General Therapeutic Doses and Uses as of 2024 Flashcards
What is the dose for Omega 3 and its benefits?
Dose: 1-3 grams/day (fish oil or algae oil).
Mechanism: EPA/DHA are critical for synaptic plasticity and reducing neuro-inflammation
Why is a 1:2 Ratio of DHA to EPA recommended?
The 1:2 DHA to EPA ratio is often recommended to reflect the natural balance found in many fish oils and to optimize their complementary effects:
1. ALA (Alpha-Linolenic Acid)
A) Function: Serves as a precursor to DHA and EPA but is inefficiently converted in the human body (<10%).
- Provides energy and structural components to cell membranes.
- Minor contribution to fetal development due to limited conversion to DHA/EPA.
2. DHA (Docosahexaenoic Acid) could remember it as Da Head Area (DHA)
A) Function: Critical for neural and ocular development, particularly in fetuses and infants.
- Supports fetal brain and retina development.
- Essential for maintaining cognitive function.and preventing neurodegenerative disorders in adults.
- It makes up 10-20% of fatty acids in the brain and is critical for synaptic pasticity, neuronal signaling, and neuroprotection
- Constitutes over 50% of the total fatty acids in photoreceptor cells
- Maintains cellular membrane integrity and fluidity
3. EPA (Eicosapentaenoic Acid) E for everything else
A) Function: Primarily anti-inflammatory and cardiovascular protective.
- Enhances DHA transfer to the fetus during pregnancy.
- May lower the risk of preterm labor and postpartum depression.
Mechanisms Behind Their Functions
Cardiovascular Health (EPA)
Reduces Triglycerides:
EPA decreases triglyceride synthesis in the liver.
It enhances the clearance of triglycerides by boosting lipoprotein lipase activity, which breaks down fat in the blood. Elevated triglycerides can impair endothelial function thus leading to vascular damage and stiffness, and EPA actively reduces them.
Lowers Blood Pressure:
EPA helps improve endothelial function (lining of blood vessels), leading by enhancing Enhancing Nitric Oxide (NO) a molecule that signals blood vessels to dilate, improving blood flow. to better blood vessel dilation and reduced vascular resistance.
Mitigation of inflammation:
EPA is converted into anti-inflammatory eicosanoids (resolvins and protectins), which reduce the production of pro-inflammatory molecules (e.g., prostaglandins and leukotrienes). By decreasing pro-inflammatory cytokines (like IL-6 and TNF-α) that can dysregulate the hypothalamic-pituitary-adrenal (HPA) axis, the body’s stress-response system. EPA Lowers cortisol dysregulation, which can improve stress resilience and emotional stability.
Promotes better hormonal signaling in the brain, improving mood and reducing anxiety.
Why This Matters:
Chronic inflammation leads to overactivation of stress hormones, contributing to mood disorders. EPA’s balancing role mitigates this effect, enhancing emotional well-being.
What else:
- Reduce Acne: By modulating inflammatory pathways.
Alleviate Psoriasis: Through its ability to decrease systemic inflammation.
Support Skin Hydration and Elasticity: By preserving the integrity of cell membranes and regulating sebum production.
Back to Omega 3’s
Benefits:- Shown to reduce depressive symptoms and improve cognition in substance users
Rationale: Reduces inflammation and pain in FM patients
Side Effects: Rare (can increase bleeding in high doses which is above 5grams)
Evidence: Omega-3s are linked to reduced inflammatory markers and improved pain thresholds
More information if needed:
Other Tissues and Systems
DHA is not limited to the brain and retina—it contributes to cell membrane health throughout the body. Examples include:
Skin
DHA supports skin barrier function by maintaining the structural integrity of keratinocytes.
It also modulates inflammatory responses in skin conditions like eczema or psoriasis.
Liver (Hepatocytes)
In hepatocytes, DHA supports membrane fluidity, which is vital for metabolic processes, including fat metabolism and detoxification.
Cardiac Cells
DHA in cardiac tissue helps maintain electrical stability and reduces arrhythmia risk.
It also supports heart muscle cell communication.
Immune Cells
DHA is present in macrophages, neutrophils, and lymphocytes, modulating inflammatory responses and promoting immune balance.
What is the dose for Zinc and its uses?
Dose: 30-50 mg/day
Mechanism: Improves immune function, reduces oxidative stress.
