Vitamins, Minerals, Prebiotics, Probiotics Flashcards
What are vitamins?
- An essential non-caloric organic nutrient needed in small amounts to adequately supplement our diets
- Vitamins in a vacuum have calories, however our bodies do not produce the enzymes necessary to metabolize - energy is not released for our bodies to utilize.
- Help fight off infection, keep nerves healthy, and regulate blood function
Which are fat-soluble vitamins?
- A,D,E,K
- Absorbed with fats from food, stored in fatty tissue and liver
Which are water-soluble vitamins?
- B, C
- Absorbed directly into blood and are not stored in body, but tissues can be saturated
Descibe Vitamin A.
- Stored in the body as “retinol”; eye function, salivary glands.
- Egg yolk, milk, cheese, green leafy vegetables, carrots
Descibe Vitamin D.
- Two forms: D2 (ergocalciferol) and D3(cholecalciferol)
- Bone function, immune function, enhances calcium and phosphorus absorption
Describe Vitamin E.
- Acquired exclusively from diet (vegetable oils, whole grains)
- Antioxidant Activity
Describe Vitamin K.
- Two forms: K1 and K2
- K1 found in leafy greens, K2 synthesized by gut microflora
- Necessary to activate clotting factors in the liver for coagulation (VII, IX, X, Protein C and S)
What are the different aspects of Vitamin A?
Vitamin A
* Stored in the body as “retinol”; eye function, salivary glands,
* Egg yolk, milk, cheese, green leafy vegetables, carrots
Toxicities
* Most commonly the result of over-supplementation
* Headaches, seizures, arthralgias, skin peeling, and liver damage
Recommended Daily Intake
Men: 900 mcg
Women: 700 mcg
Common OTC Products
Gordons-Vite A
True Vitamin A
Vitamin A Fish
What are the different aspects of Vitamin D?
Vitamin D
* D2 (ergocalciferol): Synthetic
* D3 (cholecalciferol): Produced when the skin is exposed to the sun.
* Bone function, immune function, enhances calcium and phosphorus absorption
Toxicities
* Decreased appetite, diarrhea, nausea, vomiting, and constipation
Common Uses
* Osteoporosis prevention, Vitamin D deficiency
Recommended Daily Intake
Age 19-70 years: 15 mcg (600 IU)
Adults 71 years and older: 20 mcg (800 IU)
What are the different aspects of vitamin E?
Vitamin E
* Acquired exclusively from diet.
* Antioxidant Activity
Toxicities
* High doses have been shown to increase bleeding
Common Uses
* Heart Disease, Eye disorders, and cognitive decline
Recommended Intake
Men: 15 mg
Women: 15 mg
What are some characteristics of Vitamin K?
Vitamin K
* Two forms: K1 and K2
* K1 found in leafy greens, K2 synthesized by gut microflora
* Necessary to activate clotting factors in the liver for coagulation
* VII, IX, X, Protein C and S
Toxicities
* Anemia
* Liver Toxicity
Recommended Daily Intake
Men: 120 mcg
Women: 90 mcg
Drug Interactions
Warfarin
Counseling Points
Advise patients to maintain consistent intake of Vitamin K while on warfarin
Inconsistent intake leads to abnormal lab values and decreased efficacy of warfarin
What does water-soluble vitamin mean?
Absorbed directly into blood and are not stored in body, but tissues can be “saturated”
Vitamin B
B1 (Thiamine)
B2 (Riboflavin)
B3 (Niacin)
B5 (Pantothenic Acid)
B6 (Pyridoxine)
B7 (Biotin)
B9 (Folate)
B12 (Cobalamin)
Vitamin C
Ascorbic acid
What are some characteristics of Vitamin B?
B1 (Thiamine)
* Enhances energy production, nerve function, and cardiovascular health.
B2 (Riboflavin)
* Involved in making red blood cells and keeping the nervous system healthy
Toxicities
* B1: Flushing, nausea
* B2: Urine discoloration
Common Uses
B1: Thiamin deficiency:
Alcohol dependence
Wernicke-Korsakoff syndrome
B2: People who follow a vegan diet
B3 (Niacin)
* Converted to NAD and NADP, used to catalyze reactions and produce energy
B5 (Pantothenic Acid)
* Plays a role in triglyceride and lipoprotein synthesis
Toxicities
B3: Flushing!
B5: No known toxicities
Common Uses
B3: Hyperlipidemia
B5: Hyperlipidemia
B6 (Pyridoxine)
* Enhances the body’s ability to form hemoglobin
B7 (Biotin/H)
* Involved in keeping hair, skin, and nails healthy
Toxicities
* B6: >200 mg/day results in increased the risk of peripheral neuropathy
Common Uses
* B6: Reducing cardiovascular disease, PMS symptoms, N/V in pregnancy, Tuberculosis regimens to prevent peripheral neuropathy
* B7: Hair, skin and nail health
B9 (Folate)
* Plays important role in DNA synthesis and metabolism of amino acids
B12 (Cobalamin)
* Involved in making red blood cells and keeping the nervous system healthy
Toxicities
* B9: Bitter taste, loss of appetite, nausea
* B12: Neurological disorders, headache
Common Uses
* B9: Women of childbearing age, Pregnancy
* B12: Vitamin B12 deficiency anemia
Recommended Intake In Pregnancy
* B9 (Folate) 600 mcg DFE (dietary folate equivalents)
What are common characteristics of vitamin C?
