Micronutrition Part 2

Front 1

vit E is absorbed in chylomycrons and then taken to the liver where it is inserted into...

Back 1

VLDL

Front 2

The most dominant of all vit E forms and most potent in the body

Back 2

alpha-tocopherol

Front 3

these molecules are cleaved in the gut to form regular vit E

Back 3

acetate (which along w/ succinate is derived from D-alpha fom of Vit E)

Front 4

this form of vit E consists of unsaturated isoprenoids or farnesyl side chains

Back 4

tocotrienols

Front 5

what is the name of the mixed tocotrienol product?

Back 5

tocomin

Front 6

what are the food sources for tocotrienols?

Back 6

oil fraction of rice bran, palm fruit, barley and wheat germ

Front 7

tocotrienols reduce this lipoprotein which inhibits adhesion molecules VCAM-1 and ICAM-1?

Back 7

lp(a)

Front 8

tocotrienols appear to inhibit this enzyme by increasing farnesol which downregulates this enzyme...

Back 8

HMG CoA reductase

Front 9

Most vit E supplements are made from

Back 9

soy oil

Front 10

RDA and therapeutic dosing for vit E

Back 10

RDA - 30 IU/day
(T) - 200-3000 IU/day
15 mg = 22IU nat. vit E, and 33 of synthetic vit. E

Front 11

vit E deficiency

Back 11

- increase in RBC fragility
- can become deficient in fat (malabsorption syndromes)
- dermatitis, dry skin

Front 12

vit E toxicity

Back 12

- nausea, vomiting, diarrhea, elevated triglycerides
- very high doses can have concern with increasing BP
- increased bleeding

Front 13

Vit E Therapeutics

Back 13

-CVD- anti-coagulant, lowering lipids
-fibrocystic breast disease
-menopause hot flashes (1200-1600 IUs)
-clotting disorders
-anti-inflammat. (gamma-tocopherol)
-lowers cholesterol (tocotrienols)
-antioxidant
-intermittent claudication
-restless leg syndr

Front 14

Vit E Therapeutics

Back 14

-CVD- anti-coagulant, lowering lipids
-fibrocystic breast disease
-menopause hot flashes (1200-1600 IUs)
-clotting disorders
-anti-inflammat. (gamma-tocopherol)
-lowers cholesterol (tocotrienols)
-antioxidant
-intermittent claudication
-restless leg syndr

Front 15

vit E might have an interaction w/ this drug...

Back 15

coumadin

Front 16

what substances decrease vit E absorption?

Back 16

antacids, cholestyramine, colestipol, alcoholism, mineral oils, tobacco, sucralfate

Front 17

what's the active form of cholesterol?

Back 17

calcitriol - 1,25 dihydroxyvitamin D

Front 18

what's the main source iof vit D3 (cholecalciferol)?

Back 18

-sunlight and diet
It's also the preferred form of suplementation

Front 19

what is the source of vit D2 (ergocalciferol)?

Back 19

plant sterols
it's common in supplements

Front 20

what does UV-beta sunlight react with to make previt. D3

Back 20

epidermal 7-dehydrocholesterol

Front 21

Vit. D Actions

Back 21

-induces osteoclast maturation for bone resorption
-promotes calcium deposition in bone
-reduces PTH (healthier)

Front 22

increased PTH, which leads to increased intracell. calcium leads to...

Back 22

DM, cancer, DJD, neurological diseases

Front 23

cells in what tissues take up 25-OH-D to make their own calcitriol?

Back 23

In breast, prostate, lung, skin, lymph nodes, colon, pancreas, adrenal medulla and brain

Front 24

Aside from reducing inflammation, calcitriol...

Back 24

supresses autoimmune rxns, and regulates transcription of numerous genes, esp. those associated w/ differentiation and proliferation (reduces risk for cancer (skin and colon)
-reduces risk of infectious disease (i.e. flu in mental asylum)

Front 25

vit d Therapeutics
(good for the heart and bones)

Back 25

-rickets
-osteomalacia
-osteoporosis
-chronic skeletomuscular pain
-prevent CVD
-prevent HTN
-bone fractures
-osteoarthritis
-MS
-diabetes
-psoriasis
-depression SAD
-migraines
-epilepsy

Front 26

PCOs supplementation w/ ____ mg of Ca per day and ___ IUs of Vit D2 weekly normalized the menstruation/fertility of all women in study...

