Short-term painful localized (limited to one muscle or group of muscles) cramps are called cramps . They can occur in any muscle group, but are most common in the calf muscles. And it looks like this: we lie on our backs and after a slight movement of our toes, “ convulsive pain in the calf muscles ” occurs, tightening and squeezing, extremely unpleasant. Such pain can also occur when we take off our shoes. By its nature, it is a prolonged tonic contraction of the muscle, lasting from several seconds to minutes.
Most often, cramps are associated with diseases of the lumbar spine (for example, osteochondrosis), in which, sooner or later, the nutrition of the nerve endings and muscles in the legs is disrupted, so they do not receive all the necessary nutrients and begin to work “not correctly.” Such cramps occur after physical exertion or at night while lying down.
Separately, stenosolia is distinguished - this is compressive pain in the soleus muscle (it is located deeper under the calf), also very unpleasant pain, but a little weaker than cramps. This muscle has a special structure and is very sensitive to disturbances in microcirculation in it. Stenosolia most often occurs when we lie on our side or stand for a long time, walk, or sit.
Cramps in the calf muscles (cramps) causes
Crumpy can occur as a symptom of circulatory disorders in stenotic diseases of the blood vessels of the legs (can be one of the symptoms of intermittent claudication). Patients with diabetes mellitus and hypothyroidism are at risk for developing diseases of the blood vessels of the legs, since with these diseases a disorder of cholesterol metabolism will always develop and atherosclerotic plaques will form on the vessels of the legs as well. This also includes “heavy smokers.”
Cramps can occur after active physical activity on the legs, when squatting, and in the muscles of the hands, repeated spasms can occur during prolonged work with the mouse.
There are also spontaneous cramps in the muscles of the arms and legs. They may be due to hereditary characteristics and do not require special treatment.
But cramps that occur spontaneously and often in adolescence should be taken a close look at, since they may be the first sign of a hereditary enzyme defect in McArld's disease (Glycogenosis type V, myophosphorylase deficiency).
And in adults, spontaneous cramps can be the first symptom of a serious neurological disease - amyotrophic lateral sclerosis .
Magnesium's closest companion in the fight against seizures is calcium.
The paradox of calcium is that with its deficiency, the likelihood of seizures sharply increases - this is the leading symptom of not only magnesium deficiency, but also calcium (Table 5). In addition, calcium is a physiological partner of magnesium in a 2:1 ratio. In other words, by consuming additional magnesium, we should simultaneously receive double the amount of calcium. Dairy products for muscle cramps are not the optimal source of calcium, since the phosphorus they contain in large quantities can upset the mineral balance and provoke cramps.
Vitamin D rounds out the trinity of cramp fighters
It is necessary for the absorption of calcium and is important for the absorption of magnesium. A case is described in which vitamin D alone helped with muscle cramps from which a person had suffered for many years.
Perhaps one of the best decisions in finding an anti-seizure drug that contains magnesium, calcium and vitamin D is to choose ORTHO CALCIUM + MAGNESIUM. This is a medicine that contains calcium citrate, magnesium citrate and water-soluble vitamin D.
In addition, ORTHO CALCIUM + MAGNESIUM contains a number of vitamins and minerals that enhance the effects of magnesium and calcium on cramps.
One teaspoon of ORTHO CALCIUM + MAGNESIUM (without top) contains about 100 mg of magnesium and 200 mg of calcium. In the first week, you can take 1 teaspoon 2 times a day, and then - one teaspoon at night.
Sometimes the anticonvulsant effect of ORTHO CALCIUM + MAGNESIUM develops literally immediately, especially if you stir 1-2 teaspoons in hot tea. But in most cases, it takes about 4 weeks to saturate the body with magnesium to prevent cramps. When taking ORTHO CALCIUM + MAGNESIUM for a long time, it is comfortable to use it by mixing it with fermented milk products (kefir, yogurt, etc.).
