Micronutrients are essential dietary elements that are needed only in very small quantities. Micronutrients include vitamins and trace minerals. Even though the body only needs small amounts, they are essential for good health.

Micronutrients play important roles in maintaining immune function and neutralizing the reactive oxygen intermediates produced by activated macrophages and neutrophils in their response to microorganisms.

Vitamins
Vitamins regulate chemical reactions such as digestion and energy production.

Fat-soluble vitamins, including vitamins A, D, E, and K, are stored by the body to meet future needs. Water-soluble vitamins, including B vitamins and vitamin C, are absorbed by the body and the excess is removed in urine.

Minerals
Minerals form the structures in the body (calcium in bone, iron in blood) and regulate metabolic processes involving nerves, muscles, hormones, etc.

Antioxidants
Free radicals such as reactive oxygen species are formed during a variety of biochemical reactions and cellular functions. Free radicals stress the immune system. Antioxidants neutralize free radicals and protect cells from being damaged. Antioxidants such as vitamins E, C and carotenoids, help defend against harmful free radicals which can damage cell DNA. Certain amino acids and trace minerals such as selenium are also used in the synthesis of more complex antioxidant molecules.

Pharmacodynamics

The following account summarizes the pharmacological effects of the vitamins and minerals and describes the conditions caused by a deficiency of these.

Vitamin A
Vitamin A plays an important role in the visual process. It is isomerized to the 11-cis isomer and subsequently bound to the opsin to form the photoreceptor for vision under subdued light. One of the earliest symptoms of deficiency is night blindness, which may develop into the more serious condition called xerophthalmia. Vitamin A also participates in the formation and maintenance of the integrity of epithelial tissues and mucous membranes. Deficiency may cause skin changes, resulting in a dry rough skin, with lowered resistance to minor skin infections. Deficiency of vitamin A, usually accompanied by protein-energy malnutrition, is linked with a frequency of infection and with defective immunological defence mechanisms.

Vitamin B₁ (Thiamine)
Thiamine (as the coenzyme, thiamine pyrophosphate) is associated with carbohydrate metabolism. Thiamine pyrophosphate also acts as a co-enzyme in the direct oxidative pathway of glucose metabolism. In thiamine deficiency, pyruvic and lactic acids accumulate in the tissues. The pyruvate ion is involved in the biosynthesis of acetylcholine via its conversion to acetyl co-enzyme-A through a thiamine-dependent process. In thiamine deficiency, therefore, there are effects on the central nervous system due either to the effect on acetylcholine synthesis or to the lactate and pyruvate accumulation. Deficiency of thiamine results in fatigue, anorexia, gastrointestinal disturbances, tachycardia, irritability and neurological symptoms. Gross deficiency of thiamine (and other vitamin B group factors) leads to the condition, beriberi.

Vitamin B₂ (Riboflavin)
Riboflavin is phosphorylated to flavin mononucleotide (FMN) and flavinadenine dinucleotide (FAD), which act as co-enzymes in the respiratory chain and in oxidative phosphorylation. Riboflavin deficiency presents with ocular symptoms, as well as lesions on the lips and at the angles of the mouth.

Vitamin B₆ (Pyridoxine)
Pyridoxine, once absorbed, is rapidly converted to the co-enzymes, Pyridoxal phosphate and pyridoxamine phosphate, which play an essential role in protein metabolism. Convulsions and hypochromic anaemia have occurred in infants deficient in pyridoxine.

Vitamin B₁₂ (Cyanocobalamin)
Vitamin B12 is present in the body mainly as Methylcobalamin, adenosylcobalamin and hydroxocobalamin. These act as co-enzymes in the trans methylation of homocysteine to methionine; in the isomerization of methyl malonyl co-enzyme to succinyl co-enzyme and with folate in several metabolic pathways, respectively. Deficiency of vitamin B12 interferes with hemopoiesis and produces megaloblastic anaemia.

Vitamin C (Ascorbic Acid)
Vitamin C cannot be synthesized by humans; therefore, a dietary source is necessary. It acts as a cofactor in numerous biological processes, including the hydroxylation of proline to hydroxyproline. In case of its deficiency, the formation of collagen is, therefore, impaired. Vitamin C is important in the hydroxylation of dopamine to noradrenaline and in hydroxylation occurring in steroid synthesis in the adrenals. It is a reducing agent in tyrosine metabolism and, by acting as an electron donor in the conversion of folic acid to tetrahydrofolic acid, is indirectly involved in the synthesis of purine and thymine. Vitamin C is also necessary for the incorporation of iron into ferritin. Vitamin C increases the phagocytic function of leucocytes; it possesses anti-inflammatory activity and it promotes wound healing. Deficiency can produce scurvy. Features include swollen inflamed gums, petechial haemorrhages and subcutaneous bruising. The deficiency of collagen leads to the development of thin watery ground substances in which blood vessels are insecurely fixed and readily ruptured. The supportive components of bone and cartilage also become deficient, causing bones to fracture easily and teeth to become loose. Anaemia commonly occurs, probably due to vitamin C’s role in iron metabolism.

