Advanced Ii Exam, Vitamins D & E

Front 1

Vitamin E was discovered when?

Back 1

1922

Front 2

The latin word "tokos" means _________.
The latin word "phero" means _________.

Back 2

Tokos= childbirth
Phero= To bring forth

Front 3

T/F: Vitamin E comes from plant and meat sources.

Back 3

TRUE

Front 4

Name some sources of vitamin E.

Back 4

*Plant oils including anola, olive, sunflower, safflower, corn, and cottonseed.
*Whole grains
*Legumes
*Some fruits and vegetables
*High-fat meats

Front 5

In what sources are the highest amounts of vitamin E found?

Back 5

*Wheat germ oils (192 mg/100 g)
*Sunflower oil (51 mg/100 g)
*Safflower oil (43 mg/100g)
*Cottonseed oil (38 mg/100g)

Front 6

Vitamin E is stored mostly where?

Back 6

Adipose

Front 7

Vitamin E is absorbed primarily in what part of the small intestine?

Back 7

The jejunum

Front 8

The jejunum uses what type of diffusion to absorb vitamin E?

Back 8

Non-saturable, passive diffusion

Front 9

What transports vitamin E from the small intestine to the liver?

Back 9

Chylomicrons

Front 10

**The liver recirculates some vitamin E in ______ to periphery.

Back 10

VLDL

Front 11

SLIDE 6

Back 11

......

Front 12

What did Dr. Root consider the "bad guys" to be?

Back 12

Oxygen; free radicals

Front 13

What did Dr. Root consider the "hero" to be?

Back 13

Alpha-tocopherol

Front 14

When considering the activities of tocopherols, which tocopherol has the highest relative activity?

Back 14

Alpha-tocopherol (relative activity of 1.00)

Front 15

List the remaining types of tocopherols in descending order of relative activity.

Back 15

Alpha (1.00)
Beta (0.20)
Gamma (0.10)
Delta (0.01)

Front 16

SLIDE 11

Back 16

......

Front 17

***Explain the process of lipid peroxidation.

Back 17

......

Front 18

***Explain the process of termination.

Back 18

......

Front 19

The "singlet oxygen" involves what?

Back 19

UV light

Front 20

What happens when we get free radicals in the lipids?

Back 20

Lipid peroxidation

Front 21

Who needs vitamin E?

Back 21

Everyone who breathes and has mitochondria/

Front 22

Who is at risk of deficiency?

Back 22

It is hard to find vitamin E deficiency.
Obese people could have deficiency (because the adipose tissue absorbs vitamin), as well as premature babies. Also, people who don't eat whole grains, vegetables, oils, or nuts.

Front 23

What about athletes? Don't they breathe more air?

Back 23

Athletes seem to not require more vitamin E than normal.

Front 24

Oxidized LDL is a precursor to what?

Back 24

Atherosclerosis

Front 25

In vito and human trials, tocopherols protect against oxidation of _____.

Back 25

LDL

Front 26

Oxidation damage to DNA causes what?

Back 26

Mutations that can lead to cancers.

Front 27

Vitamin E has been shown in vito and animal studies to do what?

Back 27

To reduce free radical damage and DNA mutations.

Front 28

Epidemiologic studies show that people with high vitamin E intake have....

Back 28

Lower chronic diseases

Front 29

HOWEVER, clinical trials with high doses of pure alpha-tocopherol have FAILED to prevent what?

Back 29

Heart disease or cancer

Front 30

For doses of over 300 mg/day, what was the result?

Back 30

Death increased by 4% compared to no vitamin E

Front 31

What is the conclusion then- In regards to vitamin E and chronic disease?

Back 31

Eat a balanced diet with lots of food high in vitamin E

Front 32

What is the RDA for vitamin E in adults (including pregnancy)? Lactation?

Back 32

15 mg of alpha-tocopherol
*Lactation= 19 mg

Front 33

T/F: Vitamin E deficiency is common.

Back 33

FALSE; Vitamin E deficiency is very uncommon

Front 34

Give some detail about Familial Isolated Vitamin E Deficiency.

Back 34

It is autosomal recessive, missing alphaTTP, and creates ataxia.

Front 35

What is the UL for vitamin E?

Back 35

1000 mg alpha-tocopherol

Front 36

What are some symptoms of vitamin E toxicity?

Back 36

Slows blood clotting and increases brain hemorrhages.

Front 37

Why did alpha-tocopherol supplements fail in trials to prevent cancer and heart disease?

Back 37

We don't really know- Possibly the wrong form.

Front 38

What should we recommend to patients?

Back 38

Eat whole grains, fruits, and vegetables.

Front 39

A patient has an extremely high alpha-toco and low beta and gamma-toco. What's up?

Back 39

Part of it could be natural-body selection; Or the patient is taking a supplement. They are probably supplementing with alpha-toco.

Front 40

What is the normal range for plasma concentrations?

