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Nutrition Year 1 > Supplements in Practice > Flashcards

Supplements in Practice Flashcards

1
Q

Definition of a food supplement:

A

A concentrated source of a vitamin, mineral or other substance with a nutritional or physiological effect, alone or in combination, sold in dose form

Herbal products are classed as medicine

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2
Q

3 reasons for using supplements

A
  1. DEFICIENCY states - end stage symptoms associated with an extended lack of a particular vitamin
  2. THERAPEUTIC uses - insufficiency can be identifies when there is under functioning of certain biochemical pathways
  3. PREVENTATIVE health - to maintain optimal health and wellness
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3
Q

Factors for which supplements may be needed?

A
  1. Food processing reduce nutrient content
  2. Food additive deplete nutrients
  3. Weakened digestion
  4. Stressful lifestyle
  5. Nutrient depletion at birth
  6. Soil depletion
  7. High yield crops are deficient in certain nutrients
  8. Fertilisers
  9. Pesticides deplete soil
  10. Long distance transport
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4
Q

What are prohibited claims on supplements labels?

A

Health claims:
• No medicinal claims on labels are permitted; no presentation or labelling is allowed that infers that a supplement can prevent, treat or cure human disease.

Prohibited claims:
• Reference to the rate or amount of weight loss.
• Reference to recommendations of individual doctors or health professionals.
• Health claims on alcoholic beverages.
• Claims which suggest that health could be affected by not consuming the food.

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5
Q

What is a sign of good manufacturing of supplements?

A

GMP = good manufacturing practices
Many companies are GMP compliant (self-regulated) but not GMP approved
As supplements are unlicensed they do not have to meet the requirements of GMP

– Be of consistent high quality.
– Be appropriate to their intended use.
– Meet the requirements of the marketing authorisation (MA) or product specification

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6
Q

What manufacturing method may degrade a supplement quality?

A
  • Fish oil and plant oil must be cold press
  • Whey protein must be specially filtered to remote lactose and homes
  • Cheaper extraction ad processing methods recuse the effectiveness and affect safety profile
  • Ingredients may degrade over time so company add extra to meat label claim - OVERAGE
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7
Q

what is OVERAGE ?

A

Ingredients may degrade over a supplement’s shelf life. Reputable
supplement companies will add extra so that the amount left at the
end of its shelf life still meets the label claim. This is called overage.

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8
Q

What to check when looking for a good supplement?

A
  • Are its products made in GMP facilities?
  • Does it state the source of the product?
  • Does its raw materials go through quality checks?
  • What is the GMO status of its products?
  • Are its products free from contaminants?
  • What are the values of the company?
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9
Q

What is the pros and cons of the following supplement administration methods?
Tablets
Capsules
Powders
Liquids
Enteric Formulation
Spore form
Chewable formulations
Slow-release formulation

A

Tablets
+ Cheap and easy to produce in large quantities
- more excipients

Capsules
+ fewer excipients
- not efficient for large doses

Powders
+ good for bigger doses (glutamine)
- not suitable for sticky ingredients

Liquids
+ excellent absorption
- more expensive and less stable - need antioxidant like vit E to prevent oxidation

Enteric Formulation
+ good garlic capsule
- excipients so that they survive the stomach

Spore form
+ good for probiotics

Chewable formulations
- coated before they are compressed

Slow-release formulation
- contain hydrogenated fats to hold tablets together longer

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10
Q

What are liposomal supplements ? What are the advantages? What vitamins are good in this form?

A

Liposomal supplements have a protective phospholipid bilayer to protect the active ingredient
+ high bioavailability and absorption
+ Increased oral uptake in the mouth
+ Increased uptake into large cells
+ Easier to take than larger tablets
+ Suitable for water and fat soluble nutrients

B12 and VitC

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11
Q

The therapeutically-active component in a supplement
can be as low as how much of the total content?
How are called the additives used to in forming tablets and capsules to bind active ingredients together?
What other nom-active ingredients are added to supplements?

A

As low as 2%
Excipients
Capsule shell - gelatine or plant cellulose
Flow agents - Avoid magnesium stearate.
Binding agent - maltodextrin
Fillers
Natural fillers - Lithothamnion calcareum from fossilised seaweed
Emulsifiers - to mix oil and watery ingredients together
Flavours - avoid MSG
Calours
Sweeteners - Glycerine
Preservatives - Vit E, ascorbic acid

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12
Q

What vitamins are absorbed in the duodenum, Jejunum, Ileum?

A

Duodenum: Calcium, selenium magnesium, chromium, iron, manganese, zinc.

Jejunum: B vitamins, biotin, vitamin C, choline, inositol, calcium, magnesium.

