DONE: Nutrition/Supplements Flashcards
got a little lazy with amino acids and "other" nutrients
after DVT > PE, patient has been stabilized, what nutrient would you consider? vitamin K PO, citrus bioflavonoids PO, topical vitamin E, B6 + mg in a push
300 mg citrus bioflavonoids PO
diet to follow after diverticulitis
soft, low fiber diet for 1 month then > high fiber and whole foods diet
after acute diverticulitis has passed, which two supplements would you prescribe? niacin, potassium, pyridoxine, L-glutamine, L-arginine, wheat germ, flax seed meal
L-glutamine and flax seed meal
anti-inflammatory supplement supportive of neurological system
omega 3s
supplementation for someone with cataracts
antioxidant vitamins A, C, E
diet for Meniere’s
low salt
what increases and decreases iron absorption
increases = vitamin C decreases = soy, polyphenols (tea), calcium, impaired gastric acid production (PPIs, H2 antagonists)
warfarin - notes on diet
avoid major changes in dietary intake of vitamin K - green vegetables like broccoli and spinach
what to eliminate to prevent gout
foods high in purines: organ meats, meat, sardines, shellfish, beans, peas. alcohol
supplements for osteoporosis
elemental calcium, vitamin D
what 2 instances increase the need for B1?
how much should be given?
high blood glucose, alcoholism
100-300 mg/day
food sources of vitamin B1?
brewer’s yeast, wheat germ, sunflower seeds, brown rice, egg yolk, legumes, liver, brazil nuts, peanuts, dry soybeans, rice bran, whole grains
most common form of B1 in supplements?
which form is used for alcoholic peripheral neuropathy? why?
thiamin hydrochloride
benfotiamine - fat-soluble form because it lasts longer in the body (this form is found in roasted, crush garlic, onions, and leeks
thiamine deficiency > ?
beriberi (BiBi = B1B1)
constipation, edema, enlarged liver, fatigue, memory loss, GI disturbances, tachycardia, CHF, muscle atrophy (dry beriberi), numbness of hands and feet, pain and sensitivity, tingling, weakness, weight loss
what is Wernicke-Korsakoff syndrome?
alcohol inhibiting B1 storage > memory concerns, abnormal movements, confusion, drowsiness
normal amount of B1 needed/day?
around 1.1 or 1.2, 1.4mg in pregnancy and lactation
which compounds/foods/pharm destroy thiamin?
alcohol, tannins in coffee black tea and sulfites
antibiotics, phenytoin, sulfa drugs, OCPs
a high carb diet will increase the need for B1
which two enzymes does riboflavin function in?
riboFlavin > Fmn and Fas
involved in energy production, RBC formation, Ab production, cell respiration and growth, aids in metabolism of carbs fats and proteins
food sources of B2?
torula yeast, brewers yeast, calf liver, almonds, wheat germ, wild rice, mushrooms, millet, cheese, egg yolks, fish legumes, meat, milk, poultry, spinach, whole grains, yogurt
symptoms of B2 deficiency?
chelitis, inflammation of mouth, tongue, skin lesions, sensitivity to light, loss of visual acuity, burning and itching of eyes, lips, mouth, tonguw
normal amounts of B2 needed/day?
1.1-1.3 mg, 1.5 for preg and lactation
general health: 5-10 mg/day is reasonable
B2 can help prevent which 3 things?
migraines, cataracts, sickle cell anemia
cataracts: no more than 10 mg/day (photosensitivity)
migraines: 400mg/day, however we may not be able to absorb more than 20 mg at a time
SCA: 5mg BID increased TIBC and serum ferritin and glutathione levels
which B vitamin turns your pee yellow/green
B2
OCPs reduce which vitamins?
B1, B2, B6
B2 is easily destroyed by?
light, antibiotics, and alcohol
B3 is a component in?
Niacin = NAD and NADP+
energy production, fat/carb/chol metabolism, making of sex and adrenal hormones
which amino acid is a precursor to B3?
tryptophan
food sources of B3?
beef liver, brewer’s yeast, broccoli, carrots, cheese, corn flour, dandelion greens*, dates, egg, fish, milk, peanuts, pork, potatoes, tomatoes, wheat germ, whole wheat products
deficiency in B3?
pellagra, 4 Ds:
dermatitis, diarrhea, dementia, death
recommended B3 requirements?
14-18 mg/day
niacin can be used to treat which CVD? in which form?
hypercholesterolemia - NIACIN form lowers cholesterol and raises HDL, also lowers Lp(a)
this B vitamin can be used in the treatment of acne, psychiatric disorders, taste disorders, alcohol addiction, osteoarthritis and RA, and T1DM.
in which form?