Back 40

5-20 ug/mL

Front 41

What amount in the plasma concentration is considered possibly deficient?

Back 41

Less than 5 ug/mL

Front 42

What is an erythrocyte hemolysis test?

Back 42

A functional test that shows a biological response to a nutrient level.

Front 43

How does the erythrocyte hemolysis test work?
What determines deficiency?

Back 43

Isolated RBC's are mixed with dilute hydrogen peroxide. If greater than 20% of RBC's are lysed (or broken open), then they are deficient.

Front 44

What is the primary source of vitamin D?

Back 44

Synthesis in skin by UVB in sunlight from 7-dehydrocholesterol.

Front 45

T/F: You can overdose from sunlight & 7-dehydrocholesterol.

Back 45

FALSE; you cannot overdoes

Front 46

What are some food sources of vitamin D?

Back 46

Liver, beef, veal, eggs, dairy, some saltwater fish (such as cod liver oil).

Front 47

Some vitamin D fortified foods include...

Back 47

Milk, OJ, and cereals

Front 48

Dietary vitamin D is absorbed from what?

Back 48

Micelles

Front 49

After being absorbed from micelles, vitamin D is incorporated into _________ for transport.

Back 49

Chylomicrons

Front 50

T/F: We have 7-dehydrocholesterol in our skin right now.

Back 50

TRUE

Front 51

Previtamin D3 can be broken down into _________ or __________.

Back 51

Broken down into vitamin D3 or tachysterol.

Front 52

When previtamin D3 is broken down into tachysterol, what is it protecting us from?

Back 52

It protects us from getting overdosed with vitamin D from the sun.

Front 53

We can overdose when...

Back 53

We have too much vitamin D in a supplement.

Front 54

Another name for vitamin D2 is what?

Back 54

Ergocalciferol

Front 55

Another name for vitamin D3 is what?

Back 55

Cholecalciferol

Front 56

Vitamin D2 is found where?

Back 56

In mushrooms and yeast.

Front 57

T/F: Vitamins D1, D2, and D3 are very similar in metabolism, use, and potency.

Back 57

TRUE

Front 58

T/F: Vitamin D's are getting a lot less toxic over time.

Back 58

TRUE

Front 59

Cholecalciferol (D3) diffuses from skin into blood and picked up by __________ for transport to the liver.

Back 59

Vitamin D-binding protein (DBP)

Front 60

What happens once D3 arrives in the liver?

Back 60

It is metabolized to 25-OH D3, or CALCIDIOL.

Front 61

Once it is metabolized to 25-OH D3, it is secreted where? What is it transported by?

Back 61

Secreted into the blood, and transported by DBP

Front 62

It is stored in the blood until ready to be used. Then it goes where?

Back 62

The kidneys

Front 63

Kidneys convert calcidiol to what?

Back 63

1, 25-(OH)2 D3, or CALCITRIOL.

Front 64

Calcitriol is again transported in blood via _____.

Back 64

DBP

Front 65

___________ is the active form (and hormonal form) of vitamin D.

Back 65

Calcitriol

Front 66

What is calcitriol's half life?
What about calcidiol?

Back 66

Calcitriol= 4 to 6 hours
Calcidiol= 10-20 days (hangs out in blood for longer!)

Front 67

SLIDE 5

Back 67

....

Front 68

Why is serum calcidiol a good marker for vitamin D status?

Back 68

It is a good way to measure vitamin D status because it is a blood value. Calcidiol is good to measure because it is the storage form in the blood and also very convenient.
*Also has a stable half life (2-3 weeks)

Front 69

Why isn't vitamin D fortification of skim milk and OJ working?

Back 69

They don't have fat to solubilize the vitamin. If you fortify full fat milk, vitamin D knows how to absorb. In skim, the vitamin D sticks to the bottle.

Front 70

Kidney dialysis patients often get calcitriol doses. Why?

Back 70

If the kidneys aren't working and blood isn't going to the kidneys, the body is no longer making the calcitriol form.
*Kidney dialysis patients also have poor calcium levels due to the lack of calcitriol.

Front 71

Black women require more vitamin D. Why?

Back 71

The melanin in their skin blocks the sun and absorption of UV rays; vitamin D isn't created as much because of this. Black women have much higher risk of deficiency than white women.

Front 72

Obese people require more vitamin D. Why?

Back 72

Because the vitamin D goes to adipose tissue, so with more adipose, more vitamin D is required. Adipose absorbs fat-soluble vitamin D.

Front 73

Which is better for you: 10 minutes in the noon sun or a glass of fortified 2% milk?

Back 73

The sun is definitely better- 15 minutes of sun gives you a week's worth of vitamin D.

Front 74

A client goes to a tanning bed to get her vitamin D. Good idea or not?

Back 74

NOT, the rays in the tanning bed are called UV A, which are way more energetic than the sun's rays (200-270) and puts you at more risk for skin cancer. The best rays for vitamin D are UV B rays (290-300).

