Nutrition Ch. 8 & 9

Iodine (Trace mineral): When does it become Iodide? Iodide is an integral part of what hormones?

-In the GI tract, iodine becomes iodide - Iodide is an integral part of the thyroid hormones - With low blood concentrations of iodide, the cells of the thyroid gland enlarge to trap as many particles of iodide as possible - This can lead to a visible, swelling near the thyroid called a goiter

Zinc (Trace Mineral). What can zinc deficiencies result in?

Involved in numerous processes within the body Zinc deficiency can result in: - Delayed growth, arrested sexual maturation - Impaired immune function - Loss of appetite - Abnormal taste - Abnormal adaptation to dark light

Osteoporosis. some risk factors :

Risk factors: - Advanced age - Previous fracture - Long-term glucocorticoid therapy - Low body weight (less than 58 kg [127 lb]) - Family history of hip fracture - Cigarette smoking - Excessive alcohol intake - Inadequate calcium and vitamin D - Excessive sodium, caffeine

**What are some food sources of vitamin A??

Sources of preformed vitamin A found in many animal products: Liver, fish oil, milk, cheese, fortified cereals, butter, eggs

3. Niacin. This is also used for what else? Large supplements may result in what?

(A lady named Nia with high cholesterol) Naturally occurring niacin from foods causes no harm Some practitioners use niacin as a pharmacologic agent to treat high cholesterol (1000 to 3000 mg a day/dose). Lowers LDL cholesterol. Niacin supplements in large doses may result in "niacin flush" Dilation of capillaries of the skin with tingling/pain Food sources: meat, poultry, fish, legumes (peanut butter), enriched and whole grains, mushrooms, asparagus, potatoes

7. Folate. What is the difference between folate and folic acid? What if you are of childbearing age?

(I'm fo late [so late] because I'm drunk & have poor nutrition) -Folate = the naturally occurring folates in foods -Folic acid = the form used in dietary supplements and fortified foods Folate deficiency: -Alcoholism may impair folate's absorption & increase is excretion -Poor nutritional intake -Some medications (methotrexate, phenytoin) Folate & neural tube defects - Recommendation: all women of childbearing age who are capable of becoming pregnant should consume 400mcg (0.4mg) of folic acid daily from supplements, fortified foods, or both, in addition to eating folate-rich foods.

Zinc Products and the Common Cold. FDA had to change because Meds containing Zinc caused what?

(If you have the common cold, you ZZZZzzzzzzinc) - The US Food and Drug Administration (FDA) issued a public health advisory advising that three over-the-counter zinc-containing intranasal products (Zicam) should not be used because of multiple reports of permanent anosmia (loss of sense of smell) - Zinc is also available in a homeopathic preparation as intranasal zinc gluconate for the treatment and prevention for colds. This formulation has also been found to cause hyposmia and anosmia . Zinc sulfate preparations that are syrup or lozenges seem to be better tolerated than some tablet forms.

Megaloblastic anemias. What is this characterized by? This is associated with what vitamin deficiencies?

(Mega---> B12 is alot & FOOOLLLLATE) Also known as macrocytic anemia - Characterized by larger than normal red blood cells - A type of anemia often associated with vitamin B12 and/or folate deficiencies

2. Riboflavin. Who needs more of this?

(a pregnant woman with cracks in the side of her mouth) Increased needs in pregnant and lactating women, plus those that are excessively physically active -Deficiency may co-occur with thiamin deficiency -Symptoms might include cracks in the corners of the mouth (cheilitis), sore throat -May be seen in alcoholism, anorexia nervosa, malabsorptive conditions (celiac disease), long-term use of phenobarbital Food sources: milk/milk products, meats, eggs, green vegetables, enriched and whole grain breads/cereals

Calcium (major mineral).

- An integral part of bone structure - Circulates in the blood as ionized calcium to help with a variety of cellular roles (see p. 240) - Calcium is pulled from the bones to maintain a consistent blood level Food sources: milk and milk products, dark leafy greens (except spinach and Swiss chard)

WATER. How much of adult body weight is water? Water regulation is influenced by what?

- Constitutes about 60% of adult body weight - Water regulation influenced by the hypothalamus (initiates drinking behavior) - But the person must also respond to the thirst signal by drinking - In older age, thirst sensations may be diminished - Intake/recommendations vary depending on: - Foods a person eats - Environmental temp/humidity - Activity level

Multivitamins

- For adults with a balanced diet, there is no convincing evidence that taking multivitamins in the usual doses of 50 to 200 percent of the Recommended Dietary Allowance (RDA) is either helpful or harmful. If the multivitamin includes vitamins E and/or A, these should be in low doses (eg, no more than 30 units of vitamin E; no more than 2500 international units of vitamin A). - For people on balanced, developed-world diets (ie, those eating a variety of fruits, vegetables, grains, and proteins), we suggest not taking multivitamin supplements

Water (cont'd).