Back 26

1,500 mg, 50,000 UIs respectively

Front 27

patient suffering from M/S pain received ____ IUs of Vit D in order to resolve M/S (with 100 % success) for ____ months

Back 27

5k-10k; for 3 months

Front 28

seniors make ___ less vit D with sun exposure than 22-30 yr olds.

Back 28

1/3

Front 29

what are the 2 other names that ergochalciferol is know for and what's their dosage?

Back 29

calciferol, dristol
100-500k IUs

Front 30

This substance is used therapeutically in cases of liver diseases and anticonvulsant induced osteomalacia. Give the dosage...

Back 30

calciferol or calderol
20 or 50 mcg

Front 31

this form of vit D is used in nephrotic syndrome, renal failure, and severe malabsorption. What dosage is used?

Back 31

calcitriol, calciiex, rocaltrol
0.25 mcg or 0.5 mcg

Front 32

This is the synthetic analog of vit D2. What is its dosage and when is it used?

Back 32

Dihydrotachysterol (DHT, Hytakerol)
tablets: 0.125, 0.2, and 0.4
solution: 0.2 mg/ml
capsules: 0.125 mg

It is used to correct idiopathic or post surgical hypocalcemia when more rapid action is necessary

Front 33

treatments for patients with severe Vit D defficiency

Back 33

-50k IUs orally once or twice a week for up to 2 months
-daily 6000-10k IUs/day

Front 34

moderate to mild Vitamin D defficiency

Back 34

-50k IUs/week for 2 months
-daily dosage of 4k-8k IU/day

Front 35

which forms of vit D are used as a last resort in case that ero- and cholecalciferol don't work.

Back 35

Rocatrol or calcijex

Front 36

How long do you monitor patient with abnormal indices after beginning vit. D replacement to mae sure that levels normalize?

Back 36

6-8 weeks

Front 37

vit D toxicities can occur at levels ...

Back 37

>40k IUs/day for wks/months

Front 38

Sx of Vit D toxicities

Back 38

N/V, poor appetite, constipation, weakness, weight loss, polyuria, polydipsia, nervousness
High levels of calcium --> confusion, heart arrythmias and tissue calcinosis

Front 39

vit. K deficiency symptoms

Back 39

-hemorrhagic disease of the newborn
-clotting problems
-osteoporosis
-bleeding in urine, stool, nosebleeds, bleeding gums, and heavy menstrual bleeding

Front 40

vit. K may have interactions with what drugs?

Back 40

-warfarin, coumadin (do not supplement above 100 mcg/day)
-pregnant women on anticonvulsants, rifampin, INH
-cephalosporins and salicylates may decrease vit. K recycling
-cholestyramine, cholestipol, orlistat, mineral oil, olestra,

Front 41

This is the fat lipid soluble ester of Vit. C used as an antioxidant which prevents peroxidation and is likely broken down in gut and absorbed as sat fat and vit C.

Back 41

ascorbyl palmitate

Front 42

This is the fat lipid soluble ester of Vit. C used as an antioxidant which prevents peroxidation and is likely broken down in gut and absorbed as sat fat and vit C.

Back 42

ascorbyl palmitate

Front 43

What plant contains the highest amount of vit.C?

Back 43

rosehips (7gms/100gms of fruit)

Front 44

where is vit C found in the body?

Back 44

High in pituitary, adrenals, wbc, brain.

Front 45

what's the % of vit C absorbed when comsuming 30mg, 180 mg, 1-1.5 gm?

