PHR 923 Block 2
Which water soluble vitamin is stored in the body?
3-5 years of vitamin B12 is stored in the liver
What is the effective dose for treating hypertiglyceridemia?
3-6 grams EPA/DHA daily Most supplements only contain 200-300 mg per dose Rx products or high dose DS might be required
How is calcium content in diary estimated?
300 mg per serving of dairy
Vitamin A UL
3000 mcg/day Pregnancy- less than 5000 IU/day No UL on Beta-carotene
What is the upper limit (UL) for magnesium?
350 mg per day
What are the recommendations for folic acid intake in women?
400 mcg per day starting one month before getting pregnant. Best course of action is for all women to meet this requirement during childbearing years Increase to 800 mcg per day during pregnancy 4 mg for women with high risk for neural tube defect during pregnancy
Folic acid RDA
400-600 mcg per day Pregnancy: 800 mcg per day Prior NTD-pegnancy: up to 4000 mcg per day
Vitamin D (calciferol) UL
4000 IU/day
Iron UL
45 mg/day (unless treating iron-deficiency anemia)
What is the AI for potassium?
4700mg per day
What is the therapeutic dose for iron deficiency anemia?
50-60 mg elemental iron per day
Vitamin C RDA
75-120 mg per day +35 mg for smokers
What do the dietary guidelines recommend for reducing CVD risk?
8 oz per week of seafood (about 250 mg EPA/DHA per day)
Where is calcium found in the body?
99% in bone
Vitamin D (calciferol) RDA
< 70 YO: 600 IU/day > 70 Y): 800 IU/day
What is the dietary guideline for sugar?
<10% calories per day from added sugars
What is the dietary guideline for saturated fats?
<10% calories per day from saturated fats
What are omega-3 fatty acids?
A class of polyunsaturated fatty acids
How long do probiotics last in vivo?
A few days to three weeks. Must be taken continuously to maintain effectiveness
What are common sources of omega 3 FA?
ALA- plant oils (e.g. flaxseed, soybean canola oils), nuts, leafy green vegetables DHA/EPA- fish and other seafood, krill oil, algal oil, calamari oil
What are common ADRs of probiotics?
Abdominal discomfort, flatulence, bloating May lessen effects by staring low and gradually increase dose
Calcium RDA
Adolescents: 1300 mg/day Adults: 1000 mg/day 51-70 YOF: 1200 mg/day Anyone over 70 YO: 1200 mg/day Includes dietary intake
What are rich sources of magnesium and what process removes it from food?
All unprocessed foods. Processing (removal of germ and outer layer of cereal grains) removes Mg
How does DSHEA regulate DS?
Allowed FDA to regulate DS as food products rather than prescription/non-prescription drugs. Therefore, they do not have to adhere to the same purity/potency standards or demonstrate evidence of safety and efficacy
What are rich sources of phosphorous?
Almost all foods, especially protein-rich foods and cereal grains
What are the three omega-3 FA important in the diet?
Alpha linolenic acid (ALA) Eicosapentaenonic acid (EPA) Docosahexaenoic acid (DHA) ALA is essential, EPA/DHA are non-essential but little ALA is converted to EPA/EHA so they must come from diet
What is homeopathy?
Alternative medical system largely based on principle of similars to stimulate the body's own healing responses. Often uses substances derived from plants, minerals, animals as homeopathic remedies
What is daily value (DV)?
Amount of vitamin/nutrient needed for optimum health on 2000 cal/day diet
What are dietary sources of zinc?
Animal products
Drug Interactions with probiotics
Antibiotics- concurrent administration can kill probiotic and decrease effectiveness (space doses) Immunosuppressants- might increase infection Warfarin- if probiotic alters vitamin K production it could require dose adjustments
What are the functions of Vitamin C?
Antioxidant, collagen formation, maintains cells growth, would healing, immune function
What is the function of vitamin E?
Antioxidant; protects cells from free radical damage
Recommended Dietary Allowance (RDA)
Average daily dietary intake nutritionally sufficient for 97-98% of healthy people of a particular age and gender
What are the types of B vitamins?
B1 (thiamine) B2 (riboflavin) B3 (niacin) B6 (pyridoxine) B9 (folic acid) B12 (cobalamin)
What is the proposed mechanism/hypothesis of the Paleolithic diet?