- In general, an individual consuming/expending about 2000kcal/day needs about 2-3L (or 8-12 cups) of water/day - Total water can be obtained from drinking water, other beverages (except alcohol), and foods - Caffeinated beverages are mild diuretics but still contribute to the daily fluid intake URINE is a good indicator of whether or not more/less water is needed! Pale yellow is best Healthy kidneys regulate the body's sodium and water

6. Vitamin B6. Involved in what?

- Involved in metabolism of carbs, fatty acids, and amino acids - Deficiency may manifest with weakness, depression, confusion, irritability, dermatitis, anemia - Overt deficiency is rare, marginal deficiencies more common Toxicities have been reported with megadoses Food sources: meat, fish, poultry, nuts, whole grains

Iron (trace mineral): Deficiencies can occurr from what? Who needs more iron? Food sources?

- Most is a component of the proteins hemoglobin (RBCs) and myoglobin (muscles) - Deficiencies can occur from bleeding, inadequate intake, or reduced absorption (eg, due to celiac disease, Helicobacter pylori, gastritis, or bariatric surgery) - Food sources: Heme iron (10x more absorbable): meat, poultry, fish Nonheme iron (less absorbable): vegetables, grains, eggs, meat, poultry, fish Women of childbearing age need more iron than men

Potassium (major mineral). Deficiencies result more often from what? Not enough potassium can raise what?

- Potassium deficiency results more often from excessive losses than from deficient intakes - Prolonged vomiting/diarrhea, dehydration, diabetic acidosis - Use of diuretics, steroids, cathartics (strong laxatives) Low potassium intakes can raise blood pressure Food sources: fresh fruits and vegetables

Benefits of Calcium: Calcium and Vitamin D supplements may help prevent what?

- Reduces bone loss and decreases the risk of fracturing the vertebrae - Consuming calcium during childhood can lead to higher bone mass in adulthood. This increase in bone density can reduce the risk of fractures later in life. - Calcium may also have benefits in other body systems by reducing blood pressure and cholesterol levels. - Calcium and vitamin D supplements may help prevent tooth loss in older adults.

Folate (cont'd). What is the FDA doing related to folic acid? Food sources?

-FDA mandate that enriched/fortified grain products be fortified with folic acid - Food sources; liver, legumes, beets, leafy green vegetables, oranges, orange juice, cantaloupe

Symptoms of Iron Defiency

-Fatigue -Weakness -Headache -Irritability -Exercise intolerance -Exertional dyspnea -Vertigo -Cold intolerance -Pica (craving for and consumption of non-food substances)

Iron Deficiency & Iron Deficiency Anemia: are they the same? If no, then what is the difference?

-Iron deficiency and iron deficiency anemia are NOT THE SAME - Iron deficiency is depleted iron stores and is usually caused by inadequate iron intake - Iron deficiency anemia is a deficiency in blood iron that leads to small, pale red blood cells (RBCs) - The RBCs can't carry enough oxygen from the lungs to the tissues

Risk Factors for Vitamin D Deficiency

-Obese -Taking medications that accelerate the metabolism of vitamin D (such as phenytoin) -Hospitalized on a general medical service -Institutionalized -Limited effective sun exposure due to protective clothing or consistent use of sun screens -Osteoporosis -Malabsorption, including inflammatory bowel disease and celiac disease

Signs of Iron Defiency

-Pallor -Dry or rough skin -Blue sclerae -Atrophic glossitis with loss of tongue papillae, which may be accompanied by tongue pain or dry mouth -Cheilitis -Koilonychia (spoon nails)

Iodine Deficiency: This deficiency is the most common cause of preventable what?

-The most common cause of preventable mental retardation and brain damage in the world - During pregnancy, severe deficiency can cause cretinism, which is: (irreversible mental and physical retardation) - Salt iodization programs, which many countries have implemented, have dramatically reduced the prevalence of iodine deficiency worldwide

B vitamins as Coenzymes. what is a coenzyme? What do B vitamins participate in? Do they give people energy?

A coenzyme is a small molecule that combines with an enzyme to make it active Many of the B vitamins participate in the release of energy from the energy-yielding nutrients (carbs, fats, proteins) Thus, B vitamins do NOT give people energy All B vitamins help enzymes to perform thousands of molecular conversions in the body all the time

Atrophic Glossitis. What is it? This is associated with what vitamin deficiencies?

