Nutrition Exam 2

Cobalamin

Cobalamin/Vitamin B12 is the generic name for a group of cobalt-containing compounds. It is a WATER SOLUBLE vitamin. Function: Acts as vitamin B12 coenzyme. It helps with folate metabolism to support metabolic functions and synthesis of DNA and RNA. It is also required for fatty acid and amino acid metabolism. Vitamin B12 develops and maintains myelin sheaths around nerve fibers. Deficiency: Deficiencies are usually secondary. Pernicious anemia can result from lack of intrinsic factor for vitamin B12 absorption, megaloblastic anemia results from folate dysfunction, and CNS damage caused by the breakdown of myelin sheaths. Toxicity: No toxicity has been noted. Food/Drug Interaction: Has an effect on folate metabolism. Sources: Animal sources--meat, fish, poultry, eggs and dairy.

Vitamin E

FAT SOLUABLE vitamin FUNCTION: Antioxidant, which protects polyunsaturated fatty acids and vitamin A from oxidative damage. Protects the lung and red blood cell membranes which are already exposed to copious amounts of oxygen. Vitamin E collaborates with selenium and Vitamin C in this antioxidative function as well as others. DIETARY SOURCES: Naturally occurs in tocopherols, specifically alpha-tocopherol because it is most accumulated in our bodies. Exclusively consumed in diet through vegetable oils and margarine, but also whole grains, nuts, seeds, and green leafy vegetables. DEFICIENCY: Primary deficiency is rare, but secondary deficiencies occur in premature babies & people who can't absorb fat normally. Cystic fibrosis biliary atresia... i.e. blocked bile duct. Other disorders of hepatobiliary system Liver transport problems TOXICITY: There is no evidence of toxicity associated with excess Vitamin E retention. CLINICAL SYMPTOMS ONE MAY SEE RELATED TO VITAMIN E:Legs cramps, muscle weakness, and slow tissue healing

Sodium/Chloride

Sodium Major essential mineral Function: Primary extracellular electrolyte for fluid regulation, body fluid levels, acid-base balance, nerve impulse and contraction, blood pressure and blood volume Dietary Sources: Sodium occurs naturally in many foods Sodium chloride is added to foods as salt in cooking and used as a preservative during processing Deficiency: Deficiency can develop from dehydration or excessive diarrhea Symptoms of deficiency are similar to those of fluid volume deficit and include: Headache Muscle cramps Weakness Reduced ability to concentrate Loss of memory and appetite Toxicity: Can occur from overconsumption of high-sodium foods and highly processed foods Hypertension Edema Chloride Major essential mineral Function: Acid-base balance, component of gastric hydrochloric (HCl) acid for digestion Dietary Sources: Foods that contain sodium (salt) usually have chloride as well Deficiency: Fluid volume deficit caused by vomiting and diarrhea Toxicity: Caused by dehydration: imbalance of chloride with other electrolytes

Vitamin A

FAT SOLUBLE vitamin. Function: maintain skin and mucous membranes throughout the body. Activities depending on Vitamin A: vision, bone growth, functioning of the immune system, and normal reproduction. Dietary Sources: Because Vitamin A is fat-soluble, it is already stored in the body. Often extra doses are not necessary but desired. Vitamin A is consumed in fat of animal-related food such as whole milk, butter, liver, egg yolks, and fish. Also from plant foods such as deep green, yellow, and orange fruits and vegetables. Deficiency: Night blindness which is the inability of your eyes to adjust from bright to dim light. Deficiency in Vitamin A can lead to respiratory infections, diarrhea, and other GI disturbances. Vitamin A dependent proteins are for bone growth. Toxicity: Most food sources of Vitamin A do not contain high enough levels of Vitamin A to produce a toxic effect. However, Vitamin A toxicity can happen. Symptoms of vitamin A toxicity is blistered skin, weakness, anorexia, vomiting, headache, join pain, irritability, and enlargement of the spleen and liver. Clinical Symptoms one may see related to Vitamin A: Blistered skin, weakness, anorexia, vomiting, headache, join pain, irritability, and enlargement of the spleen and liver.

Potassium

Function : Major intracellular cation (electrolyte) that maintains fluid levels. Involved in nerves and muscles functioning. Dietary sources : Unprocessed foods, white potatoes with skin, sweet potatoes, tomatoes, bananas, oranges, other fruits and vegetables, dairy products, and legumes. Deficiency : Symptoms : Muscle weakness, confusion, decreased appetite, cardiac dysrhytmias caused by Fluid Volume Deficit from vomiting/diarrhea or diuretics. Toxicity : Only if renal disease present, it can occur from diet or supplements. Symptoms : Muscle weakness, vomiting, and at excessively high levels, cardiac arrest.

