PRX 350 Vitamins and Nutrients

what are the categories of nutrients?

vitamins, macro minerals, and trace elements

RDA

recommended dietary allowance

• the average daily amount of intake to meet nutrient requirements of most healthy individuals

%DV

percent daily value

• the percent of RDA a particular nutrient makes up—> always listed on drug label of OTC supplements

UL

tolerable upper intake level

• maximum amount patients could take and no experience any adverse effects

• water soluble vitamins do not have ULs

what are the water-soluble vitamins?

B1, B2, B3, B6, B9, B12, C, H

what does it mean for a vitamin to be water soluble?

the vitamin can be easily secreted from the body if excess levels are ingested 

• taking excess amounts of water soluble vitamins will not result in any harm but do not have any added benefits if taken in large amounts 

vitamin B1

thiamine

• benefit: energy metabolism in the intestine

• patients: those with chronic alcoholism

what foods are high in vitamin B1?

• whole grains

• meat

• fish

• fortified breads

• cereals

• infant formulas

vitamin B2 

riboflavin 

• benefit: helps metabolism of fats, drugs, and steroids 

• patients: preventing migrant headaches 

• deficiency: Riboflavin 

  • symptoms: lesions at corners of mouth, swollen, cracked lips, hair loss

  • high risk groups for riboflavin deficiency: vegetarian/vegans

• toxicity: change in urine (yellow/green, fluorescent)—> harmless side effect

what foods are high in vitamin B2?

• eggs

• lean meats

• milk

• fortified grains and cereals

vitamin B3

niacin

• benefit: dyslipidemia (high cholesterol)

• patients: until 2018, was the recommended treatment for treatment of high cholesterol 

• deficiency: Niacin

  • appearance: pigmented rash or discoloration of skin, bright red tongue

  • symptoms: mostly neurological —> headache, fatigue, memory loss, hallucinations

• toxicity (side effects) —> flushing of the skin, with warm/burning/tingling sensation

  • if taken over a long period of time, it will have negative effects of the liver

what foods are high in vitamin B3?

• animal based foods (poultry, beef, fish)

• nuts, legumes 

vitamin B6

pyridoxine

• benefit: nausea/vomiting in pregnancy, peripheral neuropathy

• patients: pregnant individuals experiencing morning sickness + patients taking isoniazid, a medication for tuberculosis)—> supplementation helps prevent peripheral neuropathy

• deficiency: uncommon

  • signs: presents with a group of other vitamin deficiencies in cases of malnourishment

• toxicity: N/A

what foods are high in vitamin B6?

• fish

• starchy vegetables (potatoes)

• non-citrus fruits

vitamin B9

folic acid (folate)

• benefit: essential for the synthesis of DNA & RNA, and metabolism of nucleic acids 

• patients: pregnant patients—> need increased folic acid supplementation for fetal development 

• deficiency: folate deficiency

  • symptoms: weakness, fatigue, headache, heart palpitations, SOB

  • signs: ulcerations on tongue/mouth, fingernail pigmentation

  • fetal deficiency—> neural tube defects (NTD)—> congenital malformations

what foods are high in vitamin B9?

• dark green vegetables (spinach, asparagus, brussels sprouts

• nuts

• beans

• peas

vitamin B12

cyanocobalamin

• benefit: red blood cell formation

• patients: serum vitamin B12 levels are significantly low

• supplement form: intramuscular injection (prescription product)

• deficiency: Megaloblastic anemia—> caused by malabsorption of B12 (such as after GI surgery), or inadequate intake (vegetarian diet)

  • can also occur due to chronic use of METFORMIN

  • symptoms: pale skin, numbness/tingling, fatigue

• toxicity: N/A

what foods are high in vitamin B12?

• foods of animal origin (fish, meat, poultry, eggs, dairy)

• fortified cereals

• nutritional yeast

vitamin C

absorb acid

• benefit: antioxidant

• patients: given to those with macular degeneration (eye condition) to slow the progression in combination with other drug agents

• deficiency: scurvy

  • symptoms: fatigue, malaise(discomfort), gum inflammation, loss of teeth 

toxicity: N/A

what foods are high in vitamin C?

• citrus fruits

• tomatoes

• bell peppers

• other fresh fruits

vitamin H

biotin

• benefit: metabolism of fatty acids, glucose, amino acids

• patients: those who want to promote hair, skin and nail growth

• deficiency: very rare (hardly reported in healthy individuals)

what foods are high in vitamin H?

• eggs

• fish

• meat

• seeds

• nuts

• sweet potatoes

what are the fat-soluble (lipophilic) vitamins?