A smooth tongue that has lost its papillae and is often sore suggest a deficiency in riboflavin, niacin, folic acid, vitamin B12 or iron. This patient had vitamin B12 deficiency.

Vitamin E. What might it do? What are food sources?

Acts as an antioxidant (protects other substances from oxidation) May protect against heart disease by protecting LDL from oxidation (which encourages the development of atherosclerosis) Inconsistent findings of vitamin E supplementation in the prevention of heart disease Food sources: vegetable oils, wheat germ, fresh fruits/veggies, nuts, whole grains

Water Soluble Vitamins (B & C). Types of B vitamins? C?

B vitamins: 1. Thiamin 2. Riboflavin 3. Niacin 4. Biotin 5. Pantothenic acid 6. Vitamin B6 7. Folate 8. Vitamin B12 Vitamin C

4. Pantothenic Acid and 5. Biotin. Both involved in what? Are Biotin deficiencies rare or common and what can it result in? Are they found in limited foods?

Both involved in energy metabolism, help to release energy from carbs, fats, and proteins Both are very widespread in foods Biotin deficiencies are rare but could result in adults fed artificially by vein (parenteral nutrition) But now it is common to supplement with biotin in these individuals

Dehydration and Water intoxication. What is a decreased concentration of sodium in the blood called?

Dehydration: - May occur from inadequate intake, vomiting, diarrhea, heavy sweating, fever, burns, wounds - Along with fluid loss, there is often electrolyte loss Water Intoxication: - Hyponatremia is a decreased concentration of sodium in the blood

DASH diet

Dietary Approaches to Stop Hypertension (DASH) An emphasis on: - Potassium-rich fruits and vegetables - Fat-free or low-fat milk products - Whole grains, nuts - Poultry, fish - Reduced intake of red meats, sweets, sugary beverages

Water-soluble Vitamins. Is it likely to reach toxic concentrations? what about through foods?

Easily absorbed into the bloodstream Just as easily excreted if blood concentrations rise too high Unlikely to reach toxic concentrations Foods never deliver excessive amounts of water-soluble vitamins Vitamin supplements can reach toxic levels

Vitamin E Deficiency. What happens with RBCs? What else is it associated with?

Erythrocyte hemolysis: when red blood cells break open, often due to vitamin E deficiency Vitamin E deficiency often associated with diseases that cause MALABSORPTION OF FAT - this includes diseases of: Gallbladder, liver, pancreas, cystic fibrosis - OR due to years of extremely low-fat diets

Solubility of Vitamins What are Fat-soluble vitamins? What are Water-soluble vitamins?

Fat-soluble vitamins: Vitamins A, D, E, & K (the body absorbs them the same way it absorbs lipids) Water-soluble vitamins: B vitamins & vitamin C

How to obtain vitamin D: What foods contain Vitamin D? How long for sunlight?

Foods: Eggs, liver, butter, some fatty fish, fortified milk Infant formula Breastmilk is LACKING vitamin D, so exclusively breastfed babies need supplementation Sunlight: Expose hands, face, and arms for 5-10 minutes a few times/week THEN apply sunscreen Longer for dark-skinned individuals and those living in northern latitudes/winter

Vitamin K. What is it involved in?? Deficiency can be caused by what? Food Sources?

Involved in blood clotting ("Klotting") - Activates several proteins that make blood clots Also involved in synthesis of bone proteins - Helps to decrease bone turnover, lessening fracture risk Can be synthesized from bacteria in the intestinal tract - Deficiency may result from antibiotics - Anticoagulant medications may interfere with vitamin K metabolism Best food sources: green leafy vegetables, cabbage, vegetable oils.

Serum-25 hydroxyvitamin D

Lab value for measuring vitamin D in the body Acceptable range is 30 to 40 ng/mL (but may vary depending on the lab) Levels lower than 20ng/mL are suboptimal for skeletal health Recent estimates show about 41% of the adult population had levels below 20ng/mL

Minerals

Major Minerals: -***Calcium*** -Chloride -Magnesium -Phosphorus -***Potassium*** -***Sodium*** -Sulfur Trace Minerals: -Chromium -Copper -Fluoride -***Iodine*** -***Iron*** -Manganese -Molybdenum -Selenium -***Zinc***

Vitamins: The Basics. Do they contribute energy to the body?