Back 45

100%, 70-90%, and 50% respectively

Front 46

axns of vit C

Back 46

-reducing agent
-boosts immune sys.
-anti-oxidant
-cofactor in L-Carnitine biosynthesis and catecholamine NTs and O-3 --> EPA
-anti-histamine
-involved in biosynthesis of elastin, fibronectin, proteoglycans, collagen gene expression
-involved in normal c

Front 47

Vit C therapeutics

Back 47

-cataract prevention
-wound healing
-diabetes
-gout
-env. toxicities
-tobaco smokers and alcoholics
-infertility
-cancer
-elevated lipids
-schizophrenia
-periodontal disease
-allergies
-frequent colds and flus
-antioxidant protection
-cancer
-strengthen b

Front 48

vit C deficiency

Back 48

Scurvy--weakness; muscle fatigue; connective tissue degeneration; easily bruised skin; soft, swollen, bleeding gums; decreased wound healing, osteoporosis, anemia.

Front 49

dosage required to rpevet scurvy

Back 49

5-10 mg/day

Front 50

25% of Vit C can be lost by boiling or steaming foods, by freezing and unthawing of fruits and veggies

Back 50

25

Front 51

Cooking veggies for 10-20 minutes can cause ___% Vit C loss.

Back 51

50

Front 52

Canned and reheated veggies can lose __% of their Vit C.

Back 52

33

Front 53

Doses of vit. C above gut absorption tolerance will cause

Back 53

osmotic diarrhea

Front 54

vit C interactions

Back 54

-regenerates vit E
-These can decrease Vit C body stores: cigarette smoke, OCP, NSAIDs, corticosteroids, sulfa drugs, barbituates.
-G6PD—definitely watch Vit C intake, particularly with IVs, which mainly are contra-indicated.

Front 55

Human studies have shown that this substance can raise TPP levels up to 120-430% vs. regular thiamin.

Back 55

benfotiamine

Front 56

Found in crushed leeks, onions, garlic (Allicin family)

Back 56

allithiamine

Front 57

This substance is fat soluble and therefore more absorbable than regular thiamine

Back 57

benfotiamine

Front 58

benfotiamine increases this enzyme's activity which blocks glucose induced damage

Back 58

transketolase

Front 59

This substance cause oxidative cellular destruction all over the body and enhances hexosamine pathways

Back 59

Advanced Glycosylated End-Product formation (AGE) of benfotiamine

Front 60

benfotiamine helps this pathway which decreases aldose reductase, sorbitol concentrations

Back 60

benfotiamine

Front 61

therapeutic indications for benfotiamine include...

Back 61

-diabetic neuropathy
-diabetic retinopathy
-diabetic nephropathy

Front 62

what pathways is thiamine involved in..

Back 62

The citric acid pathway
The Pentose Phosphate pathway

Front 63

Thiamine is a cofactor for these rxns needed to turn ______ into ribonucleotides, ATP, GTP, nucleic acids, DNA, RNA, NADPH

Back 63

ribose-5-phosphate

Front 64

signs for increased need for thiamine

Back 64

fever, prego, growth spurts, high physical exertion/injuries

Front 65

Excessive thiamin loss from body results in

Back 65

Kidney failure and/or diuretic use.

Front 66

anti-thiamin factors in diet include

Back 66

-High coffee, tea, betel leaves
-Raw seafood or shellfish - contain thiaminase which is broken down by cooking.

Front 67

This disease is associated with alcoholics and vegans eating white rice. It Causes nerve degeneration, nerve tingling, poor coordination, muscle pain, confusion, heart problems, anorexia, constipation, nausea, depression, fatigue.

Back 67

Beri-beri

Front 68

this condition involves heart and circulatory system-->sodium and water retention, heart failure, peripheral vasodilation with increased cardiac output.

Back 68

"wet" beri-beri

Front 69

this disease affects peripheral nervous system-->paresthesias of toes, burning feet, loss of ankle/foot reflexes, footdrop, toedrop, calf muscle tender/cramps.

Back 69

"dry" beri-beri

Front 70

this condition is due to this vit. deficiency (due to alcoholism)--> Mental confusion, uncoordinated or paralyzed eye muscles, ataxia.

