Vitamins Pt2 Flashcards
What are tonics
- Old school remedys for seniors
- More phycological then anything
Two types of iron
- Heme: meats and is the best
- Non heme: plants,
RNI of iron and best way to reach this
- 15-18 mg for females (15 for teens, 18 for adults)
- best way to get this is through dietary measures if possible
Do we hand out iron tablets (high iron supplements)
- No we don’t
- Try to increase it through dietary measures but if not possible use lab results
- Don’t prescribe them only dispense them
Different salts iron is available in
- Ferrous fumarate: 33% iron (blue)
- Ferrous sulfate: 20% iron (red)
- Ferrous gluconate: 12% iron (green)
What % of dietary iron (heme) is absorbed
- 10-15% is absorbed by the body from diet
- When in an iron deficiency about 20%
Why are some people told to take iron supplements with orange juice
- Vitamin C causes a little better absorption of iron
why do some iron supp say less/ no side effects
A lot of iron supplements have very little iron as only 10-20% is absorbed, also say less side effects but this usually just means less iron
Absorption Interactions with iron (food, vit C, protein/calcium/antacids, coffee/tea)
- Increase: vit C
- Decrease: food (May have less then 50% of what you thought you had, but it is better to have it tolerable with food and not have any side effects), protein/calcium/antacids, coffee/ tea
How long does it take for an iron deficiency to be under control
2-3 weeks, however prescription usually 3 months
Tolerable Upper limit of iron
45 mg
Side effects of iron
- Dyspepsia (heart burn)
- Nausea vomiting
- Constipation
- Dark stools (can be via unabsorbed iron and is harmless in this state)
Do slow release formulations help?
- Iron is best absorbed quickly in the gut
- With a slow release product many of these may not be freed and may not even be available and goes through
- Slow release iron is more expensive and lower absorption
If there is discoloration in the stool what do we do
- Most likely just the iron colour
- We cant tell if it is this or an actual bleed
- Needs to be checked out by a MD
Is iron safe with kids?
- No it is not safe around kids as it can kill
Pediatric toxicity
what vitamin has pediatric toxicity
iron, can cause death in kids
Why do most people take vitamins
- Just in case 75% of people
- No value in reducing mortality, cancer, or almost any type of cardiovascular disease
What are niacin used for
- Was used for cholesterol at the prescription level but now has less value now and has
barely any value at the OTC
Flushing vs no flushing niacin
non flushing niacin means that it is deemed ineffective as the amide makes it useless (niacin/ nicotinic acid have some effect, niacinamide/ nicotinamide have no effect)
Cancer with vitamins
- Antioxidants: When there is a mix of all antioxidants it is way better then just one at a time
- Foods vs supplements: supp not helpful
Stress/ fatigue/ energy with vitamins
- B vitamins are critical just as proteins carbs… but it does not drive us to have less stress/ fatigue and more energy if you arent deficient
Depression and anxiety with vitamins
- If you are deficient has some evidence for thiamine
- Thiamine’s(B1) RNA is 1 mg but the supplements come in at much higher then this
AMD
- Age related macular degeneration: the flooding of blood and is basically high cholesterol in the eye (get fat deposits)
- Once you get it you cant reverse it (starts in the middle of the eye)
Dry vs wet types of eye vitamins
- Dry: 90%: for high cholesterol
- Wet type: 10%, vascular type and get into your high
What are AREDS
- Age related eye disease studies
- Potentially delays progression of 1 in 4 cases that have intermediate AMD
- This level of agents cant be met by diet alone
- The only evidence based eye drops for AMD
- Must say AREDS or AREDS 2 on the package
RNI of magnesium
- 320-420 mg
- What is magnesium most likely used for
- Heart health
- Leg cramps
- Bone health
- Depression
- Anti-constipation
Where do we want to get magnesium from
- Get majority with diet and then top up from supplements
UL of diarrhea and side effects of magnesium
- Tolerable upper limit it 350 mg
- At 500 mg can cause diarrhea