A sign of overdose is liquefied stool, in which case the dosage should be reduced. Rarely, in the first days of taking ORTHO CALCIUM + MAGNESIUM, increased cramps may be observed. This indicates transient processes in the electrical excitability of cells after magnesium starvation. In this situation, you should reduce the dosage and continue taking it. Severe kidney disease is a contraindication against taking ORTHO CALCIUM + MAGNESIUM.
ORTHOCALCIUM + MAGNESIUM will be especially useful for cramps and pain in the legs during fitness and other physical exercises. Indeed, in this case, magnesium “burns out” in the muscles and is lost with sweat. It should be remembered that with excess weight (a condition often accompanied by cramps), magnesium is lost due to its saponification with fatty acids, the concentration of which in the blood is increased.
Leg Cramps and Magnesium
Although cramps can be a simple manifestation of metabolic disorders in the muscle, for example, with chronic magnesium deficiency.
This is probably a very common reason . Magnesium is a unique mineral; it takes part in hundreds of biochemical processes in the body (according to modern ideas, about 300 biochemical processes in the human body occur with the participation of magnesium). This element is needed everywhere, and comes with food in insufficient quantities, since we eat foods rich in magnesium in small quantities (bran, nuts, pumpkin seeds, sesame). But magnesium is consumed intensively during stressful conditions (used by the nervous system), during heavy physical activity and in the heat (excreted in sweat), when drinking large amounts of liquid (excreted in the urine) and with frequent intake of alcoholic beverages. And if a muscle lacks magnesium, it becomes more prone to tension and spasms. For the same reason (magnesium deficiency), the eyelid may “twitch” - the orbicularis oculi muscle is tender and very sensitive to a lack of magnesium.
I was recently asked if there was an alternative to supplementing with magnesium other than using Magne B6. There are other preparations containing magnesium: Magnerot, Magnicum. It is believed that magnesium is well absorbed from the intestines in the presence of pyridoxine (vitamin B6) or in the form of an orotic acid salt, but in food products magnesium often comes with calcium or phosphorus, and they prevent magnesium from being absorbed in the intestines. When cooking products, its amount decreases significantly. And food products contain less and less of it due to the rapid development of “new technologies”. You can, of course, provide yourself with magnesium through proper nutrition, but you really have to want it.
The hero in the fight against cramps: magnesium
- Firstly, magnesium acts as a plug that prevents calcium from entering the cell.
- Next, magnesium is required for the functioning of cellular pumps.
- Finally, all processes of formation and consumption of cellular energy are impossible without magnesium.
Perhaps 75% of people suffer from leg cramps precisely because approximately 80% of people are magnesium deficient. This is due to the fact that it is impossible to obtain the required daily intake of magnesium from a standard diet (Table 1) (about 400 mg - Table 2). Magnesium deficiency is further aggravated by the fact that there are many factors that predispose to magnesium loss (Table 3).
Magnesium deficiency is very difficult to determine based on blood levels. Even with severe deficiency, it enters the blood from bones and muscles and masks the deficiency. Therefore, experts recommend focusing on the typical symptoms of magnesium deficiency (Table 4).
Severe magnesium deficiency is almost impossible to eliminate with food. Additional intake of magnesium supplements is required, which can be registered as dietary supplements or as medications.
Among the recommendations for additional magnesium intake for seizures, one can find daily dosages of 800 mg of magnesium or more. However, this is most likely not necessary. Healthy kidneys can easily increase magnesium output by 250 times. Therefore, for chronic seizures, it is best to stick to saturating dosages of 100-200 mg for a long time (four weeks or more).
Cramps are involuntary muscle contractions that vary significantly in duration, intensity and location, etiology and pathogenesis. Depending on the mechanism of development, epileptic and non-epileptic seizures are distinguished. The latter may be associated with pathology of the central and peripheral nervous system. It is well known that the development of seizures is facilitated by disturbances in the mineral balance: in particular, hypomagnesemia [1–11]. Magnesium deficiency is often not taken into account when analyzing the pathophysiology of seizures of various etiologies. Meanwhile, the participation of magnesium in neuromuscular function has been convincingly proven using evidence-based medicine methods and the results of epidemiological studies [6, 13–15].
