Nutrition EX2

What are the fat soluble vitamins?

Vitamins A, D, E, K

What are the water soluble vitamins

Thiamin, Riboflavin, Niacin, Folate, Vitamin B6, Vitamin B12, Vitamin C

Vitamin A: toxicity, active/inactive forms, RDA, UL, best sources, facts, functions

• Most toxic fat-soluble vitamin

• Active form = retinol, inactive form = beta-carotene (precursor to Vitamin A)

• RDA: Men = 900 mcg, Women = 700 mcg

• UL = 3,000 mcg; beta-carotene is non-toxic

• Sources: liver, dairy, eggs; carrots, sweet potato (beta-carotene)

• Can be stored for 1-2 years in liver

• Increased risk with supplementation of lung cancer

• Functions: vision (rhodopsin), immune function, epithelial integrity, gene expression

Vitamin A: drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: isotretinoin increased toxicity; fat malabsorption decreases absorption

• Deficiency symptoms: night blindness; xerophthalmia (eye dryness); bitot spots

• Toxicity symptoms: teratogenic (birth defects - pregnant women should avoid megadose and accutane); hepatotoxic (stored in liver), hypercarotenemia (excess betacarotene)

• Clinical applications: WHO recommends high dose of vitamin A for kids w/ measles in developing countries; acne (retinoids); malabsorption disorders need supplementation

• Prophylaxis: avoid excess in pregnancy; supplement deficiency states

Vitamin D : toxicity, RDA, UL, best sources, facts, functions

• Second most toxic vitamin fat-soluble

• RDA: 600 IU (6 cups of milk), 3.5 oz of fatty fish; 800 IU > 70 years

• UL: 4,000 IU

• Best sources: sunlight (5-30 mins daily), fatty fish, fortified milk and cereal

• Facts: Activated by liver and kidney; high risk = living north of 37’ latitude; sunscreen blocks production

• Functions: Calcium homeostasis (Signals kidneys to reabsorb calcium → less calcium lost in urine); Calcium/phosphorous absorption; bone mineralization; immune modulation

Vitamin D: drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: steroids decrease calcium absorption; thiazides increase hypercalcemia; orlistat decreases absorption

• Deficiency symptoms: rickets/osteomalacia, muscle weakness

• Toxicity symptoms: osteoporosis, chronic kidney disease, falls preventions, malabsorption disorders

• Propyhylaxis for: supplement elderly, people w/ limited sun exposure; breastfed babies

Vitamin E: toxicity, RDA, UL, best sources, facts, functions

• Second to least toxic fat-soluble

• Natural blood thinner

• RDA: 15 mg

• UL: 1,000 mg

• Food sources: nuts, seeds, vegetable oils, wheat germs (fats)

• Fact: protects Polyunsaturated fatty acids and Low-Density Lipoproteins from oxidation

• Functions: lipid-soluble antioxidant, membrane protection, blood thinner

Vitamin E: drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: Antagonizes Vitamin K; warfarin interaction (anti-clotting)

• Deficiency is rare: hemolytic anemia in preterm infants; neuropathy (nerve damage)

• Toxic symptoms: bleeding risk at high doses bc blood thinner

• Clinical application: not routinely for CVD prevention; do not take with anticoagulant b/c it increases blood thinning; malabsorption disorders

• Prophylaxis: ensure intake in fat malabsorption

Vitamin K: toxicity, RDA/AI, UL, best sources, facts, functions

• Least toxic fat-soluble vitamin

• AI: Men - 120 mcg, women 90 mcg

• Food sources: leafy greens, broccoli, soybean oil, bacteria in colon

• Fact: Newborns are born deficient ( vitamin K doesn’t cross placenta and made by bacteria in gut, but baby is born sterile)

• Essential in diet

• Functions: coenzyme for blood clotting - makes prothrombin; bone metabolism - makes osteocalcin

Vitamin K: drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: Warfarin antagonist (blood clotting vs blood thinner), antibiotics decrease gut production

• Deficiency symptoms: bleeding; prolonged PT/INR; hemorrhagic disease of new born

• Toxic symptoms are rare: synthetic forms risk hemolysis

• Clinical applications: warfarin (blood thinning) management; new born intramuscular injection

• Prophylaxis: routine newborn IM prophylaxis, consistent of intake on warfarin

Thiamin (B1): RDA/AI, UL, best sources, facts, functions

• Water-soluble

• RDA: 1.1-1.2 mg

• No UL

• Sources: pork, legumes, whole grains

• Fact: give before glucose in alcohol use disorder

• Functions: CHO metabolism (TPP), nerve function

Thiamin drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: Alcohol decreases absorption; diuretics (meds that help body eliminate excess sodium and water through increased urination) increase loss of thiamin

