Literally, a tonic is something that invigorates, restores, stimulates, or refreshes. They have been used for centuries and continue to popular the world over. Men take them to increase their vigour and potency. Women take them to overcome weakness and children are advised to take them for better health. If you trace the history you will find that hakims and vaidyas fed expensive tonics to the nawabs and maharajas of the earlier era to prolong their youth, vigour, and life. These hakims and vaidyas were not only treated as VIPs but given exalted titles in addition to gold, silver, and jewels. Today, there are no more kings and princes but tonics are still very much in demand. Hakims and vaidyas have been replaced by big pharmaceutical companies and the practice of taking tonics has been extended from the rich to the common man.
The manufacture and sale of tonics is big business. At one time, only a few pharmaceutical houses in the country made them but during the last few years, companies, new and old, have vied with each other to bring out new brands of their own. So much so, that even some of the most prestigious pharmaceutical companies of international repute have joined their ranks. They do not make these tonics for consumption in their own countries, but for sale in India and other developing countries.
Tonics are promoted to increase vigour and potency in men, to overcome weakness in women and to improve the overall health of children. None of the so-called tonic preparations available contain ingredients which can do any of the above. The usual contents of the currently popular tonics are vitamins, minerals, and proteins.
Vitamins As Tonics: Vitamins are naturally occurring biochemical substances, either biosynthesized in the body or made available from foodstuffs like meat, fish, eggs, vegetables, and fruits. These are a required for their metabolic role in nutrition and in deficiency diseases. An average diet contains a sufficient amount of vitamins for average daily requirements. The general belief that a slight deficiency of vitamins causes weakness or lowers body resistance is not correct. On the contrary, excess vitamins may do much harm. However, vitamins are required to be given in certain specific situations such as in alcoholism, to the elderly, debilitated persons, or those on a slimming diet, where the diet is inadequate in quality and quantity. It must however be remembered that vitamins are no substitute for rich food. Vitamins may also be needed in certain illnesses like prolonged diarrhoea, dysentery or vomiting, infections and worm infestations, or any other any other prolonged disease. There are other situations in which the requirement is increased, as at the time of pregnancy and lactation. In these cases vitamins are needed in higher quantities than normally required. Besides these, there are certain specific vitamin deficiency diseases in which large doses of a specific vitamin are required in preference to other constituents of the tonic. Same is true for protein and amino acid containing tonics which are available in various flavours along with vitamins. They are no substitute for a balanced diet.
The highly publicized tall claims that a particular tonic increases vitality and zest, muscle strength and memory, or height, are false and misleading. Vitamins do increase metabolic activity and promote growth but this happens only when there is a deficiency. The general belief that if 100 units of a vitamin do good, 1,000 units would do better, is unfounded and erroneous. It is generally thought that our diet is deficient in vitamins and a slight excess will do no harm. Well, a little bit of extra may not but most of the popular preparations contain huge quantities, several times more than the daily requirement, plus the extra vitamins added (up to 100%) to cover the loss in storage. A look at the table on ‘Important Constituents of Some Popular Tonic Preparations’ will indicate the excess of vitamins found in the preparations marketed by some of the most reputed pharmaceutical companies. Even if a person takes a diet totally deficient in vitamins, which is impossible, it takes quite a few days/weeks for deficiency to manifest because some vitamins are stored in body e.g., vitamin B12 is stored in the body and it requires about 6 to 7 years to exhaust body’s reserves. The quantities contained in the tonics are much too high. This is not only an economic waste for an individual but for the entire nation as many of these vitamins or their raw materials are imported by India.
Iron and Treatment of Anaemia
Iron is required for formation of hemoglobin found in red blood cells. Iron deficiney anaemia is a common disease in many developing countries.
Liver, dry beans, wheatgerm, yeast, meat, chicken, fresh spinach, banana, apple are good source. Average daily diet contains 10-20 mg of elemental iron.
A Few Facts about Iron.
- Absorption is better with haem-iron (animal) than others.
- If food has too much of phytate (maize, wheat) iron is poorly absorbed.
- Antacids retard absorption.
- Iron is largely conserved in body. Only negligible amount is lost in urine.
- Various salts available for use have varying amount of elemental iron – ferrous sulphate has about 20%, ferrous gluconate about 12%, ferrous fumarate 33% and colloidal ferric hydroxide has 50% iron. Iron hydroxy polymaltose is better absorbed.
- Among the vitamins, folic acid and vitamin B12 are required for formation of hemoglobin.
- It is not true that if higher dose is taken then absorption and effect will be more. In fact there is ‘shut-valve’ mechanism in the intestinal lining to block absorption of iron if body does not need it.
- Iron taken by mouth or injections raises hemoglobin by 0.5g to 1.0g in a week.
- Even when the iron deficiency anaemia is fully corrected the treatment is continued further for 2-3 months to replete the stores.
Preparation and Doses
About 200 mg of elemental iron is required per day to be taken by mouth in 3 divided doses. There are only a few products available in market which provide such quantities . In selecting a particular preparation, one should consider the amount of elemental iron in it, rather than the quantity of iron-salts in the formula.
Adverse Effects: Oral iron may not be tolerated equally by all individuals. Epigastric pain, heart burn, nausea, staining of teeth, metallic taste, constipation occur frequently. A smaller dose in between meals initially may improve acceptability. Injectable iron (intramuscular Imferron or Jectofer) may cause joint pains, local pain and pigmentation at the site of injection. Fever, headache and allergic reaction with a fall in BP may occur. Acute iron poisoing may occur due to ingestion of large quantities of liquid iron preparation by children. The anti-dote is desferrioxamine (5-10gm), milk and egg yolk may be given as first aid, after inducing vomiting by tickling of fauces.
Copper, cobalt, selenium, zinc, manganese, molybdenum, selenium and magnesium are enquired in very small quantities (trace amounts). All of them are needed for activation of certain enzymes. Zinc deficiency may cause growth retardation in children, copper deficiency leads to anima 10 under nourished children. Various multivitamin and iron preparations contain varying aunts of these trace elements. The use of these in normal persons cannot be recommended.