Dietary Supplements-- Minerals, Special Populations, and non-essential supplements

How much of a person’s body weight is from minerals?

4%

What is the role of calcium?

99% of body calcium in bones (also in teeth); muscle contraction and relaxation

What is the presentation of calcium deficiency?

bone density loss, rickets in children

What can cause calcium deficiency?

aging, malnutrition

What toxicity can occur from calcium?

nephrolithiasis, soft tissue deposition

What drugs need to be separated from calcium supplements?

fluoroquinolone and tetracycline antibiotics

What are the different salt forms for calcium?

carbonate, citrate, lactate, gluconate—IV, phosphate

Which calcium salts require stomach acid for absorption and need to be taken with food?

calcium carbonate, calcium phosphate

What is the optimal absorption dose for calcium?

500 mg

True or False: calcium is constipating

true :(

What are the possible risks of calcium supplementation in older adults?

increased risk of prostate cancer in men, increased risk of death and heart disease in men

What are the different forms of Iron supplements?

heme, non-heme, ferrous salts

Where can heme be found naturally?

in meats; its absorbed better

Where can non-heme be found naturally?

in veggies and grains, not absorbed as well

What are the different ferrous salt options?

ferrous sulfate, ferrous gluconate, ferrous fumarate

What is the role of Iron?

mainly into hemoglobin in RBCs

What puts you at a risk for Iron deficiency?

malnutrition or malabsorption, increased demands

What are the signs of iron deficiency?

lethargy, pallor

What patients are at risk for malnutrition or malabsorption of iron?

infants— 2 years old fed too much milk

older adults— eat less iron containing foods and less stomach acid to absorb it

What are the signs of Iron toxicity?

GI effects (possible even with normal dosage)— N/V, abdominal pain, constipation, darkening of stool

Electrolyte imbalances, cardiovascular collapse in higher doses

True or False: iron should be taken without food to increase absorption

true

True or False: iron can be taken with food to decrease GI effects

true

What are the forms of magnesium supplementation?

magnesium oxide and magnesium sulfate

What is the role of megnesium?

bone structure, enzyme formation, ATP dependent processes

What causes deficiency in magnesium?

GI or renal losses due to malabsorptive disorders, diarrhea, diuretic, PPI use

What are the signs of magnesium deficiency?

neuromuscular effects, convulsions delirium, CNS stimulation

What are signs of magnesium toxicity?

diarrhea (typical on normal doses) —> keep doses at 400mg or less; muscle weakness, lethargy, sedation, hypotension

What is the role of copper?

proper function and structure of CNS, iron metabolism

Who is at risk for copper deficiency?

premature infants, roux-en-Y gastric bypass

What is the role of Zinc?

cofactor in DNA and RNA, essential for cellular immune function

Who is at risk for zinc deficiencies?

vegetarians, malabsorption, alcoholism may require more zinc

What is zinc commonly marketed for?

common cold; evidence insufficient

True or False: intranasal zinc should be used for common cold

false

What is the role of fluoride?

prevents tooth decay

How is fluoride deficiency avoided?

most water should be fluorinated

What is AMD?

age related macular degeneration; it’s the leading cause of blindness in age >65 year old

What were the AREDS trials?

NIH trials to determine vitamin/mineral/antioxidant supplementation affects macular degeneration

True or False: AREDS prevents AMD

false!

Which AREDS is for smokers?

AREDS2

Why is ARED1 not recommended for smokers

it contains beta-carotene, which increases mortality in smokers

What specific deficiency’s are associated with breastfed infants?

vitamin D, iron

What specific deficiency’s are associated with children?

iron and fluroide

What specific deficiency’s are associated with pregnancy?

folic acid, prenatal vitamin (with or without iron or stool softeners), pyridoxine— NVP (with or without doxylamine)

What are the specific deficiency’s for older adults?