In studies by Wijst et al. (2009) found that one of the main regulators of seizures, dependent on the level of magnesium in the blood, is the magnesium channel TRPM6. The expression of this gene is influenced by certain hormones (for example, estrogens) and certain drugs (for example, cyclosporine), which change the acid-base balance and can increase convulsive readiness and even provoke it (cyclosporine A). Long-term use of drugs containing estrogen (replacement therapy and oral contraceptives) also provokes channel activity and increases magnesium loss, leading to magnesium-deficiency seizures (Fig. 1). TRPM6 channel activity depends on intracellular magnesium levels, pH, and ATP. Epidermal growth factor and estrogen receptors can also directly stimulate the activity of the TRPM channel, which regulates the absorption of magnesium in the distal tubules of the kidneys. The channel activity is also modeled by a number of proteins (RACK1, REA, RAC1) [14].
With age, the likelihood of calf muscle cramps, twitching of individual back muscles, etc. increases by 2–3 times, and magnesium levels decrease (Fig. 2). The main mechanisms of decline in magnesium levels with age include inadequate magnesium intake, decreased absorption, possibly due to decreased vitamin D intake, increased urinary losses due to diuretics and due to the above diseases of old age. Therefore, maintaining optimal magnesium levels in the elderly is a good working topic to study in large-scale clinical quality of life studies [16].
One of the first intravenous administrations of magnesium was made by the French obstetrician M. Bertrand in 1906 to relieve convulsions during eclampsia. Preeclampsia occurs in 5–50% of women and leads to the most severe complication of pregnancy – eclampsia. The generally accepted therapy is intravenous magnesium sulfate. A comparative study of gene expression was carried out in 10 placentas obtained after physiological labor, 10 from patients who had preeclampsia, and 8 placentas from patients with preeclampsia who received magnesium sulfate, which showed that in women with preeclampsia the expression levels of receptor genes are increased (p < 0.001). , similar to the calcitonin receptor (CRLR - calcitonine receptor-like receptor); receptor activity-modifying protein (RAMP-1) and inducible nitric oxide synthetase (iNOS). The use of magnesium sulfate leads to a statistically more significant (p < 0.05), higher expression of the calcitonin-related peptide (CGRP), CRLR gene and endothelial synthetase (eNOS) genes. These changes correspond to relaxation of the vascular endothelium, weakening of spasm and convulsive readiness. Calcitonin-related peptide, encoded by the CGRP gene, stimulates vasodilation through activation of CRLR with the participation of the RAMP-1 protein [15].
In medical practice, painful cramps of individual muscles are most known. They are associated with the appearance in the muscles (often after overload) of areas of local spasm: writer's cramp, night cramps of the calf muscles, spasm of the external pterygoid muscle when opening the mouth, cramps of various muscle groups in athletes. Areas of local muscle spasm are felt in the form of compactions, pressure on which is painful. Muscle overload is not the only cause of cramps. Toxic seizures are known; convulsions due to pyridoxine deficiency; with hypoglycemia; arising under the influence of psychogenic factors, with excessive physical exertion and muscle strain, tetanus, metabolic disorders, etc. Seizures occur especially easily in children, which is due to timely incomplete structural and functional maturation of the brain, intrauterine lesions of the central nervous system and developmental defects.
Regularly recurring convulsions indicate the primacy of magnesium deficiency and are described as “spasmophilia”, “constitutional tetany”, “normocalcium tetany”. Calcium therapy for patients in this group can further enhance the clinical manifestations of spasmophilia and seizures, while the pathophysiological treatment is the use of magnesium preparations [3].
Below we will consider the biochemistry of muscle contraction, the physiological role of magnesium, the relationship between magnesium deficiency and seizures, features of magnesium therapy, the synergistic effect of magnesium and one of its pharmacological carriers, orotic acid [4].
