Midterm 1 Flashcards
What nutrients reduce HOMOCYSTEINE?
B6
B9
B12
Why is it desirable to REDUCE homocysteine?
DECREASES the risk of HEART DISEASE
L. ACIDOPHILUS and BIFIDUS bacterium are supplemented when?
Patient on antibiotics.
Antibiotics destroys some of the NEEDED normal gut flora.
What does “Drinking in moderation” mean?
1-2 drinks per day
12-24 oz beer
1-2 oz hard liquor
8-12 oz wine
List examples of “special diets”
High fiber Low fat Liquid diet Vegetarian Diabetic Low Sodium
Vegan Diet
Plants ONLY
<1% of Population
Lacto Diet
Dairy + Plants
Ovo Diet
Eggs + Plants
Pesco Diet
Fish + Plants
Ave Diet
FOWL ONLY
Of the types of “diets” (Vegan, etc.), what are the two most common? Most rare?
MC: Lacto, Ovo
Rare: Ave
What does “Lite” mean?
Less than the normal product
- sodium
- sugar
- color
- kcals
- fat
- eTOH
What is the most common symptom when the CO-FACTORS for Kreb Cycle are missing?
Fatigue
What is the MAXIMUM OTC dosage for FOLIC ACID? Why?
Max OTC Dose = 400 mcg
Because it MIGHT mask the signs of PERNICIOUS ANEMIA
Examples of HEAT STABLE ANTI-THIAMINES
heat resistant
Flavinoids (citrus fruit)
Tannus (tea/coffee/wine)
Sodium Nitrate (preservatives)
Examples of HEAT LABILE ANTI-THIAMINES
easily destroyed by heat
Thiaminases
- Fresh water fish
- Shellfish
- Bacterial/fungi
(Eating primarily raw fish +/- beri-beri)
Examples of ANTI-THIAMINE drugs
Oxythiamin
Pyrithiamin
(Leads to weight loss, anorexia, neuro dmg)
Example of ANTI-BIOTINS
Avidin in raw egg whites
Avidin is destroyed by heating. Eat a cooked egg, it doesn’t deplete B7
Benefits of ALLICIN. Where is it found?
Kills bacteria
Lowers cholesterol
Lowers BP
Found in GARLIC + ONIONS
*Only works when combined with B1
Vitamins & Minerals depleted by ALCOHOL consumption
B1 B2 B3 B6 B9 B12
Vit C
Calcium
Zinc
Vitamins & Minerals depleted by BIRTH CONTROL PILLS
Vit A
B2
B6
B9
Vit C
Copper
Iron
Zinc
Vit ___ protects against TYLENOL side effects.
Vit E
Vit ___ protects against ASPIRIN + COUMADIN side effects.
Vit K
What are the hazards of FLOURIDE FORTIFICATION?
Teeth Mottling (brown spots on teeth) Bone deformities
(Calcium out of bone to soft tissue, Osteoporosis fractures, +/- allergies, +/- increase cancer risk)
What binds up ZINC? (Decreases absorption, enhances secretion)
**Check this.
PHYTATES Unleavened bread Cadmium Ca++ Cu
Fiber
Iron
Heavy metals
Coffee/tea/cocoa
What binds up IRON?
PHYTATES- Phytic acid (Grains)
Red wine
Grapes
Milk
Apple Juice
+/- be a problem in kids
(Antacids, tannic, phytates-from whole grain, phosvitin- egg yolks, XS minerals, chelating agents- EDTA)
*EDTA = common preservative
Who’s at RISK for Vitamin B DEFICIENCIES? (Commonly seen by chiros)
Alcoholics (B1, B2)
Vegetarians (B12)
Bitches on birth control (B2, B6, B9)
Old people
Diabetics
Hypothyroidism
Antibiotic users
Scurvy ssx
Pirates!!!!
