Vitamin summary (Fat soluble A,D,E, K) water soluble folate and C, MG, Ca, P Flashcards
vitamin C (ascorbic acid)/ Water soluble
Function: hydroxylating enzymes involved in:
-collagen synthesis
-carnitine synthesis
-tyrosine synthesis and catabolism
-neurotransmitter synthesis.
-antioxidants
carnitine synthesis in beta oxidation
antagonis: heat, light, oxidation and alkaline solutions can destroy, large amounts of iron or copper with vit c may result in destruction of vit c.
-pectin, zinc, high intracellular glucose, A large dose of ascorbate.
Agonist: glutathione
RDA: 90 mg/d (m)
70 mg/d (F)
Deficiency: scurvy, hyperkeratosis of hair follicles, psychological issues, wound healing, bleeding gums, ruptured capillaries.
> 2g gastro problems.
Supplementation: free ascorbic acid, calcium ascorbate, and ascorbate, ascorbyl palmitate, Ester c, rose hips
plasma vitamin C, leukocytes
fruits and veg
asparagus
papaya
citrus
strawberries
Folate (B9)/water soluble
main coenzyme derivatives of tetrahydrofolic acid
-coenzyme THP (tetrahydrofolate active form)
-single carbon transfer
-amino acid metabolism
-DNA and RNA synthesis
Folate is critical in the metabolism of nucleic acid precursor and several amino acids (purine, pyrimidine, glycine, histidine, degradation, methionine synthesis) as well as methylation reactions
-Agonists: Zn, folate binding proteins (FBP), B3,
-Antagonist: alcohol, conjugase inhibitors, lentils, legumes, cabbage, oranges.
dosage: 400 mcg/d
deficiency:
macrocytiic anemia, megaloblastic anemia, increased cardiovascular risk, increased risk fetal disformation, diarrhea, fatigue, depression, confusion
toxicity: 1000 mcg tolerable upper intake level for synthetic folic acid, symptoms neurological problems.
supplementation: from .8 mg-5 mg found to increase cancer risk and mortality.
assessment: measuring concentrations in plasma, serum or red blood cells
Food: brewers yeast, spinach, asparagus, lima beans, fortified grains, organ meats, legumes, okra, leafy veg, orange juice.
vitamin A (retinol) Fat soluble
Instructs genes to activate and to do things.
-eyes
-reproduction
-cell differentiation
-bone development (growth)
-thyroid
-Immuninty
-gene expression
-cornea, retina
-antioxidant (A,C, E)
-Anti-cancer
-Help you burn fat (can be deficient in type 11 diabetic)
- wound healing
- stored in the Liver, adipose tissue, eyes, bone tissue
excretion: urine, bonded to bile and passed out through stool.
Digestion: need a little bit of acid, must need to break down fat. If you dont have gallbladder (digesting fat is hard), need lipase and bile.
Same for E, K, and D .growth
Needed for growth: higher in males than in females. Highest need is lactation.
metabolic pathway: synthesis of rhodopsin and other light receptor pigments, metabolites involved in growth.
Agonist: fat, vitamin E,
Antagonist: vitamin E (large doses), fiber
RDA:
900mcg/d RAE (M)
700 mcg/d RAE (F)
deficiency:
vision dysfunction
night blindness
poor dark adaptation
Bitot’s spots
xerophthalmia
hyperkeratosis
poor wound healing,
UL of preformed Vitamin A is 3000 mcg RAE per day.
Hypervitamin A- blurred vision, birth defects
supplement:
All trans retinal acetate, all trans retinal palmitate used in supplementation
Assessment: plasma retinol concentrations, relative dose response or m odified relative dose response tests, other eye function tests.
FOOD SOURCES:
Plant based vitamin A: carotenoids
Orange, yellow (carrots, pumpkin, carrots)
main form vit A in foods is as retinyl (animal)
-Liver, dairy, eggs, fish, fish oil, cod liver oil
supplements: mostly in betacarotein hoping it converts to vitamin A.
Orange skin is side effect if you eat too much betacarotene.
Retinol UL: preformed vitamin A as retinol
pregnancy and liver conditions (damage) : should not have more than 10,000 units
extremely high risk of birth defect if taking too much in pregnancy.
