nutritional sciences 1034 exam 2 notes
TRANSCRIPT
Dietary Reference Intakes (DRI) 9/19/07 10:00 AM
← Ch2
←← DRIs
Replace and expand on the Recommended Dietary Aowance
Intended to prevent nutritional deficiencies as well as reduce the
risk of chronic diseases
Specific for gender, age (infants to 70+ years), and
pregnancy/lactation
Consists of several types of reference intakes
RDA – Recommended Dietary Allowance
AI – Adequate Intake
UL – Tolerable Upper Intake Level
EER – Estimated Energy Requirement
DV – Daily Value, for food labels (Not the same as the rest, RDA for
worst case scenerio)
RDA
Average daily dietary intake level that is sufficient to meet the
nutrient requirement of nearly all (97 – 98 percent) healthy
individuals in a particular life stage and gender group
o Not the minimum requrement
o You can be below RDA and not have deficiency
Developed to prevent nutrient deficiency diseases
Age and gender specific
Deficiency: intakes below 70% of RDA over and extended period
o 2/3 of RDA is ok for a few days
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Toxicity: intakes above 3 times RDA
Adequate Intake (AI)
Recommended intake value based on observed or experimentally
determined approximations or estimates of nutrient intake by a
group of healthy people
Used when an RDA cannot be determined
o Not as definitive as RDA; more research needed
← Tolerable Upper Intake Level (UL)
The highest level of daily nutrient intake that is likely to pose no
risk of adverse health effects for almost all individuals in the
general population. As intake increases above the UL, the potential
risk of adverse effects increases.
o Adverse effects over a long time of eating bad
← Estimated Energy Requirement (EER)
An estimate of the calorie needs of the average person based on
gender, age, height, weight, and physical activity level
o Energy = calories
← Range of Intake
Upper Level (UL) met or exceeded
RDA/AI/EER (good)
Deficient State
← Daily Value (DV)
Used on food labels (%DV)
Based on 2,000 kcal diet
Rough guide for comparing food nutrient content to requirements
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Vitamins: Fat Soluble (A, D, E, K) 9/19/07 10:00 AM
← What are Vitamins?
Essential organic compounds
o Essential – important to proper growth
o Organic - carbon
Needed in very small amounts
Do not provide energy
Function as coenzymes: B vitamins and vitamin K
o Work with enzymes
Fat soluble: vitamins A, D, E, and K
o Soluble in non polar things
Water soluble: B vitamins and vitamin C
o Soluble in polar things
← Why are they essential?
Vitamins either cannot be synthesized in the body or are not
synthesized in adequate amounts
o We are one of the few animals that do not make vitamin C
o We didn’t make some vitamins we needed as infants
Must be supplied in the diet
Exceptions: vitamins D, K, niacin, and biotin
Produce deficiency symptoms when missing from the diet
← Function of vitamins
Participate in energy-yielding reactions
3
Contribute to blood formation, clotting, bone health, protein
metabolism, antioxidant defense
← Sources and storage
Plant and animal foods in diet
Supplements
Fat-soluble vitamins (except vitamin K) are stored in body – not
readily excreted
o Hard to get deficiency
Water-soluble vitamins (except vitamins B6 and B12) are not stored –
readily excreted via urine
← Deficiency and toxicity
Deficiency: vitamin is lacking in the diet and the body stores are
depleted, loss of function
o Not often seen in our country
Toxicity: excessive intake can cause damage to the body
o Upper limit – line at where toxicity begins
← Toxicity
Fat-soluble vitamins accumulate in the body most readily and can
cause toxic effects (3x RDA for vitamin A-most extreme and easy to
overtake)
Water-soluble vitamins are toxic only in very large amounts (15-
100x RDA)
Toxicity most likely from supplementation
← Preservation of vitamins
Eat foods soon after harvesting
Tore properly (avoid heat, light, air)
o Cold/dark
Avoid excessive cooking
4
o Boiling in water causes vitamins to go into water
Frozen frouts and vegetables are as nutritious as fresh
← Absorption of fat-soluble vitamins (A, D, E, K)
Absorbed along with dietary fat
o Some drugs block absorption
Transported with fat through the bloodstream inside lipoproteins
Usually 40-90% of fat-soluble vitamins are absorbed
Fat malabsorption (diseases or weight loss during orlistat) may
cause deficiency
← Vitamin A
Found in several forms of foods
o carrots
Retinoids in foods of animal origin
Carotenoids (pigments) in vegetables, can be converted into
vitamin A
o Pre- or pro- vitamin A
Vitamin A Functions
o Promotes vision
Night blindness
o Promote growth, development, reproduction
o Prevents drying of the skin and eyes
Xerophthalmia (dry eye)
Need to maintain skin
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o Promotes immune function and infection resistance
o Cardiovascular disease prevention
o Cancer prevention
o Acne medication (vitamin a derivatives)
Vitamin A recommendations
o Measured in Retinol Activity Equivalents (RAE) = vitamin A +
carotenoids (beta-carotene)
o RDA is 900 ug RAE for men, 700 ug RAE for women
o DV is 1000 ug RAE
o Average intakes in the us meet the RDA
o Much of vitamin A is stored in the liver
Vitamin A Deficiency
o Leading cause of preventable blindness in children
o Night blindness
o Xerophthalmia
o Dry skin
o Poor growth
Vitamin A Toxicity
o Highly toxic
o Enlarged liver
o Fetal malformations and spontaneous abortions (why
Accutane is not prescribed during pregnancy)
o Bone/muscle pain, fractures
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o Headaches
o Hair loss
o Skin changes
o Eating polar bear liver – toxicity, makes person blind.
