriented treatments of diabetic complications are scarce, with benfotiamine and alpha lipoic acid being the only two widely available substances," said Associate Professor Dr. Alin Stirban, Head of the Diabetes and Endocrinology Department at the Sana Clinical Centre and Sana Doctors' Surgeries in Remscheid (Germany).
Benfotiamine is a highly bio-available prodrug of vitamin B1 which is used when high therapeutic dosages are required. As studies have shown, benfotiamine can inhibit four hyperglycaemia-induced pathomechanisms which cause diabetic complications. In addition, it exerts anti-oxidative effects. The benefits that this can have for the patient was explained by Dr. Stirban on the basis of clinical studies: these showed the efficacy of benfotiamine in the treatment of diabetic neuropathy combined with excellent tolerability. Furthermore, initial study data also indicate positive vascular effects.
Age as a Risk Factor: Vitamin Deficiency is widespread
Elderly individuals in particular are frequently affected by metabolic and neurological diseases, as well as vitamin deficiencies. In view of the continually increasing share of elderly individuals in the overall population, this is an increasing problem, as Prof. Gabriel-Ioan Prada from the University of Medicine and Pharmacy in Bucharest (Romania) pointed out. "Vitamins are very important for metabolic diseases in older people," explained the expert in geriatrics and gerontology. For example, a lack of vitamin D increases the risk of metabolic syndrome and type 2 diabetes. Subclinical vitamin B deficiency states were also not unusual in the elderly. In turn, these promote neuropathies, which affected 70% of elderly diabetics, and therefore also increase the risk of falls and fractures. With regard to diabetic complications in elderly people, the thiamine prodrug benfotiamine has both preventative and therapeutic effects, according to Prof. Prada.
Vitamin B12 Deficiency: Recognising the Typical Symptom Pattern
A lack of vitamin B12 is a widespread problem among elderly individuals in particular, explained Prof. Karlheinz Reiners, former Deputy Director of the Neurological Clinic at the University Hospital in Würzburg (Germany): "Most deficiency states occur in the age group over the age of 50 and result from insufficient intestinal absorption," explained the neurologist. In recent years, restrictive diets such as those followed by vegetarians and vegans have become the main causes of such deficiencies. Unfortunately, vitamin B12 deficiency was too often overlooked because of its non-specific symptoms, lamented Prof. Reiners. It was important to recognise the typical pattern of vitamin B12 deficiency, which consisted of haematological, neurological and psychological symptoms.
Neurologically, the most severe symptoms result from a conduction deficit in the dorsal column tracts of the spinal cord, leading to unsteadiness of standing and gait, ataxia and strange sensory deficits, typically felt as a 'tight cuff' around the ankles, but also 'burning feet' sensations. Moreover, a depressed mood and cognitive losses or even dementia can occur. "In recent years, B12 supplementation has been identified as one of the rare treatments counteracting age-related brain involution and cognitive decline," Prof. Reiners emphasised.
A positive message for patients was also the fact that – according to more recent studies – the deficiency could be treated just as effectively by high-dose oral therapy with 1,000 µg of vitamin B12 per day as it could by parenteral treatment, explained Reiners. This meant that with such oral supplementation there was a simple, reliable and inexpensive form of therapy available.
Overall, the experts were in agreement that more attention should be paid to the supply of biofactors. "You only see what you know," Prof. Classen pointed out. Consideration should therefore always be given to possible deficiencies among risk groups. Only if these are compensated for in good time, an ideal treatment of such patients is possible.
International Symposium of the Society for Biofactors "Biofactors in Metabolic Diseases" on September 8, 2016 in Bucharest.