Belief that human evolution stopped 10,000 years ago. Current genetics are not compatible with modern diet or lifestyle
What are the four main adverse effects of Vitamin A toxicity?
Birth defects, liver/spleen enlargement, increased risk of osteoporosis, CNS agitation and headache
What are the functions of calcium?
Bone structure and formation, muscle function, vascular contraction/dilation, nerve transmission, intracellular signaling, hormone secretion, blood clotting
What are the similarities between the keto diet and the Adkins diet?
Both emphasize fat over carbs
How are homeopathic remedies regulated?
By the FDA like OTC drugs. Should meet standard for quality, purity, packaging, labeling. Not required to provide pre-market proof of safety or efficacy
Calcium supplements come in what forms?
Calcium carbonate (40% elemental): most common, take with food in divided doses Calcium citrate (21%): doesn't require stomach acid for absorption, unlike calcium carbonate Calcium glutinate (9.3%) *AVOID* coral calcium or dolomite due to lead contamination
What are the minor minerals?
Calcium, magnesium, phosphorous
Phosphorous has a reciprocal relationship with what other mineral?
Calcium. Both regulated by PTH
What are functions of Vitamin B2 (riboflavin)?
Cellular growth, vision, skin, nails, hair Flavoproteins FAD/FMN which are coenzymes in energy metabolism and CYP450 enzymes
What are the trace elements?
Chromium, copper, iron, selenium, zinc
What are sources of Vitamin C?
Citrus, strawberries, tomatoes, peppers Sensitive to heat, oxygen, alkaline environment
What is the function of vitamin B1 (thiamine)?
Coenzyme in carbohydrate and AA metabolism Maintains nervous system and muscle function
What is the function of vitamin B6 (pyridoxine)?
Cofactor in metabolic reactions especially important for immune and nervous system function
How are probiotics measured and what is the recommended dose?
Colony forming units (CFUs). Doses vary depending on organism and condition. Can rand from 50 million to 10 billion (more is not always better)
Integrative (CAM)
Combines natural and conventional approaches in a coordinated and purposeful way
What is the function of Vitamin B3 (niacin)?
Component of coenzymes (NAD, NADP) Role in lipid management (increase HDL, decreased LDL, cholesterol, triglycerides)
Irritable bowel syndrome
Conclusions vary but may improve overall symptoms, abdominal pain, quality of life Bifidobacterium (Align)
What is a synbiotic?
Contains both probiotic and prebiotic ingredients
What is the best strategy to ensure consumption of sufficient trace/ultratrace minerals?
Content of ultra trace minerals in food typically reflects soil content, therefore you should consume foods from a variety of geographically diverse regions
What are the types/sources of Vitamin D?
D2 (ergocalciferol) - plants D3 (cholecalciferol) - generated in skin via UV exposure, fish, fortified dairy products/cereals
What are potential health benefits of omega-3 FA (DHA/EPA)?
DHA important for fetal growth and development, neurological development (positive effect on birth weight and length of gestation) Cancer prevention (limited evidence, no consistent relationship) Dementia/cognitive function (moderate evidence) Eye disease (no good evidence) Rheumatoid arthritis (adjunct to pharmacotherapy)
What do quality assurance programs certify?
DS purity/composition, but not safety or efficacy
What are main sources of calcium?
Dairy, vegetables (broccoli), fortified foods
What are common interactions with fat soluble vitamins (DEKA)?
Decreased absorption by bile acid sequestrants, Orlistat, and mineral oil
What drugs interact with vitamin E?
Decreased by anticonvulsants Warfarin/anti-platelet drugs; may prolong PT time and increase bleeding risk
What is the proposed mechanism of intermittent fasting?
Decreased glucose levels and increased response to insulin Decreased glycogen stores Increased FA mobilization Decreased leptin Heightens level of alertness
Antibiotic associated diarrhea
Decreased incidence of C. Diff up to 66% with few ADRs Variety of strains have been studied indicating a class effect
What is the proposed mechanism of the ketogenic diet?
Decreased insulin secretion Fatty acids are converted to ketone bodies rather than glucose Ketones used as alternative fuel source
What drugs interact with Vitamin K?
