N065 Exam 2

Name the fat soluble vitamins

A, D, E, K

Name the water soluble vitamins

8 B vitamins, Vitamin C

Which vitamin is not essential under optimal conditions of sun exposure

Vitamin D

which vitamin assists in the absorption of non-heme iron

vitamin C

which vitamin is used as a therapeutic for lowering serum cholesterol

Niacin

which disease presents itself with edema, muscle wasting, or both

beri beri (thiamin deficiency)

which disease presents itself with dermatitis, diarrhea, dementia, and possible death>

Pellagra (niacin deficiency)

which vitamin can be made from tryptophan with the help of riboflavin and B6

Niacin

which vitamin plays a role in blood clotting

Vitamin K

which vitamin can be used therapeutically to heal wounds

Vitamin C

which vitamin is important for reducing the risk of neural tube defects

Folate

which vitamins have a codependent relationship and need to activate each other

B12 and folate

which vitamin deficiency can increase the risk for hemolytic anemia in the preterm baby

vitamin E

which vitamin supplement can have an interaction with an anti-seizure medication

Biotin

which vitamin supplement can have an interaction with TB drug, Isoniazid

B6

which vitamin supplement has proven to help with PMS syndrome and morning sickness

B6

which vitamins can be made by bacteria in the colon

vitamin K, biotin

which vitamins are considered the most toxic in supplement form

Vitamin A, Vitamin D

which vitamin is sensitive to destruction by light

riboflavin

which vitamin deficiency can lead to macrocytic anemia?

B12, folate

what is the term for swollen, inflamed shiny red toungue

glossitis (seen in riboflavin deficiency)

which term refers to inflamed corners of the mouth with cracking and flaking

cheilosis (seen in riboflavin deficiency)

which vitamin gives a banana bag its color

thiamin

which vitamins play a key role in the integrity of the nervous system

B complex

which vitamins are widespread in both plant and animal products?

pantothenic acid, biotin

which vitamin plays an important role in collagen synthesis

vitamin c

vitamins

Essential micronutrients that do not yield energy, but that are required for growth and proper functioning of the body.

Individual molecules not chains

get in micrograms or milligrams

characteristics of vitamins

natural or synthetic

organic so easily destructible

act as coenzymes

act as antioxidants

found in food as food additives

act as drugs in megadoses

Fat soluble vitamins

A,D,E,K

found in high-fat containing foods

absorbed like fats (repackaged into kilomicrons and transported in lymphatic system and only get to blood with help of lippoproteins)

stored in liver, so considered potentially toxic

water soluble vitamins

B complex and vitamin C

found in watery portion of foods

absorbed like carbs and proteins (lining of small intestine and straight to blood)

Not stored (exception: b12 in liver)

toxicity typically only occurs with supplementation

Need to be consumed on daily basis

phytochemicals

from plants

act as antioxidants by fighting free radicals that cause disease and protect immune system

found in plant sources so need fruits and veggies (1.5-2.5 servings of fruit and 2-4 servings of veggies)

lycopene

red fruits and vegetables

reduce risk of heart disease and prostate cancer

allylsulfides

garlic and onions

kills germs in blood

polyphenols

red grapes, wine, strawberry, green tea

antioxidant fighting chronic disease, CVD, cancer

fruit vitamin sources

vit c

veggies vitamins

Vit a (beta-carotene), vit c, vit K, vit e, vit B6, folate, thiamin, niacin

grain vitamins

folate, thiamin, riboflavin, niacin, B6, A

protein vitamins

niacin, riboflavin, b6, b12, D, E

dairy vitamins

A, D, riboflavin, B12

tips for fruit and veggie intake

eat 5 a day

eat a rainbow

start a meal with a salad

always have veggies ready

non-starchy veggies good for weight management

have them visible

vitamin supplements

better to get from food than supplement

good for dieters, vegans, picky eaters, age, alcoholics, food insecure, chronic illness, chronic use of medication

safety and efficacy of supplements

FDA regulation: not enough funding to oversee supplements

more expensive doesn't mean better

USP label: meets standards for strength and purity, not necessesarily ensuring safety or benefits to health

they have fact label: serving size, ingredients, amount of nutrient, % daily value, potency, freshness date

highest risk for toxicity with single-vitamin supplements

fortified

absent originally, but put back in to prevent deficiency

ex- orange juice and bread fortified with calcium; cereal usually fortified

enriched

present originally, lost during processing, put back in

ex- thiamin, niacin, riboflavin, iron, folate put back in flour, rice, bread

Thiamin (B1)

