Vitamins And Supplements

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RDA

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Recommended daily allowance. This figure is pretty low because they are concerned about toxicity.
But--who is this good for? Male female? Old young?

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Fat soluble vitamins:

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ADEK

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Water soluble vitamins:

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C and B (many)

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Multivitamins:

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Efficacy is controversial, now mostly discouraged because not worth the money. If you have a balanced diet you really don't need them. Those that need them are really only the malnourished and alcoholics

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The three vitamins that have actual proven efficacy:

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Folic Acid
Vitamin D
Vitamin B12

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Vitamin A: what its good for

(aka Retinol)

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-Good for vision, helps in low light
-makes sperm, organogenesis in embryo
-Immunity
-Growth
-Integrity of skin and mucous membranes

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Signs of vitamin A deficiency:

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-Night blindness
-Cornea degeneration
-Skin lesions

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Signs of Vitamin A toxicity:

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-TERATOGENESIS, high birth defects
-Liver damage
-Increased fractures (because it cancels vitamin D in high doses)

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Who would be deficient of vitamin A?

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Malnourished, alcoholics, people who cannot absorb fats

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Vitamin D

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-D2 and D3 are the same things, one is plant source and one is from the sun
-stored and activated in the liver

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What vitamin D does:

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-increases calcium/phosphorus absorption from the intestine
-increases mobilization from bone into the bloodstream

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Where to find vitamin A:

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Eggs, meat and dairy
Green, leafy vegetables
Intensely colored fruits and vegetables

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Where to find Vitamin D:

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-Body makes it when exposed to the sun
(very little in foods but:)
-Dairy products
-Fish
-Fortified products (like grains and cereals)

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Who needs vitamin D?

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Now believed to be good for everything, children/menopausal/postmenopausal women are supplemented, maybe needed in autoimmune diseases

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Signs of vitamin D toxicity:

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N/V
weakness
fatigue
Kidney problems (nocturia, polyuria, proteinuria)
Severe: calcium depletion, affecting bones/heart/blood vessels

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Calcitrol

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-preparation of VITAMIN D not of calcium. Helps your calcium level though because vit D needed for calcium -absorption.
-given for people on dialysis

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Vitamin E good for:

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-Antioxidant
-cardio protection maybe?
-cancer protection maybe?
poorly understood

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Vitamin E found in:

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Oils, nuts, wheat germ, some greens, corn

Food alone does not provide enough vit E

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Signs of Vitamin E deficiency:

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Motor, an alcoholic looks drunk when they have sobered up
Neurological ataxia, neuropathy, poor reflexes

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Topical for wounds;

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evidence does not support that vit E helps with wound healing, oils help just as much

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Vit E topical a/e:

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can have contact dermatitis adverse reaction


Never use on newborns

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Signs of vitamin E Toxicity:

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suppresses coagulation factors so it might increase BLEEDING


(reverse with vitamin K)

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Vitamin K good for:

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-Needed to make prothrombin and other clotting factors
-Made in the intestine, requires presence of normal flora
(give to newborns at birth because their gut is sterile)

Phytonadione (Aquamephyton) given IM

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Phytonadione (Aquamephyton) given IM

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Vitamin K supplement, given especially to newborns because of sterile gut
But be careful because it can also raise bilirubin levels

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Vitamin K is found in:

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cabbage, cauliflower, spinach and other greens leafy vegetables, cereals

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Signs of Vitamin K deficiency:

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bleeding/hemorrhage

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Vitamin K reverses the effects of ______________ and _______________

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Warfarin (coumadin) and Vitamin E toxicity

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Antioxidants

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Remove "free radicals" that are supposedly the waste products of cell metabolism, that cause aging, and possibly by removing the free radicals you can also prevent chronic diseases and cancer

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Vitamin C other name

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Ascorbic acid

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Vit C is good for:

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cellular energy (in the mitochondria)
necessary for making adrenal steroids
needed for conversion of many substances in the body (such as folic acid into its usable form)
needed to make collagen to bind/hold cells together
Helps iron absorption
is an antioxidant

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Signs of Vit C deficiency:

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Scurvy: bad bones/teeth, bleeding gums, bruising

deficiency is rare

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Too much vitamin c:

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N/V/D
Cramping
Irritates mucous membranes

Hard to get too much because your body just pees out what it does not need if it is water soluble

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Does Vitamin C prevent colds?