Zinc is essential for taste perception because it is needed for the function of gustin, a zinc-dependent protein found in saliva.
Gustin is required for the development and maintenance of taste buds, so zinc deficiency can lead to taste disturbances or loss of taste (hypogeusia or dysgeusia).
Many hemodialysis patients have zinc deficiency due to:
Loss of zinc during dialysis
Poor dietary intake
Altered absorption and metabolism
Zinc Deficiency: Leads to hepatic encephalopathy.
More on zinc and it’s effect on the body
Role of Zinc in the Body
Zinc is an essential trace element that plays numerous critical roles in the body, including:
Enzymatic Functions:
Zinc is a cofactor for over 300 enzymes involved in processes like digestion, DNA synthesis, cell division, and immune function.
Protein and DNA Synthesis:
Zinc is essential for cell growth, repair, and gene expression.
Immune Function:
Zinc supports immune cell function and inflammation regulation.
Antioxidant and Anti-inflammatory Roles:
Zinc stabilizes cell membranes and reduces oxidative stress, protecting tissues from damage.
Zinc can inhibit the activation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), a transcription factor that promotes the expression of pro-inflammatory cytokines. By suppressing NF-κB, zinc reduces the production of these inflammatory mediators.
PUBMED CENTRAL
Modulation of Immune Cell Function:
Zinc influences the function of various immune cells, including macrophages and neutrophils, by modulating their inflammatory responses and promoting the resolution of inflammation.
PUBMED CENTRAL
Reduction of Oxidative Stress-Induced Inflammation:
By decreasing oxidative stress, zinc indirectly reduces inflammation, as oxidative stress can activate inflammatory pathways.
MDPI
Antioxidant Role of Zinc
Enzyme Cofactor for Antioxidant Enzymes:
Superoxide Dismutase (SOD): Zinc is a crucial component of the enzyme copper-zinc superoxide dismutase (CuZnSOD), which catalyzes the conversion of superoxide radicals into hydrogen peroxide and oxygen, thereby mitigating oxidative stress.
MDPI
Stabilization of Cellular Membranes:
Zinc helps maintain the structural integrity of cell membranes by preventing lipid peroxidation, thus protecting cells from oxidative damage.
PUBMED CENTRAL
- Prevention of Lipid Peroxidation
Free Radical Neutralization: Zinc indirectly prevents lipid peroxidation (the oxidative degradation of membrane lipids) by acting as a cofactor for antioxidant enzymes like CuZn-Superoxide Dismutase (SOD). This enzyme reduces the levels of reactive oxygen species (ROS) that can attack and damage the polyunsaturated fatty acids in cellular membranes.
Inhibition of Iron and Copper Catalysis: Zinc competes with iron and copper for binding sites on membrane structures. This reduces the availability of these metals to participate in Fenton and Haber-Weiss reactions, which generate hydroxyl radicals capable of initiating lipid peroxidation. - Strengthening Membrane Structure
Binding to Membrane Proteins: Zinc interacts with membrane-associated proteins, stabilizing their structure and preventing protein denaturation. This supports the membrane’s functionality and resilience under oxidative stress.
Preservation of Phospholipid Integrity: Zinc helps maintain the correct structure of phospholipid bilayers, which are essential for membrane fluidity and selective permeability. - Induction of Metallothioneins
Free Radical Scavenging: Zinc induces the production of metallothioneins, which are proteins that scavenge free radicals and protect membrane lipids from oxidative stress. This further helps maintain membrane stability under conditions of oxidative damage. - Inhibition of Enzymatic Damage
Inhibition of Phospholipase Activity: Zinc inhibits phospholipase enzymes, which can degrade membrane phospholipids. By preventing their activation, zinc reduces the breakdown of membrane components. - Role in Cell Signaling and Repair
Membrane Repair Processes: Zinc plays a role in cell signaling pathways that promote membrane repair when damage occurs. For instance, it activates enzymes involved in maintaining the integrity of the membrane during stress conditions.
Induction of Metallothioneins:
Zinc stimulates the production of metallothioneins, proteins that can scavenge free radicals and sequester harmful metal ions, contributing to the reduction of oxidative stress.
WIKIPEDIA
Ammonia Detoxification in the Liver:
Zinc is critical for the activity of the enzyme carbamoyl phosphate synthetase in the urea cycle, which helps remove ammonia from the body.