Fatigue Anorexia Easy bruising Swollen/bleeding gums Anemia Loose teeth XS wavy hair
Def. Vit C
Dry Beri-Beri ssx
PNS - neurological Neuropathies Anorexia Weakness Foot/ankle drop - calf muscle pain
*B1 def
Wet Beri-Beri ssx
(Same as DRY ber-beri PLUS..)
Cardiac enlargement
Pitting edema
*B1 def
Hemochromatosis
Sun tanned look
Cirrhosis
Diabetes (d/t decreased glucose tolerance)
*XS Iron
Ariboflavinosis
Dermatitis (around nose, mouth) Cheilosis Eye infections Stomatitis Geographic Tongue
B2 Def.
Wilson’s Disease
Kayser-Fleisher ring of Cornea
UE Tremors
Copper in piss
*XS Copper
Rickets
Bowed legs Knocked knees Rachitic Rosara - bumps on ribs Spine/Pelvis Deficiency *End stage = Convulsions
*Vit D def.
Osteomalacia
Uncalcified bone matrix DUE TO:
- collagen formation
- muscle weakness
- bone pain
- fractures
*Vit D def.
Wernicke-Korsakoff Syndrome
All beri-beri ssx PLUS
Confusion Confabulation (inventing stories) Psychosis Memory loss Nystagmus CN 6 Paralysis (Cross eyed)
*B1 def.
Pellagra
Rough skin esp. exposed area
Casal’s Collar (rough skin around neck)
Weakness Anorexia (3 Ds) Diarrhea Dermatitis Dementia
*B3 def.
Hart Nups Dx
” heart.
Lots of TRYPTOPHAN in piss
Can’t transport or absorb AAs
*B3 def.
Pernicious Anemia
Acholorhyria 2* to HYPOthyroidism Syncope Headaches Sore/red tongue Hallucinations
*B12 def.
Blood test to identify EARLY IRON DEFICIENCY ANEMIA
Serum Ferritin Depletion Test
Most SENSITIVE lab test
How to get adequate Vit D without the risk of toxicity
Sun everyday (some say 15 minutes)
Who’s at the MOST RISK for Vit D TOXICITY?
**Check this.
People supplementing XS Vit D??
Nutrients needed for MUSCLE RELAXATION (reduction of spasms)
Magnesium
Potassium
Calcium
Nutrients made by GUT FLORA
B7
B12
Vit K
Long term antibiotic use +/- lead to destruction of good gut flora…they should be given ___ + ____ supplements to INCREASE proper gut flora.
L. Acidophilus
Bifido Bacterium
Define “divided dose”
Full dose divided equally
Taken throughout the day
Define “empty stomach”
Take 1-2 hours BEFORE or
1-2 hours AFTER a meal
Define “taper off”
Gradual decrease in dosages to
ULTIMATELY NONE
Define “back up”
Take all B Vitamins
in CONJUNCTION with
SPECIFIC dose of B Vitamin
What are kids given to DECREASE the severity of MEASLES?
Vit A
Most TOXIC vitamins and minerals?
Vit D - Most toxic vitamin
Flouride - Most toxic Mineral
Vit A
Vit B3 - Liver toxic
Calcium - “Milk Alkali Syndrome”
Selenium - really toxic
Calcium deficiency ddx
Type I Insomnia
*trouble falling asleep
Muscle cramps - NO exertion
*MC legs, calves
Magnesium deficiency ddx
Type II Insomnia
- fall asleep easily
- wake frequently
Muscle cramps WITH EXERTION
Isolated Dia/Sys HTN
XS sweat
Inc risk S. Aureus
Gestational HTN
Potassium deficiency ddx
Muscle cramps UPON exertion
“Milk Alkali Syndrome”
Calcium
Where’s B1-12, Vit A&E absorbed?
Sm. Intestine
Where’s Vit D absorbed?
Skin
Where’s Vit K absorbed?
Sm. Intestine
Gut
Vit A is bound to __ to CROSS GUT LINING.
