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
which vitamin can regenerate oxidized vit E?
Vit C
this vitamin increases action of coumarin and should not be used with anti-coagulants
vit E
vitamin for blood clotting, and more specifically the production of prothrombin. also for bones and OP prevention.
K
which forms of Vit K are natural/from gut/synthetic?
K1/phylloquinone = plants *preferred K2/menaquinone = gut bacteria K3/menadione = synthetic
dietary sources of Vit K?
dark leafys, asparagus, brussels, eggs, liver, oatmeal, soybeans, wheat, yogurt
*the majority is made by gut from consuming soluble fiber - because of this def is rare
vit K def usually due to?
warfarin, coumadin, long term ABX
why do we give newborns Vit K shot?
no gut bacteria, to prevent hemorrhagic disease
requirements of Vit K?
< 6 mo = 5 micrograms/day
7-10 = 30
adults 65-80
vitamin K dependent clotting factors?
2, 7, 9, 10, protein C and S (k1 is superior)
when are large doses of synthetic vit K contraindicated?
during last few weeks of pregnancy > toxic reaction to newborn
vitamin needed for night blindness, spermatogenesis, immune function, maintenance of epithelial tissues
vitamin A
precursor to vitamin A?
carotenes - out of 600, 50 have vit A activity, beta-carotene has the most active pro-vitamin A activity
(B > A > Gamma > beta-zeacarotene)
where to get vit A?
animal-based foods, liver, fish liver oil, dairy products, dark green and bright veggies and fruits
*highest levels in liver and fish liver oils
what are other carotenoids, but arent pro-vitamin A?
lycopene, zeaxanthin, lutein, canthaxanthin, capsanthin
carotenes require ? to be absorbed?
bile acids
retinol does not require this
fat, protein, vitamin E, bile and pancreatic enzymes, mucosal cell integrity all effect the absorption of?
A
Vitamin A or beta-carotene absorbed better?
Vitamin A (90%), B carotene is 40-60%
where is vit A stored? carotenoids?
liver, goes straight to tissues
causes of vit A def?
malabsorption due to bile acid or pancreatic enzyme insufficiency, inadequate protein intake, liver disease, zinc def
conditions assoc with Vit A def?
chicken pox, RSV, AIDS, pneumonia
follicular hyperkeratosis, night blindness, and infections assoc with?
vit A def
xerophthalmia assoc with?
vit A def
most serious consequence of Vit A def? how is it handled?
blindness
WHO gives 200,000 IU doses to kids every 6 months in developing countries
what amount of vit A is teratogenic? what is the consequence
> 10,000 IU , OP and bone fracture, cleft palate and heart defects
pregnant peeps should use beta-carotene instead
dose ranges of vit A?
5000 men, 2500 women
acute viral infection: 50,000 IU for 1-2 days is safe even in infants
at what dose is vit A toxic?
single large dose of 100k-300k > acute tox in children > raised intracranial pressure with N/V, headache, joint pain, altered mental status, papilledema
if adults take > 50k daily for years it can be toxic > chapped lips, dry skin, headache, fatigue, overly emotional, muscle and joint pain
hepatotoxic? at 1.75 million IUs
side effects of beta-carotene over supplementation?
not much…maybe yellowing of skin
you have liver disease! you shouldnt take more than ? vitamin A?
10,000 IU
what 3 things are important for the proper functioning of vitamin A and the conversion of provitamin A carotenes > vitamin A?
zinc, thyroid hormone, vit E
what should we NOT add to the diet when taking systemic corticosteroids?
what nutrients do they deplete that we should consider supplementing?
for all systemic steroids (prednisone, prednisolone, methylprednisolone, dexamethasone): do not add salt to the diet as they cause Na retention.
Nutrient depletions to consider supplementing: Ca, VitD, folic acid, Mg, K, VitB12
diet and supplements for cystic fibrosis
high calorie diet and fat soluble vitamin supplements, pancreatic enzyme replacement
Boron plays a role in the metabolism of what other four compounds?