• Deficiency symptoms: Beriberi is thiamine deficiency (wet is retention of fluid, dry is nervous system defects); Wernicke encephalopathy (severe change in mental status); alcohols and substance abusers are deficient usually

• Toxicity symptoms: none

• Clinical applications: Alcohol use disorder, refeeding

• Prophylaxis: empiric in malnutrition/alcohol use disorder, avoid refeeding syndrome

Riboflavin (B2): RDA/AI, UL, best sources, facts, functions

• RDA: 1.1-1.3 mg

• UL: none

• Sources: milk, eggs, whole enriched grains

• Fact: vulnerable to destruction by light

• Functions: FAD/FMN coenzyme for energy metabolism

Riboflavin drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: Phototherapy (radiation) degradation

• Deficiency symptoms: cheilosis (mouth cracking); glossitis (red tongue): dermatitis (skin rash)

• Toxicity symptoms: none known

• Clinical applications: migraine prevention

• Prophylaxis: adequate intake during prevention

Niacin (B3) RDA/AI, UL, best sources, facts, functions

• B6 and Riboflavin make Niacin from tryptophan

• RDA: 14-16 mg

• UL: 35 mg

• Sources: poultry, beef, peanuts, seeds, legumes

• Fact: Pellagra deficiency) = 4 Ds - dermatitis, diarrhea, dementia, death

• Function:NAD/NADP; DNA repair; energy metabolism

Niacin drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interaction: With statins it enhances myopathy risk (weak muscles)

• Deficiency symptoms: pellagra = 4 Ds - dermatitis, diarrhea, dementia, death

• Toxicity symptoms: flushing (vasodilator); hepatoxicity (liver)

• Clinical applications: Rx dyslipidemia

• Prophylaxis: balanced diet

B6 - RDA/AI, UL, best sources, facts, functions

• RDA: 1.3-1.7 mg

• UL: 100 mg

• Sources: Poultry, bananas, potatoes

• Fact: INH (Isoniazid) depletes B6, PMS, morning sickness

• Functions: Amino acid metabolism, neurotransmitter synthesis; heme (blood compound)

B6 drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: INH (Isoniazid) decreased B6 levels

• Deficiency symptoms: neuropathy, microcytic anemia

• Toxicity symptoms: neuropathy (high dose)

• Clinical application: Prevent INH neuropathy w/ B6

• Prophylaxis: supplement with INH (B6 helps prevent INH toxicity bc INH decreases B6)

Folate - Synthetic form, RDA/AI, UL, best sources, facts, functions

• Synthetic form is folic acid which absorbs better

• RDA: 400 mcg

• UL: 1,000 mcg

• Sources: leafy greens, legumes, orange fruit, enriched grains

• Facts: prevents neural tube defects like spina bifida (needed during early pregnancy)

• Functions: DNA synthesis; RBC formation

Folate drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: methotrexate (chemotherapy) antagonism - give folate, masks B12

• Deficiency symptoms: megaloblastic anemia; neural tube defect risk

• Toxicity symptoms: masks B12 deficiency, GI issues

• Clinical applications: give higher dose during pregnancy, macrocytic anemia

• Prophylaxis: 400 mcg all who can conceive

B12 - RDA/AI, UL, best sources, facts, functions

• Synthetic absorbed better

• RDA: 2.4 mcg

• UL: none

• Sources: animal products only fortified foods, HCl needed to separate from animal product

• Facts: deficiency can cause neurological damage even if the person does not have anemia

• Functions: myelin, DNA synthesis

B12 drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: metformin; PPIs decrease absorption

• Deficiency symptoms: megagloblastic (macrocytic) anemia; neuropathy

• Toxicity: rare

• Clinical applications: pernicious anemia causes B12 deficiency, bariatric

• Prophylaxis: supplement vegans, monitor elderly bc less HCl

Vitamin C: RDA/AI, UL, best sources, facts, functions

• RDA: 75-90 mg (+35mg for smokers)

• UL: 2,000 mg (do megadose if pregnanct)

• Best sources: citrus, berries, peppers

• Facts: Enhances iron absorption - non-heme=plans, heme=animals

• Functions: collagen; antioxidant; wound healing

Vitamin C drug/nutrient interactions, deficiency symptoms, toxicity symptoms, clinical applications, prophylaxis

• Drug/nutrient interactions: increases iron absorption

• Deficiency symptoms: Scurvy, pinpoint hemorrhages, bruising, bleeding gums

• Toxicity symptoms: GI upset, kidney stones with too much Vit C

• Clinical applications: Wound healing, iron deficiency adjunct

• Prophylaxis: Ensure intake in smokers

Which vitamins are antioxidants?

