4. Vitamins, Minerals (and Supplements)

Question 1

What is the ultimate goal in the pharmacy?

Answer 1

To decrease the number of medications or products being taken.

Question 2

Vitamins

Answer 2

Essential organic substances that cannot be synthesized by the body and must be obtained by outside sources, such as diet or supplements. Require small amounts usually.

Generally classified as either fat-soluble or water-soluble kinds.

Question 3

Minerals

Answer 3

Essential inorganic elements that cannot be synthesized by the body and therefore must be consumed. They are required in small amounts usually.

Question 4

Fat-soluble Vitamins (e.g., VitA, VitD, VitE, VitK, etc.) dissolve in ____ and tends to ____ in the body.

Answer 4

fat; accumulate

Question 5

Water-soluble vitamins (e.g., VitC, B vitamins, folate, etc.,) must dissolve in water ____ they can be absorbed by the body; therefore ____ be stored.
a) before; can
b) after; can
c) before; cannot
d) after; cannot
e) either before or after; cannot

Answer 5

c) before; cannot

Question 6

Unused ____ vitamins of the body will be primarily be excreted through _____

Answer 6

Water-soluble; urine

Question 7

Ascorbic acid, thiamin, riboflavin, folate/folic acid, and cyanocobalamin *are all examples of what kind of vitamin? *

Answer 7

Examples of water-soluble vitamins.

• Ascorbic acid (Vitamin C), Thiamin (B1), riboflavin (B2), folate or folic acid - when included in supplements (B9), cyanocobalamin (B12)

Question 8

What are the 4 most common lipid-soluble vitamins?

Answer 8

1. Vitamin A,
2. Vitamin D,
3. Vitamin E,
4. Vitamin K

Question 9

If one multivitamin has less than another, you should recommend____?

Answer 9

Recommend a multivitamin that has Less items but has a greater amount in the ingredients.

Question 10

When looking at the ingredients in two multivitamins for a young healthy adult, you notice one includes 800iU and the other has 1000iU… Does it matter which of the two should select?

Answer 10

Yes… We should recommend the one with the higher concentration/amount.

Question 11

What is the recommended Vitamin D intake/dosage outlined by Health Canada for breastfed babies?

Answer 11

400iU (= 10mcg) daily for babies that are breastfed (either exclusively or partially - according to Health Canada).

Question 12

Why is it important to take or give Vitamin D?

Answer 12

• Helps the body absorb calcium and phosphorous;
• Builds and maintains strong bones and teeth;
• Prevent rickets (for babies and toddlers)

Question 13

Which of the following is not an example of a lipid-soluble vitamin?
a) Vitamin A
b) Riboflavin (B2)
c) Vitamin D
d) Vitamin E
e) K

Answer 13

b) Riboflavin (B2)

Question 14

Scenario: Parent visits the pharmacy and asks for recommendations for multivitamins for their toddler.

What would be your [pharmacist] thoughts for this toddler?

Answer 14

• Most toddlers in Canada are reported to get an adequate amount of vitamins naturally from the foods they eat
• Usually does not need a multivitamin
• If parents really wants to try it, can recommend stuff BUT most of the water-soluble vitamins will be flushed in the urine.

Question 15

What kinds of vitamin(s) and/or mineral(s) might be more pertinent to consider for teenage girls when making recommendations?

Answer 15

• Calcium (+ Vitamin D and phosphorous) - osteoporosis prevention
• Iron - due to menstration

Question 16

What does coconut oil represent?

Answer 16

Although popular takes on social media or magazines, many products gain popularity and increased demand but they come and go… Even so, doesn’t always equate to being better or revolutionary.

• Coconut oil previously had a consumer demand as a health food and was at one point a popular fat demand. It is NOT the best option.

Question 17

List the reasons why people take vitamins or supplements

Answer 17

• Dietary insurnance
• Energy
• Strengthen immunity (i.e., prevent illness)
• Specific medical reasons (e.g., vitamins for the eyes)

Question 18

What is the general or most common reason why people will likely take vitamins?