Ca, Ph, Mg, VitD
which mineral is needed to make natural steroids and helps prevent postmenopausal osteoporosis?
Boron: supplementation can shrink prostate tumor size and decrease PSA, boron also reduces levels of COX and LOX
RDA of Boron?
1.5-3 mg/day
Boron deficiency can accentuate what other deficiency?
VitD > it is also associated with an increased risk of bone loss and decreased levels of E and T
this mineral is mostly concentrated in bone, teeth, hair, nails, spleen, and thyroid
Boron
which mineral is needed to help VitD stimulate the absorption and utilization of Ca?
Boron
most abundant mineral in the body?
Ca - 99% of the body’s calcium is in bone and teeth
food sources of Ca?
kale is very absorbable Ca, salmon, sardines, dairy, kale, broccoli, tofu, spinach (however poorly absorbed as it is bound to oxalate)
sxs of hypocalcemia
leg cramps, brittle nails, heart palpitations, hypertension, tooth decay
can also lead to Ricket’s (children) or osteomalacia (adults)
RDA of Ca?
800-1200 mg/day
how to improve Ca absorption? (3) where is it absorbed? what potentiates the loss of Ca in urine? (6) what interferes with Ca absorption? (5) what does Ca interact with? (3)
take with food - gastric acid is a factor. can also take with lysine or vitamin D
duodenum and jejunum - Vit D dependent
ileum - not dependent and passive
large bowel 4%
protein intake - for every 50 g increment in daily protein, an addition 60mg of Ca is excreted
also caffeine, alcohol, phosphates, sodium, and sugar
oxalates - it forms indigestible salts with Ca. found in spinach, rhubarb, beets. and
phytates - soy
high doses of Mg, zinc, and fiber can also decrease absorption
D, K, and Mg
Ca is regulated by glucocorticoids, thyroid hormone, growth hormone, insulin, and estrogen. Explain how
glucocorticoids: increase renal calcium excretion
high blood ca > thyroid releasing calcitonin > slows down osteoclasts > decreases blood Ca > stimulates parathyroid gland to release PTH
growth hormone: increases Ca absorption, activates both clasts and blasts for bone remodeling > net effect of bone accumulation
Ca stimulates the release of insulin
estrogen > increases serum Vit D > increases calcium absorption
this mineral can be indicated for bone density, brittle nails, hypercholesterolemia, leg cramps, obesity, OP, Paget’s disease, periodontal disease, and PMS
Ca
Ca supplementation (not food sources) greater than 500mg daily may increase the risk of? how?
cardiovascular events - MI, stroke, death
Ca depletes Mg which is cardioprotective
Calcium impairs the absorption of which 2 minerals?
iron and zinc
Ca - food and supplemental - effects on kidney stones
food sources might decrease symptomatic Kidney stones, while supplements can increase the risk
what is milk-alkali syndrome?
combining large amounts of calcium and alkali (aluminum antacids) can cause irreversible renal failure, metastatic calcification of soft tissue, memory loss, lethargy, coma, and death
original name for chromium?
glucose tolerance factor (GTF) > isolated from pork kidney in 1957, it restored impaired glucose tolerance in rats
main role of chromium?
cofactor for insulin > improves glucose tolerance by facilitating the binding of insulin to its receptor
food sources of chromium?
meats, liver, eggs, whole-grain products, brewer’s yeast, shrimp, mushrooms, cheese meats and whole grains are the best sources
- F&V have very low chromium concentrations
RDI of chromium?
children 30-120 micrograms
> 7 yo: 50-200 micrograms
sxs of chromium def?
peripheral neuropathy, insulin resistance, elevated blood sugar and insulin levels
where is chromium stored?
bone, spleen, kidney, liver
at what age do levels of chromium start to decrease?