Ileum: Vitamin B12.

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13
Q

How to take water soluble and fat soluble vitamins for better absorption?

A

Water soluble = B vitamins and C with food

Fat soluble = A D E K and CoQ10 with fat

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14
Q

Which water soluble vitamins are contraindicated to take in the evening?
What is the exception and why

A

B vitamins as they may trigger or exacerbate insomnia

B6 is the exception because it calm the NS

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15
Q

How to take amino acids supplements?

A

Ideally with carbohydrate food / drink or on an empty stomach.

Protein shakes: Take any time of day

Absorption of amino acids in liquid shakes depends on transit time through gut, stomach acid, proteolytic enzymes, etc

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16
Q

How to take mineral supplements? More specifically Calcium, magnesium and zinc

A

Minerals: Take with food. Adequate stomach acid is needed for digestion.

• Calcium and magnesium: Take in the evening to aid restful sleep.
• Zinc: Take on an empty stomach before bed. Caution: Some people may suffer stomach discomfort after taking zinc.

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17
Q

What consideration to take when working out dosage?

A

• Age of the client: May need higher dose with increasing age.
• Digestive capability: Ability to absorb and excrete? Constipated?
• State of health: Dosing for optimum health or for disease state?
• Therapeutic doses: Evidence of dosages that are shown in clinical trials to be effective for certain disease states.
• Dietary deficiency or insufficiency: What symptoms are there?
• Lab test results: What do these indicate?
• Safe therapeutic range: Age group of client?

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18
Q

How to compare supplement dosage for Mineral, protein and fish oils?

A

Elemental amount of minerals: This is the amount of mineral available for absorption when it has been freed from its carrier molecule => the ‘elemental mineral’ is the amount of the mineral that is actually used by the body.

Protein supplements: Compare the amount of protein (in grams) per 100 g of powder.

Fish oils: Compare the active ingredients, EPA and DHA.

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19
Q

How do I find a good, efficient supplement?

A

• What are the companies’ quality control procedures?
• Are they GMP-approved / compliant?
• Are their products ISO accredited?
• What is the traceability of raw materials?
• Who formulates their products?
• What is their background / qualifications?
• What is their experience?
• What other companies have they formulated products for?
• What is the philosophy of the company?

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20
Q

When can the term natural can be used for a supplement?

A

The term ‘natural’ can be used even if only 10% of the product is natural. The other 90% could be synthetic.

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21
Q

What are the pros and cons of various supplement sources?
Natural source
Synthetic
Food cultured
Food based

A

Natural source = Nutrients from vegetable, animal or mineral sources.
+ Natural may have better efficacy than synthetic forms
- Generally not available in higher doses.

Synthetic = Manufactured with identical molecular structure to the same natural nutrients
+ When wanting to use higher doses
- The ascorbic acid in food is found within the vitamin C complex along with other compounds, including bioflavonoids, which offer additional health benefits and are not in synthetic supplements but in whole food

Food cultured - It is thought culturing makes nutrients that are more bioavailable’. Nutrient supplements are often grown in yeast or algae.

Food based = physical mix of isolated nutrients within a food base but there may not always be bonding at a cellular level.
+ metabolic outcome may be the same as food-cultured as the body recognises these two forms as food.
- low nutrient potency, fluctuating nutrient levels and limited shelf life. Nutrients are easily degraded by heat, pH changes, light, and oxygen.

22
Q

What vitamins to chose and which to avoid

A

Vitamin A: Retinol palmitate
AVOID retinyl palmitate.

Vitamin B1 (thiamine): Benfotiamine*, thiamine hydrochloride
AVOID thiamine mononitrate.

Vitamin B2 (riboflavin): Riboflavin, riboflavin 5 phosphate.

Vitamin B3 (niacin): Niacinamide (nicotinamide), nicotinic acid may cause flushing.

Vitamin B5 (pantothenic acid): Pantothenic acid, calcium D-pantothenate.

Vitamin B6 (pyridoxine): Pyridoxal 5 phosphate
AVOID pyridoxine hydrochloride.

Vitamin B12: Methylcobalamin, adenosylcobalamin, hydroxycobalamin,
AVOID cyanocobalamin.

Folic acid: Methylfolate
AVOID pteroylglutamic acid.

Choline: Choline bitartrate, lecithin
AVOID choline chloride.

Vitamin C (ascorbic acid): Vitamin C complex with bioflavonoids (listed as food), ascorbic acid (good for detoxification protocols).

Vitamin D: Vitamin D3 ( cholecalciferol)
AVOID irradiated ergosteral, calciferol.