Biochemistry of muscle contraction
Skeletal muscle consists of millions of muscle fibers interconnected by connective tissue fibers. Muscle contraction is the shortening or change in tension of the muscle fibers that make up the muscle. The following types of contractions are distinguished: isometric, in which the length of the muscle fibers remains unchanged, but their tension increases, and isotonic - with shortening and thickening of the muscle, but without a significant change in its tension. Isometric and isotonic muscle contractions represent regular contraction-relaxation cycles, and cramps occur when the cyclicity of this process is disrupted.
The structural unit of muscle fiber is myofibrils - bundles of proteins organized in a special way, located along the cell. Two proteins are involved in contraction: myosin and actin, which are localized in the side chain of the muscle fiber.
Muscle contraction causes a nerve impulse, which through the neuromuscular synapse through the mediator is transformed into a mechanical effect. A nerve impulse in the action potential phase causes the release of Ca2+ ions, which interact with the proteins of muscle cells and cause contraction of myofibrils. Magnesium ions, on the contrary, are a physiological antagonist of calcium and mediate the relaxation of myofibrils.
In addition to participating in the functioning of myofibrils, magnesium plays an integral role in the transmission of nerve impulses. Magnesium is a physiological regulator of cell excitability, necessary for depolarization of the cell membrane of nerve and muscle cells. With a lack of magnesium, the cell becomes overexcitable. The most obvious molecular mechanism for the effect of magnesium on neuronal excitability is inhibition of the activity of NMDA receptors (glutamate receptors). Activation of NMDA receptors is necessary for rapid synaptic signal transmission in the brain, which occurs as a result of changes in the flow of sodium (potassium) across the membrane. Overstimulation of NMDA receptors can lead to epileptic-type seizures, while blocking them with magnesium reduces the excitability of neural pathways.
Because magnesium plays a fundamental role in the physiology of nerve impulse transmission and myofibril contraction, a decrease in its levels leads to increased neuromuscular excitability and causes tetany.
The following symptoms of magnesium deficiency in the body are known [13]:
- trembling (tremor) – a type of hyperkinesis, the appearance of automatic violent excessive movements that interfere with the performance of voluntary motor acts;
- tic - rapid involuntary muscle contractions, usually a circular spasm of the eye or facial muscles, which causes twitching of the corners of the mouth;
- knee reflex - extension of the lower limb in the knee joint when the tendon of the quadriceps femoris muscle is struck below the kneecap; evaluate its increase (revival), decrease, loss (if the reflex arc is damaged);
- Chvostek's symptom - caused by lightly tapping the trunk of the facial nerve with a finger or a hammer, most often in the area of the bifurcation of the facial nerve; Chvostek's symptom is an indirect sign of magnesium deficiency; it occurs in 4 out of 5 examined patients with magnesium deficiency;
- a symptom determined in a test with a tourniquet: when the shoulder is compressed with a tourniquet or cuff for 2-3 minutes after the disappearance of the pulse, tetanic convulsive contracture of the hand develops.
Clinically, with latent magnesium deficiency, the following specific neuromuscular signs associated with increased convulsive readiness can be identified:
- tingling in the area of the feet and palms (paresthesia) associated with overexcitation of sensory endings;
- hyperactivity: a person cannot stay in one place for a long time, constantly moves - even in sleep (restless legs syndrome, associated with increased excitability of skeletal muscles);
- muscle contractures, cramps (difficulty in cell repolarization);
- a feeling of “interruptions” in the work of the heart, extrasystole;
- digestive disorders: diarrhea, sometimes constipation, abdominal pain, sensation of a “lump” in the throat (spasm in the pharynx);
- urinary disorders: frequent urge, pain in the bladder area [6, 7, 13].