40
which form of chromium is best?
chromium picolinate
use chromium for the treatment of?
at what dose?
improving blood sugar control, elevated blood cholesterol and TGs, promotion of weight loss, acne
1000micrograms/day
drug interactions with chromium?
insulin, glyburide, metformin, and any other hypoglycemics - coadministration could actually IMPROVE benefit by enhancing control, but need to be aware of hypoglycemic reaction
which vitamin increases absorption of chromium?
what decreases absorption?
what increases urinary excretion?
vitamin C
phytates and antacids (calcium carbonate)
diets high in simple sugars (aka my diet - FUQ)
chromium loss is seen in what conditions
long periods of stress: pregnancy, infection, trauma, strenuous exercise > exercise has been shown to induce chromium loss in athletes and leads to chromium def > impaired insulin function
this mineral aids in the formation of bone, hemoglobin, and RBCs. it works with zinc and vitamin C to form elastin (a skin protein). it is involved in the wound healing process, energy production, hair and skin coloring, and taste sensitivity
copper
richest food sources of copper?
oysters, shellfish, and legumes
brazil nuts, almonds, hazelnuts, walnuts, pecans
the def of this mineral can lead to iron deficiency?
copper > Cu is required for iron to be absorbed and utilized
def in what mineral could lead to OP, stunted growth, skin sores, and ruptured blood vessels? can also present as increased lipid peroxidation, elevated LDL and reduced HDL
Cu. it is required for the enzyme lysyl oxidase to crosslink collagen and elastin, without it you would have poor collagen integrity
4 reasons someone might be def in copper: name the reasons
- malnutrition - malnutrition
- decreased absorption due to? what is optimal ratio?
- increased loss due to?
- increased requirement due to?
- high doses of zinc (optimal ratio of Zn:Cu is 8-10:1), iron or vitamin C, chronic antacid intake, malabsorptive states (CD, crohns)
- nephrotic syndrome, chelation therapy, burns
- pregnancy and lactation
RDA copper?
supplementation amounts?
900-1300 micrograms/day
1.3-3 mg
copper plays a role in many enzymes - superoxide dimutase, lysyl oxidase, cytochrome c oxidase, DA hydroxylase, tyrosinase, ceruloplasmin - what are some of the actions?
its role is to be a metallo portion
breaks down superoxide free radical, collagen and elastin crosslinking, electron transport, converting DA > NE, melanin formation, transporter of 95% of total copper in healthy human plasma
what mineral causes nausea at 10 mg and vomiting at 60?
what is the lethal dose?
copper
adults: 10-20 grams
children: 3.5 grams
the mineral needed to make thyroid hormone
iodine
food sources of iodine
salt, seaweed, kelp, dairy products, eggs
def in this mineral can cause intellectual disability, goiter, neonatal hypothyroidism, weight gain
iodine
what is the definition of a goitrogen?
what is a goiter?
foods that block iodine utilization - bok choy, broccoli, Brussel sprouts, cabbage, canola, cauliflower, rosaceae family (almonds, apricots, cherries, peaches, pears, plums, raspberries, strawberries)
-cooking lowers the goitrogenic content
goiter is a swelling of the thyroid gland d/t it having to work harder - in some cases because there isnt enough iodine around to make thyroid hormone
iodine def effects on mom and baby?
HTN in pregnancy
mental retardation, if severe > cretinism - stunted physical and mental growth
RDA of iodine?
safe upper limit?
150-290 micrograms/day
US people get > 600micrograms/day
safe upper limit is 1100 micrograms/day
iodine effects on breast tissue?
low iodine > increases sensitivity of breast cells to estrogen > swelling, fluid buildup, increase in breast cell number = iodine can be used in fibrocystic breast changes
which mineral can be used to protect the thyroid against radiation emergencies?
potassium iodine tablets (thyroshield)
explain the Wolff-Chaikoff effect?
high acute doses of iodine actively suppresses hormone synthesis in the thyroid for up to 48 hours, after which the body adapts and returns to normal
- due to a down regulation of iodine transportation into the thyroid from plasma
sxs of iodine toxicity?