Vitamin A sources
o Yellow-orange vegetables (beta-carotene), dark green leafy
vegetables (lutein and zeaxanthin) and tomatoes (lycopene)
o Liver
o Fish oils
o Eggs
o Fortified milk and yogurt
← Vitamin D
Prohormone: activated by enzymes in the liver and kidneys
Derived from cholesterol (like a hormone
Synthesized from sunlight
80-100% of vitamin D needs can be provided by sunlight
Deficiency causes bone diseases
Functions
o Calcium metabolism and bone health
o Regulates absorption of calcium and phosperos from intake
o Regulates deposition of cacium in bones
o Influences cell development
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o Immune function and cancer prevention
o Immune system modulator
Reccomendations
o 5 ug/day for adults under 51
o Sun
Deficiency
o Rickets, deficiency in children
Bowed legs
Rib “beads” at sternum
Slow growth
Bowed spine
o Osteonalacia – deficiency in adults
“soft bones”
bones lose minerals and become pourous
Toxicity
o Toxic in high amounts, especially for infants and children
o Over-absorption of calcium, calcium deposits in organs
o Weakness, appetite loss, diahrea, vomiting, mental
confustion, increased urine
Sources
o Fortified milk/milk products
o Fortified breakfast cereals
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o Fish oils
o Sardines
o Salmon
o Sunlight
← Vitamin E
The fat soluble antioxidant vitamin
Protects unsaturated fats from oxidization
Donates electron to electron seeking compounds, “free radicals”
Found mostly in cell membranes
Improves vitamin A absorption
Recommendations
o 15 mg/day for adults
o many adults get recommended
Deficiency and toxicity
o Deficiency
Breakdown of cell membranes
Hemolytic anemia
Nerve degeneration
o Toxicity (not likely)
Muscle weakness
Headaches
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Nausea
Inhibition of vitamin K metabolism
Sources
o Plant oils and products made from plant oils
o Green leafy vegetables
o Some fruits
o Nuts and seeds
o Fortified breakfast foods
← Vitamin K
Supplied by diet as well as intestinal bacteria
Synthesized by bacteria in the colon, 10% of Vitamin K needs
Functions
o Coenzyme with major role in coagulation process (blood
clotting)
o Activates proteins invoved in bone metabolism
Deficiency
o Hemorrhage
o Fractures
o Most at risk: patient with long standing fat malabsorption,
person taking antibiotics fro long periods, infants
Toxicity
o Unknown
Sources
o Green leafy vegetables
o Liver
o Broccoli
o Peas
o Green beans
o Fresh oils
o Meats
←
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Water Soluble Vitamins 9/19/07 10:00 AM
← Water-Soluble Vitamins
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Dissolve in water
Very little is stored in body
Excreted from body if consumed in excessive amounts
Include all essential B vitamins, Vitamin C, and choline (vitamin-like
compund)
Large amounts can be lost during cooking
← B Vitamin Functions
Coenzymes in energy metabolism
o Pathways used by carbohydrates (CHO), amino acids, and fats
Red Blood Cell formation and functions
Neurological function
Nearly 50-100% of B vitamins in the diet are absorbed
← Thiamin (B1)
Coenzyme form used in CHO metabolsm
Nerve function
RDA
o 1.1 to 1.2 mg/day
o most diets exceed RDA
Thiamin Deficiecy and Toxicity
o Deficiency
Beriberi
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Sinhalese: “I cannot, I cannot”
Dry: wasting, peralisys
Wet: edema, heart failure
Seen in areas where white rice is a staple
o Non-Toxic
Thiamin Sources
o Lean pork products
o Organ meats
o Whole and enriched grain products
o Dried beans
o Seeds
o Peanuts
o Peas
← Riboflavin
Coenzyme form participate in energy-yielding metabolic pathways
(aerobic energy)
RDA
o 1.1 to 1.3 mg/day
o nutrient-poor diets are usually low in riboflavin, i.e. alcoholics
Riboflavin deficiency and toxicity
o Deficiency
Cheilosis (cracking on outside of lips), angular stomaitis