Zinc Deficiency and Hepatic Encephalopathy (HE)
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome caused by liver dysfunction, leading to an accumulation of toxins like ammonia in the bloodstream, which affects brain function. Zinc deficiency contributes to HE through several mechanisms:
Impaired Ammonia Detoxification:
The liver removes ammonia through the urea cycle, and muscles detoxify ammonia through the glutamine synthetase pathway.
Zinc is a cofactor for enzymes in both pathways. A deficiency reduces their efficiency, leading to hyperammonemia (high blood ammonia levels), a key factor in HE.
Reduced Ornithine Transcarbamylase Activity:
Zinc is necessary for the optimal function of ornithine transcarbamylase, an enzyme in the urea cycle that converts ammonia into urea for excretion. Zinc deficiency impairs this process.
Oxidative Stress and Neuroinflammation:
Zinc stabilizes cell membranes and prevents oxidative stress. In its absence, increased oxidative damage and inflammation in the brain exacerbate HE symptoms.
Altered Gut Microbiome:
Zinc deficiency can disrupt gut barrier function, allowing endotoxins and ammonia-producing bacteria to enter the bloodstream, further increasing ammonia levels.
Muscle Wasting (Sarcopenia):
In liver disease, muscle acts as an auxiliary ammonia-detoxifying organ. Zinc deficiency contributes to muscle wasting, reducing this compensatory mechanism.
Clinical Implications and Treatment
Zinc Supplementation:
Supplementing zinc (e.g., zinc acetate, zinc sulfate) has shown benefits in patients with HE by improving ammonia metabolism and reducing HE episodes.
Dietary Sources of Zinc:
Zinc-rich foods like meat, shellfish, legumes, nuts, and seeds can help maintain optimal levels.
Addressing zinc deficiency is an essential component of managing hepatic encephalopathy, alongside treatments like lactulose, rifaximin, and protein management.
What is the dose for Magnesium and what does a deficiency cause?
Dose: 300-500 mg/day orally
Side effects - Diarrhea (magnesium citrate), nausea, low blood pressure (high doses)
Magnesium Deficiency: Causes neuromuscular symptoms, requires supplementation
Rationale: Magnesium plays a role in muscle relaxation and pain modulation, reduces central sensitization
Clinical evidence: Reduces muscle cramps and pain
Form: citrate or malate
Especially good for Fibromyalgia, substance
What is the of therapeutic dose for Vitamin D and its benefits?
Side Effects- Toxicity rare, but high doses can cause nausea, kidney damage, Hypercalcemia (rare in high doses)
Therapeutic dose:
Pregnant/Lactation (P/L)
Years old (y/o)
Upper Limit (U/L), Adequate Intake (AI)
Recommended Dietary Allowance (RDA)
Estimated Average Requirements (EARs)
0 to 12 months Both 10 mcg/day or 400IU/day is the RDA/AI; (0-6 months-25mcg/day or I000 IU/day & 7- 1y/o 38 mcg/day or 1,500IU/day UL)
1-3 years old 15 mcg/day or 600 RDA/AI; 63 mcg/day or 2500IU/day UL
4-8 years old 75 mcg/day or 600IU/day RDA/AI; 75 mcg/day or 3000IU/day UL
9-70 y/o Both 15 mcg/day or 600 IU/day RDA/AI; 100mcg/day or 4,000 IU/day
P/L - same as 9-70 y/o
70 y/o+ 20 mcg/day or 800IU/day RDA/AI; 4,000 IU/day or 100 mcg/day UL/day
Dose: 2,000-5000 IU/day for mood and brain
Rationale: Vitamin D3 is essential for bone health and pain management in FM
Evidence: Vitamin D supplementation reduces musculoskeletal pain
What is the therapeutic dose for CoQ10 and it’s side effects?
Dosage: 100-300 mg/day
Side Effects: Mild (nausea, insomnia in rare cases)
Rationale: Improves mitochondrial function, reduces fatigue
Evidence: CoQ10 supplementation has been shown to reduce pain and fatigue
What is a therapeutic dose for Selenium and its benefits and side effect?
- Dosage: 200 mcg/day
- Side Effects: Rare, but excessive doses can lead to selenosis (hair loss, gastrointestinal upset)
- Rationale: Antioxidant that reduces oxidative stress and inflammation
What type of diet has been proven to be beneficial for Fibromyalgia patients?