NO Instead, vitamins serve as facilitators of body processes (i.e., assist enzymes) Many individuals use vitamin/mineral supplements, as opposed to obtaining from foods More evidence to support that vitamin-rich foods (not supplements) can be protective against cancer and heart disease Amount of vitamins from foods depends on quantity and amount able to be absorbed from the body (bioavailability)

Vitamin K for Newborns

Newborn digestive tract is sterile Vitamin K deficiency of the newborn (VKDN) is common Can lead to hemorrhage This can be prevented by early administration of IM vitamin K injection (at birth) a single dose of vitamin K, usually in a water-soluble form, is given at birth to prevent hemorrhagic disease in the newborn

Sodium (major mineral). High sodium intake correlates with what?

OVERCONSUMED by most people Average American consumes more than 3400mg/day Recommendation for adults is 1200-1500mg/day - High sodium intakes correlate with high blood pressure - Which is then related to an increased risk of death from stroke or heart disease

Fat Soluble Vitamins (A,D,E,K)

Occur together in the fats and oils of foods Stored in the liver and fatty tissues until the body needs them Not readily excreted Thus, these do not need to be consumed each and every day, but instead eaten over time

Vitamin D Toxicity. How likely and in what form (Food, sunlight) ? Tolerable Upper Intake Level?

One of the vitamins most likely to have toxic effects when consumed in excess Vitamin D from foods and the sun are unlikely to cause toxicity Supplements should be kept out of reach of children and supplementation should be monitored/advised by a healthcare provider Tolerable Upper Intake Level = 2000 IU /day

Vitamin D Deficiency

Overt (visible) vitamin D deficiency: Rickets (bone deformities), osteomalacia (soft bones, bowed legs) Subclinical (not visible) vitamin D deficiency: Osteoporosis, increased risk for falls, fractures

1. Thiamin what role does it play? What syndrome can develop? Food sources?

Plays a role in energy metabolism Deficiencies reported in: -Malnourished -Homeless -Alcoholics -Wernicke-Korsakoff syndrome can develop: Symptoms may include disorientation, loss of short-term memory, jerky eye movements, staggering gait Food sources: pork, legumes, sunflower seeds, enriched and whole grain breads

Vitamin A Deficiency

The body can store up to one year's worth of vitamin A Vitamin A deficiency is the major cause of preventable blindness in children worldwide. Especially in developing countries of Africa and SE Asia Other children may experience less severe forms of deficiency, making them vulnerable to infectious diseases Measles and diarrheal illnesses

Vitamin D. What is it involved in?

The body can synthesize vitamin D with the help of sunlight People do not need vitamin D from foods if exposed to enough sunlight Moderate exposure is best, as too much can increase risk for skin cancer Vitamin D is involved in: Muscle and bone strength in children and adults (assists with absorption of CALCIUM and PHOSPHORUS) Assists with immunity Protecting against cognitive decline May regulate adipose tissue cells that contribute to obesity

Beta Carotene

The plant-derived precursor to vitamin A A precursor is a compound that can be converted into an active vitamin An extremely effective antioxidant Protects other compounds from cell damage by free radicals Gives foods their bold pigments (orange and green) Carrots, sweet potatoes, pumpkins, cantaloupe, apricots Spinach, broccoli, bok choy

Vitamin A

Three different forms are active in the body: 1. Retinol - supports reproduction and is the major transport and storage form of the vitmain 2. Retinal - active in vision 3. Retinoic acid - acts as a hormone regulating cel differentiation, growth, and embryonic development. Supports reproduction (cell differentiation, growth, embryonic development) Active in vision (retina and clarity of the cornea) Vitamin A deficiency can lead to night blindness = difficulty of the eye adapting to changing light levels Genes are regulated by retinoic acid: it helps to activate or deactivate them Involved in immunity

Now to Vitamin C. What vitamin C's role/function? What is the belief of vitamin C preventing cancer or CHD? Food sources?

Vitamin C has many roles/functions - Antioxidant - Collagen formation (especially important in the post-op or burn patient for wound healing) - Assists in absorption of iron Evidence does not support the use of vitamin C supplementation in the prevention of cancer or coronary heart disease Food sources: citrus fruits, cantaloupe, strawberries, broccoli, brussels sprouts

8. Vitamin B12. Are deficiencies a concern? Food sources? Who in particular have a difficult time obtaining vitamin B12?

Works with folate in cell division Deficiencies are a concern. Common causes: -Pernicious anemia (usually in older adults) -Gastric disease -Strict vegans (may need fortified soy milk or supplement) -Certain medications (neomycin, metformin, omeprazole, cimetidine) Food sources: almost exclusively animal products (meats, milk, cheese, eggs) Vegans have a difficult time obtaining vitamin B12