Antiviral (take for flu, covid…)
Be careful if people have a hard time processing through the liver.
Alot have a hard time converting carotene to vitamin A SOO give vitamin A. If no GB, Take a digestive enzyme with Vitamin A, sublingual and/or eat fatty foods with pills.
SMOKERS should not take betacarotene. Give them vitamin C to be able to take betacarotene. Increasing risk for lung cancer.
Signs of too much retinol?
Hair falling out, high blood pressure, elevated intracranial pressure.
How to test for Vitamin A:
Serum Vitamin A
Drug/nutrient interactions: Acutaine, retinae (do not give anymore vitamin A) . Acutaine is VERY DANGEROUS FOR FETAL DEVELOPMENT.
Vitamin D (provitamins 7-dehydrocholesterol, vitamin D2(ergocalciferol), vitamin D3 (cholecalciferol) Fat soluble
calcium homeostasis
phosphorus homeostasis
bone health
cell differentiation
hormones
Mood
wound healing
Cant loose weight without
metabolic pathway:
-regulator of bone mineral metabolism, blood calcium homeostasis, cell differentation, proliferation and growth, regulation of blood pressure, diminishing risk of heart disease
- brings in CALCIUM AND PHOSPHORUS.
-CALCIUM AND PHOSPHORUS is dependent on Vitamin D
Digestion/absorption: same as fat soluble
excretion: through bile and stool.
Stages of lifecycle:
Infants 400 units 1 yo
1-70 600 units
70+ 800 units
0.025 mcg = 1 unit
Agonists: sunlight, cholesterol, vitamin B3 and B2, PTH, low phosphorus levels
Antagonist: high amounts of phosphorus
RDA: 15-20 mcg/day
Deficiency: RICKETS, Osteomalacia, Osteoporosis, some autoimmune conditions such as rheumatoid arthritis,, crohn’s disease, MS and type 1 diabetes mellitis have been linked to Vit D Def. poor ability to loose weight.
TOlerable upper limit: 4000 IU, or 100 mcg/d.
Hypercalcemia (calcification of soft tissue)
Toxicity seen especially in those with vit.D intakes >10,000 IU/d for several months.
supplementation: Rocaltrol (oral) and calcijex (injectable) are RX brands,
Over the counter: 25-OH D, D2 and D3 forms, once weekly doses of 50,000IU given for 8 weeks followed by lower dosages giving for deficiencies (with normal organ function)
testing: serum 25-OH concentrations
Foods: synthesized in skin exposed to ultraviolet light
-fish (fatty), herring, tuna, salmon, sardines
-shitake mushrooms, MUSHROOMS
(trick to increase vitamin D, put them in the sun).
-fortified dairy,milk, yogurt
-fortified cereals
-orange juice
Liver stage I: turns into circulating form of vitamin D. Hydroxylation controlled by vitamin C. 25-hydroxy vitamin D
Now to activate goes to KIDNEY: another hydroxylation (1, 25 Dihydroxy vitamin D) Active form goes to the gut cells and makes calbinden (pulls calcium across cell membrane)
Low vitamin D, do they have enough vitamin C.
Vitamin D2 (plant based)
Vitamin D3 (animal based) most common way.
2000-4000 units (D3) anything higher than that dose based on lab.
On lab should be 60-80 or 70-90.
Too much vitamin D: hypercalcemia, hyperphophatemia
excess: Hypercalcemia, joint pains, nausea, anxiety, thirst, renal problems,
Drug/nutrient interactions: anything that impairs absorption.
Dosing: ADK (davinci or designs for health) (oral) Designs for health (emulsified, sublingual), Klaire labs : mycelized vitamin D under tongue.
vitamin E (Tocopherols) Tocotrienols
-antioxidants
-CELL MEMBRANE INTEGRITY
-protects fats and cholesterol. Cell membrane is made of fats.
-cell membrane stability
Digestion absorption: Bile acid, lipase, careful about massive amounts of other fat solubles at a time. REALLY high fat and high fiber can be hard to absorb fats. (KETO). Limit to how much fat can be used.
Stored: Liver, adipose, red blood cells, platelets.
