Learning Outcome 10

What is the difference between fat soluble and water soluble vitamins?

Fat Soluble (A,D,E,K) stored in fatty compartments of the body. Most come from food sources.

Hypervitaminosis results from mega doses (intentional or not)

Water soluble (C and B complex (8 vitamins)).

Not stored, needed in daily food intake. Toxicity can occur.

Learning Outcome 11

The use of vitamin supplements:

Vitamins and minerals should come from food sources 1st Vitamin supplements 2nd.

Should evaluate diet 1st.

Can supplement what is missing

Vitamin C and D

Individuals who take vitamins should limit to 100% of RDA to avoid toxicity (multivitamin)

Best to get from food sources.

Use if nec.

Learning Outcome 12

Functions of vitamins discussed:

Food sources

http://ods.od.nih.gov/factsheets/list-VitaminsMinerals/?print=1

Fat Soluble Vitamins

Vitamin A Retinol up to a years supply is stored in the liver. Need protein to synthesize.

Food sources of Vitamin A? (liver, egg yolk, carrots, sweet potatoes, apricots)

Body Functions Dim light vison, Differentiation of epithelial cells (esp. eyes).

Deficiency Night blindness, Xeropthalmia (abnormal thickening and drying of the outer eye, can lead to blindness)

Fat Soluble Vitamins

Vitamin D ergocalciferol (D2-SUNLIGHT) and cholecalciferol (D3-SUPPLEMENT)

Essential for proper bone metabolism. (Rickets) (Cod liver oil)-vit d creates bridge for calcium and phosphorus to get into bone; bones become soft and malformed; lack of sunlight

Osteomalacia - adults

Recent research has found it may be essential in preventing many other chronic diseases including breast cancer.

Converted by both the liver and Kidneys (protein bound to the liver)

D2 formed when plants are irradiated by the sun

Liver converts to calcidiol

Kidney to calcitriol the active form of vitamin D

D3 formed when skin is irradiated by ultraviolet or sun light

Rickets children- soft fragile bones (bowlegs, knock knees, mishapen skulls)

Breastfeeding does not provide sufficient amounts of vitamin D.

Osteomalacia - vitamin D deficiency in adults low exposure to sunlight high risk. Soft bones esp. pelvis, spine and lower extremeties.

Vitamin D Continued

Absorbed in the duodenum and distal small intestine.-gastric bypass pts, resection

Intestinal absorption decreases with age.

Obesity (BMI > 30) may cause deficiency due to absorption into subcutaneous fat.

What surgical treatment for obesity may cause Vitamin D deficiency? gastric bypass

No RDA why? every individual is different (diet, exercise, exposure)

recommendation for sun exposure is 15 minutes per day

No RDA Multiple sources of the vitamin. Multiple reasons for deficiency

Vitamin D Continued

For individuals with low sunlight exposure, diet is critical.

Food sources: highest level to lowest

Fish (salmon, swordfish, tuna-all can be canned) 3 oz serving; Cod liver oil (453 IU per tsp)

Fortified Milk (good source of calcium)

Liver and beef

Egg yolk

Shitake mushrooms

Cod liver oil most bang for the buck

Swordfish is 566 is for 3 oz.

Fat soluble vitamins

Vitamin E

Protects integrity of cell membranes. Antioxidant,

Absorbed in the jejunum (fat and bile required for maximum absorption)

Deficiency is rare due to diet, usually related to lipid metabolism disorders.

Supplementing vitamin E is not recommended due to increase risk of stroke, prostate cancer.

Vitamin E continued

Food sources for vitamin E

Vegetable oils (wheat germ oil, 1 tbsp, 20.3 mg)

Nuts (almonds, hazelnuts, peanuts)

Sunflower seeds

Peanut butter

Fat soluble vitamins

Vitamin K

Blood clotting

Necessary for the liver to make clotting factors II (prothrombin), VII, IX, and X

Bone metabolism

2 types of vitamin K

Phylloquinone found in plant foods

Menaquinone synthesized by intestinal bacteria; antibiotic use effects blood clotting b/c of K deficiency (effects absorption)

Vitamin K continued

Food sources:

Green leafy vegetable (cooked is higher in vitamin K)

Cabbage

Pharmaceutical source (phytonadione) oral or injection. Oral water soluble solution available for those with malabsorption disorders

Overconsumption of vitamin E and A can interfere with absorption of Vitamin K

Warfarin (Coumadin) and Vitamin K-keep the limit the amounts of green leafy vegetables the samedon't decrease but definitely don't increase; will have to take higher levels of coumadin if Vit K is present, consult dietician for any dietary changes

Infants and vitamin K deficiencies- infants are not born with gut flora, will need shot of Vit K after birth

The anticoagulant warfarin interferes with the livers use of vitamin K (intended effect)

Infants born with sterile bowel. May have had inadequate vitamin K via the placenta. Takes about 24 hours for bacteria to colonize in the intestines. An IM dose of vitamin K recommended immediately after birth to prevent bleeding.