Vitamin E
Vitamin E deficiency has been linked to disorders such as cystic fibrosis where fat absorption is impaired. It is essential for the normal function of the muscular system and the blood.

Nicotinamide
The biochemical functions of nicotinamide as nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP) include the degradation and synthesis of fatty acids, carbohydrates and amino acids as well as hydrogen transfer. Deficiency produces pellagra and mental neurological changes.

Calcium
Calcium is an essential body electrolyte. It is involved in the maintenance of normal muscle and nerve function, and is essential for normal cardiac function and the clotting of blood. Calcium is mainly found in the bones and teeth. Deficiency of calcium leads to rickets, osteomalacia in children and osteoporosis in the elderly.

Phosphorus
Phosphate plays important roles in the osteoblastic and osteoclastic reactions. It interacts with calcium to modify the balance between these two processes. Organic phosphate esters play a key role in the metabolism of carbohydrates, fats and proteins and in the formation of ‘high-energy phosphate’ compounds. Phosphate also acts as a buffer and plays a role in the renal excretion of sodium and hydrogen ions.

Pantothenic Acid
Pantothenic acid is incorporated into co-enzyme A (CoA) and is involved in metabolic pathways involving acetylation, which includes detoxification of drug molecules and biosynthesis of cholesterol, steroid hormones, mucopolysaccharides and acetylcholine. CoA has an essential function in lipid metabolism.

Folic Acid
Folic acid is reduced in the body to tetrahydrofolate which is a co-enzyme for various metabolic processes, including the synthesis of purine and pyrimidine nucleotides and, hence, in the synthesis of DNA. Deficiency of folic acid leads to megaloblastic anaemia.

Biotin
Biotin is a co-enzyme for carboxylation during the metabolism of proteins and carbohydrates.

Lycopene
Lycopene is a naturally occurring compound that is found in bright red fruits and vegetables like tomatoes, watermelon, and grapefruit. Lycopene is a carotenoid. Lycopene has many health benefits, including disease prevention and protection. Lycopene is an antioxidant and protects the body from damage from free radical stress.

Selenium
Selenium is an essential trace element, the deficiency of which has been reported in humans. It is thought to be involved in the functioning of membranes and the synthesis of amino acids. Deficiency of selenium in the diet of experimental animals produces a fatty liver followed by necrosis.

Copper
Traces of copper are essential to the body as constituents of enzyme systems involved in oxidation reactions.

Magnesium
Magnesium is essential to the body as a constituent of skeletal structures and in maintaining cell integrity and fluid balance. It is utilized in many of the functions in which calcium is concerned, but often exerts the opposite effect. Some enzymes require the magnesium ion as a co-factor.

Potassium
Potassium is the principle cation of intracellular fluid and is intimately involved in the cell function and metabolism. It is essential for carbohydrate metabolism and glycogen storage and protein synthesis, and is involved in transmembrane potential where it is necessary to maintain the resting potential in excitable cells. Potassium ions maintain intracellular pH and osmotic pressure. Prolonged or severe diarrhoea may lead to potassium deficiency.

Zinc
Zinc is a constituent of many enzymes and is, therefore, essential to the body. It is present with insulin in the pancreas. It plays a role in DNA synthesis and cell division. Reported effects of deficiency include delayed puberty and hypogonadal dwarfism.

Manganese
Manganese is a constituent of enzyme systems, including those involved in lipid synthesis, the tricarboxylic acid cycle, and purine and pyrimidine metabolism. It is bound to arginase of the liver and activates many enzymes.

Chromium
Chromium is an essential trace element involved in carbohydrate metabolism

The following account describes the absorption process and resultant outcome for each of the active constituents.

Vitamin A
Except when liver function is impaired, Vitamin A is readily absorbed. Beta-carotene is Provitamin A and is the biological precursor to vitamin A. It is converted to vitamin A (retinol) in the liver; retinol is emulsified by bile salts and phospholipids and absorbed in a micellar form. It is partly is conjugated with glucuronic acid in the kidneys and is partly metabolized in the liver and kidneys, leaving 30 50% of the dose for storage in the liver. It is bound to a globulin in the blood. Metabolites of vitamin A are excreted in the faeces and the urine.

Vitamin B₁ (Thiamine)
Thiamine is absorbed from the gastrointestinal tract and is widely distributed to most body tissues. Amounts in excess of the body’s requirements are not stored but excreted in the urine as unchanged thiamine or its metabolites.

Vitamin B₂ (Riboflavin)
Riboflavin is absorbed from the gastrointestinal tract and, in the circulation is bound to plasma proteins. It is widely distributed. Little is stored and excess amounts are excreted in the urine. In the body, riboflavin is converted to FMN and then to FAD.

Vitamin B₆ (Pyridoxine)
Pyridoxine is absorbed from the gastrointestinal tract and converted to active pyridoxal phosphate, which is bound to plasma proteins. It is excreted in the urine as 4-pyridoxic acid.