- Cant say no side effects but need a lot of mg to cause diarrhea
Potassium
Important aspect of DASH diet (For hypertension and lifts potassium levels up and seems to help heart health)
RNI of potassium
- 4700 mg
- A banana has 470 mg
What does high levels of supplemented potassium do in relation to BP
- 2300 mg of supp lowered BP by 3 points
- Not to mess around in the OTC world rather prescription
What can we expect If a person starts taking multi-vitamin, calcium, iron, AMD product
- Not going to feel different unless they are maybe iron deficient
Preventative more
How long will I be on iron, calcium, AMD product
- Iron: about 3 months if iron deficient
- Calcium: for life
- AMD product: lifelong
Enteral products
- Complete nutrition has all the carbs, fats, proteins vitamins and minerals to keep you sustained as possible
- If worried about vitamins you can take them to this as this gives them everything
-Boost, ensure
- If worried about vitamins you can take them to this as this gives them everything
Why would a person take an extra fat enteral product
The plus is more fats thrown in, can drink 50% less of liquid
what are other uses for enteral products
Also used for tube feeding, nursing home, jaw wired shut
Diabetic(glucerna) enteral product
- Slower carb release
- Marketed to diabetics
- Only difference is the carbs are a bit more Complex in glucerna
Gives less spike for diabetics
kid vs adult enteral product
basically same thing with different labelling
Vitamin C
Essential vitamin
Vitamin C Needed for 19+
- Male: 90 mg
- Female: 75 mg
- Need very little amount while Most tablets are at about 500 mg
Vitamin E
- Mostly used for scar prevention
- May help
Vaseline works just as good
Needed vitamin E: 14+
- Males: 15 mg (22.4 IU)
- Females: 15 mg
- However most products have 400 IU
Vitamin K
- Generally not a self medication scenario (it affects coagulation)
- Low levels of vitamin K can raise the risk of uncontrolled bleedings but deficiencies are rare in adults
- Clotting vitamin
May have an influence on bone mineral density and osteoporosis
RNI of vitamin K
- Around 100 ug
Types of vitamin K
a) K1: phylloquinone
- Dietary form, found in plants like green vegetables, low toxicity
b) K2: menaquinone
- Created in body by intestinal flora and found in fermented foods
c) K3: menadione
- Created in body by intestinal flora and found in fermented foods
-concern for toxicity
which vitamin K is preferred usually
K1 usually preferred as lower concern for toxicity and works faster but some claim for K2 being better for boen
Fat soluble vitamins and mineral oil interactions
- Mineral oil is hard on gut, no constipation patient is taking mineral oil, fat soluble vitamins could leak into mineral oil taken out of body.
Vitamin E and anticoagulation interactions
- It is not linked to any cardiovascular value at 400IU
- It could have an effect if you had upwards of 1000 IU
Fe (not at multivitamin levels, TUL of iron is 45 mg)with antacids, coffee/tea/wine, tetracyclines, any drug with GI irritation potential, any drug with potential for constipation
a) Antacids
- PPIs can make less Acid and make iron Less absorbed
b) Coffee, tea, wine
- Could make it a little less Absorbed, not to worry about
c) Tetracyclines
- Big one (could be on for acne), Iron could make tetracycline less effective
d) Any drug with GI irritation potential, any drug with potential for constipation
- Unless your taking the TUL not an issue
Ibuprofen
Calcium with tetracyclines, corticosteroids, chronic PPI use, any drug with potential for constipation
a) Corticosteroids
- Chronic steroids can leach Ca out of the bones
- Ca would be a good thing with chronic steroids
b) Potential for constipation
- Not going to cause (at 2500mg it could) but you only have about 200mg in a multivitamin
c) Vitamin A and retinoids (oral and topical) interactions
- Retinoids (vitamin a derivatives for acne), if have both then multiple sources of vit A
- No multivitamin will interact with retinoids, vit a will not help with acne orally
d) Potassium and diuretics interactions
- Can lose a bit of potassium with diuretics
- Multivitamin will not increase K levels (not enough in them)