Fat
Bile salts
Vit D is bound to __ to CROSS GUT LINING.
Bile salts
Vit K is bound to __ to CROSS GUT LINING.
Bile salts
Pancreatic juice
*Made by gut flora
Vit C is bound to __ to CROSS GUT LINING.
SODIUM dependent transport system
B1 is bound to __ to CROSS GUT LINING.
SUCKER!!! IT’S NOT BOUND TO ANYTHING!!!
B2 is bound to __ to CROSS GUT LINING.
Protein
B3 is absorbed in what forms?
Amide (Nicotinamide)
Acid (Nicotinic Acid)
B5 (Pantothenic Acid) is bound to __ to CROSS GUT LINING.
SUCKER!!! IT’S NOT BOUND TO ANYTHING!!!
B6 is absorbed as ___
Aldehyde/Alcohol form
Pyridoxal phosphate
B7 is bound to __ to CROSS GUT LINING.
Amino residue
B9 requires ___ to CROSS GUT LINING
Enzyme in Brush Border
Pancreatic secretions
Stomach enzymes
B12 requires ___ to CROSS GUT LINING.
pH < 6
Intrinsic Factor
5 reasons to be MINERAL/VITAMIN DEFICIENT.
INADEQUATE
- Ingestion
- Absorption
- Utilization (across cell membrane)
INCREASED
- Excretion
- Needs
Lacto-Ovo Diet
Dairy
Eggs
Plants
Inadequate ingestion examples
Poverty
Bad health - can’t go out, can’t open food
Mentally handicapped
Inadequate absorption examples
Lack
- HCl
- Co-Factors
- Enzymes
GIT Diseases
Ca++ Channel problems
Ulcers
Antibiotics (Destroys good gut flora)
Inadequate utilization examples (issues reaching the end target)
Diseases (Diabetes) Drugs Throwing up Alcohol Def b vits (mood disorders) Lack co-factors/enzymes
Increased excretion examples
Diarrhea Sweat Vomit Bleeding (menses) Urinary
Increased Needs
Infants, kids, elderly Prego, lactating Athletes Post surgery Major wasting disease
5 Stages of Vitamin/Mineral deficiency
- Preliminary
- Biochemical
- Physiological
- Clinical
- Anatomical
Stage 1 Vit/Min Deficiency
“Preliminary”
Body storage gradually depleted
NO ssx
Stage 2 Vit/Min Deficiency
“Biochemical”
Decreased enzyme function
Stage 3 Vit/Min Deficiency
“Physiological”
Non-specific ssx
- memory loss
- fatigue
Stage 4 Vit/Min Deficiency
“Clinical”
Classic ssx
- Beri-Beri
- Scurvy
- Pellagra
- etc.
Stage 5 Vit/Min Deficiency
“Anatomical”
Fatal if untreated.
“Real” food brewer’s yeast
A complex of B Vitamins
*Used for Kreb’s Cycle as CO-FACTORS
+ nerve impulse conduction
B1
B3
B7
Chromium, Selenium
(support the nervous system, help maintain the muscles used for digestion, and keep skin, hair, eyes, mouth, and liver healthy)
Go look at some THERAPEUTIC USES OF vitamins and minerals.
:)
Hazards associated w/ XS IRON in the diet
“Hemosiderosis”
Iron deposits into tissues
Toxicity
What causes HEMOSIDEROSIS?
Iron deposits into tissues
Multiple blood transfusions
Red wine
HEMOSIDEROSIS can increase the risk for
Heart disease - Fe increases SERUM CHOLESTEROL LEVELS!!!
Parkinson’s
Alzheimer’s
Spread of bacterial infections
Colorectal cancer
Iron Toxicity can come from ingesting XS
Oysters Red meat Liver Dried fruit Red wine Green leafy veggies
How to ENHANCE IRON absorption
Adequate Hcl in stomach Vit C - Ascorbic Acid Fructose (fruits) Citric/Lactic Acid *Eating VEGGIES w/ RED MEAT enhances non-heme absorption
How to INHIBIT IRON absorption
Antacids
Tannic Acid (tea, coffee)
PHYTATES (whole grain)
Phosvitin (egg yolks)
XS competing minerals (Ca, P04, Cu, Zn, Mn)
Chelating agents (EDTA- common preservative)
Where does HEME IRON come from, in general?