Back 70

cerebral Beri-beri or Wernicke-Korsakoff Syndrome

Front 71

Vit B1 therapeutics

Back 71

-Deficiency in B1
-Neuropathy in Diabetics--particularly the allithiamine form.
-Depression and/or Anxiety and/or cognition
-Antioxidant--protecting brain against damage, even from lead.
-Kidney protection
-In all alcoholics and vegans.
-Congestive hea

Front 72

what substance can lower thiamine levels?

Back 72

Phenytoin

Front 73

This substance can inhibit the phosphorylation of thiamin to TPP

Back 73

5-FU

Front 74

what's the active form of riboflavin?

Back 74

riboflavin-5-phosphate

Front 75

Riboflavin turns urine this color...

Back 75

bright yellow/green

Front 76

Riboflavin is a precursor for what 2 coenzymes?

Back 76

flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD):

Front 77

FMN and FAD's actions include...

Back 77

-Involved in redox reactions
-Energy Production--CHO, PRO, Fats
-Cofactor in production of reduced glutathione (needs FAD containing enzyme glutathione reductase).
-Helps with homocysteine metabolism: FAD and FMN are needed as cofactors in enzymes involv

Front 78

This vitamin seems to aid iron absorption, decrease intestinal loss of iron, and aid synthesis of hemoglobin.

Back 78

B2

Front 79

This vitamin is needed to form Flavin Dependent Enzyme pyridoxine-5-phosphate oxidase which is needed to convert Vit B6 to ___

Back 79

vit B2, P5P

Front 80

This vitamin is needed to make Flavin Dependent Enzyme Kyurenine monooxygenase which is needed to convert Tryptophan to ___.

Back 80

vit B2, NAD and NADP

Front 81

This vitamin is needed to make this enzyme which is needed to synthesize folate coenzyme which catalyzes what reaction?

Back 81

vit B2, homocysteine-->methionine.

Front 82

B2 deficiency is also referred to as..

Back 82

ariboflavinosis

Front 83

signs of ariboflavinosis

Back 83

-Glossitis, cheilosis, angular stomatitis
-Dermatitis, inflammed eyelids
-Photophobia, sore throat
-Increased lipid peroxidation
-Normochromic normocytic anemia

Front 84

etiology or causes for B2 deficiency

Back 84

-From dietary inadequacy or anorexia
-chronic liver disease
-ETOHs,
-TPN* patients.
-Light therapy in newborn jaundice can increase B2 breakdown
-Dairy allergy/Lactose intolerance--dairy is a good source of B2.
-Hypothyroidism and Adrenal insufficiency

Front 85

B2 toxicities

Back 85

None known except for diarrhea and polyuria in doses of 400 mg/day in two people.

Front 86

B2 Therapeutics

Back 86

-Treat Deficiency
-Prevent cataracts
-Acne rosacea
-Migraines--400 mcg/day.
(Theory: Migraine etiology related to impaired mitochondrial oxygen metabolism in brain.
FMN and FAD are needed by flavoproteins in the mitochondria for proper functioning of the

Front 87

B2 Therapeutics

Back 87

-Treat Deficiency
-Prevent cataracts
-Acne rosacea
-Migraines--400 mcg/day.
(Theory: Migraine etiology related to impaired mitochondrial oxygen metabolism in brain.
FMN and FAD are needed by flavoproteins in the mitochondria for proper functioning of the

Front 88

these drugs can decrease B2 absorption

Back 88

Cholestyramine, Colestipol

Front 89

These substances can inhibit B2 by targetting FMN and FAD production

Back 89

Phenothiazine derivatives, Tricyclic antidepressants, Adriamycin, Quinacrine (anti-malarial)

Front 90

These substances can reduce NRTI lactic acidosis

Back 90

Nucleoside reverse-transcriptase inhibitors

Front 91

This substance taken with B2 may decrease absorption

Back 91

psyllium

Front 92

B2 may potentiate the antioxidant effects of what vitamin?

Back 92

Vit E

Front 93

Niacin is AKA

Back 93

nicotinic acid, nicotinamide

Front 94

what's the Bioactive form of vit. B3?

Back 94

Niacinamide

Front 95

what's the non-dietary source?

Back 95

Produced from kyurenine pathway in the liver from tryptophan.