Decreases effects of warfarin (must keep daily intake consistent) Depleted by chronic broad spectrum antibiotics
What drugs interact with niacin?
Depleted by estrogens, antibiotics, isoniazid May increase side effects of statins, alpha blockers, nicotine patches
What drugs interact with Vitamin B1?
Depleted by ethanol, diuretics, phenytoin
What drugs interact with Vitamin B2?
Depleted by ethanol, oral contraceptives, antibiotics
What drugs interact with pyridoxine?
Depleted by isoniazid (take 10mg B6 for every 100mg of isoniazid) Decreases the effects of phenytoin, phenobarbital, levodopa
What are symptoms of vitamin B6 (pyridoxine) deficiency?
Dermatitis, glossitis, depression, confusion, EEG abnormalities, seizures Similar to niacin/riboflavin deficiency symptoms
What are symptoms of Vitamin B2 deficiency?
Dermatologic conditions (chapped lips, skin rashes) Ocular issues (blurred vision, light sensitivity, itching/watery eyes)
What are health claims?
Describe the relationship between a supplement and a *disease or health related condition* Requires prior authorization by FDA
What are nutrient content claims?
Describes how much of an ingredient is in the product. "High, low, reduced, more, lite, etc." Most refer to nutrients with established daily value (DV)
What are structure/function claims?
Describes role of ingredient or its mechanism Must be truthful and not misleading Does not require FDA approval before marketing Must include disclaimer "Not intended to diagnose, cure, prevent disease" "Promote, help, improve a more nonspecific structure or function of the body"
What are some practical issues with fish oil supplements?
Deteriorates and can increase GI side effects. Avoid heat/light. Best tolerated with fatty meals and in divided doses Fish oil ~ 1/3 DHA/EPA
What is a common side effect of high doses of oral magnesium?
Diarrhea
What is a prebiotic?
Dietary fibers found naturally in food that alter the composition or function of microbiota in the gut (e.g. oligofructose, inulin, etc.)
What are the functions of magnesium?
Done formation, enzyme function (ATP dependednt phosphorylation, protein synthesis, carbohydrate metabolism) Maintenance of nerve/muscle electrical potentials
What factors determine efficacy of probiotics?
Dose, genus, species, strain, formulation, storage, etc. Organisms differ ability to withstand gastric acid and colonize the intestinal tract
Does Vitamin C prevent colds?
Doses > 200 mg per day may help people exposed to extremes of exercise/temperature and those with marginal Vitamin C status (elderly, smokers) May shorten duration and severity of symptoms
How should patients be counseled to take iron supplements?
Empty stomach to maximize absorption With food to decrease GI upset Divided doses (BID-TID) Titrate dose Take 2 hours before or 4 hours after antacids
What is the function of chromium?
Enhances action of insulin Marketed for weight loss, performance enhancement, type 2 diabetes
What were the findings of research using the 5:2 method of intermittent fasting?
Equivalent to calorie counting No significant differences in bio makers of lipid metabolism Short term improvement of insulin sensitivity and reduced body fat, but long term differences were not significant
What is the function of iron?
Essential part of hemoglobin and numerous enzymes Regulates cell growth and differentiation
Estimated Average Requirement (EAR)
Estimate that meets the requirement for 50% of healthy people of a certain age and gender
What is an ultra trace mineral?
Estimated dietary requirement of less than 1mg/day Arsenic, cobalt, copper, iodine, chromium, nickel, etc.
What is vitalism?
Every person has energy called a vital force or self-healing response. Health problems are caused by a disruption or imbalance of vital force
What is spina bifida?
Failure of the lower end of the neural tube to close during embryonic development which leads to lack of protection of the spinal cord. Disabilities rand from bowel/bladder control problems to paralysis
Iron deficiency presentation
Fatigue, intolerance to cold, infection
Iron supplements come in what forms?
Ferrous sulfate (20%): 325mg-65mg elemental Ferrous fumarate (33%) Ferrous gluconate (12%) Polysaccharide-iron complex Common GI side effect - take with food, divide doses, or gradually increase dose
What is the Paleolithic diet?