A. Mediterranean
B. Vegan
C. Gluten Free
A. Reduces chrnoic pain, improves mental health, supports heart health and weight management
B.
C
What is the therapeutic range for N-acetylcysteine (NAC) what is its benefits and side effects?
Therapeutic Dose Range:
General antioxidant support: 600 mg–1,200 mg/day (divided doses).
Chronic conditions (e.g., COPD, psychiatric disorders): 1,200 mg–2,400 mg/day (divided doses).
Acute conditions (e.g., acetaminophen overdose): IV doses of 150 mg/kg initially, followed by maintenance doses, administered under strict medical supervision.
Maximum Safe Dose:
No established UL for oral NAC. Doses up to 2,400 mg/day are considered safe for most, but higher doses may cause GI upset or rare allergic reactions.
Side Effects:
Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain.
Allergic reactions: Rare anaphylactoid reactions (more common with IV use).
Odor/taste: Unpleasant sulfur-like smell or taste.
Mucolytics lead to a small reduction in acute exacerbations and are not associated with an increase in adverse events.[113] N-acetylcysteine (NAC) is a mucolytic agent with antioxidant properties. The mechanism of action of NAC in COPD is not clearly understood. High-dose NAC (600 mg orally twice daily) may be of benefit in reducing acute exacerbations in people with moderate to severe COPD who have experienced 2 or more exacerbations in the previous 2-year period.[9][114][115] The optimal dose of NAC has not been determined. The injectable solution is administered orally, usually diluted in a cola beverage to reduce nausea and vomiting.
Benefits:
Antioxidant precursor: Boosts glutathione production, enhancing cellular detoxification.
Respiratory health: Acts as a mucolytic, thinning mucus in conditions like COPD and cystic fibrosis.
Liver protection: Protects against hepatotoxicity (e.g., acetaminophen overdose).
Psychiatric support: May reduce symptoms of depression, bipolar disorder, and obsessive-compulsive disorder through glutamate modulation.
Cardiovascular benefits: May reduce oxidative stress and inflammation in cardiovascular conditions.
NAC deficiency: Liver detox failure, neurodegeneration
N-Acetylcysteine (NAC) Deficiency
Note: NAC is a precursor to glutathione, so its deficiency reflects a lack of glutathione.
Symptoms and Conditions:
Reduced Antioxidant Capacity:
Increased oxidative stress due to low glutathione levels.
Higher risk of cellular damage and inflammation.
Weakened Detoxification Pathways:
Poor detoxification of harmful substances in the liver (phase II conjugation).
Greater vulnerability to environmental toxins and heavy metals.
Increased Susceptibility to Respiratory Issues:
Impaired mucus clearance in chronic respiratory diseases like COPD or cystic fibrosis.
Immune Dysfunction:
Low glutathione levels can impair immune responses.
Neurodegeneration:
Linked to oxidative damage in the brain, contributing to diseases like Alzheimer’s or Parkinson’s.
What is the therapeutic range for Vitamin C, it’s side effects and adverse reactions?
Fun Facts: Vitamin C enhances the absorption of Iron and is necessary for the synthesis of dopamine and norepinephrine, which are neurotransmitters involved in attention and mood regulation.
Therapeutic Dose Range:
General health support: 500 mg–1,000 mg/day.
Cold/immune support: 1,000 mg–3,000 mg/day (divided doses to reduce GI side effects).
High-dose therapy:
Oral: Up to 10 g/day may be used short-term for specific conditions like infections or cancer, though GI tolerance limits apply.
IV: 10 g–100 g, under medical supervision, for cancer or sepsis treatment.
Maximum Safe Dose:
Tolerable Upper Intake Level (UL): 2,000 mg/day (oral). Beyond this, GI symptoms like diarrhea are common.
Vitamin C (Ascorbic Acid)
*+Benefits:**
Antioxidant properties: Neutralizes free radicals, reducing oxidative stress.
Immune support: Enhances the function of immune cells, particularly during infections.
Collagen synthesis: Essential for skin, tendon, and blood vessel health.
Potential cancer support: High-dose IV vitamin C is being researched for selective toxicity to cancer cells.
Cardiovascular health: May reduce LDL oxidation and improve endothelial function.
Side Effects:
Gastrointestinal: Diarrhea, abdominal cramping, nausea (often dose-related).