burning mouth, increased salivation, swelling of salivary glands, metallic taste, sore teeth and gums, headache
this mineral is an important component of hemoglobin, and immune function
iron
food sources of iron
eggs, liver, meat, poultry, green leafys, whole grains, enriched breads and cereals
lesser amounts: almonds, avocados, kelp, pumpkin, sunflower seeds
most efficiently absorbed form of iron?
heme iron: bound to hemoglobin and myglobin - found in animal products
nonheme: plant foods and poorly absorbed
most common cause of iron deficiency?
insufficient intake - common in vegetarian diets
other causes: menstruation, pregnancy, elderly, peptic ulcers, hemorrhoids, blood donation
- antiinflammatory drugs like ASA and ibuprofen can contribute to iron loss through GI bleeding
what can cause a increase/decrease in iron absorption?
increase: vit C
lack of Hcl in the stomach, antacid use, high doses of Ca, Mg, or Zn
sxs of this mineral deficiency? fatigue, brittle hair, hair loss, restless legs, angular stomatitis
iron
RDA iron?
10-15 mg/day
30 mg/day in pregnancy
iron can be useful in the treatment of?
menorrhagia, dysfunctional uterine bleeding, fatigue, infertility, restless legs, and athletic performance
excessive iron intake can lead to an increased need for which vitamins?
C and E: iron buildup in the tissues and organs can lead to production of free radicals > need more C and E
when should someone avoid iron supplementation?
during infection - bacteria need iron to grow
SEs of iron supplementation
constipation, nausea, vomiting, abd discomfort
best test for measuring iron?
serum ferritin
how to test iodine?
urinary iodine excretion
which mineral is highly responsible for metabolism?
Mg - functions in more than 300 enzyme systems
RDA Mg?
280-350 mg/day
where is most Mg absorbed?
33% in upper small bowel
how many grams of Mg can we store? where do we store it?
20-28 g
60% bones, 26% muscle, remainder in soft tissue and fluid > brain/heart/liver/kidneys
these (3)drug classes can cause mg loss/hypomagnesmia
thiazide diuretics, alcohol, and PPIs
best dietary sources of Mg?
tofu, seeds, black beans, dark chocolate, almonds, cashews, peanuts, leafy greens, spinach, white beans
up to 50% of US population is deficient
which mineral def? fatigue, mental confusion, irritability, heart disturbances*, muscle cramps, insomnia?
Mg > can be a major cause in fatal cardiac arrhythmia, HTN, sudden cardiac arrest, kidney stones, PMS, chronic pain syndrome, depression, and insomnia
RDA of Mg?
310-420 mg/day
DOUBLE THIS for tx of MI, cardiac dysrhythmia, CHF, hypertension, claudication, fibro, OP, and PMS
supplementation of this mineral can be taken to reduce the risk of preeclampsia in pregnancy
magnesium
def of this mineral is associated with insulin resistance?
mg, but also chromium
this mineral is required for energy production, oxidative phosphorylation, glycolysis, bone structure, DNA synthesis, and GSH synthesis
Mg
natures calcium channel blocker? why?
Mg > activates the Na/K pump. blocks the entry of Ca into vascular smooth muscle cells and heart muscle cells
which form of magnesium is often found in milk of magnesia products? what are its effects?
magnesium oxide > strong laxative effect > poor bioavailability
this form of magnesium is a good form to deliver Mg into the body but still has a laxative effect?
Mg citrate > more bioavailable than oxide
this form of Mg is used for chronic fatigue syndrome?
Mg aspartate > aspartate feeds into the krebs cycle (pathway for conversion of glucose FAs and AAs > ATP)
this form of Mg is used for chronic pain and muscle hypertonicity?
Mg glycinate > glycinate is a calming AA
this form of Mg has been used in fibromyalgia?
Mg malate > malate is a substrate in the cellular energy cycle and can help improve ATP production, may reduce muscle pain and tender points
this form of Mg has been used to improve cardiac function?
