final topics
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| Flavonoids biochemistry | Potent anti-oxidants. Reduce capillary fragility. Anti-histamine, anti-inflammatory, anti-cancer. Weak hormone like actions.
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| Flavonoid indication | -Capillary fragility
-Venous insufficiency
-CVD (improve endothelial function and HDL levels)
-Osteopenia
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| Flavonoid Dietary sources and dosage | -Fruits, Vegetables, Tea, Red wine
-Dosage varies
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| Flavonoid Interactions | Grapefruit ones alter cytochrome p450 enzyme activity
-Vegetarians/Vegans should choose beans w/ lower [Polyphenols] and [Phytic acid]which inhibit Iron absorption
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| Vitamin D Biochemistry | Hormone for calcium homeostasis regulation.
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| Vitamin D Indications | -Pvx/Tx of Osteoporosis, Osteomalacia, Rickets, Falls -Psoriasis -Cancer Pvx/Tx -Seasonal Mood D/o (enhance mood) -PCOS (normalize menstruation) -Respiratory infections
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| Vitamin D Testing + Deficiency vs Insufficiency | -Serum testing: 25-OH vitamin D3 (calcidiol) and 1,25-OH vitamin D3 (calcitriol)
-Deficiency=<10ng/ml, Insuffiency=<30ng/ml
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| Vitamin D Deficiency + Causes | -Osteomalacia, Hypocalcemia, Rickets. Potential increased risk of autoimmunity, cardiovascular disease, and cancer
Causes: Malabsorptive disorders (Crohn’s, Celiac Disease, Cystic Fibrosis, etc), hypothyroidism, poor sun exposure and certain drugs
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| Vitamin D Dietary Sources + Dosages | -Sources=Fish/cod liver oil, eggs, fortified milk, Sun
-Dosages: Maintenance=1000IU, Deficiency=4000IU
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| Vitamin D Interactions | -Dilantin and ACE inhibitor and Bariatric surgery reduces D levels,
-D lowers Atorvastatin
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| Vitamin D Toxicity | >40,000IU, Kidney stone risk w/ calcium
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| Vitamin E Biochemistry | -group of eight different tocopherols or tocotrienols that act as lipid soluble antioxidants.
-Supplements mostly contain alpha-tocopherol form.
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| Vitamin E Indications | -Pvx/Tx of CVD (Reduced MI w/ 400IU) -Venous thromboembolism -Intermittent claudication -Fibrocystic breast dz/PMS, Hot flashes, migraines, dysmenorrhea
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| Vitamin E Dietary sources + Dosage | -Sources: Wheat germ oil, soy yogurt, sunflower seeds/oil, almonds/pecans/hazelnuts
-Dosage: ~400-600IU, but <1000IU
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| Vitamin E Interactions | -Reduced tardive dyskinesia by Phenothiazines -reduced cisplatin (chemotherapy)-induced neurotoxicity
-ihibitory w/ iron
-Inc Vit E need w/ PUFAs,
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| Vitamin K Biochemistry | -Needed w/ blood clotting factors, and is cofactor for bone mineralization (osteocalcin, matrix Gla), synthesized in LI by bacteria
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| Vitamin K Indications | -Tx of Blood clotting d/o, reverse coumadin overdose
-Pvx/Tx of osteoporosis -Atherosclerosis (red. CAD)
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| Vitamin K Dietary Sources + Dosages | -Sources: turnip greens, broccoli, dark/leafy veggies, beef liver, oats, cheese, green tea.
-K2 synthesized in LI by bacteria -Dosage: 100-1000mcg/day
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| Vitamin K Interactions | -contraindicated w/ Warfarin -food sources should be monitored during anti-coagulant therapies
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| Vitamin K Deficiency | Hemorrhagic Dz of the newborn, Easy bleeding
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| Vitamin K Toxicity | None reported, although adverse effects seen w/ precursor menadione and water soluble derivative menadiol (both no longer used)
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| Calcium Biochemistry | Major extracellular cation. Main constituent of bone. In intestinal lumen, binds and precipitates bile acids.
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| Calcium Indications | Osteoporosis, Leg cramps, Cancer Pvx, Preeclampsia pvx, HTN, Hypertriglyceridemia/cholesterolemia, Wt loss (fat oxidation), PMS
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| Calcium Dietary Sources + Dosages | Dairy, fortified fruit juice, fortified soy, green leafy veggies (not spinach) -Dosage: supplementation 600-1200mg/day where diet provides 400-1000 mg/day.
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| Calcium Interactions | Glucocorticoids deplete Ca, Inhibits Antibiotics, bisphonates, aluminium absorption, and thiazide diuretics may cause hypercalcemia
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| Calcium Testing | Serum
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| Calcium Defieciency | Rickets, osteoporosis, tetany (muscle pain, spasms, tingling/numbess in hands and feet
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| Calcium Toxicity | Constipation, Hypochlorhydria, Hypercalcemia, Inc. MI
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| Magnesium Biochemistry | important intracellular cation, necessary for proper function of muscle tissue and the nervous system and cofactor in a large number of enzymes.