(cracks or sores at corners of mouth, inflimation of
mouth and tounge, and dermatitis)
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o Non-toxic
Sources
o Milk and milk products
Destroyed by light
o Enriched and whole grains
o Meat, liver, eggs, spinach, oysters
← Niacin
Coenzyme forms in energy metabolism
RDA
o 14 mg/day for women
o 16 mg/day for men
Deficiency and Toxicity
o Deficiency
Pellagra – 4 D’s
Dermatitis
Diarriha
Dementia
Death
o Toxicity with intakes >100 mg/day
Vasodilation, itching, headaches, flushing
Sources
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o Poultry, beef, tuna, and other fish (high protein foods)
o Enrichd prducts
o Wheat bran
o Asparagus
o Peanuts
o Can be synthesized from tryptophan (essential amino acid)
← Vitamin B6
Coenzyme form
o Activates enzymes needed for metabolism of CHO, fat, and
protein
o Synthesizes non-essential amino acids
o Synthesizes neurotransmitters
o Synthesizes hemoglobin & WBC
o Role in homocysteine metabolism
o PROTIEN METABOLISM
RDA
o Avg daily intake is more than RDA
o Alcoholics at risk for deficiency
B6 Deficiency and Toxicity
o Deficiency
Irritability, nervousness, depression/moodiness,
vomiting, skin disorders, and impaired immune
response
o Toxicity >200 mg/day can lead to irreversible nerve damage
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Risk with using megadoses to reduce the symptoms of
PMS
Sources
o Animal products
o Dairy products
o Bananas
o Potatoes
o Widely available
← Folate
Coenzymes help form DNA and metabolize various amino acids
Red blood cell formation and maturation
RDA
o 400 ug/day adults
o 600 ug/day pregnant women
Deficiency and Toxicity
o Deficiency
Results in neural tube defects in fetus
Results in megaloblastic anemia in adults (large
immature RBC in the blood, fewer mature RBC,
decreased ability to carry O2)
o Toxicity
Excess can mask B12 deficiency
Sources
o Foliage
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o Liver
o OJ
o Enriched products
o Grains, legumes
Heat and microwave can destroy some forms
← Vitamin B12
Coenzyme form
Role in folate metabolism
Maintaining myelin sheaths
o Transfer electrical pulse
RBC formation
RDA
o 2.4 mg/day for adults
o stored in liver
Absorption
o Requires a protein from salivary gland
o Requires stomach acid
o Requires intrinsic factor
Protein-like compund produced by the stomach that
enables B12 absorption
o Absorbed in the last part of small intestine
About 50% absorbed
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Deficiency and Toxicity
o Deficiency
Pernicious anemia : (“deadly, fatal”) duue to lack of
intrinsic factor inability to absorb B12
Megaloblastic anemia
Nerve degerneration & peralysis
o Non-toxic
Sources
o ONLY in foods from ANIMAL SOURCES
o Animal products
o Organ meats
o Seafood
o Eggs, milk
o Hot dogs
o Synthesized by bacteria, fungi, and lower organism
← Pantothenic Acid
Coenzyme form essential for metabolism of CHO, fat, and protein
RDA
o 5 mg/day
Deficiency
o Rare, however usually in combination with other deficiencies
Toxicity unknown
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Sources
o Found everywhere
o Wheat, milk, veggies, sunflower seeds, mushrooms, peanuts,
eggs
← Biotin
Coenzyme form aids in fat and CHO metabolism
Helps break down certain amino acids
RDA
o 30 ug/day
Deficiency
o Rare. Scaly/inflamed skin, changes in tounge and lips,
decreased appetite, nausea/vomiting
Non-toxic
Sources
o Caluflower
o Egg yolk
o Peanuts, cheese
o Intestinal bacteria can synthesize and supply some biotin
o More than a dozen raw egg whites a day can cause absorption
to be inhibited
Vitamin C
Synthesis of callogen
o Makes up connective tissue
Iron absorption
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Immune function
Antioxitant
RDA
o More for smokers
Deficiency of Vitamin C
o Scurvy: bleeding gums, pin-point hemorrhaging, poor wound
healing, wakness
Toxicity
o Stomach inflammation and diarrhea
Sources