Magnesium therapy, its features
Magnesium requirements have been assessed in various epidemiological studies. It is interesting to analyze the latest large study assessing magnesium intake, conducted in China (2009) [15]. When assessing the diet of 324 people (55–70 years old), it was shown that the average magnesium content in erythrocytes was significantly lower (2.0 mmol/l) in patients with high blood pressure and a verified diagnosis of arterial hypertension (AH) compared to normotensive patients ( 2.2 mmol/l; p < 0.005). Dietary intake of magnesium was significantly lower in groups of patients diagnosed with hypertension (316 mg/day), diabetes mellitus (323 mg/day) compared with individuals with normal blood sugar and blood pressure (374 mg/day; p < 0. 05). When magnesium intake is below normal, muscle cramps develop within 1 to 6 weeks. In Russia, the current physiological daily requirement for magnesium in adults is about 400 mg/day (maximum – up to 800 mg/day). A balanced diet should contain magnesium in an amount of ≈ 400 mg/day, of which about 200 mg is adsorbed in a healthy person.
A decrease in the amount of magnesium taken daily can be compensated by an increasing adsorption of magnesium in the intestines and a decrease in its excretion through the kidneys. This can be promoted by eating certain foods. Thus, fresh vegetables and fruits contain relatively more actively absorbed magnesium than other foods. The required amount of magnesium is determined at the rate of 5 mg/kg/day. Some people need more magnesium due to significant magnesium losses. Children require 5 to 10 mg/kg/day, pregnant women (or nursing mothers) – 10–15 mg/kg/day, athletes or people engaged in heavy physical labor (depending on the load) – 10 to 15 mg /kg/day
There are primary and secondary magnesium deficiency. Primary magnesium deficiency is caused by congenital disorders of mineral metabolism: renal tubulopathy, decreased absorption of magnesium in the intestine, etc. Secondary magnesium deficiency occurs when there is insufficient replenishment of its losses (with food, drink). The mechanism of this condition lies not only in insufficient intake of magnesium, but also in increased losses in the urine. Secondary magnesium deficiency can also occur due to dysregulation of ion metabolism, gluten enteropathy, shortening of the intestine after resection, etc. If the cause of secondary magnesium deficiency is known, the situation can be normalized by acting on the root cause of the deficiency.
In case of magnesium deficiency of any etiology, correction of its content in the body is indicated. In a healthy person, the concentration of magnesium in the blood serum is maintained in a fairly narrow range (the norm is 0.75–1.26 mmol/l; in pregnant women, the lower limit is > 0.81 mmol/l). This extracellular magnesium is in continuous exchange with magnesium stores in bone and muscle tissue. In many cases, it is not possible to compensate for the lack of magnesium with dietary measures alone, and then there is a need to use pharmacological drugs containing magnesium. The disadvantages of magnesium preparations of the first generation include not only relatively low absorption and digestibility, but also its slow inclusion in metabolism. In the last 20 years, there has been a fairly strong tendency towards the transition to the use of II and subsequent generations of magnesium-containing preparations, in which the mineral is contained in the form of an organic salt or a complex with amino acids (for example, magnesium orotate).
Organic magnesium salts are not only much better absorbed by the body, but also have less side effects. Currently, magnesium preparations based on numerous organic salts continue to be used: orotate, asparaginate, lactate, magnesium citrate, etc. Therapy with magnesium preparations is more effective if administered simultaneously with the so-called. magnesium protectors – compounds that enhance the absorption of magnesium and its transport into the cell. Magnesium protectors include orotic acid, vitamins B6, D, B1, A, C and E, riboxin, carnitine, taurine and calcium preparations, since all these substances increase the magnesium content in the cell.
For seizures caused by hypocalcemia, hypomagnesemia, alkalosis, intravenous administration of calcium and/or magnesium is required, followed by their use [8]. In patients with epilepsy, complex therapy is supplemented with magnesium preparations [12].