B3, NIACINAMIDE
OA/RA:900-4000mg BID
B3 enhances insulin secretion and sensitivity
side effect of niacin supplementation? > what mg?
vasodilation > flushing and itching. 20-30 minutes after taking > 50 mg
side effect of time-released niacin?
liver damage
safest form of niacin?
inositol hexaNIACINate
at what dose is niacin hepatotoxic?
≥ 3 g/day
can niacin be combined with other lipid-lowering drugs?
YES
who should be cautious in using B3 supplementation?
pregnant, diabetes, glaucoma, gout, liver disease, peptic ulcers
niacin can elevated blood glucose
this B vitamin is a precursor to CoA and ACP
B5, pantothenic acid
key compounds in utilizing fats and carbs for energy and creating adrenal hormones and RBCs
food sources of B5?
avocados, beef, brewer yeast, eggs, fresh veggies, kidney, liver, legumes, lobster, mushrooms, saltwater fish, whole rye flour, whole wheat
burning foot syndrome?
deficiency in B5 - numbness and shooting pains in the feet, however B5 def is rare. the first sign is fatigue.
B5 requirements?
4-7 mg/day
most available form of B5? to treat?
most active and useful? to treat?
calcium pantothenate > adrenals (250mg) and RA (2 grams daily)
pantethine > lower blood cholesterol, LDL and TGs, increases HDL (300mg TID)
B5 (and B7) works synergistically with carnitine and CoQ10 in fatty acid transport/utilization
food sources of B6?
whole grains, legumes, poultry, bananas, avocados, seeds and nuts, brussel sprouts, cauliflower, organ meats
this B vitamin plays a role in multiplication of cells, pregnancy, immune function, brain chemistry (creating AAs and NTs such as serotonin, DA, melatonin, Epi, NE, GABA)
B6 - pyridoxine
sxs of B6 deficiency
cheliosis, glossitis, anemia, glucose intolerance, depression, convulsions in children, insomnia
recommended intake of B6?
1.3 - 2 mg/day
doses of up to 250 mg/day are safe
in what populations is B6 deficiency more prevalent?
elderly, pregnant and lactating women
in what vitamin deficiency do we see an elevated plasma homocysteine?
B6
elevated homocysteine damages the vessels of the arteries > atherosclerosis. high homocysteine causes 10% of MIs
most active form of B6? where is it absorbed?
pyridoxal-5-phosphate - jejunum and ileum
which vitamin can be used to treat carpal tunnel, epilepsy, peripheral neuropathy, gestational DM, N/V in pregnancy, preeclampsia, PMS, anxiety, autism, dementia, depression, schizophrenia, DM, asthma, immune enhancement, OP, and kidney stones?
B6
why is B6 beneficial in asthmatics?
defect in TRP metabolism and reduced plt transport of serotonin could be due to B6 def
50 mg BID
combining B6 with which other supplement could improve behavior?
Mg
doses of B6 > 80-400mg/day could interfere with which class of pharm?
anticonvulsants
can supplement 25-50 mg/day for epilepsy
an increase in homocysteine can contribute to osteoporosis, which 3 B vitamins could be low in OP?
B6, 9, 12
how much B6 can the liver process at a time?
50 mg
at what dose is B6 toxic? at what dose does it cause ataxia and severe peripheral neuropathy?
chronic in take of 500mg daily
2-6 grams/day
which two lab tests tell us B6 amount in blood?
PLP and PL
which two other components are needed to convert pyridoxine > pyridoxal-5-phosphate?
Mg and B2
the following are antagonist to which B vitamin? food coloring, diuretics, cortisone drugs, OCPs, alcohol, and excessive protein intake
B6
explain levodopa, carbidopa, B6 relationship?
if someone is taking levodopa only - they should avoid B6
carbidopa + levodopa is OK
this vitamin is obtained from a dietary source or from bacteria synthesis in the gut
B7/biotin
most of the biotin in this food source is bound and not available
wheat
fruits and meats contains negligible amounts of biotin
sources of biotin?
peanuts* and mushrooms*, liver, soy flour, yeast, egg yolk
eating a lot of egg whites can induce which vit deficiency?
B7: the glycoprotein avidin binds strongly to biotin, cooking the egg whites will denature avidin
long term use of which drug class can result in biotin def?
anticonvulsants
sxs of biotin def? due to what pharms/lifestyle?
scaly dermatitis, alopecia, depression, hallucinations, paresthesia, nausea
antibiotics, alcohol
def in this vitamin can contribute to cradle cap and alopecia in babies
B7
recommend intake of B7?