Sources-Whole grain and enriched grain

Function-Coenzyme in energy metabolism; nerve system transmission

Deficiency Symptoms- Beri Beri-edema, muscle wasting, fatigue, confusion, apathy; Alcoholism-high risk

easily destructed by heat

wet beri beri

edema

dry beri beri

muscle wasting, marasmus

korsokoff-wernicke's syndrome

neurological defects resulting from thiamin deficiency

riboflavin (B2)

Sources-Milk, Dairy

Function-Coenzyme ; helps make niacin from tryptophan

Deficiency Symptoms-glossitis(tongue) & cheilosis (corners of mouth)Alcoholism; dermatitis;

susceptible to destruction by light

Niacin (B3)

Sources-Protein rich foods-animal proteins; whole grains and enriched grains

made by tryptophan with help of riboflavin and B6

Functions-Coenzyme; Nerve system function;Medicinally-Lower cholesterol

Deficiency-Pellagra- (dermatitis, diarrhea, dementia and confusion, death); Alcoholism-high risk

Toxicity- When megadosed as a drug for lowering cholesterol; niacin flush; can cause liver damage

B6 (pyroxidine)

Sources-legumes, M/F/P, nuts and seeds, whole grains and enriched

helps make niacin from tryptophan

-drug/nutrient interaction: Isoniazid (TB med) interferes with its absorption

-therapeutic use: PMS symptoms, morning sickness when combined with histamine

pantothenic acid

widespread in foods

meat, poultry, fish, whole-grain cereal, dried peas and beans are best sourcesPart of coenzyme A used in energy metabolismdeficiency: rare, general failure of all body systemstoxicity: no symptoms except large dose may cause diarrhea

Biotin

Sources-Produced by bacteria in colon but still essential; widespread in foods

- no hard core research on if it helps with hair and nail growth

non-toxic

can interfere with anti-seizure meds

used as lab assay in thyroid condition screening

Folate

Sources-green leafy vegetables, legumes, avocado, nuts and seeds, oranges, fortified grains;

Synthetic name =folic acid

Functions-coenzyme in DNA synthesis; vital for new cell synthesis; integral for GI function; reduces risk of neural tube defects; activates b12

Deficiency Symptoms-Macrocytic Anemia; mental status change; depression, alcoholism-high risk;

MTFHR gene can supress folatate

Synthetic folate vs natural folate

synthetic folate (folic acid) is more easily absorbed by body

History of mandation of fortified grains with folic acid to reduce risk of neural tube defects

Deficiency can lead to spina bifida, anencephaly (no brain), encephalocele (lack of closure of neural tube at brain level)

Folic acid fortification began to be mandated which lessened incidence of neural tube defect

B12

Sources-found in all animal products; no plant sources unless fortified with it

synthetic versions have better bioavailability

Functions-DNA synthesis; RBC maturation; myelin sheath integrity; activates Folate

Toxicity-liver can store some b12- no toxicity reports

Deficiency; same as folate deficiency; macrocytic anemia; supplementation of pill form or fortified foods

B12 supplementation

atrophic gastritis due to decreased production (HCL) and intrinsic factor decrease so absorption decreases

take 5-10 years to develop a deficiency of b12 in most cases

vitamin C

Ascorbic acid

Sources-fruits and veggies; citrus, cantaloupe, kiwi, berries, red and green peppers

Functions-collagen synthesis, antioxidant, promotes non-heme iron absorption; immune system function, thyroxine (thyroid hormone) synthesis

Deficiency- Scurvy-pin point hemorrhaging, softening of bones, bleeding gums, anemia, prone to infection; skin changes.