Mg taurate > potentiating effects on insulin sensitivity and calming on neuromuscular excitability, BP reducing effects, stabilize nerve cells, improve heart contraction, anti-thrombotic low B6 levels can further deplete Mg and taurine
this form of Mg is used in enhancing short term memory and longer term memory > boosting scores
Mg-L-threonate: why the F wasnt i taking this all muh life?
crosses the BBB and raises brain Mg levels > increased neural synaptic density, improved brain function
this mineral’s toxicity level is variable depending on renal function? children upper tolerable limit?
Mg: 1-3 < 65mg.day, 4-8 yo < 110 mg.day
AEs: nausea, vomiting, diarrhea, hypotension, when extreme toxicity > resp depression and asystole
mg supplementation is contraindicated in what 3 conditions?
ESRD, MG, cerebral hemorrhage
which vitamin works synergistically with Mg?
which vitamin + mineral can reduce Mg absorption?
Mg will decrease the absorption of which 2 pharms?
Mg will enhance the effects of which 2 pharms?
what 3 things increase the body’s Mg requirement?
B6 Vit D + calcium ABX and bisphosphonates muscle relaxants and CCBs alcohol, diuretics, and high doses of Zn
how to test for Mg?
serum Mg
this mineral is used in the formation of cartilage and synovial fluid of joints
Mn/manganese
dietary sources of Mn?
nuts, whole grains, and green leafys
def of this mineral looks like: skin rahs, reduced growth of hair and nails, bone remodeling, decreased HDL
in animals: impaired growth, impaired reproductive function, skeletal abnormalities, impaired glucose tolerance, and altered carb and lipid metabolism
manganese - however def is rare
RDA of Mn?
there aint one
1.8-2.6 mg/day
indications of this mineral include: strains, sprains, inflammation, epilepsy, diabetes
manganese, 15-30 mg/day or 5-15 in DM
these are mostly animal studies
miners are chronically exposed to this mineral ? what do toxicity sxs look like?
manganese > psychosis/violence and hyperirritable, parkinsons-disease like sxs
doses > 60mg/day can cause tremors and excessive salivation but nutritional supplement toxicity is very rare
avoid these two minerals when taking Mn?
Ca and Iron
this mineral is part of cofactors that are involved in the detox of sulfites, alcohol, and uric acid formation?
molybdenum
food sources of molybdenum?
beans, lentils, peas = the richest sources
grains and nuts = good
animal products, fruits, vegetables = low
RDA of molybdenum
45-50 micrograms/day
dietary def has never been seen in healthy people, in people on parenteral nutrition they lost the ability to detox sulfites
this mineral has been used in the tx of sulfite sensitivity, esophageal cancer
molybdenum
this mineral interacts with copper in the GI traact and should be taken away from one another?
molybdenum
this mineral is involved in cell membrane and nucleic acid structure, as well as bone mineralization, energy production, cell signaling, and regulation of the acid-base homeostasis
phosphorus
food sources of phosphorus?
dairy, cereal, meat, fish
cola soft drinks!
def of this mineral is rare but can lead to anxiety, bone pain, fatigue, irregular breathing, irritability, weakness, and weight changes
phosphorus
usu only seen in near total starvation
RDA phosphorus?
700mg/day (but processed food gets up to about 4000mg/day)
phosphorus interacts with intake of what other mineral?
Calcium
richest sources of potassium?
fruits and vegetables
also can find in nuts, seeds, and dairy
most common cause of potassium deficiency?
excessive fluid loss due to sweating, diarrhea, diuretics, laxatives, drugs, etc
more common than a dietary deficiency
sxs of hypokalemia? chronic?
sxs of hyperkalemia? most serious AE?
fatigue, muscle weakness are first, mental confusion, nerve conduction issues, and cramps
chronic > hypertension. muscular paralysis, fatal cardiac arrhythmias
tingling of the hands and feet, muscular weakness, temporary paralysis. fatal cardiac arrhythmias
rec intake of K?
at what dose would we give potassium for HTN?
at what oral dose would be too high and could lead to toxicity/severe hyperkalemia in a healthy person?