o Citrus fruits
o Potatoes
o Green peppers
o Cauliflower
o Broccoli
o Strawberries
o Lettuce
o spinach
← Choline 8-3
Essential nutrient, however it is not considered a vitamin
All tissues contain choline
Precursor for acetylcholine (neurotransmitter)
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Precursor for phospholipids
o Good for tying things together
RDA
o 425-550 mg/day for adults
← Choline Deficiency (never the right answer)
Deficiency
o Rare
Toxicity
o In high doses: associated with fishy body odor, vomiting,
salivation, sweating, hypotension, GI effects
← Choline Sources
Widely distributed in foods
Milk
Liver
Eggs
Peanuts
Lecithin added to foods
←
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Major/Macro Minerals 9/19/07 10:00 AM
← Minerals
Various functions in the body
Do not provide energy
Major/macro minerals
Micro/trace minerals
Bioavailability depends on interactions with fiber, vitamins, and
other minerals
o Sometimes 10% absorbed
o Fiber keeps some from being absorbed
o Compete for absorption
Toxic in excessive amounts, especially trace minerals
← Major/Macro Minerals
Calcium (Ca)
Magnesium (Mg)
Sodium (Na)
Sodium (Na)
Chloride (Cl)
Potassium (K)
Phosphorus (P)
Sulfur (S)
← Calcium
99% in bones and teeth
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makes up 40% of all the minerals present in the body
Functions
o Forming and maintaining bones
o Blood, nerve, muscles, and cells
RDA
o 1000 to 1200 mg/day for adults
o 1300 mg/day for children
o Avg intake is NOT enough
Absorption of calcium
o Normally 25% absorbed from food
o Vitamin D and acidic gut help absorption
o Absorbed in upper part of small intestine
o Absorption increased to 60% in time of need, i.e. pregnancy,
infancy
Decreased Absorption of Calcium
o High fiber intake
o Excess phosphorus
soda
o Vitamin D deficiency
o Polyphenols (tannins) in tea
o Diarrhea
o Aging
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Calcium Deficiency
o Deficiency
Osteoporosis: loss of bone mass
Most at risk
Post-menopausal women
Slender, inactive women who smoke
Previntion
Build peak bone mass when young with
adequate calcium and vitamin D intake
Weight-bearing physical activity
o Calcium Toxicity
Not common
Risk of kidney stones and other problems
o Sources
Dairy products
Canned fish
Ca-fortified orange juice
Supplements
← Magnesium
60% is found/stored in the bones
Functions
o Bone formation
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o Enzyme function
o Nerve and heart function
RDA
o 310-320 mg/day for women
o 400 to 420 mg/day for men
Deficiency
o Unlikely unless diurectic use or alcoholism
o Weakness, muscle pain, poor heart function
Toxicity
o Overuse of antacids, laxatives, or supplements
o Causes diarrhea and weakness in patients with kidney failure
Sources
o Whole grains
o Nuts, beans, green vegetables
Sodium
Major positive ion in extracellular fluid
Blood Na levels controlled by the kidneys
Functions
o Water balance
o Nerve and muscle function
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RDA
o 1500 mg/day age 19-50
o 1300 mg/day age 51-70
o 1200 mg/day age 71 years and older
Deficiency
o Hyponatremia
Rare, only with persistent vomiting, diarrhea, or
excessive perspiration (losing 2-3% body weight-
marathon runners)
Muscle cramps, nausea, vomiting, dizziness, shock,
coma
Toxicity
o Contributes to hypertension in susceptible
Increases Ca loss in the urine
Sodium Sources
o Table salt (40% Na)
o Processed foods
o Condiments
o Chips
o Added to flavor foods
← Chloride
Major negative ion for extracellular fluid
Functions
o Hydrochloric acid in stomach
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o Nerve function
o Water balance
RDA
o 2300 mg/day
Deficiency
o Rare, convulsions in infants
Toxicity
o Unlikely, linked to hypertension in susceptible people when
combined with Na
Sources
o Table salt (60% Cl)
o Some vegetables
o Processed foods
← Potassium