Vitamin E, Vitamin C, Vitamin A-betacarotene

True or false? Folate and b12 are better absorption in synthetic form

True

Which vitamin is vulnerable to destruction by light

Riboflavin

True or false? Not all B vitamins are coenzymes

False - the 8 B complexes are coenzymes

Which vitamins are often megadosed and for what?

Vitamins that are megadose 10X RDA - niacin to lower cholesterol and vitamin C to help with pressure wound healing 

Major minerals

More than 5g in body

Sodium, potassium, calcium, phosphorous, magnesium

Trace minerals

Less than 5g in body

Iron, zinc, iodine, selenium, fluoride, chromium

Sodium - RDA/AI, daily needs, sources UL, facts

• Bad

• Preservative that inhibits pathogen growth, and flavor enhancer

• All salt the same

• Daily needs: < 200 mg

• AI: < ¾ teaspoons = 1500 mg

• College athletes who sweats a lot needs more

• Monitor/limit diabetics, hypertensive, cardiovascular disease, kidney issue patients

• UL: 2300g/day = 1 teaspoon

  • Processed foods; canned meats, vegetables, soups; convenience foods and restaurant fast foods

Sodium - functions, deficiency/toxicity signs and symptoms

• Functions: fluid and electrolyte balance, acid-base balance, regulates cell membrane permeability, nerve impulse transmissions, maintains muscle irritability

• Deficiency: rare except with chronic diarrhea or vomiting and certain renal disorders; nausea; dizziness; muscle cramps; apathy

• Toxicity: hypertension, edema

Potassium - RDA/AI, daily needs, sources UL, facts

• Good

• Natural diuretic (help kidneys remove excess sodium and water from the body)

• More potassium, excrete more sodium

• Potassium chloride = salt substitute good for cardiac patients

• Renal patients have a hard time getting rid of potassium, sodium, phosphorous

• AI: Men - 3400 mg, women - 2600 mg

• No UL

• Sources: baked potato, leafy greens, yogurt

Potassium - functions, deficiency/toxicity signs and symptoms

• Functions: cation of intracellular fluid, maintains fluid balance, acid-base balance, transmits nerve impulses, muscle contractility, diurectic, controls blood pressure

• Deficiency: muscular weakness, paralysis, anorexia, confusioln

• Toxicity (from supplements/drugs): muscular weakness, vomiting, heart erthymia bc potassium controls rhythm of heart

Calcium - RDA/AI, daily needs UL, sources, facts

• RDA: Men - 1000 mg, over 70 is 1200 mg; Women - 1000 mg, over 51 is 1200 mg

• Adult UL: 2500 mg, over 50 is 2000 mg

• Sources: dairy (cheese, yogurt milk), fortified in plant based foods

Calcium - functions, deficiency/toxicity signs and symptoms

• Functions: bone and teeth formation, blood clotting, nerve transmission, muscle contraction, blood pressure

• Vitamin D acts as hormone for calcium homeostasis

• Antacid that used in excess can constipate and cause kidney stones

• Deficiency: children have impaired growth, adults get osteoporosis

• Toxicity: constipation, increased risk of renal stones formation, impaired absorption of iron and minerals

Phosphorous - RDA/AI, daily needs UL, sources, facts

• RDA: 700 mg

• UL: 70 y=4g/day, >70 y=3 g/day

• Sources: all animal products, eggs, cereal, whole grains

• Soda has phosphoric acid as preservative

• Renal patients are restricted from phosphorous, potassium sodium

Phosphorous - functions, deficiency/toxicity signs and symptoms

• Functions: bone and teeth formation, acid-base balance, energy metabolism, cell membrane structure, regulation of hormone and coenzyme activity

• Deficiency: unknown

• Toxicity: low blood calcium

Magnesium - RDA/AI, daily needs UL, sources, facts

• RDA: Men=400 mg, over 30=320 mg, Women=310mg, over 30=320 mg

• UL: 350 mg/day from supplements only

• Sources: spinach, beet greens, okra, almonds, fatty fish

• Magnesium sulfate is orally and relaxes muscles, magnesium glycinate for nervous system

Magnesium - functions, deficiency/toxicity signs and symptoms

• Functions: bone formation, muscle and nerve function, protein synthesis, blood glucose control, blood pressure regulation, RNA and DNA