Foods that in the fast could be obtained by hunting and gathering (fruits, veggies, nuts/seeds, lean meats) Prohibits cereals, grains, legumes, dairy
What is the purpose of iodine supplementation for pregnant women?
For brain development and thyroid hormone production. Processed foods are predominant in the diet and contain salt that is not iodized
What are sources the B vitamins?
Fortified foods, lean mets, fish, beans, milk
How do patients normally become magnesium deficient?
GI or renal losses e.g. malabsorptive syndromes, diarrhea, diuretic therapy, etc.
What are symptoms of niacin toxicity?
GI symptoms Flushing (>50mg per day): commons side effect when used therapeutically to decrease cholesterol
What are symptoms of selenium toxicity?
Garlic-like breath
What are some recommendations to manage herbal-drug-food interactions?
Gather complete info from patient Recommend against use of DS for high risk patients Suspect interaction when patients lose therapeutic effect or experience adverse reactions Consider spacing doses, changing dose Report to Medwatch program
Are there safety concerns for probiotics?
Generally safe in healthy adults. Rare reports of infection in certain populations. Trace amounts of milk proteins (may not be on label). Use caution in pregnant women, children, immunocompromised, elderly
Who needs a supplement?
Geriatric patients, smokers, pregnant/breastfeeding women, < 1000 calories/day or limited variety diet, heavy drinkers, strict vegetarians
What is the function of vitamin A?
Growth/development, skeletal muscle, teeth, vision, bone growth, immune function
What drugs interact with vitamin B12?
H2RAs, PPIs, long term antibiotics decrease absorption High levels of folic acid may mask B12 deficiency
What are the three types of permissible claims for DS labels?
Health claims, nutrient content claims, structure/function claims
What are sources of iron?
Heme iron: red meat, fish, poultry (best source) Non-heme iron: fruits, vegetables, fortified foods (e.g. grains)
What is associated with increased calcium intake/supplementation?
Higher CV risk, prostate cancer
Tolerated upper limit (UL)
Highest level of daily nutrient intake likely to pose no risk of adverse health effect for almost all individuals in the general population *consider all sources of nutrient (both diet and supplements)*
What are effective therapeutic uses of fish oil?
Hypertriglyceridemia- effective; best evidence for patients with very high triglyceride levels > 500mg/dL Cardiovascular disease- likely effective; many studies concluded fish consumption has an impact on primary and secondary prevention
What are some benefits of the ketogenic diet?
Improved blood glucose control (short term) Faster weight loss Ability to maintain lean muscle mass
What is Wilson's disease?
Inborn error of metabolism resulting in copper retention
What are symptoms of vitamin E toxicity?
Increased bleeding risk, GI symptoms, fatigue
What are symptoms of vitamin K deficiency?
Increased bruising, bleeding
What are possible benefits of the Paleolithic diet?
Increased weight loss Increased glucose tolerance BP control Lower triglycerides Appetite management
What are some causes of vitamin B12 deficiency?
Insufficient diet (vegetarian) Achlorhydria Bariatric surgery Lack of intrinsic factor (pernicious anemia)
Which vitamins/minerals are required by pregnant women?
Iron 27 mg Folic acid 400-8000 mcg Calcium 1000mg Iodine 150 mcg
What is the most common unintentional childhood overdose?
Iron toxicity (20-60 mg/kg)
What are the sources of Vitamin K (quinone)?
K1: plants; dark leafy greens K2: animals K3: synthetic and water soluble
What are symptoms of Vitamin C toxicity?
Kidney stones, nausea, GI upset, skin rashes
What microbes are commonly found in probiotics?
Lactobacillus, bifidobacterium, sacchromyces boulardii, streptococcus thermophilus, Escherichia coli Nissile 1917
What is the dietary guideline for sodium?
Less than 2,300 mg per day of sodium
What are the omega-6 fatty aids?
Linoleic acid and arachidonic acid Found in the diet, does not need supplementation Can be mediators of inflammation, vasoconstriction, platelet aggregation
What is a probiotic?
Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (e.g. Lactobacillus, bifidobacterium)
What is the ketogenic diet?
Low carb (5%) High fat (80%) Less protein (15%)
What is the dietary guideline for grains?
