Micronutrients Self Care

Micronutrients

Smaller amount needed for

optimal performance

● Essential for functions like

digestion, hormone production

and brain function

Ex: vitamin and minerals

Macronutrients

Large amount needed

● Maintain body’s structure and

functioning - give our body energy

Ex: proteins, fats and carbs

Vitamins

Nutrients that cannot

be synthesized in the body in

sufficient quantities - must be

obtained from our diet

Ex: Vitamin D3

Minerals

inorganic elements that are

essential for the function of

our body - obtained through foods

Ex: calcium

Trace Elements

Elements required in minute

quantities for our body to

function

Ex: zinc

DRI

Daily Recommended Intake

AI

Adequate Intake

EAR

Estimated Average

Requirement

UL

Tolerable Upper Intake Level

RDA

Recommended Daily

Allowance

DV

Daily Value

*Based on 2000 calorie diet

for adults > 18 yo

Fat Soluble Vitamins

A D E K or (KADE)

Dissolve in fat

● Accumulate in the body - stored

in tissue

● Absorbed in lymphatic system of

small intestine

● Occurrence of deficiencies: limited

fat intake or compromised

absorption

Water Soluble Vitamins

C B

Must dissolve in water before

can be absorbed by the body

● Cannot be stored

○ Daily intake is ideal

● Primarily lost through urine

Vitamin D2 vs D3

D2 = ergocalciferol

● D3 = cholecalciferol

Tip to remember: how many c’s in the name???

Vitamin D Deficiency

Patients can receive a diagnosis of being vitamin D

deficiency

● optimal serum 25-hydroxyvitamin D (25[OH]D) level

has not been established

○ Deficiency: 25(OH)D levels < 12 ng/mL

○ Insufficiency: 25(OH)D levels 12 < 20ng/mL

● Prescription vitamin D for treatment of deficiency

○ Cholecalciferol 1,250 mcg (50,000 units) once

weekly

Vitamin A role of fat soluble

Cell maintenance and

vision development

● Vision

● Reproduction

● Bone Health

● Immune System

● Skin

Vitamin D role of fat soluble

● Strengthens Bones

● Calcium Absorption

● Immune System

Vitamin E role of fat soluble

Antioxidant

● Immune System

● Flushes Toxins

Vitamin K role of fat soluble

● Blood clotting

● Bone Health

Vitamin A Fat Soluble Vitamin Deficiencies

● Deficiency

uncommon

○ Primarily

stored in

liver

Vitamin D Fat Soluble Vitamin Deficiencies

● Increased risk of

deficiency with

renal/hepatic

dysfunction

● Early sign: rickets

more common

Vitamin E Fat Soluble Vitamin Deficiencies

● Deficiency is very

rare

● May occur in

premature infants

or if have fat

absorption disorder

Vitamin K Fat Soluble Vitamin Deficiencies

● Deficiency is

uncommon unless

a malabsorption

disorder is present

Vitamin A Fat Soluble Vitamin: Signs of Overdose

● Acute toxicity: mental

status changes

● Chronic toxicity:

alopecia, anorexia,

pruritus, dry mucous

membranes, muscle

and bone pain,

dyslipidemia

Vitamin D Fat Soluble Vitamin: Signs of Overdose

● Anorexia

● Kidney stone

● Tissue calcification

● Renal failure

Vitamin E Fat Soluble Vitamin: Signs of Overdose

● Increased risk of

heart failure

Vitamin K Fat Soluble Vitamin: Signs of Overdose

● Uncommon - need

to consider with

warfarin therapy

Vitamin B1

Thiamine

Vitamin B2

Riboflavin

Vitamin B3

Niacin

vitamin B5

pantothenic acid

vitamin B6

Pyridoxine

vitamin B7

Biotin

vitamin B9

Folate or Folic Acid

Vitamin B12

Cyanocobalamin

Vitamin C

Ascorbic Acid

Vitamin C About

● Assists with collagen production and wound

healing

● Helps protect against infection

● Inadequate dietary intake for multiple months (3-5) can lead to deficiency

● Sign of deficiency: scurvy

● Acute mega doses can cause:

○ Nausea

○ Diarrhea

○ Cramping

B1

Generate Energy

Cause of deficiency → Alcoholism

B3

Help change food to energy

+ help digestive system,

skin, and nerves

Cause of deficiency → Alcoholism

Result of deficiency → Dermatitis, Diarrhea

Overdose signs → Flushing, LFTs elevated (rare)