Phosphorus

Function: 85%: in our bones and teeth as a component of hydroxyapatite (natural mineral structure) 15%: plays a role in... Energy transfer Part of genetic material (DNA and RNA) Phosphoric acid (balances the body's acid/base levels) Component of phospholipids (transport and structural functions) Sources: Protein-rich foods - the best sources Dairy, eggs, meat, fish, poultry, and cereal grains Processed convenience foods and soft drinks (due to the processing of the foods) Deficiency: The RDA is 700 mg for men and women older than 19 The effects of deficiency are unknown (this is part of the genetic material of every cell...) Toxicity: Excessive amounts (usually due to supplements) can lead to calcium excretion from the body and reduced calcium absorption Disrupts the calcium-phosphorus ratio (an acid-base balance within the body) Problem especially if calcium intake is inadequate (due to calcium being replaced by phosphorus-containing foods and soft-drinks) Food/Drug Interaction: when using phosphorus preparations Alcohol: may pull phosphorus out of bones and deplete it within the body Antacids containing aluminum, calcium, or magnesium: may bind to phosphate and prevent its absorption Anticonvulsants: may lead to lower phosphorous levels Bile acid sequestrant: decrease the absorption of phosphates Corticosteroids: may increase phosphorus levels in urine Diuretics: may increase the elimination of phosphorus in urine (lowering levels of phosphorus within the body) Insulin: decrease the blood levels of phosphorus for those with diabetic ketoacidosis Potassium supplements: high blood levels of potassium (hyperkalemia) which may lead to arrhythmias Clinical symptoms you may see present in patients (from an extraneous source: http://emedicine.medscape.com/article/241185-overview): Deficiency: typically asymptomatic with patients reporting symptoms of the underlying cause of the deficiency Toxicity: typically asymptomatic Patient may report hypocalcemic symptoms Muscle cramps, tetany, numbness, bone and joint pain, itching, rash Patient may report symptoms related to the underlying cause of the hyperphosphatemia

Calcium

Function: 99% of the body's calcium is used to keep your bones and teeth strong, supporting skeletal structure and function. 1% is used in cell signaling, blood clotting, muscle contraction and nerve function. Dietary sources: salmon, orange juice, tofu, cottage cheese, milk, yogurt, cheese, LEGUMES (i.e. beans) Effects bone health, during growing years, inadequate intake can stunt growth and reduces density of bone mass. In adults long term deficiency can lead to osteoporosis Toxicity: not typically of concern, but may cause urinary stone formation, constipation, and reduced absorption of iron, zinc, and other minerals Deficiency: frail bones, minor numbness or tingling in fingers, muscle cramps, poor appetite, and confusion Toxicity: fatigue, depression, muscle weakness, and kidney stones

Iron

Function: Distributes oxygen in hemoglobin and myoglobin; assists enzymes in the use of oxygen by all cells of the body using ionic charges Dietary Sources: Animal sources of meat, fish, and poultry contain both heme iron (more easily absorbed) and nonheme iron (not absorbed as well as heme iron). Plants such as vegetables, legumes, dried fruits, whole-grain cereals, and enriched/fortified grain products contain nonheme iron Deficiency: Anemia (low iron affects the availability of oxygen throughout the body) is most common in young children (insufficient intake), teenage girls (blood loss during menses), and women in child-bearing years (menses or high iron demands during pregnancy). It is also more common in low income minorities. If low enough, patient will be pale, tired, cognitive function is compromised, may always feel cold, decreased wound-healing ability. For pregnant women, there is an association between iron-deficiency anemia and greater risk of premature delivery and low birth rate. An unusual behavior associated with iron deficiency is Pica, which is characterized by the craving of non-food substances such as ice (pagophagia), clay and dirt (geophagia), or cornstarch and laundry detergent (amylophagia). Toxicity: hemosiderosis (storing too much iron in the body) from consuming too much iron - liver and heart damage, diabetes, arthritis, can damage tissue cells, bacterial microorganisms may thrive on high iron, potential lethal overdose (particularly in children) Food/Drug Interaction: Foods that promote iron absorption: foods high in vitamin C such as oranges and cantaloupes, alcohol (liver may malfunction and absorb too much) Foods/Drugs that inhibit iron absorption: continual use of antacids, excessive intake of other minerals, milk, foods that contain binders such as phytates and oxalates, tannins in foods such as tea and coffee Clinical symptoms one may see related to iron: discoloration of skin/paleness, dark stool, tiredness, feeling cold, hemochromatosis can lead to a misdiagnoses of diabetic or liver disorder symptoms

Magnesium

Function: Helps regulate multiple biological systems in the body including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation. Required for energy production and also plays a role in the active transport of calcium and potassium essential for nerve impulse control and muscle contraction. Deficiency: Uncommon because the kidneys limit urinary excretion of this mineral. Low intakes or losses can be due to chronic health conditions, chronic alcoholism, and certain medications. early signs of magnesium deficiency: loss of appetite, nausea, vomiting, fatigue, and weakness. As magnesium deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms can occur. Toxicity: Consuming over 5,000 mg/day can result in magnesium toxicity. Symptoms include hypotension, nausea, vomiting, facial flushing, retention of urine, ileus, depression, and lethargy before progressing to muscle weakness, difficulty breathing, irregular heartbeat, and eventually cardiac arrest. Food/Drug Interaction: Magnesium can decrease the absorption of Bisphosphonates, it can interfere with antibiotics, Diuretics can increase the loss of magnesium in urine and lead to magnesium depletion. Sources: Green leafy vegetables, such as spinach, legumes, nuts, seeds, and whole grains, are good sources. Generally foods high in dietary fiber have a lot of magnesium. Magnesium is also added to breakfast cereals and bottled waters.

