Vitamins, Minerals, and Supplements

Recommended Dietary Allowance (RDA)

Average daily level of intake sufficient to meet the nutrient requirements of nearly all healthy people

Adequate Intake (AI)

Established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy

Tolerable Upper Intake Level (UL)

Maximum daily intake unlikely to cause adverse health effects

Senior/silver formulations

Added Calcium (may not be enough), Vitamin B12, Vitamin D

Vitamin D

Necessary for calcium absorption

Target for Vitamin D

target 30 ng/mL

Vitamin D deficiency

below 20 ng/mL

Vitamin D2

Ergocalciferol

Vitamin D3

Cholecalciferol

Characteristics of Vitamin D3

• Synthesized in the skin on exposure to sunlight

• More potent

• Preferred product

Monitor Vitamin D by

checking 25-hydroxyvitamin D level

Toxicity of Vitamin D is

rare

1 mcg cholecalciferol =

40 IU vitamin D

Vitamin B12

cyanocobalamin

Daily requirement for vitamin B12

2.4 mcg/day

Vitamin B12 Deficiency

• May be caused by chronic use of proton pump inhibitors or metformin

• Fatigue, weakness, constipation, loss of appetite, mouth sores and weight loss, megaloblastic, macrocytic anemia and neurologic problems that may be irreversible

Fat Soluble Vitamins

Vitamins A, D, E, and K

Folic Acid Content in a multivitamin

400 mcg

Folic Acid Content in an OTC Prenatal

800 mcg

Folic Acid Content in an Rx

1000 mcg

Calcium Carbonate

• (40% elemental) provides most calcium per tab and generally lower cost

• Must be taken with food

• Ingredient in Tums

• more potent = more calcium per tablet

Calcium Citrate

(20% elemental) better absorbed in patients on acid blockers or elderly

symptoms of hypercalcemia

constipation

Citracal Maximum

Calcium Citrate with Vitamin D

Fish Oil

Omega 3

What does Fish Oil/Omega 3 do?

lowers triglyceride levels and CV (cardiovascular) risk reduction

What can be done about fish burp?

eat food with fish oil, refrigerate before taking, take at bedtime

Ubiquinol

Coenzyme Q10/ CoQ10

Ubiquinol/CoQ10

Generally for cardiovascular conditions (heart failure) and for reduction of statin-associated adverse effects (muscle pain), can be expensive

Melatonin

immediate-release formulation for patients with trouble getting to sleep or a sustained-release preparation for patients having trouble staying asleep

starting dose for melatonin

3 mg taken 30 to 60 min before bedtime

Glucosamine

For osteoarthritis pain and joint health

Glucosamine should not be taken with what allergy?

shellfish allergy

mild Glucosamine symptoms

abdominal pain, heartburn, diarrhea

salt forms of iron

ferrous fumurate 33%, ferrous sulfate 20%, ferrous gluconate 12%

Gold standard for supplemation

Ferrous Sulfate 20%

Dietary Interactions of Iron

food, milk, and eggs will decrease absorption by 50% and orange juice (vitamin c) will increase absorption by 10%

Patient Counseling for Iron

limit H2 blockers - iron may cause nausea, vomiting, diarrhea, constipation, dark stools, and metallic taste

therapeutic dose for treating iron deficiency

2–4 tablets containing 325 mg ferrous sulfate daily for 3 months

Black Cohosh

• Indication: Women’s Health 

• Serious AEs: Hepatotoxicity

• Special populations: Avoid during pregnancy and lactation

Butterbur

• Indication: Migraine prevention

• Serious AEs: Hepatotoxicity, carcinogenesis

• Special populations: Avoid during pregnancy and lactation

CBD

• Indication: Nausea, vomiting, pain

• Common AEs: Drowsiness, lethargy, sedation

• Serious AEs: angioedema

• Special populations: Avoid during lactation

Echinacea

• Indication: Prevention and treatment of colds and respiratory infections

• Serious AEs: Hepatotoxicity

• Special populations: Avoid in immunocompromised individuals

Evening Primrose Oil

• Indication: Women’s health 

• Serious AEs: Seizures

• Special populations: Avoid use during pregnancy

Ginkgo Biloba

• Indication: CNS (support memory) and age-related macular degeneration

• Serious AEs: Bleeding 

• Special populations: Avoid during pregnancy

Goldenseal

• Indication: Anti-infective, traveler’s diarrhea

• Serious AEs: Hypotension, bradycardia, bleeding, hypoglycemia

• Special populations: Avoid during pregnancy and lactation

Milk Thistle

• Indication: Liver disease

• Serious AEs: heart attack

• Special populations: Avoid in pregnancy and in patients with ragweed allergy

Saw Palmetto

• Indication: Benign prostatic hyperplasia (BPH)

• Serious AEs: Bleeding

• Special populations: Avoid in pregnancy and during lactation 

St. John’s Wort

• Indication: CNS (Depression, anxiety, obsessive-compulsive disorder)

• Serious AEs: Withdrawal symptoms

• Special populations: Limited evidence to assess safety during pregnancy and lactation