Vitamin E: D-alpha tocopherol, d-alpha tocotrienol
AVOID dl-alpha tocopherol, dl-alpha tocopherol acetate or succinate.

23
Q

Consideration when opting for natural vs synthetic supplements:

A
  • Natural supplements usually have better bowel tolerance than synthetic ones so they are retained longer in the body
  • Food-state supplements may not be enough to supply the optimal dosage when someone has a high nutritional requirement
  • Sensitivities to foods or fillers in food-based products, such as gluten or nightshades, can cause mild to severe reactions; isolated, synthetic nutrient products may work better for some sensitive people.
  • What is the desired outcome? As naturopaths, it is preferable to opt for naturally-sourced nutrients. However, synthetic forms can have a useful role depending on the reason for supplementing.

example: If you use ascorbic acid, the most common synthetic form of vitamin C, it will be rapidly excreted from the body but will take a significant amount of free radicals with it. This is ideal if detoxification is the desired outcome.

example: methylfolate, although the most bio-effective form of folate, cannot be natural or from food sources.

Try to avoid: preservatives, colourants, fillers or binding agents to allow the activity of, and synergy between, vitamins, minerals, plant enzymes, phytonutrients without physiological or biochemical interference. Avoid GMO and irradiated products.

24
Q

What is the issue with irrigation in supplements?

A

Irradiated supplements:
• High-doses of radiant energy used to destroy pathogens.
• Destroys delicate nutrients and disrupts their natural frequencies.
• Less damaging technologies include dry steam sterilisation.

25
Q

What is the issue with GMO supplements?

A

Genetically modified organisms (GMOs):
• Low quality supplements are often filled with GMOs
— often added to compensate for poor quality ingredients.
• May be GMO: Citric acid, corn syrup or corn starch, maltodextrin,
MSG (monosodium glutamate), soy lecithin, xanthan gum.

26
Q

What are the pros and cons common mineral carriers?
Organic Salts
Inorganic salts
Amino acid chelates

A

Organic Salts = natural => more effectively absorbed than inorganic salts
Inorganic salts => adverse effects and not very good absorption
Amino acid chelates => Best form for mineral absorption.

27
Q

What is the most recommended mineral carrier x2 as a naturopathic practitioner?

A

CITRATES : Mineral ion bound to citric acid; Ca2+, Zn 2+, Mg2+.
+ More bioavailable: The + acidic form requires less stomach acid
+ Important as low stomach acid

PICOLINATES: Natural chelator for absorption of certain minerals in the small intestine.
• High absorption in gut giving high serum levels.
• Zinc and chromium most common minerals used with picolinates.

28
Q

What is a chelator and what are the advantages of a chelator for mineral absorption?
What considerations to take when using a chelator with a mineral?

A

Chelator: Substance that binds tightly to mineral atoms and forces the mineral to go wherever the chelator goes

Advantages:
+ Bypasses competitive absorption that can occur between different minerals (amino acid disguise); absorbed as a protein instead of as a mineral.
+ Body treats it as a peptide and is efficient at absorbing amino acids.
+ Extends length of absorption sites to large portion of small intestine.

Considerations:
- AA may be too tightly bonded.
- Minerals may not be released from this tight bond if cellular energy is poor.
- AA chelate complexes often too large for capsules
- Quality and price limitations AA chelates may be too expensive for clients.

29
Q

What other nutrients should be given when supplementing calcium and why?

A

Vit D3/K2
Calcium supplementation can cause kidney stones and soft tissues calcification if low in vit D and K

Calcium carbonate is most commonly recommended
Calcium Citrate is easier to absorb

30
Q

What are the differences in bioavailability between organic and inorganic calcium?

A

Organic form of calcium are:
- higher bioavailability (especially calcium GLYCINATE)
- Easily assimilated by the body (calcium CITRATE)

Inorganic form of calcium:
- Are more cost effective
- Can cause adverse effects like nausea, gas and constipation) - Calcium CARBONATE
- Requires more HCl for absorption than other forms
- Calcium OXALATE should never be supplemented as it mais lead to kidney stones
- Calcium CITRATE MALATE = exceptional absorption

31
Q

Calcium supplements nutrient iteractions?

A

Negative:
- Magnesium: compete for absorption - separate by 2h
- Zinc and Iron: may reduce absorption
- Excess intake of phosphorus (soft drinks), caffeine and dietary fats: increase calcium excretion
- Excess salt: calcium loss as Ca binds to excess sodium for excretion

Positive
Lysine: enhances intestinal absorption and reduces excretion

32
Q

What nutrients are required for Magnesium absorption?