Thiamin

Function: serve as a coenzyme, a substance that activates an enzyme, in energy metabolism; it also has a role in nerve functioning relate to muscle actions. Dietary Sources: Thiamine must be obtained through consumption. It can be consumed in lean pork, whole or enriched grains and flours, legumes, seeds, and nuts. Deficiency: alters the nervous, muscular, gastrointestinal, and cardiovascular systems. Marginal deficiencies may occur, producing psychologic disturbances, recurrent head-aches, extreme tiredness, and irritability. Beriberi is a serious disease resulting from thiamine deficiency. Toxicity: Excess thiamine is excreted in urine and produces no toxicity Clinical Symptoms: Muscle weakness and loss of coordination (ataxia), pain, anorexia, mental disorientation, and rapid beating of the heat (tachycardia)

Vitamin K

Vitamin K is a FAT SOLUBLE vitamin Function: "Cofactor" (substance whose presence is essential for activity or function) in the creation of blood clotting factors, including prothrombin. Also assists in protein formation in bone, kidney, and plasma. Dietary sources: Sythesized by microflora in the digestive tract, consumed in diet through dark leafy vegetables Deficiency: Inhibits blood clotting... i.e. increased risk for bleeding Given to newborns who are unable to immediately produce vitamin K Long term antibiotic therapy may destroy intestinal bacteria that help produce vitamin K in the gut Toxicity: Overconsumption of foods high in vitamin K produces no toxicity May interact with medications that help to decrease risk of blood clots (warfarin) Clinical Symtoms one may see related to Vitamin K: Easy bleeding, bruising

Vitamin C

Water-Soluble Vitamin Function: coenzyme and an antioxidant. As an antioxidant, it prevents the oxidation of folate, vitamin E, and polyunsaturated compounds. prevents damage of vascular tissue, allows for better absorption of nonheme iron, collagen formation within the bone matrix, teeth, cartilage, and connective tissue as well as enhancing wound healing. Food/Drug Interaction: Smokers typically have less Vitamin C circulating in the blood compared with non-smokers, at. may interfere with blood thinning agents as well as medications that control blood glucose or blood pressure. Dietary Sources: citrus fruits, tomatoes, peppers, strawberries, and broccoli (men need 90 mg/day and women need 75 mg/day) Toxicity: cramps, nausea, kidney stone formation, gout, and rebound scurvy Deficiency: scurvy: collagen is not produced, so tissues cannot be held together Clinical Symptoms one may see related to Vitamin C: Scurvy: gingivitis (gums bleeding), teeth come loose, joint and muscle aches, bruising, compromised immune system, and poor wound healing

Zinc

a trace mineral Function: Impacts growth processes, taste and smell, healing, immune responses, carbohydrate metabolism through assisting insulin factors. Over 200 enzymes rely on zinc to function properly. Recommenced Intake and Sources: RDAs: Men- 11mg Women- 8 mg (11 to 12 mg while pregnant or lactating) Foods: meat, fish and poultry whole grains, eggs and legumes Deficiency: Symptoms: (related to zinc's function in the body) impaired growth, reduced appetite, diseases of the immune system (during growth years) dwarfism, hypogonadism (impaired functioning of the reproductive organs) Toxicity: Most often caused by inappropriate supplementation (taking too much) GI distress (vomiting and diarrhea), fever, exhaustion

Vitamin D

fat-soluble vitamin Function: Vitamin D regulates blood calcium levels in bone mineralization and mineral homeostasis and is a key factor in absorbing calcium and phosphorus in the intestine. It can also effect growth and regulation, immunological performance, and cardiovascular function Dietary sources: Vitamin D can be obtained from fat of animal related foods like egg yolks, butter, and fatty fish. It can also be produced by the human body when exposed to ultraviolet light! Deficiency: Lack of vitamin D can lead to these disorders: rickets, osteomalacia, and osteoporosis. Risckets is due to insufficient mineralization and leads to malformed skeletons. Osteomalacia is when bones are demineralized and are at a high risk of fracturing. Osteoporosis is a condition when bond density is reduced and the rest of the bone is brittle and can break very easily. Deficiency in vitamin D can also increase the risk of rheuatoid arthritis, CVD, cancers, multiple sclerosis, and type 1 diabetes mellitus. Toxicity: Having too much vitamin D can lead to hypercalciuria (high calcium in the urine) and hyercalcemia (high calcium in the blood). These conditions can affect the kidneys and could cause cardiovascular damage.