**Exam 1 Study Guide** Flashcards
define homeopathy
the idea that a disease can be cured by a substance that produces similar symptoms in healthy people
believes the lower the dose of med, the greater its effectiveness
define naturopathy, who is it practiced by? (type of physician)
based on a combo of traditional practices and health care approaches and is practiced by naturopathic physicians
what is ayervedic medicine?
ancient Indian medical system which relies on natural holistic approaches to physical and mental health
examples of traditional Chinese medicine
acupuncture
tai chi
herbal products
dietary supplements health and education act (DSHEA)
what did it do?
who is responsible for the supplements safety?
when must a supplement label be given to the FDA? (how many days)
excludes dietary supplements from being defined as “food additives”
safety of supplements is up to manufacturers, but proof is determined by FDA
supplement label must be given to FDA within 30 days of marketing
8 steps in developing safe and effective botanical dietary supps
- search scientific literature
- acquire and authenticate plant material
- determine mechanisms of action and identify active compounds
- prep for preclinical and clinical studies
- investigate metabolism of active compounds
- test drug metabolizing enzymes and transporters
- develop formulation
- conduct phase 1 & 2 clinical trials
what does cGMP stand for and what is it?
current Good Manufacturing Processes
An FDA requirement on producers of botanical dietary supplements
what types of claims are permitted for dietary supplements?
is supporting data required by manufacturer for any claims?
What must every claim be accompanied with? (Hint: FDA)
health claims
structure/function claims
nutrient content claims
Yes
This statement has not been evaluated by the U.S. Food and Drug Administration (FDA). This product is not intended to diagnose,
treat, cure, or prevent any disease
what dietary supplements are not allowed by DSHEA?
any supplement not already on U.S. market or commonly used
if it contains a drug approved by FDA
anything toxic or harmful
Any dietary supplement containing synthetic constituent(s)
who regulates accurate labeling of dietary supplements?
The U.S. Federal Trade Commission (FTC)
define complementary medicine
an uncommon practice (herb,drug,meditation,etc) used together with conventional medicine
Which state banned yoga in 1993?
Alabama
When was the ban on yoga lifted?
May 2021
Who is more likely to see a chiropractor, men or women?
Women
What did DSHEA define a dietary supplement as?
A product intended to supplement the diet that contains one or more of (a) Vitamin, (b) Mineral, (c) Herb/Botanical, (d) Amino acid (e) Supplement that increases total dietary intake
what is the mission of the Office of Dietary Supplements (ODS)?
strengthen knowledge of supplements by educating the public through scientific research in order to enhance the quality of life and health for the U.S.
T/F Aristolochia species is commonly in weight loss supplements in many countries?
False: It is toxic to humans and is banned
How Can Accidental Contamination of Botanical
Dietary Supplements be Prevented? (2 Main practices)
Implement Good Agricultural Practices (GAP)
Implement Good Manufacturing Practices (GMP)
What are mycotoxins?
How does it affect humans?
toxic compounds naturally produced by certain types of fungus
causes disease and death in humans
What does cGMP not do?
Limit consumers’ access to products
Evaluate the safety of dietary supplement ingredients
Evaluate product efficacy
Define a structure/function claim
describes the role of a nutrient or dietary ingredient intended to affect normal structure or function of the human body
if a product treats/prevents a disease, can it be regulated as a dietary supplement?
Does this type of product violate DSHEA?
No
Yes
If a supplement is not produced using cGMP, who has the right to remove it from the market?
The FDA
Who can prosecute offenders of making a false label or advertising claim?
The federal trade commission (FTC)
T/F A supplement must be for oral consumption only according to DSHEA
True
Who reviews products on the market that are not dietary supplements after DSHEA was enacted?
NDI
What was PC-SPES?
Why was it removed from market?
dietary supplement for men with prostate cancer
reported to be adulterated with prescription-only drugs
How many warnings does the FDA give to a manufacturer and what can they do if compliance is not met?
2 warnings
FDA may seize products and refer the case to the Department of Justice
What website is used to access dietary supplement product labels?
NIH Office of Dietary Supplements
Accurate labeling of dietary supplements is regulated by?
Federal Trade Commission (FTC)
What is the lead agency in the U.S. for scientific research on complementary and integrative health?
National Center for Complementary and Integrative Health (NCCIH)
Most B Vits function as? (inside your body)
co-enzymes
Vit B1:
Name?
function?