Extrection: bile
stages: slowly goes up, adolescents to end of life (same in both )
More in lactation:
-eye health, prevention of cataracts and age related macular degeneration
-heart health
-Helps recycle vitamin A and C.
-Agonist: fats
-Antagonist: excess amount of vit D
RDA: 15 mg/d alphatocopherol
400-800 units
higher dose helps with arthritis.
Use vitamin E cream for knees.
deficiency is rare:
-neuromuscular problems
-hemolytic anemia (fragile and brittle cell membranes)
-Myopathy
Tolerable upper intake level of 1000 mg/d
-one of the least toxic vitamins
-mild gastrointestinal problems.
-increased risk of hemorrhage
Supplement:
Active form: D-alphatercopherol (you want this) : up to 400 units.
DL-Alphatocopherol (always synthetic, dont get same benefit)
Mixed tocotrienols.
recommended as an antioxidant with conditions characterised by increased lipid peroxidation. i.e. iron toxicity and diabetes.
Blood analysis; plasma concentrations, aslo a crude assessment from erythrocyte hemolysis test
food: vegetable seed oils (sunflower, saflower)
-wheat germ
-nuts, seeds
-cooked spinach, broccoli, and collard greens
-fortified cereals
-animal products contain some, but are an ingerior source.
CAN CAUSE HEMORRHAGE (impairment of clotting)
Interactions: blood thinners, cancer meds, statins (deplete)
vitamin K
-coenzyme / cofactor in carboxylation reactions.
-blood clotting
-bone health
-tooth health
-blood insulin production
metabolic pathway: activates blood-clotting facets by y-carboxylating glutamic acid residues; carboxylates other proteins
Digestion/absorption/excretion: same as all other fat soluble.
IF digestion is good: should make some vitamin K2.
Store: liver, cell membranes (least stored of all fat soluble)
Lifestyle: very little in infancy, little more in toddler, childhood, jump in preadolescents, adulthood stay stable throughout life .
men need more than women.
pregnancy has no change.
Agonist: fat, bile, pancreatic juices
Antagonist: warfarin, vitamins A & E
120 mcg/d(m)
90 mcg/d (F)
-vitamin K deficiency bleeding (VKDB)
Toxicity: no known effects, no tolerable upper intake lvel established.
supplementation:
ALL NEWBORNS advisable;
-intramuscular injection of .5 to 1.0 mg phylloquinone shortly after birth, supplements available for others with deficiencies; absorbed best with dietary fat.
-assessment: multiple biomarkers such as plasma or serum concentrations of phyllooquinone, whole blood and prothrombin clotting times, measure percentage of under carboxylated vitamin K dependent proteins.
Foods:
-synthesized by intestinal bacteria (k2)
-kale, collards
-spinach
-broccoli
-brussels sprouts
-soybeans
-beef liver
-harder to get from animal
deficiency: hemorrhage (test babies right after birth) , change in bone mineral density
Too much: overdose: primarily in people with liver damage.
Interact: Antacids, excess amounts of other fat solubles, antibiotics
warfarin (Coumadin): interacts directly with vitamin K. CAN NOT GIVE VITAMIN K Because it will make people clot more.
testing: osteocalcin is carboxylated fully? serum.
GIVE AEDK all together.
K2 (MK4, MK7)
MK4 three times per day, Ca, Vitamin D (increase bone density)
designs for health: ADEK with digestive enzyme.
becomes MK4 at the cellular level.
Calcium (Ca)
Bone and Tooth structure, muscle function, clotting, heart rhythm, Nerve function, blood vessel expansion/contraction, hormone and enzyme secretion, cell membrane permeability. BP regulation.
calcium and magnesium oppose each other: calcium create contraction, magnesium release contraction.
Too much calcium can make muscle contraction more intense, push up blood pressure, create arrhythmia.
Too little can create arrhythmia too.
Digested/excreted (minerals)
digested needs stomach acidity to get it out of the food.
Store it in bones, teeth, muscle cells, nerve cells, blood, soft tissue
excreted in urine and small amount in sweat.
Stages of lifecycle:
more in childhood, greatest need in adolescence.
19-70 stay same , 70+ goes up (men)
19-50 stay same, 50+ goes up (women)
not measurable change in pregnancy and lactation.