A

Selenium, Vit B6 and Vit D

33
Q

What nutrients/food inhibits magnesium absorption?

A
  • Phytates, fibre, alcohol, excess saturated fat
  • High ZINC, Ca and Phosphorus - take within 2h
34
Q

Magnesium supplements forms and effect

A
  • Magnesium gluconate: Good absorption: avoids laxative effects.
  • Magnesium citrate: Excellent absorption and utilisation.
  • Magnesium gluconate: Good absorption: avoids laxative effects.
  • Magnesium glycinate: good choice for insomnia
  • Magnesium sulphate (Epsom salts): great in the bath, both magnesium chloride and sulphate can be absorbed through the skin.
  • Magnesium malate: good for energy production
35
Q

What conditions contraindicate the use of magnesium supplements?

A
  • Heart block
  • Renal failure
36
Q

What are the best form of iron to be supplemented?

A

Best absorption:
- ferrous fumarate - may inhibit the absorption of vitamin E.
- ferrous sulphate - Can cause nausea and constipation.
- ferrous gluconate

37
Q

What caution need to be taken around Iron supplementation?

A
  1. Overdosing iron is toxic in children; can be fatal.
  2. Has pro-oxidant effects — can cause free radical damage.
  3. It also feeds bacteria ― avoid in GI bacterial overgrowth.

Always check serum ferritin and transferrin levels before
supplementing. With males, beware of haemochromatosis.

38
Q

Which form of chromium supplement is available?

A

Chromium picolinate - Readily absorbed with high serum levels

39
Q

How various forms of zinc supplements impact health in distinct ways?

A
  • Zinc gluconate: used in cold remedies, such as lozenges and nasal spray. Widely available and cost-effective form.
  • Zinc acetate: Often added to lozenges to reduce cold symptoms and speed up rate of recovery.
  • Zinc picolinate: Best assimilation and absorption but more expensive than citrate or gluconate.
  • Zinc citrate: Absorbed as well as gluconate form but less bitter, with a more appealing taste.
  • Zinc sulphate: Inorganic form may cause stomach irritation and nausea. Absorption better with liquid form.
40
Q

How best to take zinc supplements?

A

Zinc is best taken at night on an empty stomach, or at least one hour before, or two hours after meals. If zinc supplements cause stomach upset, they may be taken with a meal

41
Q

what mineral supplement can cause hyperkalaemia?

A

Potassium

42
Q

What vitamin C to supplement for various presenting symptoms?

A

For health maintenance: Use low-dose food forms, such
as rosehip and acerola; the body recognises these as food

Detoxification: High dose ascorbic acid acts as an antioxidant; is quickly excreted from the body but takes free radicals with it

  • Ascorbic acid: Form found naturally in food with good bioavailability. Acidic so may be harsh on the GIT.
  • Bioflavonoids: Beneficial plant compounds such as hesperidin, quercertin and rutin, often added; work synergistically to deliver extra immune benefits and may help to increase bioavailability.
  • Liposomal: Increased bioavailability due to phospholipid outer casing protecting the vitamin C inside from damage.
  • Time-release vitamin C: Better bioavailability when taken in smaller doses throughout the day; time-release formulas maximise total absorption of vitamin C over a prolonged period.
43
Q

What is Ester-C vitamin C supplement?

A

Ester-C®: Patented form of buffered vitamin C
(mainly calcium ascorbate) shown to be well absorbed and tolerated in the gut like other mineral ascorbates.

44
Q

What vitamin supplement can accelerate lung cancer?

A

Vitamin A supplement

45
Q

To who oral vit A supplement may be beneficial?

A

Oral vitamin A supplements mainly benefit those with poor or limited diet, or with conditions where there is increased need such as pancreatic disease, eye disease or measles:

46
Q

What are the two types of vitamin D

A

Vitamin D3: Cholecalciferol (active form). Most effective form.

Vitamin D2: Ergocalciferol (inactive vegetarian form).

Vegan form of D3 from lichen is suitable for vegetarians / vegans.

47
Q

Why prefer the natural form of vitamin E vs the synthetic form?

A

Natural form: D-alpha-tocopherol most commonly used.
• 1.4 times more biologically active than the synthetic form and retained in the body more efficiently.

48
Q

What is the best supplement form of Selenium?

A

Higher bioavailability of selenium in selenomethionine (90%) compared to about 50% from selenite. Most bioavailable and easily-assimilated form of selenium.

49
Q

Which b vitamin colour the urine bright yellow?

A

B2 Riboflavin

50
Q

What condition can put someone at risk of B1 Thiamine deficiency?

A

Alcoholism or old age

Nutrition Year 1 (10 decks)

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