Involvement in Krebs cycle
Thiamin
helps metabolize macronutrients
required as a coenzyme in metabolism of carbs and proteins
plays a critical role in production of energy
What is the citric acid (Krebs) cycle?
metabolism in mitochondria that oxidizes acetyl compounds from food to make ATP
What foods contain Vit B1?
meat/meat subs
cereals & grains
fruit
ADME for Thiamin
A: active transport
D:50% skeletal muscle 50% other organ tissues
M: intestinal enzymes
E: high dose causes rapid urine excretion
** idk if we need to know half life
How does alcohol effect thiamin absorption?
impairs intestinal ability to absorb
name of disease from severe thiamin deficiency?
Beriberi
Negative outcomes of too much thiamin?
None
Vit B2: Name? Function? its two primary coenzymes? What is it a part of in the mitochondria?
Riboflavin
assists antioxidant enzymes, converts food to energy
FAD & FMN
electron xport chain
what foods contain Vit B2?
meat/meat subs
cereals & grains
dairy
veggies
ADME for Riboflavin
A: active xport
D: small amounts in liver, heart, kidneys
M: intestinal enzymes
E: urine excretion
Ariboflavinosis occurs when?
deficient in riboflavin
T/F low B2 impairs iron metabolism
True
Common symptoms of riboflavin deficiency?
skin disorders hyperemia (excess blood) edema of mouth and throat hair loss reproductive problems
Negative outcomes of too much riboflavin?
None
Vit B3:
Name?
Function?
Active forms?
Niacin
coenzyme for many redox rxns
NAD & NADP
what foods contain Vit B3?
Cereals & grains
meat/meat subs
veggies
ADME for Niacin
A:active xport and passive diffusion
D: all tissues as NAD
M: hydrolysis and conversion to NAD
E: urine excretion
disease from severe niacin deficiency
pellagra
Negative outcomes of too much Niacin?
flushing, itching, rashes, GI upset
Max dose of Niacin for adults?
35 mg/day
Vitamins 1,2,and 3 are required for what enzyme?
pyruvate dehydrogenase
NAD synthesis requires which two vitamins?
thiamin (B1) and riboflavin (B2)
Which forms of a supplement are typically better for more nutrients per serving?
lozenges, softgels, and tablets
which forms of a supplement are typically better if someone wants a pleasant experience from taking it?
chewables, gummies, powders
Recommended intake for calcium?
1000-1300 mg/day
Rank from least absorption to most absorption for compounds combined with magnesium:
Inorganic salts (magnesium oxide) -> Organic salts (magnesium citrate) -> chelates (magnesium glycinate)
name of the only organization recognized for verifying dietary supplements?
United States Pharmacopeia (USP)
Vit B5:
Name?
function?
Pantothenic Acid
component of coenzyme A (CoA) in krebs cycle
What is CoA needed for? (fatty acids, amino acids, bioactive compounds)
beta-oxidation of fatty acids
oxidative degradation of amino acids
synthesis of bioactive compounds
what foods contain Vit B5?
meat
eggs
cereals & grains
certain veggies
ADME for Pantothenic Acid
A: active xport at low doses, passive diffusion at high doses
D: rapid uptake by blood cells to tissues
M: intestinal enzymes
E: hydrolyzed to pantothenate before urine excretion
disease from too little pantothenic acid?
pantothenate kinase-associated neurodegeneration (PKAN)
symptoms of pantothenic acid deficiency?
numbness headache fatigue restlessness irratibility
symptoms of too much pantothenic acid?
mild GI upset if over 10mg consumed in a day
Vit B7:
Name?
Function?
Biotin
convert food to energy and makes glucose
5 essential carboxylases vit b7 is a co-factor for?
acetyl-coa carboxylase 1 acetyl-coa carboxylase 2 methylcrotonyl-carboxylase propionyl-coa carboxylase pyruvate carboxylase
what foods contain Vit B7?
cereals & grains
eggs
meat
veggies
ADME for Biotin
A: active xport
D: mostly stored in liver
M: protein bound biotin in stomach. intestinal enzymes
E: urine excretion
common symptoms for rare deficiency of Biotin
brittle nails
rashes
hair thinning/loss
depression, hallucinations
symptoms of too much biotin?
none
how can high levels of biotin interfere with medical testing?
can cause false high or low results
Humans lack which enzyme to synthesize vit C?
gulonolactone oxidase
foods containing vit C?
citrus fruits, brussels sprouts, broccoli, kiwi
Absorption of Vit C
sodium-dependent co-xporters
secondary active transport
Other name for Vit C?