Vitamin B₁₂ (Cyanocobalamin)
Cyanocobalamin is absorbed from the gastrointestinal tract and is extensively bound to specific plasma proteins. A study with labelled vitamin B12 showed that it was quickly taken up by the intestinal mucosa and held there for 2-3 hours. Peak concentrations in the blood and tissues did not occur until 8-12 hours after dosage with maximum concentrations in the liver within 24 hours. Cobalamins are stored in the liver, excreted in the bile and undergo enterohepatic recycling. Part of a dose is excreted in the urine, most of it in the first 8 hours.

Vitamin C (Ascorbic Acid)
Ascorbic acid is readily absorbed from the gastrointestinal tract and is widely distributed in the body tissues. Ascorbic acid in excess of the body’s needs is rapidly eliminated in the urine and this elimination is usually accompanied by a mild diuresis.

Vitamin E
Vitamin E is absorbed from the gastrointestinal tract. Most appears in the lymph and is then widely distributed to all tissues. Most of a dose is slowly excreted in the bile.

Nicotinamide
Nicotinic acid is absorbed from the gastrointestinal tract, is widely distributed in the body tissues, and has a short half-life.

Calcium (Dicalcium Phosphate)
A third of ingested calcium is absorbed from the small intestine. Absorption of calcium decreases with age.

Phosphorus
The body contains from 600-800 g of phosphorus, over 80% of which is present in the bone as phosphate salts, mainly hydroxyapatite crystals. The phosphate in these crystals is available for exchange with phosphate ions in the extra-cellular fluids.

Calcium Pantothenate
Pantothenic acid is readily absorbed from the gastrointestinal tract and is widely distributed in the body tissues. About 70% of pantothenic acid is excreted unchanged in the urine and about 30% in the faeces.

Folic Acid
Folic acid is absorbed mainly from the proximal part of the small intestine. Folate polyglutamates are considered to be deconjugated to monoglutamates during absorption. Folic acid rapidly appears in the blood where it is extensively bound to plasma proteins. Some folic acid is distributed in body tissues, some is excreted as folate in the urine, and some is stored in the liver as folate.

Biotin
Following absorption, biotin is stored in the liver, kidneys and pancreas.

Selenium
Although it has been established that selenium is essential to human life, very little information is available on its function and metabolism.

Copper
Copper is absorbed from the gastrointestinal tract and its major route of excretion is in the bile.

Magnesium
Magnesium salts are poorly absorbed from the gastrointestinal tract; however, sufficient magnesium will normally be absorbed to replace deficiency states. Magnesium is excreted in both the urine and the faeces, but excretion is reduced in deficiency states.

Potassium
Potassium salts are absorbed from the gastrointestinal tract. Potassium is excreted in the urine, the faeces, and in perspiration. Urinary excretion of potassium continues even when intake is low.

Zinc
Zinc is poorly absorbed from the gastrointestinal tract. It is widely distributed throughout the body. It is excreted in the faeces, with traces appearing in the urine.

Manganese
Manganese salts are poorly absorbed.

Chromium
Although it has been established that chromium is essential to human life, little information is available on its function and metabolism.

• Unbalanced diets in case of loss of appetite due to diseases or drugs, incomplete or interrupted nutrition, and in the elderly.
• Digestive malabsorption in intestinal infections, or due to substances as tannins, or oxalates that interfere with the absorption of vitamins.
• Increased demand for vitamins, minerals and trace elements in childhood and adolescence due to unbalanced meals, during pregnancy and lactation, exercise, and during the convalescence stage of different diseases.
• Increase utilization of vitamins, minerals and trace elements in fever, infection, cancer, surgical operations and critically ill cases.
• Enhancement of body immunity in the convalescent stage after surgical operations, acceleration of wound healing, and in debilitating cases.
• Enhancement of body immunity in the convalescent stage after surgical operations, acceleration of wound healing, and in debilitating cases.
• Increased loss of vitamins, minerals and trace elements from the body in burns, diarrhoea, bleeding, and renal impairment.
• To enhance liver function competency.

Yesmvit Tablets

One or two tablets daily

Yesmvit Syrup

Children (Aged 1-12 years): 5 ml twice daily.

Adolescents (Aged 12-18 years): 5 ml thrice daily.

Yesmvit Drops

Children (Aged Below 1 year): 1 ml, 1-2 times a day.

Contraindicated in patients known to be hypersensitive to any of components and in patients with hypervitaminosis.

While taking the multivitamins, both protein and energy are also required to provide complete nutrition in the daily diet. No other vitamins, minerals or supplements with or without vitamin A should be taken with this preparation except under medical supervision.

Do not take on an empty stomach. Do not exceed the stated dose. Keep out of the reach of children.

Folic acid can reduce the plasma concentration of phenytoin. Oral iron and zinc sulphate reduce the absorption of tetracyclines.

Generally multivitamin and Multiminerals are well tolerated by the body. Sometimes, reactions could occur, but they disappear rapidly after continuous and regular use.

Yesmvit Tablets: Strip of 10 tablets

Yesmvit Syrup: Bottle of 200 ml

Yesmvit Drops: Bottle of 15 ml