2800-3400mg/day
2340-2535 mg/day
> 18 grams taken at once
most common AE of K supplementation?
nausea, vomiting, abd discomfort, diarrhea = GI sxs
how does hyperkalemia usu occur?
acute or chronic kidney failure, potassium sparing diuretics, insufficient aldosterone secretion
avoid these pharms (3) when taking K
digitalis (cardiac glycosides), K sparing diuretics (like spiro), ACEI (lisinopril)
this mineral plays a role in reproduction, thyroid hormone metabolism, DNA synthesis, and oxidative damage/infection protection
selenium
sources of selenium?
whole grains, dairy, products, pork, beef, turkey, chicken, fish, eggs, brazil nuts
selenium is a vital antioxidant, esp when combined with this vitamin?
E
def in this mineral leads to Keshan disease? daily intakes of how much can prevent it?
Selenium
selenium def + a second stress such as a viral infection = Keshan disease = cardiomyopathy
≥20micrograms/day
def in this mineral puts you at an increased risk of cancer, heart disease, low immune function, and male infertility
selenium
RDI selenium?
toxic dose?
55-70 microg/day
dont get more than 1000microg/day, upper tolerable limit is 400microg/day
avg american intake = 90-127
where is selenium absorbed?
concentrated?
excreted?
small bowel
liver and kidneys (slightly in myocardium)
urine, stome stool
most absorbable form of selenium?
selenomethionine (90%)
selenite (only 50%)
principle uses of selenium?
cancer prevention (esp bladder and prostate) CVD imune dysfunction
most common sxs of elevated selenium/selenosis?
brittle nails and hair, hair loss
GI sxs, skin rashes, garlic breath odor, fatigue, irritability, emotional instability
selenium acts synergistically with what 2 vitamins?
C and E - it regenerates them from their oxidized forms
this mineral is the second most abundant element on earth after oxygen?
silicon
this mineral is necessary for the formation of collagen for bones and connective tissues, hair, nails, skin, and calcium absorption
silicon
richest sources of silicon?
unrefined grains - whole oats, rice bran, brown rice, beets, alfalfa, bell peppers, green leafys
where is there the highest concentration of silicon?
in what organs does silicon content decline with age?
hair, skin, and growing bones
aorta, thymus, and skin (doesnt in other tissues)
available forms of silicon?
equisetum/horsetail and orthosilicic acid (Biosil)
usu dose for silicon?
5-20mg/day although there is no RDA
this mineral is a major extracellular electrolyte that helps control BP, water balance, homeostasis
sodium - virtually all foods contain some sodium
causes of dilutional hyponatremia?
inappropriate ADH secretion > high ADH causes the kidney to retain water
could also be from consuming too much water
conditions that increase sodium and chloride loss?
severe or prolonged vomiting or diarrhea, excessive or persistent sweating, diuretics, kidney disease, restricting too much Na in renal pts w HTN and CHF
sxs of hyponatremia? severe and rapidly developing?
headache, N/V, cramps, fatigue, disorientation, fainting
cerebral edema, seizures, coma, brains damage, death
RDA sodium?
no more than 2300mg (1 tsp)
adequate intake would be 1200-1500
when would we give sodium?
prevention and treatment of hypotension, heat cramps
what population does hypernatremia happen?
usu first sign of hypernatremia?
older adults who are mentally/physically impaired and are not eating or drinking enough, are sick with a high fever, vomiting, excessive sweating or diuretics, etc
> Na accumulates in the blood > water leaves cells and into the blood to dilute it > fluid shift can cause brain or lung fluid buildup
intense thirst, also N/V, weakness, loss of appetite, confusions, kidney damage
this mineral is needed for cellular metabolism and bone/teeth formation
vanadium
where can you find vanadium
RDA?
dill, shellfish, olives, mushrooms, buckwheat, parsley
there is none, but 10-60 microg is prob safe
this mineral has been shown to improve the utilization of insulin. in animal studies, it can inhibit chol synthesis and improve bone and tooth mineralization
vanadium
popular form of vanadium?
vanadyl sulfate
this mineral plays an important role in DNA and protein synthesis, wound healing, immune function, neurotransmission, vision, reproduction, and iron transport in the intestines
zinc
where is most of our zinc stored?
muscle and RBCs/WBCs
also in bone, kidney, liver, pancreas, retina, and prostate
best sources of zinc?