Fat Soluble vitamins

Water and fat do not mix

Fats are circulated in the water-based blood.

The liver attaches fat-soluble vitamins to protein carriers

Protein deficiency can hinder the use of fat soluble vitamins

Water Soluble vitamins

Vitamin C (Ascorbic acid)

Diverse functions

Wound, burn and fracture healing

Antioxidant

Enhances absorption of iron

Assists in the synthesis of hormones and neurotransmitters (adrenals) (serotonin)

Necessary for the formation of collagen

Vitamin C continued

Deficiency

Scurvy

Signs and symptoms:

Tender sore gums that easily bleed

Weakened blood vessels (Petechiae)

Breakdown of collagen

Delayed wound healing

Separation of scar tissue

Ends of long bones soften, leading to malformation and pain.

Fracturing occurs

Teeth loosen and fall out

Sudden death due to internal bleeding

Limey

Vitamin C Continued

Scurvy still exist today with certain populations.

Elderly

Neurodevelopmental disabilities

Psychiatric illnesses

Unusual dietary habits

In America, often times dietary deficiencies are not included in differential diagnosis.

Food sources for vitamin C

Fruits with the highest sources of vitamin C include:

Cantaloupe

Citrus fruits and juices, such as orange and grapefruit

Kiwi fruit

Mango

Papaya

Pineapple

Strawberries, raspberries, blueberries, cranberries

Watermelon

Vegetables with the highest sources of vitamin C include:

Broccoli, Brussels sprouts, cauliflower

Green and red peppers

Spinach, cabbage, turnip greens, and other leafy greens

Sweet and white potatoes

Tomatoes and tomato juice

Winter squash

Increased needs of Vitamin C

Smokers

Exposed to second hand smoke (esp. children)

Critically ill individuals

Vitamin C levels fall after uncomplicated surgery and fall even more in patients in the SICU.

Supplementation is recommended in those post gastrointestinal surgery.

Water Soluble Vitamins

B-Complex Vitamins

Thiamin

Riboflavin

Niacin

Vitamin B6

Folate

Vitamin B12

B-Complex Vitamins

Thiamin

Essential coenzyme in metabolism of glucose and certain amino acids.

Located primarily in the skeletal muscles. Also located in the liver, heart, kidneys and brain.

Absorbed in the small intestine, primarily jejunum and ileum.

As energy expenditure increases, need for thiamin increases.

Mainly excreted in urine

B-Complex Vitamins

Thiamin deficiencies:

Dry Beriberi:

Muscle weakness and wasting, primarily lower extremeties.

Symmetrical sensory and motor conduction problems affecting limbs

Wet Beriberi:

Progression to right sided heart failure.(cor pulmonale)

Occurs in infants 2 to 6 months old who do not get enough thiamin.

Alcoholism: liver dysfunction effects the usage of the vitamins due to storage problems (of the vitamins)

food sources: pasta, breads, liver, nuts, seeds

In Israel there was a soy based infant formula that did not have detectable levels of thiamin.

Thiamin deficiency common in alcoholism.

B-Complex Vitamins

Vitamin B2 Riboflavin

Coenzyme in the metabolism of protein and other vitamins.

Clients undergoing major healing processes such as burns require more than the average person.

Turns urine yellow/orange color

B-Complex Vitamins

Riboflavin (B2) deficiencies

Signs and symptoms (usually occur after 4 months)

Painful lesions on outside of lips and corners of the mouth

Redness and swelling in the mouth

Inflammation of the skin

Anemia

Peripheral nerve dysfunction

B-Complex Vitamins

Riboflavin deficiencies cont.

Clients at risk:

Those who avoid dairy products

Congenital heart disease

Some cancers

Alcoholism

Hypothyroidism

Adrenal insufficiency

B-Complex Vitamin

Food sources for Riboflavin

Dairy products.

Eggs.

Green leafy vegetables.

Lean meats.

Legumes.

Milk.

Nuts.

B-Complex Vitamins

Niacin (vitamin B3)

Coenzyme required for energy metabolism.

Participates in the synthesis of steroid hormones and fatty acids.

Requisite for more than 200 enzymes

Liver can convert Tryptophan to Niacin (requires riboflavin, B6, and iron). When Tryptophan levels are low protein synthesis takes precedence.