Front 96

60 mg Tryptophan--> X mg of Niacin

Back 96

1

Front 97

Actions of NAD and NADP

Back 97

-Cofactors for numerous dehydrogenase enzymes, such as lactate or malate.
-NAD: Involved in catabolism of CHO, PRO, Fats to garner energy.
-NADP: Involved in synthesis of EFA and cholesterol.

Front 98

Niacin Lipid Actions

Back 98

-Inhibits hepatic uptake of apolipoprotein A-1-->higher levels of HDL in blood-->more cholesterol taken from peripheral cells to liver for excretion.
-Reduces LDL-C and TG by interfering with their production in the liver.
-Blocks mobilization of FFAs fro

Front 99

B3 deficiency leads to

Back 99

pellegra- The Four Ds: Dementia, Dermatitis, Diarrhea, Death.
- In US, alcoholics are biggest risk.

Front 100

Causes of B3 deficiency

Back 100

-Low niacin or tryptophan dietary intake
-Hartnup disease--defective conversion of tryptophan to B3.
-Malignant carcinoid syndrome--excess serotonin production thus less tryptophan enters kyurenine pathway,
-Drug therapies (isoniazid).

Front 101

B3's (Niacin) side effects

Back 101

Niacin:
-Vasodilation esp to face, neck, chest--perhaps due to prostaglandin and histamine.
-Pruritus
-Headaches
-Dizziness, palpitations, SOB, sweating, chills, N/V.
-Hepatoxicity--in time-released form at 3 gm or higher a day.
-Impaired glucose tolera

Front 102

B3/Niacin Toxicities

Back 102

Should monitor liver enzymes on:
-Risk increasing uric acid and gout
-Flushing Cardiac arrhythmias, tachycardia, palpitations
-Hypotension
-Acanthosis nigricans
-Worsening of peptic ulcer disease
-In combination with statins: Higher risk of myopathy and

Front 103

Absolute B3 CIs

Back 103

- Hepatic dysfunction
- Active PUD
- Arterial bleeding

Front 104

B3 precautions

Back 104

-gallbladder disease
-gout predisposition
-unstable angina
-renal dysfunction

Front 105

B3 therapeutics for lowering lipid panels w/ no toxicity

Back 105

-Inositol hexaniacinate

Front 106

This substance treats:
-Osteoarthritis
-Helps prevent pancreatic damage in honeymoon phase of DM 1.
-Anxiety

Back 106

Niacinamide

Front 107

This substance lowers cholesterol , small dense LDL, VLDL, lp(a), and triglycerides, raises HDL--reduces fatty acid mobilization from adipose tissue
-Can reduce glycogen and fat stores in heart and muscle tissue
-Can increase blood glucose
-Can increase

Back 107

Niacin

Front 108

B3 (SSUN)

Back 108

-Schizophrenia--Hoffer protocol
-Stop smoking
-Used for energy production: NAD, NADPH
-Needed for desaturase enzyme systems

Front 109

Form of Niacin that offers immediate release

Back 109

Niacor, OTC Nicotinic Acid

Front 110

Form of Niacin that offers extended release

Back 110

-Niaspan
-Advicor (ER Niacin with lovastatin)

Front 111

sustained release form of Niacin

Back 111

Slo-Niacin, OTC slow release Nicotinic Acid.

Front 112

Effx of immediate release niacin

Back 112

Most Over The Counter
High Flushing: 52-100% of patients
High discontinuance problem with patients
Flushing effect may decrease
ASA may decrease flushing effect
Hepatotoxicity
At doses >3 gm, may increase serum glucose, temporarily

Front 113

Extended release Niacin

Back 113

-Dissolves intermediate to IR and SR
-Lower flushing effects
-No increased risk of hepatotoxicity
-FDA approved for treatment of dyslipidemia.
-Niaspan—dosed once daily at bedtime.

Front 114

Sustained release

Back 114

-Less flushing effect
-Associated with hepatotoxicity and liver failure.