OYSTAs, shellfish, beef, red meats, nuts and legumes
*less available in plant proteins as they have phytates which inhibit zn absorption
zn def sxs?
slowing of growth and development, delayed sexual maturation, skin rash, diarrhea, immune deficiencies, impaired wound healing, diminished appetite, impaired taste, night blindness, swelling and clouding cornea, behavioral disturbances
RDA for zinc? how much would you supplement for immune/sexual function/etc
12-19 mg/day, supplement 15-60
american diet - 10-15
what mineral might be a useful supplement for Wilsons disease?
zinc. WD is high copper and zinc interferes with copper absoprtion
levels of this mineral are lower in teenage males more than any other group
Zn - acne association?
principle uses of zinc?
immune, male sexual function, acne, macular degeneration, wilsons disease, pregnancy, alzhemiers,
most common nutrient deficiency in the elderly?
zinc
GI distress occurs at what dose of zinc? > other sxs of too much zinc?
50-150 mg/day
nausea, vomiting, abd cramps, diarrhea, loss of appetite, anemia, headache, metallic taste in mouth
doses of zinc greater than ? can suppress immune system?
100
should take zinc 2. hours away from which 2 pharms?
tetracyclines and quinolone ABX - reduced efficacy of both zn and the meds
zinc competes with what 2 minerals?
zinc is required to transport what vitamin in the blood?
copper and iron
vitamin A
name the essential amino acids
PVT TIM HALL phenylalanine valine tryptophan threonine isoleucine methionine histidine (arginine) - essential in infants and adults who cant make it endogenously leucine lysine
this amino acid can be made from BCAAs, is highly concentrated in muscle, and is known for increasing immunity and providing energy for the brain and CNS
alanine
name the 4 inhibitory neurotransmitters
GABA, alanine, taurine, glycine
this amino acid can be preventive of nighttime hypoglycemia in type 1 diabetics
L-alpha-alanine
this amino acid is an immediate precursor to nitric oxide and is important in cell division, wound healing, and immune function
L-arginine
forms of arginine?
L-citrulline is better absorbed and is converted to arginine in the kidneys
this amino acid can be taken for angina, hypertension, erectile dysfunction, and PAD
arginine
arginine toxicity?
30-60 grams/day
can antagonize lysine > HSV outbreak
hyperkalemia in pts with renal insufficiency
this amino acid plays a large role in the krebs cycle and is an excitatory amino acid
L-aspartate or aspartic acid
this amino acid is frequently used for tiredness, improved athletic performance, muscle size and strength, immune function, cognitive function, and toxin removal
aspartate
this amino acid is formed from L-methionine while using vits 6, 9, and 12
cysteine
this amino acid is used for skin and hair, antiaging, inflammation, stroke reduction risk
cysteine
this excitatory amino acid increases the firing of neurons and is converted easily to an inhibitory amino acid. it is used in mental health, detox, and heart function
glutamic acid > (Glu or GABA)
this amino acid is the most abundant free amino acid found in muscles of the body
glutamine
this amino acid can prevent muscle loss during times of stress, helpful for the immune system, mucous membrane cells in the small intestine, cells in the mouth and tongue, and muscle for athletes
glutamine
this amino acid supports the production of glutathione and protects the liver from acetaminophen overdose, can be used in muscle building, good for digestive system, immune and nervous systems, as well as adjunctive CA treatment
glutamine
this amino acid is made from serine and threonine, is good for mental health, tissue, repair, muscle growth, and has been used in schizophrenia, bipolar, mania, and seizures
glycine
this amino acid is important for myelin sheaths to protect nerve cells, is needed for RBC and WBC production, protects the body from radiation
histidine
these two amino acids are used w body builders
isoleucine and leucine
this amino acid can antagonize the viral growth promoting action of arginine (HSV)
lysine
this sulfur containing amino acid is good for joint, heart, hair health, UTIs. brazil nuts are the best source of it
methionine
this amino acid is a precursor to tyrosine, which makes what 2 neurotransmitters?