B-Complex Vitamins

Niacin Deficiency

Pellegra

Signs and symptoms

Symptoms can present as soon as 60 days

diarrhea, dermatitis, dementia, and death

High risk population

Alcoholism

Aids

Homelessness

Absorption problems

Aneroxia nervosa

B-Complex Vitamins

Food sources for Niacin

Fish (Cooked Yellowfin Tuna)

Chicken & Turkey (Cooked Chicken Breast)

Pork (Cooked Lean Chop)

Liver (Cooked Lamb Liver)

Peanuts (Oil Roasted)

Beef (Cooked Lean Rib)

Coffee (small amount)

B-Complex Vitamins

Vitamin B6

Coenzyme in the metabolism of amino acids

Involved in the metabolism of over 100 enzymes

Including those that convert tryptophan to niacin and heme for hemoglobin

Proper immune funtion

B-Complex Vitamins

Vitamin B6 cont.

High risk for deficiency

Women of childbearing age

Current and former oral contraceptive users

Smokers

Non-Hispanic Black

Elderly

High heat during commercial processing of foods

B-Complex Vitamins

Vitamin B6 deficiencies:

Signs and symptoms:

Rash on face, neck, shoulders and buttocks

Mouth lesions

Fatigue and weakness

Confusion

Peripheral neuropathy

anemia

B-Complex Vitamins

Vitamin B6 food sources

richest sources of vitamin B6 include fish, beef liver and other organ meats (any animal source)

Whole grains

Vegetables (potatoes and other starchy vegetables)

Fruit (non-citrus)

Fortified Cereals

B-Complex Vitamins

Folate

Involved in protein synthesis, including amino acids, DNA, RNA and Heme.

Folate participates in the reproduction of every cell.

Particularly for rapidly growing cells (GI tract, blood and fetal tissue)

Absence of adequate folate can be catastrophic. Birth defects occur 1st 3-4 weeks. Effects fetuses brain and spinal cord.

B-Complex Vitamins

Folate deficiency

Poor dietary intake most common cause.

Results in impaired cell division and protein synthesis, including red blood cells (anemia).

Signs and Symptoms:

Bright red tongue

Fatigue and weakness

Headaches, irritability

Shortness of Breath

Heart palpitations

B-Complex Vitamins

Folate food sources;

Beef liver, braised, 3 ounces

Green leafy vegetable (spinach), cooked

Black-eyed peas

Breakfast cereals, fortified with 25% of the DRV

Rice, white, medium-grain cooked

Asparagus cooked

Spaghetti, cooked, enriched

Brussels sprouts

B-Complex Vitamins

Vitamin B12

A coenzyme involved in the synthesis of DNA, RNA and the metabolism of fatty and amino acids.

Involved in the synthesis and maintenance of myelin (the fatty insulation that permits speedy transmission of impulses along the nerves)

Excessive intake of alcohol or vitamin C interfere with absorption.

B-Complex Vitamins

Vitamin B12 deficiency:

Common cause of neuropsychiatric problems in the elderly

Pernicious anemia

Signs and Symptoms:

Fatigue

Pallor

Shortness of breath

Heart palpitations

Numbness and tingling in the extremeties

Abnormal gait, poor coordination of movement

Memory loss, disorientation

Psychosis, dementia

Pernicious Anemia - Pernicious anemia is a type of vitamin B12 anemia. The body needs vitamin B12 to make red blood cells. n adults, symptoms of pernicious anemia are usually not seen until after age 30. The average age of diagnosis is age 60. You are more likely to get this disease if you:Are Scandinavian or Northern EuropeanHave a family history of the condition

B-Complex Vitamins

Vitamin B12 Food sources:

meat

poultry

Shellfish

eggs

dairy products

Learning Outcome 13

What is the importance of minerals to the body?

Necessary for biochemical reactions in the body

Obtained from the Earths crust, absorbed by plants, animals eat plants, humans eat animals and plants.

Water is the medium of absorption of nutrients for plants and the basis of the bodys nutrient delivery system.

Learning Outcome 14

How are minerals classified?

Macrominerals DR is >100 mg, help to balance pH. (calcium, chlorine, magnesium, phosphorus, potassium, sodium, and sulfur).

Microminerals DR is < 100mg (chromium, cobalt, copper, fluorine, iodine, iron, manganese, molybdenum, selenium, and zinc).

Healthy People 2020

Weight and growth

Food and nutrient consumption

Iron deficiency and anemia

Schools, worksites, and nutrition counseling

Food security

10/28/14