40% Animal tissues
*Found to cause cancer
Where does NON-HEME IRON come from, in general?
60% Animal
100% Plant Iron
Dried fruit Green veggies Legumes Nuts Seeds
*LESS BIOAVAILABLE
Ferrous Sulfate
Cheap Iron in supplements.
Nausea
Constipation
Iron Oxide = Rust
Cheapest Iron
Causes side effects
Best form of CALCIUM to PREVENT OSTEOPOROSIS (bone)
& what’s the TRACE ELEMENT
Microcrystalline Hydroxyapetite
Trace element = BORON
Best form of CALCIUM for MUSCLE FUNCTION
GLUCONATE - best for muscle spasms
- Usually combined w/ CITRATE
- Lactate is good at reducing m. spasms, too.
Common OXALATE containing FOODS
Beets Berries Black Tea Celery Cucumbers Grapefruit Parsley Asparagus Brussel Sprouts Beans Carrots Chard Kale Peppers Plums Peanuts Rhubarb Spinach Chocolate, cocoa Instant Coffee Sweet Potatoes
Dietary TREATMENT for URIC ACID stones
Decrease animal protein
Decrease red wine
Eat MORE fruits + veggies
Avoid:
- Canned fruit
- Sports drinks
- Lots of Vit C
Dietary TREATMENT for CALCIUM/OXALATE stones
Drink super mucho H2O
(8 oz/hour MINIMUM) …bad diets, bigger bodies need more
Eat a HIGH FIBER DIET
Eat MORE CITRUS fruits + veggies
Eat less meat
*POTASSIUM CITRATE
Reduce
- Ca/Oxalates
- XS animal protein
- Sodium
- Sugar
- Coffee, soda
- XS Vit D
What are the DEFICIENCY AND TOXICITY SSX for ALL vitamins & minerals?
Diarrhea
Nausea
Who gets MILK ALKALI syndrome?
*XS Calcium
This is SECONDARY to HYPERCALCEMIA.
- hyperparathyroidism
- bone diseases
- Vit D poisoning
Ingesting XS
- milk
- antacids (Ca Carbonate) - wants to prevent osteoporosis
- baking soda (Na Carbonate)
Vitamins & Minerals that PREVENT ANEMIA
Vit ACE
B 6, 12
Iron Folate Copper Zn Phosphorous
Vitamins & Minerals needed for BONE INTEGRITY
Vit AD
Calcium Phosphorous Flouride Zinc Magnesium
Vit/Min that ENHANCE NERVE TRANSMISSION/FUNCTION
B1 B5 B6 B9 - Choline/Purine synthesis B12 - Myelin Sheaths
Potassium Phosphorous Magnesium Vit C Calcium
What INCREASES CALCIUM absorption?
Vit D - Sunlight Inc. pH Lactose Estrogen Acidic Stomach Exercise Prego
What DECREASES CALCIUM absorption?
Oxalates Fiber (phytate) Alcohol Dec Vit D XS Coffee XS Sodium XS Competitive Minerals XS PTH Liver/Kidney Disease Malabsorption Sedentary lifestyle Amenorrhea
PROTEIN’s affect on CALCIUM status
DECREASES Ca++
Inc Protein = Dec Phosphate
= Dec Calcium
Where is Ca++ stored for use, why?