B6

break down proteins, make

hemoglobin, make

antibodies, normalize

glucose levels

Cause of deficiency → Alcoholism, Malabsorption disorder, Use of isoniazid

Result of deficiency → Dermatitis, Scaly skin

B9

Help tissues grow and cells

to work, produce DNA

Cause of deficiency → Alcoholism, Malabsorption, Severely restricted diets

Result of deficiency → Megaloblastic anemia, sore mouth

B12

Protein metabolism;

formation of red blood clots,

maintain nervous system

Cause of deficiency → Dietary restrictions, older patients with reduced gastric acid; associated with folate deficiency

Calcium

● Keep component of bones and teeth

● Dosing is in elemental calcium

○ Several salt forms are available

● An 8 oz serving of nonfat milk contains

roughly 300 mg of calcium

● Any dose > 500 mg should be given as

divided doses

● Doses > 3 g can lead to kidney stones

Calcium Carbonate

1-2 tablets (500 mg each) 2-3 times

daily

400 mg per 1 g

Least expensive

Stomach acidity improves

absorption

Calcium Citrate

1-2 tablets (950 or 1000 mg each) 2-3

times daily

211 mg per 1 g

Less dependent on acidity

for absorption

(Use if patient is on PPI)

Calcium Gluconate

500, 648 or 972 mg

93 mg per 1 g elemental

Calcium Lactate

300 or 325 mg

130 mg per 1 g

Oyster Shell Calcium

Varies

30 elemental

Primarily made of calcium

carbonate

Calcium + Vitamin D

● Vitamin D helps promote calcium absorption

in the intestine

○ Vitamin D deficiency can lead to

low calcium

● As we age, our ability to absorb calcium

naturally decreases, leading to

decreased bone density

Magnesium

Types → Glycinate, Lactate, Oxide, Citrate

Role in body → Bone structure formation, proper function of many bodily enzymes, nerve and muscle

Cause of deficiency → Malabsorption, Acute or chronic diarrhea, Drug induced magnesium wasting

Result in deficiency → Neuromuscular irritability, Increased CNS stimulation, Delirium, Convulsions

Overdose signs → Muscle weakness, Lethargy, Sedation

Iron

Role in body → Oxygen and electron transportation Functional vs Storage Iron

Dietary sources → Heme iron ● Found in meats ● Well absorbed

Nonheme iron ● Found in enriched grains, dark green vegetables ● Poorly absorbed

Cause of deficiency → Inadequate intake, increased demand

Result of deficiency → Fatigue, pale skin, spoon shaped nails, sore tongue, cold extremities

Overdose signs → Must be dispensed in child proof container Abdominal pain, vomiting, diarrhea, electrolyte imbalances, shock Eventually leading to: cardiovascular collapse

Zinc: A Trace Element

● Cofactor in the synthesis of DNA and RNA

● Many patients have heard it helps treat the common cold

○ Formulations vary, leading to conflicting

data and insufficient evidence to support

this

● Zinc can be toxic at high quantities

○ Emetic effect occurs after consumption of

large amounts which helps minimize

potential problems

■ Vomiting, dehydration, poor muscle

coordination, dizziness and

abdominal pain

Choosing a Multivitamin

Nutrients to focus on → Calcium, potassium, dietary fiber, vitamin D

Basic and Essential Vitamins and Minerals

Patient factors to consider → Age, gender, previous history of bariatric surgery

Prenatal Vitamins

● Provide extra vitamins and minerals essential before and during pregnancy

● Main difference from a regular multivitamin: folic acid quantity

○ 400-800 mcg recommended for women of reproductive age

○ 600 mcg recommended during pregnancy

● May contain other additions or higher quantities of things like omega-3 (fish oi) or iron

Children’s Multivitamins

● American Academy of Pediatrics states that for children who

consume a well balanced diet which meets the

recommended dietary allowances of vitamins and minerals

which vary by age

○ Common age groupings:

■ 0-1

■ 1-3

■ 4-6

■ 7-9

■ 10-12

■ 12+

● Things to consider:

○ If a child consumes little meat or iron rich foods: iron

supplementation (multivitamin with iron)

○ Lack of dairy or calcium rich foods: calcium + vitamin

D supplementation

○ Minimal animal products: vitamin B12 +/- iron

supplementation

○ Little or no fruits or vegetables: daily multivitamin

Examples of Medications and

Related Deficiencies

Medication Deficiencies

For reflux → Calcium, iron, magnesium, B12, C

Oral Estrogens → Folic acid, Magnesium, B6

Ozempic, Mounjaro → Vitamins A, B, C, D, E, potassium, magnesium, iron, calcium, fiber

Diuretics → Calcium, magnesium, potassium, B1

Anti-depressants → Calcium, Vitamin D