If giving other minerals in large doses you can impact absorption of other minerals.
Distribution: 99% in bones and teeth, 1 % blood, muscle and intracellular fluid.
Antagonist: caffeine, coffee, alcohol, sods, smoking, oxalates, antacids, phytates, fiber, toxic metals, tetracycline, XS: fat, prot, Fe, Na, Phos,
Def: Mg, D.
Enhancers: D3, Mg, B6, B0, Si, EFA< K, Taurine, Protein, Lactose, PTH, Calcitriol, Calcitonin.
Deficiency diseases: Rickets, Osteoporosis, periodontosis,
Deficiency symptoms and associated conditions: Osteopenia, cramps, periodontitis, tremors, seizures, insomnia, hypertension, irritability, anxiety, brittle nails, muscle pain, bone issues.
Diagnostic tests: serum ca, Ionizable Ca, Serum osteocalcium, urine crosslinked, pyridinolines.
25-39% absorption, acet. aspart, chelate, carbonate, cl, citrate, glucon, Hydroxyapatite, oratate, lactate, monopho
RDA: Ch: 210-800 mg, adol: 1300 mg, adult: 1000 -1300 , UL for all 2500 mg
Therapy: 250-1500 mg
Toxicity: >2500
Symptoms of excess: Def: Mg, Mn, Phosphorus, Zn, Alkalosis, constipation, joint pain, soft tissue calcification.
avoid in : Hypercalcemia
sources: milk prod, salmon, sardines with bones, mollusks, vegetables, (not high oxalates: spinach, rhubarb, chard), pumpkin seeds, nuts and seeds, greens
Supplementation: calcium citrate, calcium malate, calcium lactate
calcium lactate: useful for poor stomach acid dont need alot to absorb, doesnt require acidity to absorb).
calcium citrate is the EASIEST TO ABSORB.
if getting a fair amount of calcium from food, if got good vitamin D, K, A and eating good food likely absorbing enough calcium.
If osteopenia, give calcium but you must give D and K too. ( and A).
Designs for Health
serum calcium is not directly tied to calcium dietary intake.
Calcium goes down, bones make more, parathyroid hormone tells bones to release calcium to make sure blood vessel stays consistent.
Test ionized calcium if overdosed on vitamin D.
Primary drivers: High urinary calcium, is due to high levels of glucose,
-hyperglycemic, diabetic, pre-diabetic are higher risk.
more calcium is dumped out of kidneys
Test with best information about stored calcium: DEXA (done on same machine every time) .
Nutrient drug interactions: calcium channel blockers, PPI, antacids, steroids, Antibiotics, Diazides, caffeine,
Phosphorus (P)
Bone: tooth, PH, muscle function, Brain, Nerve function, calcium metabolism, cell membranes, phospholipids.
2nd most abundant: 85% in bne 14% soft tissue, 1 % blood
Antagonists: antacids containing aliminum or Mg, Kidney malfunction, Phytates, XS Mg,Ca, Al
Enahncers: D3, PTH, Calcitrol, calcitonin.
Deficiency: Rickets, cardiac myopathy,
Deficiecncy, symptoms: Deficiency is rare,
Anorexia, bone loss, weakness, neurological problems, ataxia, paresthesia, muscle myopathy.
Diagnostic: Serum phosphorus
Supplements: K phos., Neutra Phos K
Ch: 100-500 mg
UL 3000 mg
Adult: 700-1250 mg
UL: 3000-4000 mg
Therapy: 250-750 mg
Toxicity: Rare
Symptoms of excess: hypocalcemia, tetany
avoid in: hypophosphatemia
Sources: Meat, poultry, fish, eggs, milk, nuts, legumes, cereals, grains
Magnesium (Mg)
> 300 enzymes finctions, neuromuscular:
osteoporosis
Isnt just minerals, it is hormones
estrogen and progesterone affect (HRT)
what are your blood sugars look like.
High glucose levels will dump calcium.
Vegan (type II diabetic, obese, osteopenia, osteoporosis), blood sugars are high.
Weight bearing exercises.
diet important
supplementation
Bisphosphonates (build bone) impact calcium.