• Deficiency: weakness, confusion, growth failure in children

• Sever deficiency: convulsion, hallucinations, tetany

• Toxicity: none from food; supplements can cause diarrhea, nausea, cramping

Iron - RDA/AI, daily needs UL, sources, facts

• Most toxic essential mineral

• RDA: Men=8mg, women=18mg, over 50=8mg

• UL: 45 mg

• Sources: M/F/P, not dairy, cooked leafy greens

• Non-heme iron=plants, nuts, grains, eggs — not as good for absorption

• Macrocytic anemia — B12 or folate deficient

• PICA - abnormal cravings of non-food

Iron - functions, deficiency/toxicity signs and symptoms

• Fucntions: oxygen transport via hemoglobin and myoglobin

• Deficiency: impaired immune function, decreased work capacity, apathy, lethargy, fatigue, itchy skin, pale nail beds and eye membrane, impaired wound healing, intolerance to cold

• Toxicity from supplements: increased risk of infection, apathy, fatigue, lethargy, joint disease, hair loss, organ damage, enlarged liver, impotence

• Accidental poisoning in kids causes death

Zinc - RDA/AI, daily needs UL, sources, facts

• RDA: Men=11mg, Women=8mg

• UL= 40 mg

• Sources: oysters, red meat, poultry, dried beans and beans, cereals, yogurt, cashews, milk

• Aphrodesiac = sec hormones and sec drive

Zinc - functions, deficiency/toxicity signs and symptoms

• Functions: catalytic activity of 100 enzymes, immune function, protein synthesis, wound healing, DNA synthesis, cell divison, normal growth and development, sense of taste and smell

• Deficiency: dwarfism, hair loss, diarrhea, delayed sexual maturation and impotence, eye and skin lesions

• Toxicity: anemia, elevated low-density lipoprotein, diarrhea, vomiting, impaired calcium absorption, fever, renal failure, muscle pain, dizziness, reproductive failure

Iodine - RDA/AI, daily needs UL, sources, facts

• RDA: 150 mg

• ULL 1100 mg

• Sources: iodized salt, seafood, bread, dairy

Iodine - functions, deficiency/toxicity signs and symptoms

• Functions: produces thyroid hormones that regulate growth, development, and metabolic rate

• Deficiency: hypothyroidism leads to goiter and cretinism (in utero)

• Toxicity: enlarged thyroid gland, decreased thyroid activity

Selenium - RDA/AI, daily needs UL, sources, facts

• Only mineral that acts as antioxidant

• RDA: 55 mcg

• UL: 400 mcg/day

• Sources: brazil nuts, seafood, organ and muscle meats, poultry, cereals, dairy, eggs

Selenium - functions, deficiency/toxicity signs and symptoms

• Functions: antioxidant, thyroid hormone

• Deficiency: enlarged heart, poor heart function, impaired thyroid activitry

• Toxicity is rare: nausea, vomiting, abdominal pain, diarrhea, hair and nail changes, nerve damage, fatigue

Fluoride - RDA/AI, daily needs UL, sources, facts

• AI: Men=4mg, Women=3mg

• UL: 10 mg

• Sources: fluoridated water, tea, seafood

Fluoride - functions, deficiency/toxicity signs and symptoms

• Functions: formation and maintenace of tooth enamel, resistance to dental decay, bone formation

• Deficiency/toxicity: fluorosis, dental decay, nausea, chest pain, diarrhea

Chromium - RDA/AI, daily needs UL, sources, facts

• AI: Men=35mcg, over 50=30mcg; Women=25 mcg, over 50=20 mcg

• UL: none

• Sources: widely distributed by plants and meat

Chromium - functions, deficiency/toxicity signs and symptoms

• Functions: activates insulin (good for T2 diabetics)

• Deficiency: rare, insulin resistance, impaired glucose tolerance

• Toxicity: unknown

Functions of water

• Shape and structure

• Regulates body temperature

• Aids in digestion and absorption of nutrients

• Transports nutrients and oxygen to cells

• Serves as solvent for vitamins, minerals, amino acids,glucose

• Participates in metabolic reactions

• Eliminates waste products

• Major component of mucus and lubricating fluids for joints and upper respiratory

Is and Os for Renal Patients

• Less than 500 mL of urine — renal failure

• Metabolic water — water produced as a byproduct of micro/macronutrient metabolism

• Sensible water loss — measurable water loss (water output, urine, feces)

• Insensible water loss — immeasurable water loss (respiration, skin)