Major positive ion in intracellular fluid
Functions
o Water balance
o Nerve and muscle function
RDA
o 4700 mg/day
Deficiency
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o Rare, only with persistent vomiting or prolonged diuretic
usage
o Irregular heart beat, muscle cramps
Toxicity
o Unlikely, seen only in kidney failure
Sources
o Fruits, vegetables, milk, grains, meats, dried beans
o Bananas
o Orange juice
← Phosphorus
Major negative ion of intracellular fluid
Bone and tooth component
Component of cell membranes, DNA
Acid/base balance
RDA
o 700 mg/day for adults
o 1250 mg/day for children
o Average intake exceeds RDA
Deficiency
o Unlikely, possible bone loss
Toxicity
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o Impairs bone health in people with kidney failure or low Ca
intake
Sources
o Wide variety of foods
o Dairy products
o Breads and cereals
o Meats and fish
o Soft drinks
←← Sulfur
Dietary proteins supply all we need
Functions
o Part of amino acids and vitamins
o Drug detoxification
No deficiency if protein is adequate
No toxicity
Sources
o Protein foods
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Minerals: Micro/Trace 9/19/07 10:00 AM
← Micro/Trace Minerals
Needed in much smaller amounts than macro minerals
Essential for health
Difficult to study
o Only trace amounts in the body
Animal sources of mineral are generally better absorbed
← Minerals
Iron (Fe)
Iodine (I)
Zinc (Zn)
Copper (Cu)
Chromium (Cr)
Fluoride (F)
Selenium (Se)
←← Iron
~ 18% is absorbed, determined by body’s need
Heme iron vs. nonheme iron (heme as in hemoglobin which iron is
part of)
o Heme iron found in animal products, better absorbed that
nonheme iron
No hemoglobin in plants
Redder the better
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o Meat protein factor my aid in nonheme absorption
Vitamin C enhances absorption of nonheme iron
Functions
o Component of hemoglobin in RBC transport of oxygen and
carbon dioxide
o Energy metabolism
o Immune function
Need iron to fight off disease
o Cognitive development (brain)
RDA
o 8 mg/day men
o 18 mg/day women
o Average intakes for men exceed the recommendation, most
women’s intakes are low
Deficiency
o Microcytic hypochromic anemia, low levels of hemoglobin
and hematocrit, insufficient intake and stores
o At risk: infants, toddlers, chronic blood loss, vgans, runners,
and women of childbearing years
o Signs: paleness, brittle nails, fatigue, poor temperature
control, poor growth
Toxicity
o Fairly rare (1/250 have both hemochromatosis genes)
o Liver and heart damage (extreme cases of Fe overload)
o GI upset with Fe supplements
o Infants/children at risk of Fe poisoning
31
Vitamins and mineral supplements can poison children
Iron Sources
o Med (redder the better)
o Seafood
o Broccoli
o Peas
o Whole and enriched grains
← Iodine
70-80% of Iodine in the body is found in the thyroid gland
Functions
o Supports thyroid hormone synthesis
o Regulates metabolic rate, growth, and development
RDA
o 150 ug/day
Deficiency
o Goiter: thyroid gland enlarges
Mountainous areas
o Cretinism: stunting of fetal growth and mental development
as a result of low iodine in maternal diet
Toxicity
o Thyroid hormone synthesis is inhibited
o Looks like iodine deficiency, swelling of thyroid gland
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o Consumption of seaweed poses risk
Sources
o Iodized salt
o White bread
o Saltwater fish
o Dairy products
← Zinc
Involved in many areas of metabolism
40% of Zn in absorbed, competes with copper and iron for
absorption
Functions
o Required for nearly 200 enzymes
o Normal growth and sexual development
o Immune function
o Protein and nucleic acid metabolism
o Wound healing
RDA
o 8mg/day for women
o 11 mg/day for men
Deficiency
o Dwarfism
Groth retardation and poor sexual development
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Decreased appetite and taste sensation
Poor wound healing
o Toxicity