Bone & Teeth
*Buffers blood
Therapeutic for OSTEOPOROSIS
Vit D Vit E Ca Phosphate Shark Cartilage Cod Liver Oil
Therapeutic for HEALING of DISEASE/INJURY
B9
Therapeutic for WOUND HEALING
Zn
Therapeutic for LBP
Vit C (increases collagen synthesis)
Garlic
Bromeline
Magnesium
Therapeutic for SUBDELTOID BURSITIS
B12
Therapeutic for CARPAL TUNNEL
B6
Therapeutic for TRAUMA
Dec inflammation = BIOFLAVINOIDS
*take w/ Vit C
Proteolytic Enzymes
- Bromelin
- Trypsin
- Chymotrypsin
Therapeutic for PAIN
Tryptophan?
Therapeutic for FIBROMYALGIA
Vit E B9 Lythamin Carbonate Flaxseed oil Low purine diet
What is COUMADIN’s affect on Vit K?
Stops blood from clotting
Top 3 killers of kids
Diarrhea
Pneumonia
Hemmorhage
What’s the ONLY VITAMIN we “TAPER OFF”?
Vit C
Define “bowel tolerance”
Gradually increase amount until stool is SOFT, but not diarrhea
Define “megadose”
RDA x10
Where is Vit C mainly stored?
Adrenal Gland
What is the main function for Vit C?
Collagen synthesis.
Enhances absorption of IRON
- stimulates collaged for the repair of wounds
- NOT for tissue growth
Random Vit C functions
Aids in formation/function of CARNITINE (shuttling FAs)
Lowers histamine response
Converts B9 into it’s ACTIVE FORM
What is B9’s active form?
Tetrahydrofolate
How long does it take SCURVY to develop?
2-4 months
Common THERAPEUTIC USES for Vit C
Tx cold + flu (take upon 1st sx)
Improve cortisol levels (times of stress)
*Asthma
What are FLAVINOIDS?
H2O Soluble PHYTOCHEMICAL
It enhances Vit C utilization
Acts as an anti-oxidant
(In citrus, berries, leafy veggies)
Effects of ISOFLAVONES?
Decrease risk of cancer
Decrease ssx of menopause (hot flashes)
Decrease risk of heart disease
Juvenile Beri-Beri ssx
*Neurologic problems mostly
Can’t wear well
Ptosis - droopy eyelid
Nystagmus
What is the MAIN side effect of Vit B, and how do you solve it?
Nausea/Queasy
Take w/ food
Divided doses!!
What’s the recommended dose of B1 for women on birth control?
B100 formula
Daily
B25, 4x/day
You would NOT want to store B2 (Riboflavin) in what kind of bottles?
Glass
Clear
Plastic
*Because it’s DESTROYED BY LIGHT
Main function of B2?
Co-Enzyme FAD, FMN
Dehydrogenase enzyme in FA oxidation ETC Kreb's AA Oxidases
What are EARLY/SUBMARGINAL ssx of for a B2 deficiency?
Photophobia w/ tearing, itching, burning eyes
Loss of visual acuity
Sore lips, mouth, tongue, scrotum, labia
THERAPEUTIC use of B2
Cataracts
Treatment of deficiency states
B3 is LOW in ___ & ___, but HIGH in ____.
Low = milk, eggs Hi = Tryptophan
What percentage of TRYPTOPHAN is converted to NIACIN?
90%
What are the 3 GLUCOSE TOLERANCE FACTORS? (GTF)
Chromium
Niacin - helps insulin @ cell receptor
Zinc
(Helps blood sugar regulation)
Casal’s Collar
Pellagra - B3 Def.
Dermatitis on neck.
Those on HIGH ___ diets are at risk for B__ deficiencies.
Hi Leucine
B3 def.
Leucine causes Tryptophan excretion.
Tryptophan is converted to B3.
Need TRYPTOPHAN to get NIACIN!!!
What B vitamin is needed to convert TRYPTOPHAN to NIACIN?