Make at least half your grains whole (3-8oz equivalents)
Iron RDA
Male: 8 mg per day Female: 18 mg per day Pregnancy: 27 mg per day
What is totality of symptoms?
Malfunctions of any organ or body system can affect the entire body
What is the FDA recommendation for DHA/EPA supplements?
Max 2g per day from supplements Limit of 3g per day total for self treatment due to due to anticoagulant effect, immune suppression at high doses
Storage conditions for probiotics
May require refrigeration, keep out of heat and light, keep away from moisture. Products are white/off-white or can be pink (preservative)
What are the overall best diets?
Mediterranean DASH (dietary approaches to stop hypertension) Flexitarian MIND (Mediterranean-DASH intervention for neurodegenerative delay) Weight Watchers
What are symptoms of folic acid deficiency?
Megaloblastic anemia without neurologic symptoms, fetal neural tube defects, poor growth
What are postbiotics?
Metabolites or bacterial products of probiotics that have activity in the host independent of probiotic activity (e.g. butyrate, hydrogen peroxide, bacteriocins, etc.)
What is iron deficiency?
Most common nutritional deficiency Develops gradually --> anemia Cause include insufficient intake/absorption, blood loss, renal failure
What symptoms occur in teeth and bones if chronic over-fluoridation occurs?
Mottling of teeth (white, patchy plaques), brittle bones
What info is required on a DS label?
Must be labeled as dietary supplement (Supplement Facts section) List all ingredients Propriety blends can be used, must list ingredients in order of content, but exact amount is not required Name/location of manufacturer Contact info for submission of ADRs
What are symptoms of iron toxicity?
N/V, diarrhea, abdominal pain Weakness, tachycardia, cyanosis, convulsions, coma
What are symptoms of zinc toxicity?
N/V, diarrhea, headache, stomach cramps, anosmia from nasal sprays
What are symptoms of Vitamin D toxicity?
N/V, poor appetite, constipation, hypercalcemia, weakness, weight loss
What are symptoms of vitamin E deficiency?
Nerve/muscle degeneration, dry skin/hair, impaired wound healing Rare; most common in pts with diseases of fat absorption
Does everyone need a vitamin/mineral supplement?
No, healthy adults can get needed nutrients from food. Supplements should NOT substitute for a healthy diet.
What are the properties of water soluble vitamins?
Not stored in appreciable amounts in the body; excess intake is excreted in the urine
What is anencephaly?
Occurs with the portion of the neural tube that forms the brain does not close which results in the baby lacking parts of the brain, skull, and scalp. Remaining brain tissue is often exposed
What is primary omega-9 FA?
Oleic acid Use in place of saturated fat to improve lipids Non-essential, can be made in the body when needed
What is the "minimum number of doses" principle?
Only a small stimulus is needed to initiate healing process Dose would produce same or similar symptoms of healthy people if given in larger doses
What is the "single remedy" principle?
Only one disease processes occurs at one time despite numerous symptoms and only a single therapeutic agent is used at one time. Treatment should be individualized and based of total picture of the patient
What are the concerns with the Paleolithic diet?
Oversimplified hypothesis and lack of long term studies. Absence of dairy/grains/etc. which are key sources of fiber, vitamins, and other nutrients
What are contamination concerns with fish?
PCBs, dioxins, mercury Found in long-lived fish (king mackerel, shark, swordfish, tilefish). Avoid these in pregnancy/breastfeeding and in children
What drugs interact with iron supplements?
PPIs, antacids, fluoroquinolones, tetracyclines decrease absorption - spaces doses by 2 hours
Which patients are at a higher risk of interactions or adverse effects with DS?
Patients taking 3+ medications for chronic conditions (diabetes, HTN, depression, CHF, high cholesterol Special populations such as kidney/liver disease, children, elderly
What are symptoms of pyridoxine toxicity?
Peripheral neuropathies and sensory ataxia (>500mg per day)
What drugs interact with vitamin D?
Phenobarbital, phenytoin, carbamazepine: increase vitamin D metabolism Corticosteroids: decrease vitamin D metabolism
What production issues cause variability between products and effect their safety/efficacy?
Plant species and products, method of preparation, standardization, etc.
In what populations is copper deficiency likely to occur?