Front 75

A client just got a sunburn and is now convinced that he has overdosed on vitamin D. Any advice?

Back 75

The body is getting rid of extra vitamin D from the sun- Not a worry.

Front 76

T/F: Vitamin D is currently one of the most researched vitamins.

Back 76

TRUE

Front 77

What are some functions and mechanisms of vitamin D? Include 3.

Back 77

1. Calcium homeostasis
2. Cell differentiation, proliferation, and growth
3. Other possible roles- BP control, autoimmune disorders, insulin secretion.

Front 78

T/F: Vitamin D has a similar mode of action to vitamin A in many tissues of the body.

Back 78

TRUE

Front 79

1-hydroxylase is found where?

Back 79

Breast, prostate, and other tissues

Front 80

SEE SLIDE 9!

Back 80

...

Front 81

Why do vitamin D supplements not help people with osteoporosis much?

Back 81

They aren't helping osteoporosis because damage has already been done. Women who were measured as vitamin D deficient DID benefit from vitamin D supplements; However, if the women had enough vitamin D already, more vitamin D did not help the absorption of calcium.

*The theory is that osteoporosis is not a calcium and vitamin D deficient disease, but a hormone disease.

Front 82

Women start losing bone at what age?

Back 82

30+ years

Front 83

What is the primary preventative action for osteoporosis?

Back 83

Exercise (especially upper body)
Hormone replacement therapy.

Front 84

Vitamin D receptors are in the ________.
They bring messages where?

Back 84

In the intestines.
Bring messages to enterocytes.

Front 85

Vitamin D lowers what?

Back 85

Angiotensin II and blood pressure

Front 86

At sufficient blood levels, vitamin D lowers _____ and raises _____.
(Effects heart disease)

Back 86

Lowers LDL, and raises HDL

Front 87

Inadequate vitamin D may lead to what?

Back 87

Autoimmune diseases such as Crohn's and type I diabetes.

Front 88

Where do autoimmune diseases tend to be at greater risk?

Back 88

Higher latitudes.
*People near equator have lower risk because of more sun exposure.

Front 89

What is the RDA for 1-70 years?
Older than 70?

Back 89

1-70 years is 15 ug or 600 IU
*Over 70 is 800 IU

Front 90

How many IUs are equivalent to 1 ug?

Back 90

1 ug = 40 IU!!!!

Front 91

Why does the RDA requirements cause an issue?

Back 91

Because the majority of vitamin D comes from the sun. In older adults, there is less sun exposure.

Front 92

Vitamin D deficiency is what?

Back 92

Rickets & osteomalacia

Front 93

What vitamin D deficiency occurs in children?

Back 93

Rickets

Front 94

What are the effects of rickets on children?

Back 94

Seizures, growth retardation, and bones don't mineralize.

Front 95

What are the effects of osteomalacia?

Back 95

Bone mineralization defects; Causes a LOT of pain

Front 96

Rickets is most common in what demographic?

Back 96

African American children

Front 97

T/F: African Americans need less sun than other demographics.

Back 97

FALSE; African Americans need more!

Front 98

What is the UL for vitamin D?

Back 98

100 ug or 4000 IU

Front 99

Is toxicity of vitamin D a concern?

Back 99

NO; Study showed that 10000 IU per day for 5 months caused no toxicity.

Front 100

What is hypercalcemia?

Back 100

Calcification of soft tissue

Front 101

What is the effect of too much vitamin D on hypercalcemia?

Back 101

Too much vitamin D bring too much calcium; The calcium deposits itself where it shouldn't (such as the arteries).

Front 102

Plasma concentration of 25-OH D3 of what range is considered normal?

Back 102

30-80 ng/mL

Front 103

Plasma concentration of 25-OH D3 of what is considered deficient?

Back 103

Less than 20 ng/mL

Front 104

About how many people are marginal or deficient worldwide?

Back 104

About 1 billion
*Not getting vitamin D from the sun

Front 105

HIGH or LOW blood calcidiol is associated with reduced auto-immune diseases.

Back 105

HIGH

Front 106

Give some factors for the "Rickets Perfect Storm"

Back 106

African American mother
Overweight
Lactose intolerant
Exclusively breastfeeding
No supplements for mom or baby
No intentional sun exposure
Increased soda with phosphorus
Live at high latitude

Front 107

Give some factors for the "Osteomalacia Perfect Storm"

Back 107

Decreased 7-dehydrocholesterol
Decreased 1-hydroxylase
Less appetite= less dietary vitamin D
Less sunshine
Less fluid milk
Existing osteoporosis
Exercising less

Front 108

Who should be getting supplements?

Back 108

Black women, eldery, young children, people living at higher latitudes

Front 109

What do you say to dermatologists who insist on constant sunscreen?

Back 109

Chill- 15 minutes a day won't kill you!

Front 110

As a public health official, how would you improve the vitamin D status of American's especially vulnerable groups?

Back 110

Supplements for targeted population. Exercise and getting outdoors more for others.