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Unsure so far
research says it might reduce the severity but not the number of colds

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Vitamin B1 other name

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Thiamine

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Thiamine (B1) uses:

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carbohydrate metabolism
neurologic and cardiac health

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Thiamine (B1) deficiency (beriberi):

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CHF
Arrhythmias
Neuropathies

most common in alcoholics: CNS effects (wenicke-Korsakoff syndrome): ataxia and agitation, memory loss, may be irreversible so thiamine is given immediately to alcoholics

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Vitamin B2 other name

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Riboflavin

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What riboflavin (B2) is good for:

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Affects many enzyme processes, skin/mucous membrane integrity, corneal integrity. may help migraines in high doses

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Where to find riboflavin (B2):

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Cereals, nutes, milk/eggs, green leafy vegetables, and lean meat

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Vitamin B3 other name:

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Niacin (Nicotinic acid)

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Niacin (B3) is a typical nutrient and a medication for:

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lowering cholesterol

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Signs of Niacin deficiency (pellagra):

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Poor skin integrity, GI pain/D/sores, CNS memory loss/anxiety/dementia
All are reversible with replacement supplement of nicacin

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Toxicity (high doses) of niacin:

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Vasodilation, extreme flushing, dizziness, nausea

Supposedly less profound with extended release

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Vitamin B6 other name

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Pyroxidine

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Vit B6 (Pyroxidine) needed for:

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enzyme in metabolism of amino acids and protein, healthy brain function, formation of RBCs, synthesis of antibodies so support of immune system

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Vitamin B6 deficiency from:

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Poor diet, alcoholism, use of ISONIAZID (a Tb drug)

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Vitamin B6 (pyroxidine) routinely given with: (and why)

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TB DRUGS to prevent peripheral neurotpathy

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Deficiency of Vitamin B6 looks like:

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anemia, depression

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Vitamin B6 Pyroxidine interferes with what drug?

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Levodopa, the Parkinson's drug
Pyroxidine is contraindicated in Levodopa

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Vitamin B9 other name

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Folic Acid

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Vitamin B9 is needed for:

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To make DNA (along with B12)

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Folic acid (B9) deficiency looks like:

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Anemia, neurological deficits, BIRTH DEFECTS (spina bifida, anacephaly, which is why now all grain products in the US are enriched with folic acid, and if a woman is planning to get pregnant she should definitely be taking folic acid as a supplement)

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Vitamin B12 other name

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Cyanocobalamin

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B12 Cyanocobalamin found in:

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mostly animal foods, shellfish, milk/milk products

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B21 (cyanocobalamin) is needed for:

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Metabolism, the formation of RBCs, and the maintenance of the CNS (brain + spinal cord)

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Calcium as a supplement

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Given PO or IV, if given IV must be given slowly on a cardiac monitor

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Calcium is regulated by:

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Absorption from the intestine
Renal excretion
Resorption, or deposition of calcium into bone

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These processes are controlled by:

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Parathyroid hormone (increases absorption)
Vitamin D (increases absorption)
Calcitonin (decreases blood calcium)

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Foods that decrease the absorption of calcium in the body:

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spinach, rhubarb, chard, beets, whole grains, bran

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DDI with calcium salts (PO) (3)

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Thiazide diuretics (decrease excretion)
Glucocorticoids (decrease absorption)

Calcium decreases absorption of thyroid hormone, must given several hours apart

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Regulation of herbs and CAM:

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Most products exempted from FDA regulation, do not have to prove safety and efficacy, assumed safe by general public until proven harmful in court, what it says on the bottle may not even be inside and vice versa

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Some products have been found to have very dangerous substances:

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mercury, lead, arsenic

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Ma Huang

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Ephedra/epinephrine, ANS and CNS stimulant, neuro and cardio effects

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Kava:

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alternative to benzodiazepines, hepatotoxicity. relaxes and numbs you

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Comfrey

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more likely topical, does the same thing as kava, hepatotoxicity

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Decreased platelet aggregation from:

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garlic, ginger (in very large amounts), ginko biloba, feverfew

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St. John's Wort

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Increased potential for serotonin crisis if on antidepressants, especcially SSRIs
Sun sensitivity is especially an issue, wear sunscreen
Liver enzyme inducer, lowers efficacy of all other drugs

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Slow weight loss is safer and more likely to be kept off

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10% over 6 months, or one pound a week

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Weight loss with drugs is usually modest:

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4-22 lbs on average, most only lose 4-6 lbs

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Sibutramine Meridia (discontinued)

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May elevate BP, contraindicated in Hypertensive clients

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Fluoxetine (Prozac) and bupropion (Welbutrin)

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Appetite suppressants that help you lose weight

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Fen-Phen

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Withdrawn due to damage to heart valves

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Orlistat

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Decreases fat absorption by 30%
Only diet drug recommended for long-term use

A/E: oily spotting, oily flatulence, fecal urgency, fatty stools, reduces absorption of fat soluble vitamins ADEK (take multivitamin 2 hours after taking orlistat)

Liver failure?

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Sugar substitutes

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only approved for OCCASIONAL use, not primary

may be useful for diabetics, not for PKU