True or false? In intake and output of water should not be equal

False - they should be equal

Total Water Intake Daily

Percent from fluids - 80%

Percent from solids - 20%

Sources

Water, watery veggies like lettuce — the more fat, the less water in the food

AI of Water

• Men = 3.7 L/day — 3L/day from fluids

• Women = 2.7 L/day — 2.2L/day from fluids

• 240 mL=1 cup

Clinical causes of fluid loss

• Diarrhea

• Burn victim

• Vomiting

• Sepsis

• Fever

• Hemorrhaging

• DKA -Diabetic uncontrollable drainage loss — polyurea (constant urinating)

Effects of inadequate fluid intake

• Dehydration — impaired mental functions, motor functions, increased body temp, increased resting heart rate, increased risk of heat stroke

• 1%-2% water loss of body weight — thirst, fatigue, weakness

• 7-10% water loss of body weight — dizziness, muscle spasms, balance loss, fatigue

• 20% water loss of body weight — death

Excessive fluid intake

• Hypoatremia

  • rare in healthy people

  • Low sodium in the blood/serum (normal Na is 135-145 mEq/L)

  • Symptoms are mental change, fatigue, weakness

  • At risk: acute patients, organ failure patients (COPI), Contractile vomiting/diarrhea, athletes

• High sodium = not enough water = hyperatremia

• Low sodium = too much water = hypoatremia

Characters of minerals

• Inorganic (no carbon)

• % of body weight

• Digestion is as is, in simplest form

• Chemical identity is unchangeable

• Not destructible (vitamins are)

• Foods soaked in water

Functions of minerals

• Provide structure (ex: calcium, phosphorous, magnesium help with bone/teeth)

• Fluid balance (sodium, potassium, chloride)

• Acid-base balance (sodium phosphorous)

• Nerve cell transmission and muscle contraction (sodium potassium, calcium)

• Vitamin, enzyme, and hormone activity (iodine is thyroid hormone, chromium activates insulin)

• Muscle relaxation (sodium, potassium, magnesium)

Mineral homeostasis - how does the body maintain mineral balance?

• Releasing minerals from storage for redistribution

• Altering GI absorption rate (increasing)

• Altering urinary excretion rate (decreasing)

When can certain minerals be toxic?

In supplement form, environment, commercial food processing errors, disease/chronic conditions

A healthy kdney can easily excrete which minerals

potassium, sodium, phosphorous

An unhealthy kidney cannot excrete and what do you do

potassium, sodium, phosphorous — put patient on restriction

What restritcion would also be put on end-stage kidney failure patient

fluid restriction

The inability to get rid of iron

Hemechromatosis

Mineral interactions

• Caffeine increases excretion of calcium

• Vitamin D and lactose increases calcium absorption

• Protein increases calcium excretion

• Sodium stops calcium absorption

• Potassium increases and sodium decreases

• Phylates/oxalates decrease calcium absorption

• Zinc and iron cancel absorption

True or false? All minerals consumed in excess of need are excreted in the urine

False - not all

True or false? Sodium is the most plentiful mineral in the body

False - calcium is

True or false? An increase in sodium intake is associated with an increase in blood pressure

True

True or false? Calcium supplements are a safe and effective way to ensure an adequate calcium intake

False - natural is better

True or false? Foods high in sodium tend to be low in potassium and foods high in potassium tend to be low in sodium

True

True or false? Major minerals are more important for health than trace minerals

FalseTrue or false?

True or false? For most people, thirst is a reliable indicator of fluid needs

True, especially in eldersTrue or false?

True or false? A chronically low intake of calcium leads to hypocalcemia

False - osteoporosis

What is megadosed fro PMS and morning sickness

Niacin and B6P

What are phytochemicals?

Phytochemicals are compounds found in plants that are antioxidants, anti-inflammatory agents, and protective compounds against chronic diseases like cancer and heart disease

What are oxalates?

A type of phytochemical found naturally in plants. They are considered an antinutrient because they can:

• Bind to minerals like calcium, iron, and magnesium → reducing their absorption

• Contribute to kidney stones (calcium oxalate stones) in susceptible people

Need to be cooked

True or false? Alcohol use disorder all B vitamins

True

What is lycopene?

• Lycopene is a bright red carotenoid phytochemical and antioxidant found primarily in tomatoes and other red/pink fruits

• it can reduce risk of prostate cancer, cardiac disease

What are Allyl sulfides?

• Allyl Sulfides are a type of phytochemical found in the allium family of vegetables

• Important in killing pathogens in the blood and anti-inflammatory