Front 115

-Niacin is metabolized via two pathways:

Back 115

1)Conjugated with glycine-->nicotinuric acid--> FLUSHING
-Used only when other pathway is saturated which IR does quickly.
2) Converted to nicotinamide-->pyrimidine metabolites-->HEPATOTOXICITY
SR niacin mainly flows through this pathway.

Front 116

Is there a higher or lower risk of liver disease when switching from IR to SR.

Back 116

higher

Front 117

what's the max therapeutic dosage for IR and ER Niacin dosing?

Back 117

3000 and 2000 mg/day respectively

Front 118

What are B3s combined with possibly causing increased risk for rhabomyolysis?

Back 118

statins

Front 119

what effect do alpha 1 blockers (doxazosin, prazosin, terazosin) and calcium channel blockers have when taken w/ B3?

Back 119

may potentiate the hypotensive effect of A1B

Front 120

Alpha glucosidase inhibitors (Acarbose, miglitol) and metformin and meglitinides and Sulfonylureas and TZDs with high doses of B3 may...

Back 120

antagonize antidiabetic action

Front 121

these substances may reduce absorption of B3

Back 121

Cholestyramine, colestipol

Front 122

what drugs combined w/ B3 blunt B3 flushing and which may aggravate flushing effect

Back 122

nicotinic patch - aggravate
NSAIDS, ASA - blunt

Front 123

what drug can induce pellagra when combined w/ B3?

Back 123

5-FU, and INH (maybe)

Front 124

Red yeast rice and B3

Back 124

has resulted in rare cases of rhabdomyolysis.

Front 125

ETOH with B3

Back 125

can increase flushing effects.

Front 126

Hot beverages and hot foods

Back 126

may increase flushing

Front 127

Pantothenic acid is formed from

Back 127

alanine and pantoic acid.

Front 128

Pantothenic acid actions

Back 128

-Synthesis of CoA
-Acyl Carrier Protein-->Fatty acid synthesis, phosopholipids, sphingolipids

Front 129

B5 Deficiency/Toxicity

Back 129

Deficiency is Rare: h/a, acne, orthostatic low BP, fatigue, constipation, V, gut distress, numb/tingling in hands/feet, insomnia.
-there are no known toxicities

Front 130

B5 Therapeutics

Back 130

-Adrenals-needed for adrenals to produce steroid hormones.
-dermititis
-Lowers total cholesterol, LDL, apoB and TG
-Increases HDL and apoA1
-Rheumatoid Arthritis--only type of arthritis B5 seems to help (2000 mg/day).
-High dose may help acne vulgaris

Front 131

what substances may increase need for B5?

Back 131

OCP with estrogen and progestin

Front 132

high dose B5 can inhibit the absorption of ______

Back 132

Biotin

Front 133

high dose B5 can inhibit the absorption of ______

Back 133

Biotin

Front 134

what's the bioactive form of B6?

Back 134

pyridoxal-5-phosphate (P5P)

Front 135

Typical supplement of B6

Back 135

Pyridoxine HCL

Front 136

B6 actions

Back 136

-Cofactor for over 100 enzymes--transaminases, decarboxylases: Schiff’s base formation is the basic chemistry accounting for the wide range of B6 reactions.
(Schiff’s Bases are reaction products of aldehyde and amino groups attached to P5P.
Basis for

Front 137

Signs of B6 deficiency

Back 137

PMS
Microcytic, hypochromic anemia
Insomnia, Depression
Smooth tongue
Convulsions--due to low GABA levels
Kidney stones
Dermatitis
Carpal tunnel

Front 138

Neuro symptoms for B6

Back 138

numbness/tingling in extremities: At very high doses and will not occur if magnesium is added (Pfeiffer)

Front 139

This vitamin helps with dream recall (Pfeiffer)

Back 139

B6

Front 140

B6 Therapeutics

Back 140

-Carpal Tunnel Syndrome--50-200 mg/day.
-PMS and other menstrual disorders--perhaps by increasing dopamine and serotonin
-Nausea of pregnancy
-Preeclampsia
-Seborrheic dermatitis
-High homocysteine levels--antiatherogenic.
http://lpi.oregonstate.edu/info