Orotic acid preparations (orotate) are used for disorders of protein metabolism (in the post-infarction period, during fasting, liver diseases, in sports medicine, etc.). Orotic acid is a derivative of the pyrimidine base uracil and is involved in the biosynthesis of pyrimidine nucleotides, uridine monophosphate (UMP) and cytidine monophosphate. Increasing the concentration of orotate as a result of taking orotic acid salts significantly increases the concentration of UMP, uridine diphosphate (UDP) and uridine triphosphate (UTP) [5].
The mechanism of action of orotic acid is to increase the synthesis of UMP and other uridine phosphates, which are signaling molecules that interact with purinergic receptors and promote relaxation of smooth muscle and striated muscles. Orotic acid, like thiamine and pyridoxine, promotes the movement of magnesium into the cell. Therefore, the combination of magnesium with orotic acid enhances the effect of eliminating seizures.
When considering the treatment of magnesium deficiency seizures, you should pay attention to the drug MagnerotR (magnesium orotate; Worwag Pharma GmbH & Co., Germany). 1 tablet of the drug contains 500 mg of magnesium orotate, or 32.8 mg of pure magnesium. This salt is slightly soluble in water, does not bind hydrochloric acid of gastric juice, and does not have a laxative effect, unlike some other magnesium salts. Magnesium orotate is a good source of elemental magnesium, which is important for extracellular magnesium deficiency in the body [3].
Orotic acid salts are used as mineral carriers because orotic acid increases the cellular bioavailability of cations. In this case, orotic acid is a kind of transporter of magnesium ion into the cell. Thus, providing high bioavailability of magnesium, Magnerot® has a number of additional synergistic properties associated with the biological role of the orotic acid anion. This magnesium preparation has anabolic, hepatoprotective, uricosuric properties and can be used in long courses.
In patients after heart surgery, the recovery period is less likely to be complicated by heart failure and arrhythmia, and proceeds more favorably with metabolic therapy, including magnesium orotate [10]. Magnesium orotate can be used as an adjuvant therapy in people with severe heart failure, tachyarrhythmia and extrasystole [11]. However, magnesium sulfate is considered ineffective for tetanus seizures [9].
Magnesium and orotic acid have a positive effect on energy metabolism, the structure of muscle and connective tissue and vascular tone, helping to reduce the content of catecholamines in the blood plasma, significantly reducing the hyperreactivity of the muscle cell, which ensures their anticonvulsant effect. The combined use of magnesium and orotate potentiates their effect in magnesium-deficient seizures, which arise for various reasons and have different development mechanisms.
Self-diagnosis. How to suspect you have a vitamin deficiency?
Murzaeva Irina Yurievna
Endocrinologist, Preventive Medicine Doctor
April 3, 2019
In spring, like no other time of the year, we especially notice changes in our appearance and often not for the better. The reason for this, as a rule, is hypovitaminosis. By looking at the skin and its so-called “appendages”: hair, nails, eyebrows, you can perfectly determine the lack of a particular vitamin or microelement. And so, I carry out the most pathognotomonic symptoms for a lack of one or another vitamin. (in medicine, this is the name for symptoms clearly describe a certain disease and are a sign for making a specific diagnosis) As many people hate at the beginning of the swimming season - cellulite or lipedema (it can be characterized as stagnation - a violation of microcirculation and lymphatic drainage in adipose tissue, leading to its degeneration ), but as it turned out, everything is simple - the cause of this condition is a banal iodine deficiency , common in more than 100% of the Russian population. Recurrent atheromas (“wen”;)) are also an indicator of iodine deficiency, but the point is that this is treated not with banal doses of 200 mcg of Iodomarin, but with doses exceeding 500 mcg of Iodine! Only then will the therapeutic effect be noticeable. Fibrocystic mastopathy, so often diagnosed in women, is often well treated by selecting adequate doses of iodine. I couldn’t ignore this complex condition (read only for men! and their treating urologists) - Peyronie’s disease - in 30-40% of cases it can be cured with adequate doses of iodine. White spots on the nails are often a zinc