30-35 micrograms/day
where is B7 absorbed?
jejunum
biotin is mainly used in the treatment of which 2 things?
hair/skin/nails and diabetes (improves insulin sensitivity)
which two B vitamins function synergistically?
B9 and 12
def in this B vitamin > neural tube defects. what dose should be given to prevent?
B9 (folic acid)
≥ 400 micrograms per day - usu 600
food sources of B9?
folic acid = foliage = green leafys = kale, spinach, beet greens
legumes, broccoli, asparagus, cabbage root vegetables, whole grains, lentils, kidney beans, avocado, chickpeas, spinach, OJ
where is B9 absorbed?
jejunum
most common vitamin def?
folate/B9
what decreases availability fo folic acid?
food, goes from being 100% > 85% bioavailable with fod
these pharm impair folic acid metabolism >
alcohol, estrogens, sulfasalazine, barbiturates, light, heat
megadoses (10mg/day) could be helpful in?
cervical dysplasia
megaloblastic anemia can be caused by a def in?
B9 or B12 (macrocytic anemia)
rec intake of B9?
400 normally, 600 in pregnancy
these vitamins act as methyl donors
B9, B12 (and SAM)
available forms of B9?
folic acid/folate
folinic acid/5-MTHF
B vitamin in the tx of: atherosclerosis, stroke, hyperhomocyteinemia, psoriasis, vitiligo, seb derm, migraine, peripheral neuropathy, restless legs, autism, dementia, depression, cervical dysplasia, gingivitis, OP, sickle cell disease. recurring miscarriage
B9
these three vitamins combine to form BH4 (tetrahydrobiopterin)
B9. B12. vitamin C
BH4 is needed in the synthesis of 5-HT, melatonin, DA, NE, epi
at what dose is B9 toxic?
≥ 10 mg/day
at 5-10 mg, seizure activity could be increased
best serum assessment of B9?
RBC folate
drugs that impair folate metabolism
OCPs, TMP-SMX, chemo, anticonvulsants, alcohol, ASA
what is needed to absorb B12?
intrinsic factor > small intestine absorption
best source of B12?
meats - liver, kidney, clams, eggs, fish, cheese
how many years does it take for B12 def to show up? where is it stored?
5 years, liver and kidneys
which organ system is affected first in B12 def?
brain and neuro - numbness, pins and needles, burning feelings, elderly could mimic AD, common cause of depression
other sxs of b12 def?
glossitis (BEEFy red tongue), diarrhea
the supplementation of which B vitamin can mask a deficiency in which B vitamin?
B9 supp masks B12 def
who is most susceptible to B12 def?
elderly
rec intake of B12?
2.1 - 2.4 micrograms/day
most effective form of B12? most common?
methylcobalamin*
cyanocobalamin
which vitamin is used in AIDS, AD, impaired mental function, depression, neuropathy, low sperm count, MS, tinnitus, asthma, sulfite sensitivity?
B12
without this nutrient, we would have fatty buildup in the liver, cardiac sxs, gastric ulcers, HTN, inability to digest fats, kidney and liver impairment, stunted growth
choline
needed for the manufacture of acetylcholine, phosphatidylcholine (lecithin) and sphingomyelin
choline can me made from either of these amino acids
methionine or serine
phosphatidylcholine is found in which foods?
free choline is found in ?
grains, legumes, egg yolks
cauliflower, lettuce, whole grains, liver, soy
requirement levels of choline?
425 (females) - 550 (males and lactation) mg/day
principle uses of choline/phosphatidylcholine
liver disorders, elevated cholesterol, Alzheimers, Bipolar depression
> how many grams of choline can you get N/V/GI pain, diarrhea, fishy body odor
20 grams
inositol is found in what food sources?
brewer’s yeast, citrus, legumes, meatrs, raisins, vegetables, whole grains
fiber component of inositol = phytic acid
similar to choline, this vitamin has a lipotropic effect and promotes fat to be exported form the liver, also necessary for brain/nerve/muscle functioning
inositol
principle uses of inositol
liver disorder (100-500mg QD), depression and panic attacks (12 grams daily), diabetic neuropathy (1000-2000 mg daily)
this vitamin is an essential cofactor for EIGHT enzymes, functions as an electron donor and facilitates hydroxylation
vitamin C/ascorbic acid
this vitamin is essential for collagen and carnitine biosynthesis, immune function, NTs, hormones, antioxidant, antiviral, antibacterial
vit C
food sources of vitamin C
citrus, cateloupe, broccoli, cauliflower, potatoes, OJ, strawberries, oranges, kiwi, salsa fresh as is it destroyed by high temp cooking and exposure to air
what is considered a vit C def? less than how many mg in adults?