Ascorbic Acid
Ascorbate
oxidized form of ascorbic acid?
dehydro-ascorbic acid
dehydro-ascorbic acid is xported by?
sodium-independent glucose xporters (GLUTs)
ascorbic acid in plasma is actively xported into cells by which xporters?
sodium-ascorbate co transporters SVCTs
ascorbate functions as a co-factor in what type of reactions? what does it maintain?
hydroxylation
iron or copper
Examples of processes ascorbate is used in? (forms of synthesis/catabolism)
collagen synthesis
carnitine synthesis
tyrosine catabolism
neurotransmitter synthesis
what is alkaptonuria?
prevents the body from fully breaking down tyrosine and phenylalanine which results in an accumulation of homogentisic acid leading to painful joints
What is converted in collagen synthesis? (main compounds)
proline converts to hydroxyproline
What is converted in carnitine synthesis? (main compounds)
trimethyllysine converts to carnitine
What is converted in tyrosine catabolism? (main compounds)
two reactions:
tyrosine converts to homogentisate which converts to maleylacetoacetate
What does Vit C help defend against?
cardiovascular disease
cataracts
cancer
colds
where is Vit C filtered? (nephron)
glomerular capsule
ascorbic acid breaks down into what other acids?
oxalic acid, threonic acid, and xylonic acid
why is high vit C intake dangerous? (which dangerous acid does it break down into and what can form as a result?)
vit c breaks down into oxalic acid which causes kidney stones to form
ascorbic acid enhances intestinal absorption of? (iron)
non-heme iron
T/F too much vitamin C can cause you to pee more?
True
T/F over 2g of vit C a day helps prevent disorders involving iron metabolism
False
Define polypharmacy
the use of 5 or more drugs
which age population of people is most susceptible to potential drug interactions?
Elderly
Which vitamin did we discuss in class that can cause impairment of micronutrient metabolism/ micronutrient synthesis?
Vit D
which class of drugs did we discuss in class that can increase intestinal/renal excretion?
diuretics
what common OTC drug class did we discuss in class that can impair absorption/bioavailability?
antacids
which amino acid did we discuss in class can disrupt metabolism? (cause metabolic dysfunction)
homocysteine
T/F iron or folic acid supplements should be separated by 2 hours
True
T/F proton-pump inhibitors and histamine-2 receptor antagonists have been associated with Vit B12 malabsorption and deficiency
True
if antacids are used long-term, how does this effect calcium absorption in the gut? what can malabsorption of calcium lead to?
antacids make the GI more basic, thus decreasing the solubility and absorption of calcium since it requires an acidic environment for absorption.
dec absorption of calcium will lead to dec. bone mineral density
Which diet is a concern for calcium content, especially if someone is taking a proton-pump inhibitor (PPI)
vegan
if antacids are used long-term, how does this affect iron absorption in the gut?
gastric acid is needed for iron absorption, thus dec gastric acid production could dec iron absorption
which prescription drug decreases vit B12 absorption from food?
Colchicine
which drug-nutrient interaction can lead to a hemorrhagic event?
warfarin and vit K
T/F pts should consume the same amount of vit K in their diet while taking warfarin
True
what is vit C an inhibitor of which allows it to counteract cancer?
hypoxia-induced factor-1 (HIF-1)
what is the goal of supplementing folic acid with pts taking methotrexate?
reduce adverse rxs to methotrexate treatment
T/F individuals with obesity who undergo bariatric surgery end up having less complications with malabsorption
False, they are at an inc risk of malabsorption
Vit B6
Name?
function?
Pyridoxine
heavily involved in enzyme rxns for protein metabolism
enzymatic processes that require B6 include?
releasing glucose from stored glycogen
making glucose from amino acids
synthesis of heme
foods containing vit b6?
meat
cereals & grains
fruits
spinach
ADME Pyridoxine
A: passive diffusion
D: binds to albumin, goes to muscle and liver
M: intestinal enzymes
E: urine excretion
common symptoms of pyridoxine deficiency
confusion
dermatitis
epileptic convulsions
microlytic anemia
who’s at risk of pyridoxine deficiency?
alcoholics
autoimmune disorder
impaired renal function
too much pyridoxine?
high doses can cause sensory neuropathy
Vit B9
Name? (2, difference between them?)