D, E, A, K (DEAK)

what does it mean for a vitamin to be fat-soluble?

the vitamin is absorbed into the lymphatic system and stored

• can reach toxic levels if over-supplementation occurs

vitamin A + provitamin A

retinol (vitamin A) & carotenoids (provitamin A)

• benefit: vision, vitamin A is an essential component of protein in retina, rhodopsin

• patients: used to slow the progress of macular degeneration (eye disease) in combination with other drug agents

• deficiency: night blindness—> permanent blindness (carotenoids)

  • risk groups: premature infants, individuals with cystic fibrosis

• toxicity: hypervitaminosis A

  • symptoms: headache, blurred vision, myalgia, coordination impairment

  • can cause congenital birth defects when high doses are taken in pregnant patients

what foods are high in vitamin A?

• fish

• eggs

• dairy product (retinol)

• leafy green vegetables, yellow/orange vegetables, tomatoes (carotenoids)—> why we are told to eat carrots!!

vitamin D2 + vitamin D3

ergocalciferol (vitamin D2) & vitamin D3 (cholecalciferol)

• benefits: bone health and anti-inflammatory effect

• patients: promotes calcium absorption to enable bone mineralization & those with inadequate sun exposure

• deficiency: rickets and osteomalacia

  • rickets: occurs in children —> skeletal deformities and soft bones

  • osteomalacia: occurs in adults and adolescents —> weak bones, pain, and dental abnormalities

• toxicity- occurs with over-supplementation, not with too much sun exposure

  • hypercalcemia (increased calcium levels), renal failure, cardiac arrthymias

why its important to step outside when it is sunny!

what foods are high in vitamin D2 and vitamin D3?

• fatty fish (trout, salmon, tuna)

• mushrooms

• not a food—> absorbed through UV sunlight 

vitamin E

alpha-tocopherol

• benefit: antioxidant that stops product of free radicals

  • may help prevent or delay coronary heart disease and cancer

• patients: used to slow the progression of macular degeneration (eye disease) in combination with other drug agents

• deficiency:

  • symptoms: peripheral neuropathy, myopathy, retinopathy

  • high risk groups: individuals with Crohn’s disease, cystic fibrosis, and chronic diarrhea

• toxicity: oversupplementation—> increased bleeding risk

what foods are high in vitamin E?

• nuts

• seeds

• oil- sunflower, soybean and canola oil

vitamin K

phylloquinone

• benefit: essential for hemostatic—> a coenzyme for synthesis of blood clotting proteins

• patients: used to reverse bleeding risk in patients taking warfarin

• deficiency: in severe cases—> cause bleeding and hemorrhage

• toxicity: hypercoagulation (theoretically)

what foods are high in vitamin K?

• green leafy vegetables (spinach, broccoli, lettuce)

• vegetable oils

what are the six macrominerals?

• sodium

• calcium

• potassium

• chloride

• phosphorous

• magnesium

why is sodium important?

this electrolyte is essential for fluid balance (i.e. serum osmolality)

• important for nerve transmission and muscle contraction

what is the RDA of sodium in adults?

2.3 g per day

• consuming too much —> increased blood pressure and fluid retention

what populations should watch their sodium intake?

patients who have:

• hypertension

• heart failure

• chronic kidney disease (CKD)

what are common uses of potassium supplementation?

decreasing blood pressure, muscle aches, and bone health 

what medications affect potassium levels?

• ACE inhibitors & antihypertensive drugs (increase K⁺ levels)

• potassium-sparing diuretics (increase K⁺ levels)

• loop & thiazide diuretics (decrease K⁺ levels)

what groups are at risk for a calcium deficiency?

• postmenopausal women

• lactose intolerance/avoidance

• vegetarians/vegans 

true or false: calcium carbonate requires an acidic stomach environment for full absorption.

true

true or false: calcium citrate is the preferred agent if the patient is taking acid-reducing medications (H2RAs or PPIs)

true

what are trace elements?

essential for the normal metabolism or biologic function for humans in small amounts

• if you ingest or produce too much—> toxicity

what are the 8 trace elements?

• iron

• iodine

• zinc

• chromium

• copper

• manganese

• selenium

• fluoride

true or false: iron is NOT the most abundant element in the body

false

what is the importance of iron?

oxygen transport throughout bloodstream and cellular energy

• inadequate amount of iron —> iron-deficiency anemia

  • symptoms: fatigue, pale skin, cold extremities, brittle nails

important counseling points with consideration to iron

• taking vitamin C increases absorption of iron

• best taken on an empty stomach, but may cause stomach upset

  • taking with food will decrease this side effect

• may also cause constipation or darkened stool

what are common uses of zinc?

• immune health

• common cold (rhinovirus)

• age-related macular degeneration (in combination with beta-carotene, vitamin C & vitamin E)

what are some adverse effects of zinc supplementation?

• over-supplementation —> copper deficiency

• nasal formulations can cause anosmia, the partial or complete loss of smell