Kidney stones: Increased risk in susceptible individuals due to oxalate formation.
Pro-oxidant effects: At very high doses in the presence of metals (e.g., iron overload).
Vitamin C deficiency: Scurvy, iron deficiency anemia
Vitamin C Deficiency
Symptoms and Conditions:
Scurvy (severe deficiency):
Symptoms:
Fatigue, weakness
Swollen and bleeding gums
Easy bruising
Poor wound healing
Joint and muscle pain
Corkscrew-shaped hair and perifollicular hemorrhages
Cause: Impaired collagen synthesis.
Weakened Immunity:
Increased susceptibility to infections (e.g., colds, pneumonia).
Iron Deficiency Anemia:
Due to reduced non-heme iron absorption.
Dry Skin and Brittle Hair:
Lack of collagen support in skin and hair.
What is the therapeutic range for Vitamin E (Alpha Tocopherol), it’s benefits and it’s side effects?
Therapeutic Dose Range:
General health: 100 IU–400 IU/day (typically adequate for supplementation).
Chronic conditions (e.g., neurodegeneration): 400 IU–800 IU/day has been studied.
Maximum Safe Dose: 1,000 mg/day (1,500 IU) as the tolerable upper intake level (UL) for adults.
Cautions at High Doses:
Doses >400 IU/day for prolonged periods have been associated with increased bleeding risk, especially in those taking anticoagulants or with vitamin K deficiencies.
Side Effects:
Bleeding risk: High doses (>800 IU/day) may inhibit platelet aggregation, increasing bleeding risk.
GI discomfort: Nausea, diarrhea, abdominal cramps.
Possible interactions: May interact with anticoagulants, increasing bleeding risk.
Cancer risk: Some studies suggest high doses could increase the risk of certain cancers (e.g., prostate cancer) in susceptible individuals.
Vitamin E (Alpha-Tocopherol)
Benefits:
Antioxidant properties: Protects cell membranes from lipid peroxidation.
Neurological health: May reduce symptoms of neurodegenerative diseases like Alzheimer’s.
Skin health: Promotes wound healing and reduces scarring when used topically.
Cardiovascular health: May improve arterial function and reduce oxidative stress in atherosclerosis.
Reproductive health: Supports fertility by protecting sperm and egg membranes.
Vitamin E deficiency: Ataxia, hemolytic anemia, vision loss
Symptoms and Conditions:
Neuromuscular Problems:
Muscle weakness due to oxidative damage in cells.
Ataxia (poor coordination) from damage to peripheral nerves.
Peripheral Neuropathy:
Tingling, numbness, or burning in extremities.
Hemolytic Anemia:
Premature breakdown of red blood cells due to insufficient antioxidant protection.
Vision Problems:
Retinopathy or progressive degeneration of the retina.
Weakened Immune Function:
Impaired ability to fight infections.
Infertility (in animals):
Rare but linked to reproductive issues in humans under experimental models.
What is Vitamin A therapeutic range and its benefits?
RDA 3000 IU/day (American Academy of Pediatrics, 2017)
Side effects Photosensitivity
Cell turnover refers to the process where the skin produces new skin cells and sheds the old ones. This is a natural process that helps the skin maintain its health, appearance, and ability to repair itself.
Retinoids, which are derived from vitamin A, play a key role in speeding up this process. They help the skin cells in the epidermis (the outer layer of the skin) to renew more quickly.
How it works:
Retinoids (like tretinoin) bind to specific receptors in the skin, which then activates genes that promote skin cell production and shedding of dead skin cells.
This increase in cell turnover helps to prevent clogged pores, which are a primary cause of acne. When pores become clogged with dead skin cells, oils, and bacteria, acne lesions can form. By encouraging faster skin renewal, retinoids help keep the pores clear.
Additional Benefits:
Increased cell turnover can also help reduce pigmentation from old acne lesions, and promote the development of fresher, more even-toned skin.
It also encourages the production of collagen, which can improve skin texture and elasticity over time.
Recommended Dietary Allowance (RDA):
700 mcg/day RAE or 2,333IU/day for females 14+. For males 14+ it is 900 mcg/day or 3000IU/day
According to
https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-vitamins.html
Caution - monitor intake from dietary supplemts and high-retinol foods like liver.
