Vitamins Flashcards
What is the most useful lab to assess B12 status?
MMA
Methylmalonic Acid
Serum or urine
At a high level, B vitamins are cofactors for what 2 things?
Energy production
Red blood cell production
Energy production =
*turning carbs into glucose
*metabolizing fats and proteins
KEDAC is an pneumonic for what?
Fat Soluble Vitamin Deficiency
Think Kodak, but misspelled to
KEDAC
He Steals the Rickshaw at Night Sky
K – Hemorarhage
E – Sterility (fertility?)
D – Rickets
A – Night blindness
C – Scurvy
Cracked floor visualization is for what?
B vitamin deficiencies
Beri Cracks the Floor Playing with Papan
Thiamin – Beri beri
Riboflavin – Cracks in lips/mouth
Niacin – Pellagra (play/pellagra)
Pantothenic Acid – Paresthesia (pins/needles/acne
Pyroxidine - Anemia (microcytic)
Folate – Anemia (macrocytic)
Cobalamin – Anemia
What are the 3D’s of B3?
Diarrhea
Dementia
Dermatitis
Death if it goes far enough
How to differentiate between B9 and B12 deficiency
B9
no neuro symptoms
MMA normal
B12
neuro symptoms
MMA elevated
takes years to develop
Major Function of Vitamin E
Anti-oxidant
others include
*protects against membrane per oxidation (membranes of RBC, muscles, nerves, retina)
*synthesis of CoQ10
*Synthesis of RNA/DNA
When you think of excessive bleeding, you think of what micronutrients?
Vitamin K and E
Functions of Vitamin E vs Deficiency of Vitamin E
Protects membranes against peroxidation
RBCs / Hemolyis
Muscles / Muscular dystrophy
Nerves. / Neuropathy
Retina. / Retinopathy
These nutrients interact with Warfarin
K
E
How are K and E partners vitamins
They kind of work opposite of each other
K def = bleeding
K tox = hemolytic anemia
E def = hemolytic anemia
E tox = bleeding
Vitamin E can interfere with K
K is trying to boost gamma-carboxylation
E is trying to inhibit gamma-carboxylation
Sources of vitamin E
think oils
seeds like sunflower seeds, almonds, hazelnuts
also tomato, avocado, spinach, asparagus, swiss chard
Vitamin A deficiency is often found alongside this mineral deficiency
Iron
supplementing with A in iron-deficiency anemia has better outcomes
Fetal brain development think of these micronutrients
Folate
Choline
Plant sources of B12
shitake mushrooms
nori
tempeh (but not soy, comes form the fermentation)
When you think of B5, think of these things (3)
Everywhere
Liver
any place CoA thank B5
Therapeutic/prescription dose of niacin
(what’s it used for?)
6,000 mg
hyperlipidemia
Thiamin Meal
Who is it for?
What are they eating?
Alcoholic that has beriberi
Acorn squash stuffed with ground pork, rice, and sunflower seeds
1.2 and 1.1
Riboflavin Meal
Who is it for?
What are they eating?
Client with sore and inflamed tongue and mouth
Beef liver and mushroom pate
or
Oatmeal with almond butter
Niacin Meal
Who is it for?
What are they eating?
Pellagra (3D’s of B3)
Diarrhea, Dermatitis, Dementia
keeping with the D theme, we are going to dice things up and make a salad
Chix/turkey breast or tuna salad with a side of bird seed/nuts (sunflower, pumpkin, peanut)
The seagull from picmonic, think yummy…poultry
Pantothenic Acid Meal (fact check)
Who is it for?
What are they eating?
Adrenaline junky (think picmonic)
Beef liver and Shitake mushroom pate
or
Pellagra
Bluefin tuna fish salad with eggs and greek yogurt/avocado on pita bread
(pita and pellagra)
Vitamin B6 Meal
Who is it for?
What are they eating?
Friend feeling extra irritable since starting birth control
Sushi and homemade banana ‘ice cream’
Biotin Meal
Who is it for?
What are they eating?
Someone on Abx that notices hair is thinning
Eggs and lox
Scrambled eggs with smoked salmon
(avidin)
Folate Meal
Who is it for?
What are they eating?
Pregnant woman
Bean salad over mixed greens
Side of asparagus
400 (600 pregnant, 500 lactating, TUL 1000)
Vitamin B12 Meal
Who is it for?
What are they eating?
Older client
Surf and turf
Seafood buffet
(2.4)
pregnancy 2.6 and lactation 2.8
Vitamin C Meal
Who is it for?
What are they eating?
Smoker
Brussel Sprout and pepper coleslaw with citrus vinaigrette and fruit salad
(90, 75)
smokers need 35 extra
Vitamin A Meal
Who is it for?
