Antioxidants and Micronutrients

Approved and Clinically Accepted Uses:

• Prevention and Treatment of Nutritional Deficiencies:
  To prevent or correct deficiencies of vitamins, minerals, and trace elements caused by inadequate intake, malabsorption, or increased physiological needs (e.g., pregnancy, aging, chronic illness).
• Adjunctive Support in Chronic Diseases:
  Utilized to reduce oxidative stress and support cellular function in diseases such as cardiovascular disorders, diabetes mellitus, neurodegenerative diseases (e.g., Alzheimer’s, Parkinson’s), and chronic inflammatory conditions.
• Immune System Support:
  To enhance immune response in immunocompromised individuals or those experiencing physiological stress.
• Wound Healing and Tissue Repair:
  Applied in cases of delayed wound healing or recovery from surgery, burns, or trauma.
• Specific Clinical Indications:
• Vitamin C: Prevention and treatment of scurvy.
• Zinc: Treatment of zinc deficiency, support in diarrhea management in children, and acne treatment.
• Selenium: Support in certain thyroid disorders and antioxidant functions.
• Copper, Manganese, and other trace elements: To address specific deficiencies as part of balanced supplementation.

Off-Label or Investigational Uses:

• Antioxidant supplementation for cancer prevention (evidence inconclusive).
• Use in age-related eye diseases such as macular degeneration and cataracts.
• Potential neuroprotective effects in neurological disorders (under investigation).

General Principles:

• Dosages depend on the specific nutrient, patient age, health status, and indication.

Adults:

• Vitamin C:
  Recommended dietary allowance (RDA) approximately 75–90 mg/day; therapeutic doses up to 500–1000 mg/day orally may be used in specific clinical contexts.
• Vitamin E:
  RDA around 15 mg (22.4 IU) daily; doses up to 400 IU/day have been employed in clinical trials.
• Zinc:
  RDA ranges from 8–11 mg/day; therapeutic doses for deficiency or specific conditions typically 15–30 mg/day.
• Selenium:
  RDA is 55 mcg/day; supplementation up to 200 mcg/day may be indicated in certain situations.
• Copper:
  RDA approximately 900 mcg/day.

Pediatrics:

• Dosage adjusted according to age and weight; adherence to pediatric RDA is essential.

Elderly:

• May require supplementation at or slightly above RDA due to reduced absorption or dietary intake.

Special Populations:

• Pregnancy and Lactation:
  Increased needs for some micronutrients; supplementation typically adjusted accordingly.
• Renal or Hepatic Impairment:
  Caution required with minerals such as potassium and magnesium due to altered clearance.

Administration Routes:

• Primarily oral supplementation.
• Parenteral administration reserved for severe deficiency or malabsorption cases.

Antioxidants neutralize free radicals and reactive oxygen species (ROS) by donating electrons, preventing oxidative damage to cellular components such as lipids, proteins, and DNA. Micronutrients act as cofactors for endogenous antioxidant enzymes (e.g., glutathione peroxidase requires selenium; superoxide dismutase requires copper, zinc, or manganese), enabling detoxification of harmful oxidants. This collective action reduces oxidative stress, preserves cellular integrity, supports immune function, and facilitates enzymatic processes critical for maintaining physiological homeostasis and preventing disease progression.

• Absorption:
  Varies by nutrient; water-soluble vitamins (e.g., vitamin C) are well absorbed, while fat-soluble vitamins (A, D, E, K) require bile salts and dietary fats for optimal absorption.
• Distribution:
  Nutrients distribute widely; fat-soluble vitamins are stored in liver and adipose tissue.
• Metabolism:
  Some vitamins undergo activation to biologically active forms (e.g., vitamin D to calcitriol); many minerals remain in ionic form.
• Excretion:
  Water-soluble vitamins are primarily excreted renally; fat-soluble vitamins and minerals are excreted via bile and feces.
• Half-life:
  Varies considerably; for example, vitamin C approximately 10 hours, vitamin E 13–17 hours.

• Pregnancy:
  Most antioxidants and micronutrients are essential and safe at recommended doses. High doses, especially of fat-soluble vitamins (notably vitamin A), may be teratogenic and should be avoided.
• Lactation:
  Generally safe when taken at recommended doses; nutrients are transferred into breast milk and contribute to infant nutrition.
• Caution:
  Safety data for high-dose antioxidant supplementation during pregnancy and lactation are limited; medical supervision is recommended.

• Primary Class: Nutritional supplements
• Subclasses: Antioxidants (e.g., vitamins C and E), essential minerals, and trace elements (e.g., zinc, selenium).

• Known hypersensitivity to specific vitamins, minerals, or excipients.
• Hypervitaminosis or mineral overload conditions (e.g., vitamin A toxicity, hemochromatosis).
• Individual contraindications depending on specific micronutrient and patient condition.

• Risk of toxicity with excessive intake of fat-soluble vitamins (A, D, E, K).
• High-dose antioxidant supplementation may interfere with chemotherapy or radiation therapy.
• Potential for nutrient interactions affecting absorption and efficacy (e.g., calcium impairing iron absorption).
• Monitor for allergic reactions and gastrointestinal side effects.
• Use caution in patients with renal impairment to avoid accumulation of minerals like potassium and magnesium.

• Common:
  Gastrointestinal disturbances (nausea, diarrhea), allergic reactions (rash, itching).
• Serious or Rare:
  Symptoms of hypervitaminosis (headache, dizziness, liver dysfunction with excess vitamin A or D), mineral toxicity (e.g., copper overload), and iron overload.
• Dose Dependence:
  Side effects typically increase with doses exceeding recommended levels.

• Minerals such as calcium and magnesium can reduce absorption of certain antibiotics (e.g., tetracyclines, fluoroquinolones).
• Vitamin E may potentiate anticoagulant effects of warfarin, increasing bleeding risk.
• High-dose antioxidants may reduce the efficacy of certain chemotherapy agents.
• Alcohol use may exacerbate micronutrient depletion.

• World Health Organization (WHO) and Food and Agriculture Organization (FAO):
  Emphasize micronutrient supplementation in vulnerable populations to reduce disease burden.
• National Institute for Health and Care Excellence (NICE):
  Recommends balanced micronutrient intake, cautions against unnecessary high-dose antioxidant use.
• U.S. Food and Drug Administration (FDA):
  Advises evidence-based use of supplements, discourages indiscriminate high-dose consumption.

• Store in a cool, dry place at temperatures between 20°C and 25°C (68°F to 77°F).
• Protect from light, moisture, and heat.
• Keep containers tightly closed and out of reach of children.
• Follow specific product instructions regarding refrigeration if applicable (rare).