Retinol Activity Equivalents (RAE):
1 mcg RAE equals:
1 mcg retinol.
2 mcg supplemental beta-carotene.
12 mcg dietary beta-carotene.
24 mcg dietary alpha-carotene or beta-cryptoxanthin.
Essential for:
Vision.
Immune system function.
Organ development in the fetus.
Teratogenic Risks:
High doses of vitamin A (>3,000 mcg RAE or 10,000 IU per day) are teratogenic and can cause fetal abnormalities.
Precaution:
Discontinue use of high-dose vitamin A supplements prior to conception.
Vitamin A derivatives are among the most potent human teratogens.
Specific Anomalies:
Central Nervous System:
Ventriculomegaly (enlarged brain ventricles).
Craniofacial Defects:
Malformed facial bones or cranium.
Microtia (small ears) or anotia (absent ears).
Micrognathia (small jaw).
Cleft palate.
Cardiac Defects:
Conotruncal heart anomalies (e.g., Tetralogy of Fallot, transposition of the great arteries).
Thymus Defects:
Thymic aplasia (absent thymus) or hypoplasia (underdeveloped thymus).
Why Photosensitivity Happens with Retinoids:
Faster skin turnover means that the outer layer of your skin (the epidermis) is renewing itself more rapidly, revealing newer, fresher skin.
This new skin is often more delicate and not as thick or tough as the older skin that has been exposed to environmental factors like sunlight.
Because this newer skin hasn’t had time to build up the natural protective barrier (like melanin, the pigment that helps protect against UV radiation), it’s more vulnerable to the harmful effects of UV rays.
Vitamin D what is the therapeutic dose and the benefits
Therapeutic range from 9 years old until death for both men and women (even pregnant and lactating) 400 RDA/AI/Day and 4000 IU/day UL (Upper Tolerable Limit)
per as of 2025: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-vitamins.html
Vitamin D Synthesis Through the Skin
Skin Production: Vitamin D3 (cholecalciferol) is synthesized in the skin when UVB rays from sunlight interact with a cholesterol derivative (7-dehydrocholesterol).
Washing After Sun Exposure: The idea that washing the skin shortly after sun exposure could interfere with vitamin D synthesis stems from the fact that the precursor to vitamin D is formed in the skin’s outer layers (epidermis). Some studies suggest that it may take time for this precursor to be fully absorbed into the bloodstream. While the exact time needed is debated, waiting at least 1-2 hours before washing the skin is often recommended as a precaution to ensure optimal absorption.
- Can Vitamin D Be Absorbed Through Glass?
No, UVB Cannot Penetrate Glass: UVB rays, which are critical for Vitamin D synthesis, do not pass through regular glass. Therefore, sitting behind a window will not contribute to Vitamin D production, even if you’re exposed to sunlight. - Does Vitamin D Synthesis Require Direct Exposure to the Eyes?
Not Necessary: Vitamin D synthesis occurs in the skin, not the eyes. While sunlight exposure to the eyes is essential for other processes, such as regulating the circadian rhythm and stimulating the release of certain neurotransmitters like serotonin, it does not play a role in Vitamin D production.
Caution About Direct Sunlight in the Eyes: Looking directly at the sun can damage the retina and is not necessary for Vitamin D synthesis. Instead, focus on getting safe exposure to your skin.
Vitamin D2 (Ergocalciferol): Vitamin D2 is derived from plant-based sources, such as fungi and yeast. It is less potent than vitamin D3 but can still be converted into the active form, calcitriol, in the body through similar hydroxylation processes.
Folate what is the therapuetic dose and what is it used for?
Also Folate is the natural form and Folic Acid is the synthetic form of vitamin B9.
Therapeutic dose:
- 9 to 13 year old males/females 300 mcg/day RDA/AI/day & UL 600 mcg/day
- 14 year old males/females 400 mcg/day RDA/AI/day & UL 800mcg
- 19 year old+ males/females 400 mcg/day RDA/AI and 1000mcg Upper limit (UL)
Dietary Sources:
* Natural Folate:
* Legumes.
* Dark green leafy vegetables.
* Liver.
* Citrus fruits and juices.
* Fortified Foods:
* Cereal grains (mandatory fortification by Health Canada).
Folic acid 400- 800mcg/day for pregnant females or 4-5mg for patients on antiepileptic drugs or those with a history of NTD-affected pregnancy.