deficiency. A lack of zinc can be easily suspected from a blood test - ALP (alkaline phosphatase) will be persistently reduced in a biochemical blood test. Zinc deficiency explains the decreased sense of smell and taste! (reduced ability to sense sweet, sour, bitter, salty, etc.). Which leads to decreased feelings of satiety and overeating!! Weakness in the first half of the day (this is an important symptom of thyroid dysfunction) and, above all, selenium deficiency. Selenium and Iodine are two “partners” that should be used together for the treatment of thyroid gland. And not in all cases, AIT is a contraindication to iodine administration. A phrase like “You have AIT and you can’t take iodine” is a thing of the past. Impaired skin pigmentation - depigmentation, early gray hair - deficiency of such a little-used element as copper. But copper is also a powerful immunomodulator; if there is a lack of it in a clinical blood test, persistent neutropenia (a drop in the level of neutrophils) can be observed, which is more often observed in children. Photosensitivity, especially on a sunny day, sarcopenia (muscle dystrophy, well defined by bioimpedance) is a lack of vitamin E. Migraines, a difficult diagnosis, debilitating headaches - imagine, can develop as a result of a lack of vitamin B2 (riboflavin), can be treated with large doses 100 mg per day of injectable riboflavin (not included in the usual Milgamma, injected only with a separate injection). Seborrheic dermatitis, cracked lips, peeling skin of the nostrils, red and swollen tongue are often also a sign of riboflavin deficiency. Numbness and tingling of the toes and hands, radiation reserve syndrome, pain along the “course of nerves” and PMS (premenstrual syndrome:)) are most often a consequence of a lack of vitamin B6 (pyridoxal-5-phosphate), but it accumulates poorly in the body, with under stress it quickly “burns out”; taking it during prolonged stress can be permanent. As well as the next element……. Aggressiveness, uncontrollable anger - in Russia everyone must be given MAGNESIUM , just as they used to give free milk in hazardous industries. Bleeding gums, “age spots”, petechiae (small hemorrhages) with a minimal mechanism of injury - vitamin C deficiency. And a dose of 500 mcg will not help here, doses of more than 1.5 g per day are needed, yes, so large, there are diseases for which doses of 4-5 grams of vitamin C will be “just right” :). Now about my dearly beloved and undeservedly forgotten vitamin A. There are many vitamin A deficiencies and they are poorly diagnosed! Heals quickly! Follicular keratosis , a change in the structure of the skin of the arms and legs, which is usually regarded as hereditary, that is, “goose or chicken-type” skin with papules and peeling is nothing more than a genetic lack of vitamin A! Dry and rough skin, dry eyes, decreased twilight vision, cracked and dry tongue, decreased immunity, dry intimate areas, tendency to gopothyroidism! (in the thyroid gland there are structures that work on vitamin A!!!) - all this is vitamin A deficiency!!! Therefore, I really like to make mixed drops for the prevention of hypovitaminosis A and D3 (especially for children). You need to take 3 drops of retinol acetate 3.44% and 3 drops of vitamin D3 in the morning under the tongue or on bread. Even persistent acne (acne) is treated with drugs based on high doses of retinol (vitamin A). Split ends!!!, diffuse hair loss - look for iron deficiency. Seeing these signs in yourself, you can adequately, together with the doctor, select “working” doses of vitamins. And there is no need to join the crowd of skeptics who are sure that we will get vitamins from food and at sea; taking vitamins in tablets is not necessary. "Blessed is he who believes." I believe in modern medicine. Dedicated to skeptics: it is also possible a laboratory that you have a deficiency of vitamins and microelements, vitamins can be donated by blood - vitamins A, D, vitamins B, but I would prefer to check microelements using a spectral analysis of hair, a blood test in this case is not very reliable. (Believe me, I have studied this issue a lot and I am sure that it is more reliable to check microelements in the hair!). Those who test a genetic predisposition to the absorption of this or sometimes a vitamin have gone even further, but this is “already the aerobatics” of medicine and this service is not available in many cities in Russia. And its cost is not routine.
Therefore, we will trust traditional research methods - clinical examination and history taking.