Excessive intakes reduce copper absorption
Diarrhea
Depressed immune function
Zinc Sources
o Seafood
o Meats
o milk
o legumes
o Whole grains
← Copper
Function
o Aids in Fe metabolism
o Hemoglobin formation and Fe transport
o Elastin and collagen synthesis
Proteins that hold everything together
o Antioxidant enzymes
o Immune function
RDA
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o 900 ug/day
Deficiency and Toxicity
o Deficiency
Anemia
Low WBC count
Poor growth
Bone loss
Some forms of cardiovascular disease
o Toxicity
Vomiting
Wilson’s Disease: A genetic deficit that causes an
accumulation of Cu in the brain or liver brain
damage, liver failure, death
Copper sources
o Organ meats
o Whole grains
o Legumes
o Nuts
Chromium
Recently discovered essential trace element (1959)
Functions
o Maintenance of glucose uptake into cells
o Aiding insulin function
35
RDA
o 25 to 35 ug/day
Chromium Deficiency and Toxicity
o Deficiency
Impaired glucose control
Diabetes like symptoms
Elevated blood cholesterol and triglycerides
o Toxicity
Caused by industrial contamination, not by food sources
Liver damage and lung cancer
Chromium Sources
o Egg yolks
o Whole grains
o Pork
o Nuts
o Mushrooms
o Beer
← Fluoride
Functions
o Strengthens tooth enamel
o Decreases the risk of dental caries
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o Inhibits tooth demineralization and enhances tooth
remineralization
RDA
o 3.1 mg/day for women
o 3.8 mg/day for men
Fluoride Deficiency and Toxicity
o Deficiency
Increased risk for dental caries
o Toxicity
Fluorosis: mottling (staining) of teeth during tooth
development
Bone pain
Stomach upset
Sources
o Fluoridated water
o Toothpaste
o Tea
← Selenium
Functions
o Antioxidant enzymes (glutathione peroxidase)
o May help prevent cancer
RDA
o 55 ug/day
Selenium Deficiency and Toxicity
o Deficiency
Muscle pain and weakness
In China a while back
Form of heart disease
o Toxicity
Hair loss, nausea/vomiting, weakness, rashes, cirrhosis
of the liver
Selenium Sources
o Meats
o Eggs
o Fish
o Seafood
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Review 9/19/07 10:00 AM
← Functions of B-Vitamins
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Fat, CHO, and Energy metabolism
o Thiamin
o Riboflavin
o Niacin
o Pantothenic Acid
o Biotin
Protein and Amino Acid Metabolism
o Vitamin B6
Red Blood Cell formation
o Folate,
o Vitamin B12 (& Vitamin B6)
Functional Roles
Coenzymes
o B-Vitamins
o Vitamin K
Antioxidants
o Vitamin E
o Vitamin C
o Selenium
Bone Health
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o Vitamin D
o Vitamin K
o Calcium
o Phosphorus
o Magnesium
Red Blood Cells
o Folate
o Vitamin B12
o Iron
o Copper (& Vitamin B6)
← Water Balance Minerals
H2O Balance
o Sodium (Na), Potassium (K), Chloride (Cl), Phosphorus (P) as
Phosphates
Extra cellular: Na (+) Cl (-) (Salt)
In tracellular: K (+) P(-)
Notable Deficiencies
Xerophthalmia
o Vitamin A
Rickets
o Vitamin D
Beriberi
40
o Thiamin
Cheilosis
o Riboflavin
Pellagra
o Niacin
Scurvy
o Vitamin C
Goiter
o Iodine
Dwarfism
o Zinc
Night Blindness
o Vitamin A
Osteomalacia
o Vitamin D
Neural tube defect
o Folate
Osteoporosis
o Calcium
Weakness, muscle pain
o Magnesium
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Creinism
o Iodine
High Blood Glucose
o Chromium
Dental Caries
o Fluoride
← Deficiency Anemias
Megaloblastic Anemia
o Folate
Pernicious Anemia
o Vitamin B12
Microcytic, Hypochromic Anemia
o Iron (Copper)
← Deficiency and Toxicity
Most likely to be deficient in US diet
o Vitamins
Vitamin E
Folate
o Minerals
Calcium, Iron
High potential for toxicity
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o Vitamins
Vitamin A
o Minerals
Iron
Chromium
← Enriched/Fortified Foods
Flour and other refined grains
o Thiamin
o Riboflavin
o Niacin
o Folate
o Iron
Milk and dairy products
o Vitamin A
o Vitamin D
Salt
o Iodine
Water and toothpaste
o flouride
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