Answer 18

Nutritional reassurance
* Making sure getting essential nutrients and to either maintain or improve their overall health.

Question 19

Natural vs. Synthetic Vitamins?

Is natural better than synthetic?

Answer 19

Yes, in most cases.
* Body absorbs (most) vitamins better in their natural form instead of synthetic form.
* Exception: Vitamin B12 (cyanocobalamin) - it’s a water-soluble vitamin. As we get older, stomach acid becomes less efficient to breakdown the B12 off of the protein complex (from animal source).

Question 20

Why is it better to rely on a synthetic form of B12 as a source instead of a natural form (i.e., diet - eating animal products)?

Answer 20

B12 is bound to the proteins found on animal-sourced foods and must get released first before can be absorbed. Due to the complex factors of the B12 being bound to an animal-sourced protein, digestive enzymes are inefficiently able to free the bound B12 and therefore cannot be absorbed properly. This is especially common among older adults (>50 yo) due to decreased stomach acid. It is recommended for such adults to take either a synthetic B12 (or a multivitamin with B12 in it).

Question 21

What role does Vitamin B12 have?

Answer 21

Energy metabolism
* it is good for energy and has a cache that if you take more B12, you will get more energy.

Question 22

What happens to individuals who have Propionic Acidemia (PA) condition?

Answer 22

Unable to convert certain amino acids and fats into energy as a result of lacking an enzyme that prevents them from being able to process certain AAs and fats.
* Physiologically unable to drive the metabolic processes to get more energy.

Question 23

Why is there controversy about Biotin (B7) supplements?

Answer 23

Claims to be effective on hair, skin, and nails. It is NOT.

It is almost impossible to tackle all three parts of the integumentary system and are made of similar cells in the body.

There is little to no evidence to suggest they are beneficial.

Question 24

During the months of Oct to Apr, what is the recommended dose of Vitamin D for those who live in Northern regions of the country?

Answer 24

• Breast-fed infants = 800iU (double the amount of non-northern infants)
• Formula-fed infants = 400iU ***

Question 25

How would you advise a parent or guardian of an infant to properly administer Vitamin D drops?

Answer 25

Gently squirt or administer the drops orally on the inside of the infant’s cheek. If the infant is resisting drops being administered in the dropper, can suggest to mix it in a bottle of formula or in breast milk that is bottled.

Do NOT squirt the liquid at the back of the infant’s throat as this can result in choking.

Question 27

List of demographics that could benefit from taking vitamins/supplements (5)

Answer 27

• Impoverished - due to malnutrition
• Alcoholism - alcohol might interact to deplete vitamin levels
• Pregnancy & Lactation - avoid risks of permanent damage to fetus, avoid chances of some birth defects; to ensure adequate nutrients are in the breast milk and to foster healthy infant development
• Intense Dieting - when you eat less, you don’t take in adequate amounts of vitamins and minerals.
• Elderly/Geriatrics - Don’t always absorb nutrients naturally as well as we age, which can sometimes be linked to medication use. To also ensure more nutrients are supplemented if necessary.

Question 28

Approximately ____ people have decreased stomach acid and would possibly need vitamin B12

Answer 28

1/5 people (or 20% of individuals)

Question 29

What is one of the most common single nutrient deficiency?

Answer 29

Iron deficiency - if severely low, it is concerning as this can impede on oxygen delivery to vital organs like the heart, lungs, and brain.

Question 30

Folate vs. Folic Acid?

Answer 30

Folate is a natural form of B9 that can be supplemented with diet.

Folic Acid is a synthetic/man-made form of folate.

Question 31

Why is it important for women to take folic acid before and during their pregnancy?

Answer 31

• Decreases the risks in early fetal development, particularly reducing the risks of Neural Tube Defects (NTDs).
• It can help prevent some major birth defects of the baby’s brain (anencephaly) and spine (spina bifida)

Question 32

Vitamin Counsels - Who is this for?