Can shorten life-span and severity of a cold but not prevent it

Who needs more vitamin C?

smokers (35mg more), birth control users

Vitamin A

Sources-preformed (Animal-whole milk, fish, liver; fortified in low fat milk) vs provitamin (plant-Beta Carotene-yellow and orange colored produce); fortified cereals

Functions-vision, skin maintenance, reproduction, growth of bone and teeth; immune function; antioxidant in form of beta carotene from food is better than from supplement for antioxidant

Deficiency-storage in liver can be up to a year; deficiency rare in our country but world-wide health problem especially in developing countries; deficiency can lead to blindness; needed for rhodopsin production; Xeropthalmia-dryness of the eye can lead to night blindness.

Toxicity-non toxic form is beta carotene; toxic form would be pre-formed animal sources of supplementation; can be teratogenic and also cause liver damage and hair loss. CNS damage and bone and skin changes; carotonemia

Vitamin D

sources: Sunlight, Liver, fatty fish, eggs, cod liver oil, fortified yogurt and fortified milk, fortified foods

Functions-increase absorption of calcium in GI tract and reabsorption from kidneys; maintains serum calcium levels. May be protective against certain cancers, diabetes, depressions, MS, HTN, metabolic syndrome

Deficiency-rickets-in children- osteomalacia in adults; decayed teeth malformed; 90% of adults in our country need vitamin d supplementation; Need 3 servings of fortified dairy to get 100% RDA (8 oz milk, 6 oz yogurt, 1 oz cheese)

Toxicity- no toxicity form sun; toxicity from over supplementation; increase risk for kidney stones, kidney damage, bone weakness, loss of appetite, headache

Calcium and vitamin D

Vitamin D facilitates calcium absorption from small intestine, calcium reabsorption from kidneys, rebuilding of bone tissue

how is vitamin D activated in body?

during cholesterol synthesis, 7-dehydrocholesterol is formed as intermediate and when exposed to light, converted to cholecalciferol (Vit D3) in skin

People with darker skin need more time in sun to get same amount of production

Vitamin E

Sources-oil, wheat germ, nuts seeds, vegetable oils

Functions-antioxidant-protects vitamin A and PUFA in body; protects LDL from oxidation; immune support; cell membrane integrity; RBC formation

Deficiency-preterm infants high risk for RBC hemolysis

Vitamin K

Sources-leafy green vegetables

Functions-activates prothrombin and osteocalcin (blood clotting, bone formation)

Newborns: shot given directly after birth

Drug/nutrient interaction: works against blood thinners

Produced by bacteria in colon

Water percentages in body

Body: 72%

Lungs: 90%

Blood: 82%

Skin: 80%

Muscle: 75%

Brain: 70%

Bones: 22%

Water functions

shape and structure

Regulates body temp

Aids in digestion and absorption of nutrients

Transport nutrients and oxygen to cells

Solvent for vitamins, minerals, amino acids, and glucose

Participates in metabolic reactions

Major component of mucus and lubricating fluids

water balance

Intake should equal output

Water comes from liquids, food, and metabolic water

Output in urine, respiration, feces, and skin

Minimum urinary output is 500cc

Average intake is 2.5L

80% comes from liquids while 20% from food

metabolic water

water produced in metabolic reactions

insensible water output

can't be measured (respiratory and skin)

sensible water output

can be measured (feces and urine)

water recommendations

AI for men is 3.7L and for women is 2.7L

Formula for estimating fluid needs

--1mL of water/kcal

--30cc/kg/day

In general, paler urine correlates to more hydrated

Clinical causes of fluid loss

Diabetes, fever, fistula, renal disorder, diarrhea, vomitting, thermal injury (ex-burn)