What are they eating?
Night blindness and/or skin issues
Sweet potato topped with boiled and sautéed spinach, carrots, peppers
Vanilla ice cream with mango
(Can’t see so they accidentally choose all the same color instead of a rainbow)
(900,700 TUL 3000)
Vitamin E Meal
Who is it for?
What are they eating?
Crohn’s or other fat malabsorption
Trail mix and kiwi
(sunflower seeds, almonds, hazelnuts, peanuts, dried mango)
(15 TUL 1000)
Vitamin D Meal
Who is it for?
What are they eating?
Someone with bone issues who doesn’t go outside
Salmon, mushroom omelette
Very similar to biotin meal
think to add the mushrooms because mushrooms live in dark places and agoraphobics don’t go outside)
Vitamin K Meal
Who is it for?
What are they eating?
Not for warfarin
Someone on Abx with malabsorption issues
Natto with a green salad
(120, 90)
Liver is high in what nutrients?
Thiamin
Riboflavin
Niacin
Pantothenic acid
B6
Biotin
Folate
Vitamin B12
Vitamin A
Vitamin D
Vitamin K
Vitamin C
Choline
Copper
Iron
Not In
Vitamin E
(have not yet gotten to minerals)
Choline Meal
Who is it for?
What are they eating?
A client MASLD
Eggs with chx sausage and home fries
(550, 425, TUL 3500)
What is a niacin equivalent?
1 mg NE = 60 mg of tryptophan = 1 mg niacin
Functions of folate (2)
DNA synthesis
Cell replication
Mnemonic to remember where things are absorbed (3)
Laundry order
IRON your clothes (duodenum) (iron)
FOLd them (Jejunum) (folate)
Put in Closet (ileum) (B12)
What is the primary site for biosynthesis of niacin from tryptophan?
Liver
kynurenine pathway
Nutrients that increase during pregnancy
Vitamin A - 700 >770
Vitamin C - 75 >85
Thiamin 1.1 > 1.4
Riboflavin 1.1 >1.4
Niacin 14 > 18
Pantothenic Acid
B6
Folate
Vitamin B12
Nutrients that increase during lactation
Vitamin A - 700 > 770 >1300
Vitamin C - 75 > 85 > 120
Vitamin E - 15 > 15 > 19
Thiamin 1.1 > 1.4 > 1.4
Riboflavin 1.1 >1.4 >1.6
Decreases
Niacin 14 > 18 >17
Calorie increases during pregnancy and lactation
1st - no increase
2nd - 340
3rd - 450
lactation = 2000-2800
lactating takes 500 calories but recommend less to facilitate weight loss
Nutrients that don’t change for pregnancy
Electrolytes, Doncha Know!
Sodium
Chloride
Calcium
Phosphorus
Fluoride
Vit D
Vit K
What micronutrients are important for Type 2 Diabetes?
Chromium
Magnesium
Zinc
Rx depletions of
Folate
B12
Mag
What micronutrients are important for the microcytic anemia?
Iron
Vitamin A
Copper
Vitamin C
What micronutrients are important for the macrocytic anemia?
Folate
B12
What micronutrients are important for the pernicious anemia?
B12
When thinking of labs for microcytic anemia think…
Low
What micronutrients are important for
osteoporosis? (7)
Calcium
Vitamin D
Vitamin K
Magnesium
Phosphorous
Boron
Vitamin C
Take meds away from supplements
What nutrients are important for CVD? (11)
Fiber
B6
Folate
B9
B12
Calcium
Magnesium
Omega 3
C
E
Selenium
Account for Rx depletions (dependent on med)
Signs and symptoms of B6 deficiency
Irritability
Depression
Confusion
Anxiety
Mouth symptoms
Muscle twitching
Headache
Insomnia
seborrheic rash
Signs and symptoms of biotin deficiency
Hair loss
Dermatitis
Grayish pallor
Unusual fat distribution under skin
Depression
Lethargy
Hallucinations
Tingling in extremities
Numbness
Anorexia
Nausea
Muscle pain
Increased serum cholesterol
Signs and symptoms of folate deficiency
Headache
Irritability
Difficulty concentrating
Forgetfulness
Heart palpitations
Angular stomatitis
Anorexia
Weight loss
Signs and symptoms of B12 deficiency
Neurological
GI
Unexplained weight loss
Darkening of skin, hair, nails
Nutrient tricks
1+2=3
B1, B2, B3 = whole grain sources
Multiples of 3 are fortified in products because they are important for BLOOD building. B6, B9, B12
Electrolytes, most common
Sunny Places Create Many Cool Bicycle (or beach if you prefer) People
Sodium
Potassium
Calcium
Magnesium
Chloride
Bicarbonates
Phosphorus