phenylalanine
dopamine and NE
this amino acid is good for vitiligo, mood, pain, parkinsons
phenylalanine
this amino acid is the principal AA used to make collagen, good for skin and tissue repair
proline
this amino acid is good for mental health and muscle building.
serine
this amino acid is a precursor to serine and glycine, aids in tooth enamel, digestion of fats, and promotes the growth of the thymus gland
threonine
this amino acid is necessary for production of B3, is converted into serotonin, and is good for ADHD, anxiety, insomnia, migraine, OCD, SAD, bulimia, IBS, restless legs, PMDD, smoking cessation
tryptophan
this amino acid is a precursor to DA, NE, and epi. is used to make active thyroid hormone, and aids in production of melanin. deficiencies are seen in people with PKU
tyrosine
this BCAA, like the other BCAAs, is associated with insulin resistance when in high levels. it helps stop muscles from breaking down during periods of high stress
valine
this supplement can be used to improve utilization of fats, improve CHF, dementia, diabetic neruopathy
carnitine
Vitamin C, B6, niacin, and iron are all needed to create this nutrient
carnitine
carnitine works synergystically with?
CoQ10
this supplement can be used for cataracts or osteoarthritis
chondroitin sulfate
indications for this supplement include: CHF, HTN, myalgias with statins, heart protection from doxorubicin, muscular dystrophy, immune def, periodontal disease, DM
coQ10
this kind of fiber can ease stooling
insoluble: dont dissolve in water and absorb water in the colon
this kind of fiber promotes regular bowel movements and is fermented to provide SCFAs to the colon, can also help lower cholesterol
soluble
this fiber supplement is the most potent cholesterol lowering agent and reduces fasting and post meal blood glucose and insulin levels
mucilages
this fiber slows the absorption of food after meals and has cholesterol lowering effects
pectin
this supplement can help reduce joint pain
glucosamine
this supple,etns can be good for venous insufficiency, retinopathy, chronic inflammation, and cancer prevention
flavonoids
this supplement can be helpful for anxiety, ADD, and reduced alcohol cravings
GABA
this supplement can help prevent cancer, lower cholesterol, reduces blood clotting, decrease cardiovascular risk
green tea
this vitamin (kindof) used to be used in topical sunscreen as it protected from UBV, it is indicated for dermatitis, scleroderma, pemphigus, vitiligo, and autoimmune diseases
PABA
this supplement may reduce the risk of dementia
phosphatidyl serine
this flavonoid is antioxidant and anti-inflammatory often used in HTN, exercise induced respiratory infections, kidney transplant, lung cancer, prostate cancer
quercetin
this amino sulfonic acid can be used for energy, retinal health, CNS, and cardiovascular health
taurine
which supplement is most anti-inflammatory? Docosohexanoic acid, Linoleic acid, Gamma linolenic acid, Eicosapentanoic acid?
EPA has the most benefit as far as anti-inflammatory nutrients, when compared with DHA or GLA. Alpha linoleic acid is an unsaturated omega-6 essential fatty acid that becomes GLA. DHA is particularly helpful for nerve and brain development and proper function. EPA and DHA come from the unsaturated omega-3 essential fatty acid called alpha linolenic acid. (I like to remember this with the mnemonic ‘LinoLENic is omega-3, and 3 is LESS than 6.’)
linoleic (6) > GLA
linoLENic (3) > EPA and DHA
