Vitamins, Minerals and Trace Elements Flashcards
What are the basics of a healthy diet?
Carbohydrate (simple and complex) Fat Protein Dairy Vitamins Minerals and trace elements
What role do vitamins and minerals play in the body?
They play a key role as co-factors or co-enzymes in most metabolic reactions
They also have an antioxidant effect in their role as free radical scavengers
How much vitamins and minerals are required?
Only required in small quantities
What are vitamins?
‘Vital amines’, complex organic substances
Why do we need vitamins in our diets?
The body does not make sufficient quantities and so we must obtain them from food or supplements
How is vitamin D made?
By exposure to sunlight (synthesised in the skin via cholesterol by sunlight), problematic for those who may be housebound
Where do we get vitamin B12 from?
Animal products, problematic for vegans
Which are the water soluble vitamins?
Vitamin C, B1, B2, B3, B5, B6, B7, B9, B12
Which are the fat soluble (stored) vitamins?
Vit A, D, E, K
What are water soluble vitamins like (in terms of structure)?
Tend to have polar structures with alcohols and esters
What are fat soluble vitamins like (in terms of structure)?
Tend to be lipophilic with long fatty acid chains
Where are most water soluble vitamins absorbed?
Small intestine (duodenum)
Where are most fat soluble vitamins absorbed?
By bile in the large intestine
What can reduce levels of fat soluble vitamins?
Levels of fat soluble vitamins are reduced if fat absorption is reduced e.g. by lack of pancreatic enzymes/low fat diet
How is vitamin B12 absorbed?
By intrinsic factor (IL) in the ileum
What produces vitamin K in the body?
GI flora from original plant sources
Why are vitamin K levels important to consider?
Interaction with warfarin/INR, antibiotics
Where do we get vitamin D from?
Dietary but also synthesised (sunlight)
Which vitamins are stored in the body?
Fat soluble
Which units are used to describe vitamins?
Milligrams or micrograms
Vitamin A, D and E are also quoted in International Units (IU)
Are vitamins sources of energy?
No, they simply take part in the body’s metabolic processes and act as antioxidants
Which external factors affect vitamins?
Heat Light Oxygen Enzymes Minerals
How are vitamins lost from foods?
Poor storage and preparation methods
What is the effect of a vitamin A deficiency?
Poor night vision
What is the effect of a vitamin B1 deficiency?
Wenikes encephalopathy
What is the effect of a vitamin B7 deficiency?
Hair loss, anaemia
What is the effect of a vitamin B9 deficiency?
Megaloblastic anaemias, neural tube defects
What is the effect of a vitamin B12 deficiency?
Pernicious anaemia, peripheral neuropathy
What is the effect of a vitamin C deficiency?
Painful joints, scurvy
What is the effect of a vitamin D deficiency?
Rickets, osteoporosis
What is the effect of a vitamin K deficiency?
Abnormal clotting
Which vitamin is important in pregnancy and why?
General principles of good nutrition apply in pregnancy, but particularly folic acid
Folic acid is important in the prevention of neural tube defects (including spina bidifda)
Which doses of folic acid are given in pregnancy?
No previous history of NTD - 400mcg OD until 12th week of pregnancy
Previous history, epilepsy or taking anti epileptics increased to 5mg OD
Which foods should be avoided in pregnancy and why?
Fish (shark, swordfish, marlin, tuna, as high mercury contents which can have neuro effects)
Raw shell fish (food poisoning)
Soft cheeses (Listeria)
Mayo and raw/undercooked eggs (Salmonella)
Liver and pate (Vit A teratogenic and listeria)
Restrict caffeine (miscarriage and low birth weight)
Alcohol
What are some examples of minerals?
Electrolytes Calcium Magnesium Phosphorus Sodium Potassium
What are some examples of trace elements?
Iron Zinc Iodine Fluoride Selenium Copper
What are minerals and trace elements?
Inorganic substances
How much minerals and trace elements are needed?
Minerals are needed in large amounts (particularly sodium and potassium)
Trace elements are needed in smaller quantities
What are minerals and trace elements needed for?
Formation of bones and teeth Essential constituents of body fluids and tissues Components of enzyme systems Nerve function Blood constituents
What are sources of minerals and trace elements?
Food, supplements, water
No one food provides everything, need a balanced diet
What affects the absorption of minerals and trace elements?
Presence of other minerals/vitamins either at high or low levels
Components found in food
Amount of mineral already in body
What can a potassium and magnesium deficiency cause?
Cardiac arrhythmias
What can a calcium and magnesium deficiency cause?
Osteoporosis, muscle cramps, tetany
What can a zinc deficiency cause?
Hair loss and poor wound healing
What can an iron deficiency cause?
Anaemia
What is Copper-Wilson’s disease?
A rare genetic disorder that causes copper poisoning in the body
What does RDA stand for?
Recommended dietary amount
What does RDI stand for?
Recommended dietary intake
What does RNI stand for?
Reference nutrient intake
What does SUL stand for?
Safe upper level
Made for only 8 vitamins and minerals
Guidance issued for 22 others
What is fortification?
Addition of nutrients to appropriate food vehicles
What are some examples of fortification?
Vitamin D fortified margarine
B vitamins and iron in cereals
Calcium, iron, thiamine and niacin in white and brown flour
Fluoride in drinking water
What are supplements?
Contain nutrients and other ingredients
People believe they will have a beneficial effect on health, but results are often anecdotal/misinterpretations
Give one example of a claim from a supplement.
Vitamin C boosts the immune system
Who uses supplements?
Over 40% of men and women regularly use supplements in the UK
Mostly used by the ‘worried well’ i.e. do not need them
Who may actually need supplements?
People living in places with little sunshine (e.g. Manchester) - vitamin D deficient
Older people - calcium and vitamin D deficient, especially those who are housebound
Vegetarians/vegans - B12 and folic acid
Pregnant women - folic acid and possibly iron if anaemic
Babies and pre school children - vitamins A and D
Alcoholics (poor diet and poor GI absorption) - vitamin B1 (Wenikes and Korsikoffs psychosis)
People with vitamin/mineral deficiency (e.g. coeliac, UC/Crohns, lack of IF)
CKD - activated vitamin D and calcium
People taking antiepileptics drugs - vitamin D deficient
What are some of the problems associated with supplements?
Toxicity/accumulation, especially with iron
Complacency and bad diet
Legal status means there is practically no control over them
Not viewed as a medicine so difficult for us to offer advice
Give 3 examples of drug/supplement interactions.
Methotrexate and folic acid
Iron and vitamin C
Tetracyclines and metal salts
What is our role as pharmacists?
Give advice on healthy diet
Identify patients who may benefit from supplements
Be aware of the common symptoms of deficiency
Be able to recommend appropriate supplements