Vitamin C (Ascorbic Acid)
* Enhances immune function and possesses antioxidant activity
Toxicities
* >1000 mg/day results in increased risk of stomach pain, flatulence, and diarrhea
Common Uses
* Common cold, reduction in cardiovascular disease, and some data to support use in Age-Related Macular Degeneration (AMD) and Cataracts
What is St. John’s Worts?
St. John’s Wort: Used in management of depression, OCD, and ADHD
* Interacts with MANY drugs due to CYP enzyme interactions
* Inducer: decreases drug levels due to increased metabolism, decreasing efficacy
What are the 5 G’s?
- Garlic
- Ginseng
- Glucosamine
- Gingko
- Ginger
What are key counseling points for the 5 G’s and St. John’s Worts?
5 G’s: Avoid if on anticoagulants (blood thinners): warfarin, apixaban (Eliquis), rivaroxaban (Xarelto)
St. John’s Wort: Serotonergic, avoid with SSRIs/SNRIs
List the components of caffeine as a natural product..
Caffeine:
* The most popular drug in the world!
* Increases Heart Rate and Blood Pressure
* Recommended to not consume more than 400 mg/day
~ 2.5 cups of coffee (12 oz)
~1.5 energy drinks (16 oz)
2 caffeine pills (200mg)
Pregnancy:
* ACOG recommends <200 mg/day
What are minerals?
- Naturally occurring, inorganic elements that originate from the earth, soil, and water.
- Essential for biological functions in the human body.
- Bone health
- Electrolyte balance
- Immune support
- Macro minerals (Calcium, magnesium, potassium)
- Trace Minerals (Zinc, Iron)
How do potassium vitamins impact the body?
Potassium Chloride (KCl)
* Essential for proper heart function, kidney function, muscle contraction, nerve function
Toxicities
* Hyperkalemia (High Potassium): can result in cardiac arrythmias, abdominal pain, difficulty breathing
Interactions
* ACE/ARBs – exacerbate hyperkalemia
* K-sparing diuretics – exacerbate hyperkalemia
Recommended Daily Intake
Male - 3400 mg
Female – 2600 mg
How do iron supplements impact the body?
Ferrous Sulfate
* Commonly used in Iron Deficiency, Iron-deficiency anemia, and restless leg syndrome
* 65 mg of elemental iron in 325 mg of ferrous sulfate
Toxicities
* Darkening of stools, abdominal pain, constipation
Interactions
* Avoid concomitant administration with antacids and dairy products inhibits iron absorption.
Counseling
* Take 30 minutes before a meal or 2 hours after meal/medication.
Recommended Daily Intake
Men: 8 mg
Women: 18 mg
Describe calcium vitamins.
Calcium Carbonate (Tums), Calcium Acetate
* Many uses:
* Calcium supplementation, acid reflux relief, hyperphosphatemia in chronic kidney disease
Toxicities
* Constipation, bloating, flatulence (especially carbonate)
Important Counseling Point
* Carbonate → acidic environment to enhance absorption
* Acetate → alkaline environment to enhance absorption
* Separate from other medications by at least 2 hours
Recommended Daily Intake
* 19-15 yo: F-> 1000 mg, M–>1000mg
* 51-70 yo: F-> 1200 mg, M-> 1000mg
* over 70 yo: F-> 1200 mg, M-> 1200 mg
What are the components of zinc supplements?
Zinc Gluconate, Zinc Acetate
* Important role in optimizing immune function
Toxicities
* N/V, diarrhea, bad taste
* Otherwise, well-tolerated
Recommended Daily Intake
* Male: 11 mg
* Female: 8 mg
Counseling Points
* Separate by at least 2 hour from other medications.
* Polyvalent cations can bind to other medications resulting in decreased absorption
What are the components of Magnesium supplements?
Magnesium Oxide Many OTC products available
* Regulates transport of calcium and potassium across cell membranes
* Important role in immune function, limited data to support use in managing migraines.
Toxicities
* Diarrhea
Counseling points
* Separate by at least 2 hour from other medications.
* Polyvalent cations can bind to other medications resulting in decreased absorption
Daily Recommended Intake
Men: 420mg
Women: 320 mg
What are probiotics?
Our bodies are home to over 100 trillion “good bacteria” → essential to our survival.
Align, Culturelle, Florastor
* Stimulates the growth of microorganisms, specifically those that promote growth of intestinal flora
* Most studied product → Align
* Assists in managing bloating, abdominal pain, and bowel movement difficulty.
Acidophilus
* Commonly prescribed for individuals traveling abroad.
Food products with probiotics
* Cottage Cheese, Kombucha, Kimchi, Pickles, Yogurt
Commonly prescribed for patients who are traveling to other countries.
* Traveler’s Diarrhea
* Antibiotic-associated diarrhea
Limited data to support use in:
* * GI-associated complications (diarrhea, Irritable Bowel Syndrome (IBS), etc.)
* Booming $$$ industry, however…
NOT recommended to take a daily probiotic in most healthy adults
Limited data to warrant benefit and rule out risks
What are prebiotics?
- Carbohydrates and fibers: non-digestible compounds used as ‘food’ to enhance growth of beneficial gut microbiota.
- Data has shown to support protection of the GI system, improve the body’s ability to fight off infection, and improve fasting glycemic levels in patients with diabetes.
- Don’t forget your fruits and vegetables!
- Products:
Benefiber
How does the FDA relate to vitamins, minerals, probiotics, and prebiotics?
- The FDA does not approve or regulate dietary supplements before they are sold.
- Supplements are only regulated for safety and labeling after they reach the market.
- USP (U.S. Pharmacopeia) sets standards for dietary supplements.
- Recommend products with the “USP Verified” label