Premature infants, severely malnourished infants fed milk-based, low copper diets Patients receiving parenteral nutrition with inadequate copper
What are reasons to take a vitamin/mineral supplement?
Prevent deficiencies, replenish depleted stores, maintain present nutritional status
What is the primary benefit of fluoride supplementation?
Prevents dental carries by making enamel more resistant to erosive action of acids produced by bacteria in the oral cavity
What are the principles of homeopathy?
Principle of Similars Vitalism Totality of symptoms Single Remedy Potentization Minimum number of doses
What is the principle of potentization?
Process used to prepare homeopathic remedies. Serial dilution. Remedy is more effective by extracting the vital essence of the substance 1X potency - 1:9 dilution 1C potency- 1:99 dilution High potency- 30X or greater Low potency- 15X or lower
What are some mechanisms of probiotic action?
Produce antimicrobial molecules, promote production of anti-inflammatory cytokines (immune modulation) and enhance mucosal barrier integrity
What is the function of Vitamin B12 (cobalamin)?
Production of DNA and myelin, energy metabolism, maintains nerve cells and RBCs
How does the FDA define dietary supplements?
Products intended for oral use only and for supplementing the diet. However, many consumers use DS to maintain health/wellness and to treat symptoms of medical conditions
What is the primary function of iodine in the body?
Provides thyroxine and triiodothyronine (hormones which regulate metabolic rate of cells)
What is the function of folic acid?
RBC maturation, purine/pyrimidine bases and methionine synthesis, development of fetal nervous system
Adequate intake (AI)
Recommended intake based on approximations or estimates for a group of healthy people when and RDA cannot be calculated
What are the functions of Vitamin D?
Regulates calcium/phosphorous Promotes reabsorption and modulates bone mineralization Involved in calcium homeostasis with PTH and calcitonin PTH/Vitamin D pull calcium out of bone Calcitonin promotes deposition of calcium in bone
What are symptoms of vitamin K toxicity?
Relatively non-toxic and therefore there is no recommended UL
What are symptoms of folic acid toxicity?
Relatively nontoxic but may mask B12 deficiencies at high doses, which is why we set the UL at 1000 mcg/day
What are the properties of fat soluble vitamins?
Require bile for absorption; excess intake is stored in body fat and can accumulate to toxic levels Absorption is compromised with liver disorders
What is a vitamin?
Required in small amounts as cofactors for essential biochemical reactions Not produced in sufficient quantities endogenously Do not directly supply energy (calories)
What non-GI indications for probiotics are being studied?
Respiratory infections, allergy, psychiatric disorders, obesity, etc
What are the sources of vitamin A?
Retinol (active form) from animal sources and beta-carotene (precursor) from plant sources
What is an RAE?
Retinol activity equivalent; accounts for differences in bioactivity of different form of vitamin A 1 RAE = 12 mcg of beta carotene 1 RAE = 1 mcg retinol
What are symptoms of Vitamin D deficiency?
Rickets, osteomalacia, osteoporosis
Lactobacillus probiotics are most likely effective for...?
Rotaviral diarrhea (strongest evidence in children) All other indications are *possibly effective*
What are symptoms of Vitamin C deficiency?
Scurvy, dry skin/hair, gingivitis, poor wound healing, increased infection, anemia, bone fragility, atherosclerotic plaques
What is common practical issue with probiotics?
Stability. CFUs will decrease over time (50-90% loss of activity from manufacture to expiration date). Label should say viable count of each strain at end of shelf life
Where is iodine primarily found in the body?
Stored as thyroglobulin in the thyroid gland
Acute infectious diarrhea
Strongest evidence in children. Lactobacillus (e.g. Culturelle) and S. Boulardii (Florastor)
What is the function of Vitamin K?
Synthesis of clotting factors and anticoagulant proteins Activates osteocalcin that has a role in bone mineralization
What are general recommendations for vitamin/mineral use?
Take less than 100% of RDA unless recommended by health professional No standard formulation Quality varies greatly Price is not a good measure of quality
What drugs interact with calcium?
Tetracycline, iron, fluoroquinolones bind calcium and prevent absorption PPI/H2RAs decrease absorption of calcium carbonate
What is the difference between the keto diet and the Adkins diet?