Supplementation should start at least 1 month before conception and continue through the first trimester.** Per class notes 3 year 2nd semester preconception health PCS 350**
What is the therapeutic Dose for Iron and what is its side effects and benefits?
Therapeutic dose:
Pregnant/Lactation (P/L)
Years old (y/o)
Upper Limit (U/L), Adequate Intake (AI)
Recommended Dietary Allowance (RDA)
Estimated Average Requirements (EARs)
0 to 13 year old males/females UL 40 mg/day
0- 6 months 0.27mg/day RDA/AI
7- 12 months 11mg/day RDA/AI
1-3 years old 7 mg/day RDA/AI
4-8 years old 10 mg/day RDA/AI
9-13 years Both 8mg/day RDA/AI
14-18 years 11mg/day |15mg/day UL 45mg/day
19 years old+ Male 8mg/day | Female 19-50y/o female 18mg/day then back down to 8mg/day, at 51y/o+ UL 45mg/day
Pregnancy All ages 27mg/day UL 45mg/day P/L
Lactation 18 or under 10 mg/day, 19+ 9mg/day
https://canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-elements.html
- Vitamin C increases its absorption
- Tea, coffee and calcium supplements decreases its absorption be sure to wait 1 to 2 hours after a meal to prevent the decrease in absorption of iron
Oxygen Transport:
Iron is a crucial component of hemoglobin, the protein in red blood cells responsible for carrying oxygen from the lungs to tissues and organs throughout the body. Hemoglobin’s iron binds to oxygen molecules, allowing for efficient oxygen transport.
Iron is also a component of myoglobin, a similar protein found in muscles that helps store and transport oxygen within muscle tissue.
Electron Transport:
Iron is involved in the electron transport chain in mitochondria, which is crucial for the production of ATP, the energy currency of cells. Iron is a part of several enzymes involved in energy production, especially in cellular respiration.
Enzyme Functions:
Iron acts as a cofactor for various enzymes involved in metabolic processes, including those responsible for the synthesis of DNA, collagen, and neurotransmitters. These processes are vital for growth, development, and the maintenance of bodily functions.
Immune Function:
Iron is important for maintaining the immune system, as it plays a role in the proliferation and maturation of immune cells, such as lymphocytes. It also supports the generation of reactive oxygen species used by immune cells to kill pathogens.
What is the therapeutic Dose for Calcium and what is its side effects and benefits?
2,500 mg/day UL
What is the therapeutic dose for iodine and what is it’s functions?
RDA: 220 mcg/day.
Upper Limit (UL): 1,100 mcg/day.
Thyroid Hormone Synthesis:
Essential for the production of thyroid hormones (T3 and T4), which regulate metabolism and energy balance in both the mother and fetus.
Fetal Brain Development:
Supports proper neurological and cognitive development, particularly during the first trimester.
Prevention of Cretinism:
Adequate iodine intake prevents congenital hypothyroidism and intellectual disabilities caused by iodine deficiency.
Side Effects (Excessive Intake):
Can cause thyroid dysfunction (hyperthyroidism or hypothyroidism).
Nausea, metallic taste, or burning sensation in the mouth (high doses).
nemonic for Side Effects
“MVI-ZOS Can Upset Stomachs”
This mnemonic groups the main nausea/diarrhea/vomiting triggers based on their effects:
💦 Diarrhea (MVI = “Moves Very Intestines”)
Magnesium
Vitamin C
Inositol
🤢 Nausea (ZOS = “Zinc, Oil, SAMe”)
Zinc
Omega-3
SAMe
🤮 Vomiting (Can Upset Stomachs)
Calcium overload (from Vitamin D)
Upset liver (from Vitamin A)
Selenium toxicity
🔑 Quick Memory Hacks
✅ Diarrhea = Water-moving vitamins (osmotic laxatives: Magnesium, Vitamin C, Inositol)
✅ Nausea = Gut irritants or metabolism-changers (Zinc, Omega-3, SAMe)
✅ Vomiting = Toxicity risks (Vitamin A, Vitamin D, Selenium overdose)
Why Do These Supplements Cause These Side Effects?
🚽 Diarrhea (Think: Water and Electrolyte Disruptors)
Magnesium → Pulls water into the intestines (osmotic effect, especially citrate or oxide forms).
Vitamin C → Acts as an osmotic laxative at high doses.