B6
B3 (Niacin) TOXICITY ssx
Acute: Flushed GI irritation (Nausea, Vomit) Headache Diarrhea
Chronic:
Liver dmg, cirrhosis, jaundice, elevated AST, ALD
B5 is therapeutic for
Burns + skin lesions Fights against COPPER toxicity (Wilson's) Atherosclerosis Chronic stress Prednisone
2 Hours of sunlight exposure will DESTROY 70-100% of your B__.
B6
What main B vitamin helps produce energy from GLYCOGEN?
B6
Trans-Amination
B6
Who is at risk for a B6 deficiency?
Baby’s on the teet
Bitches on birth control
Alcoholics
B6 Therapeutic uses
Decrease nausea/vomiting in prego
Decrease PMS ssx
Decrease risk of OXALATE KIDNEY STONES
B__ is one of the most POTENT vitamins.
B7 - Biotin
B__ is the most SENSITIVE vitamin to environmental damage.
B9 - Folic Acid
Which VITAMIN is essential in converting B9 to it’s ACTIVE form “Tetrahydroflorate”?
Vit C - Ascorbic Acid
A diet HIGH in ___ will ENHANCE the uptake of FOLIC ACID
Carbs
What is the most common VITAMIN deficiency in the WORLD?
B9- Folic Acid
Who’s at risk for a B9 deficiency?
Baby's on goat's milk Junk diet Alcoholics Teens Those with increased cell proliferation (chicken pox, cancer, prego, injuries)
B9 deficiency conditions
Megablastic anemia
Glossitis
Neural Tube Defects (Spina Bifida)
Do ANTACIDS cause B12 to increase or decrease?
Decrease
What is the most ABUNDANT MINERAL in the BODY?
Calcium
Calcium is an UNBOUND ION found in the blood as either ___ or ___.
Ionized
Albumin bound
XS Phosphorus may result in cases of
HYPOparathyroidism
Renal Insufficiency
Which MINERAL is needed for the PROPER utilization of Vit B, E, C?
Magnesium
Toxicity of POTASSIUM
Kidney Disease
People with XS IRON are at risk of
Parkinson’s
Alzheimer’s
Spread of BACTERIAL infections
COLORECTAL cancer
What is the most common MINERAL deficiency in the WORLD?
Iron
What is the most common MINERAL deficiency in the US?
Magnesium
Classic IRON def. ANEMIA ssx
Nails
- spoon-shaped
- vertical ridges/splitting
Mouth
- glossitis
- cheilosis
- stomatitis
Blue sclera
Rosy-pink lips
What do you give someone who is at risk of IRON deficiency?
Serum Ferritin
Recommended dose for IRON def.
100-400 mg IRON GLYCINATE
Daily
w/ Vit A, C
Between meals
Who is likely to get IRON POISONING ?
American Kids
*Accidental
ZINC enhances the ABSORPTION of Vit __
Vit D - Cholecalciferol
What DECREASES the ABSORPTION of zinc?
PHYTATES
XS Cu, Fe, Ca, Cd
Caffeine
Main functions of Zinc
Support absorption/utilization of B vitamins
Supports dev/maintenance of GUY PARTS
Helps with CALCIUM deposit in bones/teeth (carbonic anhydrase enzyme)
Growth/wound healing - TOPICAL
Regulates lipid metabolism
Therapeutic uses of ZINC
Wound healing Sickle Cell Anemia Nyctolopia RA Immune support Male infertility, low count MACULAR DEGENERATION (MC cause of blindness) KILLS H. PYLORI
Copper is transported in plasma as ___ with some BOUND to ___ in the RBC’s.
CeruloPlasmin
Bound to ALBUMIN
Which TRACE MINERAL helps with OXYGENATION/FORMATION of RBCs?
Copper
Which TRACE MINERAL converts FERRIC to FERROUS state?
Copper
Which TRACE MINERAL helps with PIGMENTING HAIR?
Copper
*It’s the co-factor for TYROSINE.
Tyrosine -> Melanin pigmentation
Does WILSON’S Disease cause tremors?
Yes
Kayser-Fleisher ring
Wilson’s Disease
XS Copper