The keto diet is more restrictive and difficult to maintain while the Adkins diet introduces flexibility and a wider range of foods over time.
Where is microbial colonization most rich?
The large intestine is richly colonized with a diversity of microbes
Are enteric coated or sustained release products recommended to prevent GI upset from iron supplements?
They have reduced absorption, as there are primarily absorbed in the duodenum where pH is more basic
What are symptoms of Vitamin B3 (niacin) deficiency?
Three D's Dermatitis Dementia Diarrhea
What are symptoms of iodine deficiency?
Thyroid hypertrophy, goiter, hypothyroidism
What drugs interact with folic acid?
Trimethoprim and methotrexate are folic acid antagonists Phenytoin and related anticonvulsants prevent absorption
Complementary (CAM)
Use of natural products *in addition* to conventional medicine
Alternative (CAM)
Use of natural products *in place* of conventional medicine
IBD (ulcerative colitis, Crohn's)
VSL #3 (classified as medial food; not a self care product, recommended by prescriber) has effectiveness for UC but not Crohn's
What type of diet impairs zinc absorption?
Vegetarian diets rich in fiber and phytates hinder zinc absorption
What are symptoms of Vitamin A deficiency?
Vision changes (poor night vision, xerophthalmia) Decreased immune function Slowed growth in children Often linked to zinc deficiency
What are the water soluble vitamins?
Vitamin B complex, folic acid, Vitamin C, biotin
What is pernicious anemia?
Vitamin B12 deficiency anemia Autoimmune diseases can damage parietal cells in GI that produce intrinsic factor (IF) which prevents absorption of B12
What are the fat soluble vitamins?
Vitamins D, E, K, A
What are symptoms of Vitamin B1 deficiency?
Wernicke's encephalopathy (associated with alcoholism) Korsakoff syndrome Beriberi
Vitamin A RDA
Women: 700 mcg/day Men: 900 mcg/day
What is the primary function of zinc?
Wound healing, immune function, serves as a cofactor for DNA/RNA synthesis, sense of smell and taste
What is the function of selenium?
antioxidant
What is the primary dietary source of iodine?
iodized salt
What are symptoms of Vitamin B12 deficiency?
megaloblastic anemia, loss of coordination, peripheral neuropathies, weight loss, constipation
What are sources of vitamin E?
vegetable oils, nuts, seeds, wheat germ, fortified foods
What is intermittent fasting?
16/8 - fast for 16 hours of the day and eat during the other 8 hours 5:2 - normal eating 5 days a week and minimal eating the other 2 days
What is the dietary guideline for protein?
2-6.5 oz equivalents; lean protein
What is the distribution of magnesium in the body?
200 mEq in the average 70kg adult 50% in bone 45% intracellular 1-5% extracellular
Calcium UL
2500 mg/day
What is the normal fluoridation level of municipal water supplies?
2ppm
What is the dietary guideline for dairy?
3 cups per day to provide calcium, vitamin D
What are some concerns with the ketogenic diet?
"Keto flu" (headache, fatigue, irritability) Kidney stones, liver disease, vitamin/mineral deficiencies (long term) Disease state interactions and therapeutic alterations (e.g. diabetes, BP management)
What is the principle of similars?
"Like cures like" Substances that trigger symptoms in a healthy patient will cure similar symptoms in the sick
What is the dietary guideline for fruits?
1-2 cups per day
What is the dietary guideline for vegetables?
1-3 cups per day; include a variety of vegetables from all 5 subgroups (dark green, red/orange, starchy, beans/peas, other)
Stages of Vitamin Deficiency
1. Inadequate intake, synthesis, absorption of nutrients 2. Depletion of nutrient stores 3. Biochemical changes 4. Physical manfestations of nutrient deficiency 5. Morbidity and mortality
What is adulteration according to DSHEA?
1. Presents significant/unreasonable risk of illness/injury when used in accordance with suggested labeling 2. New entity lacking adequate evidence to ensure safety of use 3. Declared imminent hazard by DHHS 4. Contains ingredient present in sufficient quantity to be poisonous or deleterious to human health Can be intentional or unintentional
Folic acid UL
1000 mcg per day
What is the AI for dietary fiber?
14g per 1000 calories or about 28g per day