Inositol → Alters fat metabolism and gut bacteria, leading to loose stools in high doses.
🤢 Nausea (Think: Irritating or Metabolism-Altering)
Zinc → Irritates the stomach lining (especially on an empty stomach).
Selenium → Toxic at high doses, leading to nausea, vomiting, and even hair loss.
SAMe → Alters neurotransmitters (serotonin & dopamine) and can cause nausea/dizziness.
Omega-3 → Fish oil is hard to digest, leading to nausea and fishy burps.
🤮 Vomiting (Think: Toxicity or Overdose-Related)
Vitamin A → Stored in the liver → Toxic buildup can cause nausea, vomiting, headaches.
Vitamin D → Excess calcium buildup from overdose → nausea, vomiting, kidney damage.
Selenium → Too much is toxic, leading to vomiting and metallic taste.
Why is vitamin C relevant in ADHD treatment?
(a) It is needed for dopamine and norepinephrine production
(b) It directly increases hyperactivity
(c) It functions as a primary ADHD medication
(d) It should be taken at the same time as ADHD medications
Answer: (a) It is needed for dopamine and norepinephrine production
(a) ✅ Vitamin C is necessary for the synthesis of dopamine and norepinephrine, which are neurotransmitters involved in attention and mood regulation.
Explanation:
(b) ❌ Vitamin C does not increase hyperactivity; it supports cognitive function.
(c) ❌ Vitamin C is not a replacement for ADHD medications.
(d) ❌ Vitamin C can interfere with ADHD medication absorption, so it should be taken at least 1 hour apart.
What is therapeutic Dose for vitamin B1 for and its side effects and benefits
Recommended Dosage:
Adults (men): 1.2 mg/day
Adults (women): 1.1 mg/day
Pregnant women: 1.4 mg/day
Breastfeeding women: 1.4 mg/day
Children: Ranges from 0.3 to 1.2 mg/day, depending on age.
Supplementation: For individuals with deficiency or those under medical care, dosages can be higher. In certain medical conditions like beriberi, Wernicke’s encephalopathy, or alcohol-related disorders, high doses may be administered through injections or intravenous therapy (200 mg to 500 mg daily).
Deficiency Symptoms:
Thiamine deficiency can lead to several health conditions, with the most notable being:
Beriberi: There are two types:
Wet beriberi: Affects the cardiovascular system, leading to heart failure, swelling, and fluid retention.
Dry beriberi: Affects the nervous system, leading to nerve damage, muscle weakness, and paralysis.
Wernicke-Korsakoff Syndrome (WKS): This is a severe neurological condition that is often seen in chronic alcoholics. It consists of:
Wernicke’s encephalopathy: Acute symptoms include confusion, muscle coordination issues, and vision changes.
Korsakoff syndrome: Long-term effects include memory loss, confabulation (making up stories to fill memory gaps), and cognitive decline.
Peripheral neuropathy: Thiamine deficiency can lead to nerve damage, resulting in symptoms like tingling, burning sensations, and weakness in the extremities.
Fatigue, irritability, and loss of appetite may also occur.
What is therapeutic Dose for Carnitine for and its side effects and benefits?
1-3 g/day normal
0.5 - 2g/day for Hemodialysis
Side effects of Carnitine:
Gastrointestinal Issues:
Common side effects include nausea, vomiting, stomach cramps, and diarrhea. These side effects are generally mild and can be minimized by starting with a lower dose.
Fishy Body Odor:
High doses of carnitine may lead to a fishy odor in the body or breath due to the breakdown of carnitine into trimethylamine, a compound that is responsible for the smell. This side effect is typically more noticeable when taking high doses.
Potential for Increased Risk of Atherosclerosis:
Some studies have raised concerns that excessive carnitine may lead to the formation of trimethylamine-N-oxide (TMAO) in the body, a compound linked to atherosclerosis (plaque buildup in arteries). However, this effect is generally seen in people consuming large amounts of red meat (which contains high levels of carnitine), rather than through supplementation.
Hypotension:
In some cases, carnitine supplementation can cause low blood pressure (hypotension), particularly when combined with other blood pressure-lowering medications. Monitoring blood pressure is recommended during supplementation.
Seizures:
Although rare, there have been some reports of seizures in individuals taking high doses of carnitine, especially in people with underlying conditions that affect seizure threshold.