B12, D, calcium

What are the specific deficiencies for people with bariatric surgery?

fat soluble vitamins, B vitamins, iron, calcium, zinc, copper

What are the most commonly used non vitamin/mineral dietary supplements in adults?

fish oil, glucosamine & chondroitin, pre/probiotics, melatonin, co-enzyme Q 10

What are the most commonly used non vitamin/mineral dietary supplements used by children?

fish oil, melatonin, pre/probiotics, echinacea

What system does coenzyme Q10 work in?

cardiovascular

What system does fish oil work in?

cardiovascular

What system does garlic work in?

cardiovascular

What system does red yeast rice work in?

cardiovascular

What system does ginkgo work in?

CNS

What system does melatonin work in?

CNS

What system does St. John’s Wort work in?

CNS

What system does ginger work in?

GI

What system does milk thistle work in?

GI

What system does peppermint oil work in?

GI

What system does pre/probiotics work in?

GI

What system does green tea work in?

Physical performance

What system does cinnamon work in?

endocrine

What system does echinacea work in?

immune function

What system does elderberry work in?

immune function

What system does cranberry work in?

urogenital

What system does saw palmetto work in?

urogenital

What system does glucosamine work in?

musculoskeletal system

What system does chondroitin work in?

musculoskeletal system

What system does SAMe work in?

musculoskeletal system

What system does turmeric work in?

musculoskeletal system

What system does black cohosh work in?

women’s health

what system does evening primrose oil work in?

women’s health

What are the uses of coenzyme Q10?

statin associated myopathy, heart failure

Dose of coenzyme Q10

50-100 mg daily or BID

Coenzyme Q10 MOA for myopathy

statins decrease CoQ10; CoQ10 converts to ubiquinol; cofactor required for mitochondrial ATP formation, found throughout the body including the muscle

Coenzyme Q10 MOA for heart failure

improve endothelial function, C0reactive protein

side effects of coenzyme Q10

well tolerated, may slightly lower BP

What is fish oil?

omega-3 fatty acids composed of docosahexaenoic acid (DHA) and eicosatetraenoic acid (EPA)

What is the AHA recommendation for fatty fish intake?

twice a week

What are the uses for fish oil?

hypertriglyceridemia, cardiac health, inflammatory arthritis

What is the MOA of fish oil for hypertriglyceridemia?

increase free fatty acid oxidation— suppressing lipogenesis; reducing plasma TG, reduced VLDL

What is the MOA of fish oil for cardiac health?

components of chemical mediators, resolvins and protectins → reduce plaque inflammation; may inhibit platelet aggregation and reduce thromboxane A2

What is the MOA of fish oil for inflammatory arthritis?

increases non-inflammatory cytokines; decreases pro-inflammatory cytokines

What is fish oil made from?

fish or algae

What are the side effects of fish oil?

fish burps, possible increased risk of bleeding

True or False: fish oil supplements contain mercury

false

What are the uses for garlic?

hyperlipidemia, hypertension

What is the MOA of garlic in hyperlipidemia?

allicin can inhibit cholesterol synthesis; modest benefit on TC and LDL

What is the MOA of garlic in hypertension?

increases vasodilation (NO and others) and may inhibit ACE; may be as good as antihypertensive agents

What are the side effects of garlic?

reflux, heartburn, garlic breath, increased bleeding risk

What is red yeast rice?

yeast that grows on fermented rice; contain monacolins

What is monacolin K?

lovastatin; sooo FDA declared products containing it illegal— “unauthorized drug”

What are the uses of red yeast rice?

hyperlipidemia

What is the MOA of red yeast rice for hyperlipidemia?

works well to lower LDL similar to statin reductions; unknown if other CV benefits are seen

What are the side effects of red yeast rice?

well tolerated, less myopathy than statins, yeast can generate citrinin which is a nephrotoxin

Who should avoid taking red yeast rice?

patients with CKD

What are the uses for Ginkgo biloba?

memory

What is the MOA of ginkgo biloba for memory?

improves vascular perfusion and has neuroprotective antioxidant effects; benefit when combined with conventional dementia medications; inconsistent benefit to support prevention of cognitive decline

What are the side effects of ginkgo biloba?

well tolerated, increased bleed risk

What is melatonin synthesized from?

tryptophan,,, gobble gobble

What is the MOA of melatonin?

regulates sleep and circadian rhythm; induced by darkness and suppressed by light (especially blue light)

True or False: melatonin causes sleepiness

FALSE