Function?
Folate: natural form in food and body
folic acid: supplemental form
DNA synthesis, cell growth and repair
prevents neural tube defects
DNA synthesis is dependent on? (Vit B9)
folate coenzymes
folate is required to make __________ which controls gene expression
S-adenosylmethionine (SAM)
Is folate beneficial during pregnancy?
Yes
Why is folate beneficial for depression? (what does it synthesize and what does the thing synthesized do?)
neurotransmitters, increases serotonin, norepinephrine, and dopamine
Foods containing folate?
beans & lentils
cereals & grains
Broccoli, spinach
ADME folate
A: active xport at normal dose, passive diffusion at high dose
D: liver before circulation
M: intestinal enzymes hydrolyze folates
E: most secreted folates is reabsorbed
who is at risk of folate deficiency?
pregnant women/ childbearing age
common symptoms of folate deficiency?
changes in skin, hair, fingernail color
GI issues
oral/tongue sores
Megaloblastic Anemia
too much folate?
high doses can mask vit b12 deficiency which could result in neurological damage
Vitamin B12
Name?
Function?
Cobalamin
makes red blood cells
required for nerve function
works with folate to make methionine from homocysteine
since vt B12 and B9 convert methionine from homocysteine, what is methionine needed for to make which is needed for dna methylation?
S-adenosylmethionine (SAM)
Vit B12 is needed to make which enzyme?
succinyl-CoA
what does the enzyme succinyl-CoA do?
produces energy from fat and protein and synthesizes hemoglobin
Why is vit b12 important in regulating hemoglobin?
because it helps make succinyl-CoA which synthesizes hemoglobin
foods containing cobalamin?
eggs
milk & dairy
meat
ADME Cobalamin
A: active xport
D: 50% liver, 50% other tissues
M: transported bound to proteins
E: urine excretion
whos at risk of cobalamin deficiency?
elderly
vegans/vegetarians
common symptoms of cobalamin deficiency?
megaloblastic anemia neurological disorders fatigue weakness constipation loss of appetite weight loss
too much cobalamin?
nothing
Some diagnostic lab tests may show false results in presence of elevated vitamin C due to an interaction with this molecule
H2O2 (hydrogen peroxide)
These four vitamins are legally mandated as food supplements due to their importance in this role
B1, B2, B3, B9
Pregnancy, fetal development, neural development
Prolonged use of this drug class is correlated with B12 malabsorption
Antacids/ PPIs & H2RAs
Methotrexate inhibits the conversion of ______ to THF
Dihydrofolate
B vitamins important for the Krebs Cycle?
B1, B2, B3, B5, B7
B vitamins important for One Carbon Metabolism
B6, B9, B12
which B vits can cause hyperemia?
B6, B9, B12, B2
Which B Vit helps protect against neural tube defects?
B9
acute beriberi in infants is caused by ________ and is characterized by ________
thiamin deficiency
acidosis due to conversion of pyruvate into lactic acid
wernicke-korsakoff syndrome is associated with?
thiamin deficiency
what symptom can excessive vit b12 cause?
acne
patients on methotrexate should not take supplemental _____?
Vit B9
thiamin’s role in health?
Alzheimer’s
diabetes
heart failure
riboflavin role in health?
early development
eyes
migraines
ariboflavinosis resembles what other disease/deficiency?
pellagra and vit b6 deficiency
niacin role in health?
cardiovascular health
skin
symptoms of pellagra include:
dermatitis
diarrhea
dementia
pantothenic acid role in health?
heart health
wound healing
biotin role in health?
early development
hair, skin, nails
whats a major concern of high levels of biotin? (false low for what?)
troponin
which B vitamins play a role in the electron transport chain?
B2, B3, B5
what is the metabolically active form of folic acid?
5-methyltetrahydrofolate (5-MTHF)
What are the forms of cobalamin?
cyanocobalamin
methylcobalamin
hydroxycobalamin
adenosylcobalamin
one carbon metabolism role on health?
cancer
cardiovascular health
cognition
T/F plasma B12 is associated with a higher risk of breast cancer
true
does vitamin B6 reduce cancer risk?
yes
pyridoxine role in health?
immune system support
nervous system function
folate role in health?
early development
mental wellness