10mg/day
sxs of vit C def?
scurvy (bleeding abnormalities, petechiae, bleeding gums, hemarthrosis), delayed wound healing, infections, bone pain, OP, edema, fatigue, depression
subclinical vit D def is common in which pt population?
elderly
requirements of vit C?
85-120mg/day
max vitamin C/day in regards to absorption?
500mg
this antioxidant works synergistically with vit E, carotenes, glutathione peroxidase, catalase, superoxide dimutase
vit C
most common and least expensive form of Vit C?
which form is more absorbable?
ascorbic acid
ester-C has NOT been shown to be more absorbable
vit C supplementation caution in people sensitive to?
corn
this vitamin can be used in atherosclerosis, elevated cholesterol, HTN, AIDS, cold, influenza, measles, TB, UTIs, asthma, allergies, cataracts, gingivitis, DM, cancer prevention, wound healing, PD, preeclampsia, prevention of PROM
vitamin C
how does vitamin C cause diarrhea in some people
unabsorbed vit C it has an osmotic effect
concern about too much vit C?
only in people on hemodialysis - concern of kidney stones
which 3 things does vitamin C interfere with and how?
increases iron absorption
decreases copper ab
interferes with vitamin B12 lab testing
vitamin D is important in the regulation of which 2 minerals in our bodies?
explain it
calcium and phosphorus
Vit D stimulates the absorption of Calcium
natural sources of Vit D?
SUN, cod liver oil, salmon, mackerel, sardines, herring, egg yolks, tuna
at what level do we consider Vit D to be def?
< 200 IU per day
what disease does vit D def cause in adults? children?
osteomalacia, ricket’s
vit D requirements?
200-400 IU/day
explain the pathways taken to make Vit D starting with sunlight
sunlight converts 7-dehydrocholesterol > Vit D3 (cholecalciferol) in the SKIN
D3 travels to the LIVER and is converted into 25-OH cholecalciferol (25OHD3) which is 5X more potent than D3
25OHD3 travels to the KIDNEYS and gets converted into 1, 25 dihydroxy cholecalciferol (1,25 OH2 D3) which is 10X more potent than D3
where is vit D stored?
adipose, making it less bioavailable in obese individuals
how many IUs of Vit D does breast milk provide?
25
most common form of Vit D supplementation?
what is the prescription form? who is it usually prescribed for?
D3/cholecalciferol (D2 is just as effective as D3)
calcitriol - which is 10X more potent than D3 - kidney pts because they cant convert D > active form
this vitamin is used in bone health, OP, cancer, and immunity, paget’s disease, rickets, colds, fatigue, etc
VIt D
in which populations is D def more common?
little outdoor exposure, live in northern latitudes, darker skin, malabsorption
Vit D is more effective when combined with?
Calcium
vit D is toxic at what doses? what can it cause?
40,000 IU per day > hypercalcemia, hypercalciuria, soft tissue calcification, kidney stones
what are the fat soluble vitamins?
A, D, E, K
the vitamin known as anti-sterility
vitamin E. tocopherol
where to get Vit E?
polyunsat vegetable oils, nuts, seeds, whle grains, avocado, dark green leafy, asparagus, eggs, tomatoes
who is at risk of vit E def?
low intake of vegetable oils, nuts, seeds
vit associated with antiaging, antioxidant, to treat: infertility, menstrual problems, neuromuscular impairment, poor coordination, shortened RBC span, spontaneous abortion, uterine degeneration
E
individuals with severe malnutrition can develop these kinds of disorders >
fat malabsorption syndromes - CD and CF
recommended vit E?
22-28 IU/day
this vitamin can protect from heavy metals, benzene, carbon tetrachloride, drugs, radiation, free-radicals
E
vitamin E protects which gland and which blood cell from damage?
thymus, WBCs
vit E is a group of 8 antioxidant compounds. list them.
which one is found in the largest amount in human blood and tissue?
which one exerts more of an antitumor activity?
which one may help prevent heart disease?
4 tocopherols (a, b, g, d) 4 tocotrienols (a, b, g, d)
alpha-tocopherol
alpha-tocotrienol
gamma-tocopherol
is d- or dl- the natural form of vit E?
d- , natural forms are much more expensive, but much more potent
which patient population should supplement with Vit E longterm?
CF patients, fat-soluble forms are adequate although water-soluble are more available
vitamin supplement for: herpes, AK, Scl, B-thalassemia, sickle cell, cramps, myopathy, Dupuytrens, epilepsy, PD, restless legs, fibrocystic breast changes, PMS, vaginitis, allergies, cataracts, cancer, DM, infertility, wounds
E
vitamin that protects LDL from oxidation?
E
general dose for vit E?
400 IU/day