Effects of inadequate fluid intake

Dehydration

--Impaired mental function, motor control, increase

body temperature, increase resting heart rate,

increased risk of heat stroke, muscle aches

1-2% water loss

--Feel more thirsty, tired

7-10% water loss

--Dizzy, lightheaded, loss of balance

20% water loss

--life-threatening

excessive fluid intake

Chronic high intake of water

--For most part, body doesn't let water become toxic,

but it is possible

--High water intake can lead to electrolyte imbalance

Hyponatremia

hyponatremia

Low sodium in blood

Occurs when serum sodium is low

Mimics dehydration symptoms

MUST BE CORRECTED

At risk: athletes drinking lots of water and not replacing electrolytes, patients who tend to retain fluid, those losing electrolytes (vomitting, diarrhea), MDMA users, patient on diuretics, person on antipsychotics

minerals

Inorganic

4% of body weight

Don't need to be broken down to be absorbed since already in simplest form

Keep chemical identity

Are indestructible

Minerals can be leeched out of food if soaked in water

Macromineral

found in greater than 5g in body (aka major mineral)

sodium, potassium, chloride, calcium, phosphorus,magensium, sulfur

Micromineral

found in less than 5g in body (aka trace mineral)

iron, selenium, copper, chromium, zinc, fluoride, manganese, molybdenum, iodine

Mineral functions

Provide structure (calcium, magnesium, phosphorus)

Fluid balance (sodium, potassium, chloride)

Acid-base balance (sodium, phosphorus)

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

Vitamin, enzyme, and hormone activity (ex- chromium activates insulin)

How does body maintain mineral balance?

Releasing minerals

Altering rate of absorption

Altering rate of excretion

Mineral toxicities

Supplementation (ex-iron)

Environmental (contamination by chemicals)

Commercial food processing errors (ex-accidents when making supplements)

disease/chronic conditions (ex: Na, K, and P toxicity in kidney disease)

Wilson disease: can't get rid of copper

mineral interactions

If eating blanched diet with variety, interactions should take care of themselves

caffeine and calcium

Caffeine increases calcium excretion

Increases risk of osteoporosis

Vit D, lactose and calcium

Increase absorption of calcium

Protein and calcium

Excess protein increases calcium excretion

sodium and calcium

Excess sodium increases calcium excretion

Potassium and sodium

More K we take in, more Na we excrete

K can help w/ hypertension (which is increased by Na)

Phytates with calcium, iron, magnesium

phytate=compounds in whole grains and other foods rich in fiber

Phytates bind with calcium, iron, and magnesium and decrease their absorption

Zinc and iron

Excess zinc decreases iron absorption and vice-versa

Milk anemia

When toddlers transition to cow milk from formula or breast milk and they get hooked on it. Calcium can bind to iron from other foods, so at higher risk for anemia. Limit to 16-24 ounces a day

Sodium functions

Used in preservatives (inhibits growth of food-borne pathogens)

Modify flavor

Binds ingredients enhances color

Extracellular cation, electrolyte

Important in nerve functioning

Essential nutrient

Salt comes from processed and prepared foods (79%), natural sources (12%), 6% added while eating, other from coming

Salt recommendations

Daily sodium needs: less than 200mg

AI Daily rec: less than ¾ teaspoon (1500mg)

UL= 2300 mg/day=1 teaspoon salt/day

--Risk for hypertension, edema

Needs are higher if you are athlete, training in heat, etc.

Forms of salt

Types of salt: sea salt, kosher salt, table salt.

ALL SALTS ARE EQUAL: all forms have same amount of sodium unless you get light salt

potassium sources/functions

All plant-based foods are rich in it in addition to yogurt, milk, green leafy vegetables, oranges, bananas, potatoes

Nerve impulses, rhythym of heart

Natural diuretic (water pill; get rid of excess fluid)

More potassium you take in, more sodium and fluid you get rid of

IV potassium

must be careful with. Too much can kill someone

salt substitutes

Potassium chloride=salt substitute

In kidney disease, need patient on potassium and sodium restriction, so salt and salt substitutes aren't appropriate for them

Why is the calcium (and iron) in spinach not well absorbed?

Oxalate is a compound found in foods like spinach, collard greens, and kale

While foods are high in calcium and iron, the oxalate makes them not absorb, so not good source

How can the calcium and iron in spinach be better absorbed?

When you cook oxalate-containing foods, you get rid of a lot of oxalate, so you get good source of calcium and iron