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| Magnesium Indications | Mitral Valve prolapse sxs, CVD (MI, CHF), Asthma, Mg Deficiency Sxs, Diabetes (improve insulin resistance), HTN (hypotensive), Osteoporosis,
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| Magnesium Dietary Sources/Dosages | Sources:whole grains, nuts, legumes, dark green vegetables, fish, and meat. -Dosages:Supplemental 200-600mg/day, RDA range: 80-420mg/day
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| Magnesium Interactions | Diuretics/Platinum/B agonists/laxatives (deplete),
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| Magnesium Toxicities | Diarrhea and IV form (cautions: hypotension, bradycardia, or respiratory depression (avoid in those w/ recent heart attack)
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| Magnesium Deficiencies | fatigue, depression, anxiety, irritability, insomnia, hyperventilation, muscle spasms and fasciculations, chest tightness, confusion, and memory loss.
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| Magnesium Testing | Serum levels not predictive of stores (RBC and WBC forms better), 24 hr urine test best.
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| Potassium Biochemistry | major intracellular cation. Imbalances in sodium / potassium ratios can cause serious trouble, including cardiac arrest.
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| Potassium Indications | HTN (DASH diet), Renal stones (dec. recurrence), Diabetes (inc. glucose tolerance)
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| Potassium Dietary Sources/Dosages | Sources: meat, avocado, apricot, banana, kiwi, spinach, tomato, lima bean, coconut water -Dosages: RDA: 3500mg/day FDA caps @ 99mg, liquid or effervescent preparation or extended release. In diet usually 50-100mEq~2000-4000mg. IV not recommended.
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| Potassium Interactions | Thiazides and loop diuretics may deplete, ACE inhibitors inc. levels
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| Potassium Testing | Serum tests sufficient
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| Potassium Toxicities | Diarrhea, Gastric irritation/ulceration. CI: pts w/ renal failure or diabetes w/ K metabolism abnormalities,
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| Potassium Deficiencies | seen in individuals with excessive fluid loss such as vomiting, diarrhea, sweating or medication. Sxs include muscle weakness, irritability, fatigue, heart disturbances, and confusion.
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| Zinc Biochemistry | involved in over three hundred enzymes, is necessary for proper wound healing, normal immune function, reproduction and as direct viricidal effect.
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| Zinc Indications | Skin conditions (Acne, Furuncles, Acroderm. enteropathica, Seborrheic dermatitis (pruritis, erythema, dandruff), warts), Infectious Dz (cold sxs, Pneumonia, herpes, OM), gastric ulcer, hepatic encephalopathy, macular degeneration, immune function, BPH.
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| Zinc Dietary Sources | Oysters, crimini mushrooms, spinach, sea vegetables, basil, thyme, pumpkin seeds, yeast, beef, lamb, green leafy vegetables, whole grains, nuts, poultry and eggs.
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| Zinc Dosages/Testing | RDA: 15mg/day, Supplemental: 15-90mg/day. no reliable test for subtle deficiency. Picolinate and Citrate forms more bioavailable and less risks than sulfate form.
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| Zinc Interactions | Diuretics/NSAIDS/OC (deplete), Tetracycline/Fluoroquinine/Iron inhibited, Cu deficiency(30x:1Cu ratio best),
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| Zinc Toxicities | GI upset. (taken intranasally->anosmia), CU deficiency
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| Zinc Deficiencies | Taste test? Horizontal white spots on fingernails? impaired wound healing, dermatitis, rough skin, poor nail health, and increased infections
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| Copper Biochemistry | involved in synthesis of collagen, regulation of cholesterol levels and in formation of bone, is a cofactor in one of the superoxide dismutase enzymes.
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| Copper Indications | Deficiency, High cholesterol, arthritis (bracelet), Osteoporosis
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| Copper Dietary Sources/Dosages | Sources: whole grains, nuts, legumes, vegetables, and meat. -Dosages: Recommended: 1.5-3mg/day, RDA: 900mcg (adults), 1000/1300 (pregnant/nursing)
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| Copper Interactions | NSAIDS/penicillamine/AZT/ethambutol/Zn (deplete), prevents GI toxicity of aspirin
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| Copper Testing | Serum ceruloplasmin good screening test better along w/ serum non-ceruloplasmin copper test.
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| Copper Toxicities | nausea, vomiting, other GI distress. Liver cirrhosis, Psychiatric Dz.
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| Copper Deficiencies | impaired glucose tolerance, hypercholesterolemia, hyperuricemia, cardiovascular disease, osteoporosis, emphysema, anemia, neutropenia, and impaired immune function
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