A recent in-depth review study published in the journal Nutrients tried to help us better understand how micronutrients are connected to specific neurological diseases and show possible ways to treat them in clinical practice.

Background

Micronutrients, like vitamins and trace elements, are essential for basic body functions. Too little or too much of these micronutrients can cause serious health issues. Recent studies show that long-term imbalances in micronutrients might be connected to common neurological diseases. Also, sudden changes in micronutrient levels can lead to serious issues in neurological disorders.

Water-soluble vitamins (such as B and C) are not stored in the body, while fat-soluble vitamins (such as A, D, E, and K) are stored, and deficits in the latter may become noticeable at a later time. Micronutrients mainly help enzymes work better, micronutrients function as enzymatic cofactors, enhancing the efficiency of biochemical reactions. Additionally, they possess multifaceted roles such as restructuring the immune system, antioxidant properties, and aiding healing wounds. These micronutrients play a pivotal role in clearing harmful substances from our body, strengthening our immune system, and indirectly aiding in tissue repair.

Micronutrients in Clinical Practice

Manifestations of micronutrient deficiency often become apparent following prolonged depletion. These symptoms can encompass a range from increased susceptibility to infections to skin-related issues and to severe deficiencies like osteomalacia (associated with vitamin D deficiency) and scurvy (related to vitamin C deficiency). Prolonged deficiencies can manifest acutely and may even result in lactic acidosis development.

In certain health problems, cytokines released can cause tiny blood vessels to leak, which then lowers the levels of micronutrients in the blood. Additionally, when there’s inflammation, the micronutrients with antioxidant abilities tend to be most concentrated there, and this involves shifting them around in the body. Moreover, in cases where there’s fluid drainage, urine, repeated hemodialysis, or burns, the loss of micronutrients makes the decrease in blood micronutrient levels even worse.

It’s important to acknowledge that the reduction in plasma micronutrient levels is often estimated rather than definitively detected, standard tests are only accessible for a few micronutrients, this poses a significant challenge in the field.

Micronutrient Administration: Who and How?

Micronutrient administration is generally recommended for patients admitted to the intensive care unit (ICU), as they experience oxidative stress, redistribution, and increased utilization. Patients undergoing repeated hemodialysis and those with exudates, burns and wound areas are also considered candidates for supplementation.

In patients receiving home parenteral nutrition (HPN), special attention is crucial during the substitution process. Using the digestive system, either through regular meals or specialized nutrition via tubes, is the most natural way to provide these micronutrients. But one needs to be careful due to some micronutrient interference with others when taken in large amounts. For example, if you consume a lot of iron, it might make it harder for your body to absorb copper (Cu) and zinc (Zn), which could lead to a lack of copper and a type of anemia called microcytic anemia.

Synergistic interactions in absorption may also occur, such as vitamin C enhancing iron absorption. Keep in mind that our digestive system can only absorb a certain amount of nutrients, especially vitamin C. In people who have trouble absorbing nutrients or are sick, they might not be able to absorb all the vitamins and minerals from the food they eat.

Using pharmaceutical mixtures to provide micronutrients directly into the bloodstream is another way, and it can be handy when using different combinations of these medications.

Monitoring and Supplementation in Selected Neurological Disorders

In the context of specific neurological disorders, monitoring and supplementation of micronutrients play a crucial role:

• Alzheimer’s Disease (AD) and Parkinson’s Disease (PD): Supplementation with vitamins A, B, C, D, E, Folic Acid, Selenium, and Zinc has shown benefits. Monitoring parameters include Homocysteine (Hcy), 25-OH vitamin D, Cu, and Zn for AD and B6, 25-OH vitamin D, vitamin E, and Hcy for PD. Diets rich in antioxidants (DRA) can complement therapy.
• Amyotrophic Lateral Sclerosis (ALS): Monitoring 25-OH vitamin D and vitamin E is vital. Supplementation recommendations include Vitamins E, D, B, and C, with DRA as an adjuvant therapy.
• Wilson’s Disease (WD): Supplementation of FD Zinc (Zn) is advised, alongside monitoring Cu, Zn, and ceruloplasmin levels, with DRA serving as an supplementary treatment.
• Huntington’s Disease (HD): Monitoring 25-OH vitamin D levels is crucial, and beneficial supplements include Coenzyme Q10, vitamins A, D, E, C, B1, B3, biotin, Se, and Zn (pyruvate).
• Myasthenia Gravis (MG): Vitamin D supplementation is recommended.
• Multiple Sclerosis (MS): Supplementation with Vitamins A, D, and E is advised.
  
  

This study also dives into several other neurological disorders, including Epilepsy, Ischemic stroke, Myopathy, Neuropathy, Restless leg syndrome, Injury to the central nervous system, Injury to the peripheral nervous system, and Sarcopenia.

In summary, understanding the intricate relationship between micronutrients and neurological health is an essential aspect of modern healthcare, offering potential avenues for improving the management and treatment of neurological disorders. Further research in this area holds promise for enhancing our ability to support individuals affected by these conditions.