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Questions and Answers
What role does vitamin C primarily play in the body?
What role does vitamin C primarily play in the body?
Which of the following is a known effect of excess vitamin E intake?
Which of the following is a known effect of excess vitamin E intake?
Which demographic group is advised to receive vitamin K injections to prevent deficiency bleeding?
Which demographic group is advised to receive vitamin K injections to prevent deficiency bleeding?
Which of the following conditions is vitamin B1 deficiency primarily associated with?
Which of the following conditions is vitamin B1 deficiency primarily associated with?
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What is a common symptom of vitamin B2 (riboflavin) deficiency?
What is a common symptom of vitamin B2 (riboflavin) deficiency?
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Which vitamin is known for its role in lowering triglycerides while raising HDL levels?
Which vitamin is known for its role in lowering triglycerides while raising HDL levels?
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What is a significant risk factor for vitamin B1 deficiency?
What is a significant risk factor for vitamin B1 deficiency?
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What is the primary pathological condition associated with vitamin B3 deficiency?
What is the primary pathological condition associated with vitamin B3 deficiency?
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Which vitamin should be monitored for interaction in patients taking warfarin?
Which vitamin should be monitored for interaction in patients taking warfarin?
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What are the dietary sources primarily rich in vitamin C?
What are the dietary sources primarily rich in vitamin C?
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What is the maximum recommended intake of Vitamin B6?
What is the maximum recommended intake of Vitamin B6?
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Which condition is NOT associated with Vitamin B6 deficiency?
Which condition is NOT associated with Vitamin B6 deficiency?
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What is a known side effect of taking excessive amounts of Vitamin C?
What is a known side effect of taking excessive amounts of Vitamin C?
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What is the role of Vitamin B12 in the body?
What is the role of Vitamin B12 in the body?
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Which of the following is a consequence of Vitamin B9 excess?
Which of the following is a consequence of Vitamin B9 excess?
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What is true regarding Biotin (Vitamin B7) deficiency?
What is true regarding Biotin (Vitamin B7) deficiency?
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What is a consequence of Vitamin B12 deficiency?
What is a consequence of Vitamin B12 deficiency?
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Which of the following is NOT a natural source of Vitamin C?
Which of the following is NOT a natural source of Vitamin C?
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Calcium is important for all of the following functions EXCEPT:
Calcium is important for all of the following functions EXCEPT:
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Which vitamin can be affected by taking anticonvulsants?
Which vitamin can be affected by taking anticonvulsants?
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What is the primary function of Vitamin A in the body?
What is the primary function of Vitamin A in the body?
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Which of the following is NOT a risk factor for nutritional deficiencies related to vitamins?
Which of the following is NOT a risk factor for nutritional deficiencies related to vitamins?
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What is the role of Vitamin D in calcium homeostasis?
What is the role of Vitamin D in calcium homeostasis?
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Which vitamin's deficiency can lead to Rickets in children?
Which vitamin's deficiency can lead to Rickets in children?
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What is the recommended maximum daily intake of Vitamin A for an adult?
What is the recommended maximum daily intake of Vitamin A for an adult?
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Which vitamin is known for its role as an antioxidant?
Which vitamin is known for its role as an antioxidant?
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Which of the following vitamins must be obtained exclusively from dietary sources?
Which of the following vitamins must be obtained exclusively from dietary sources?
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What is the primary consequence of hypervitaminosis D?
What is the primary consequence of hypervitaminosis D?
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Which factor can influence the recommendation for Vitamin D supplementation?
Which factor can influence the recommendation for Vitamin D supplementation?
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In which organ is Vitamin D primarily activated?
In which organ is Vitamin D primarily activated?
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What is the primary function of Coenzyme-A (CoA) derived from Vitamin B5?
What is the primary function of Coenzyme-A (CoA) derived from Vitamin B5?
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Which condition is Vitamin B6 most commonly used to treat based on the best evidence?
Which condition is Vitamin B6 most commonly used to treat based on the best evidence?
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What symptom is associated with Vitamin B5 deficiency?
What symptom is associated with Vitamin B5 deficiency?
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At what dosage does Vitamin B5 toxicity typically begin?
At what dosage does Vitamin B5 toxicity typically begin?
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What is Inositol hexanicotinate (INH) suggested to be ineffective for?
What is Inositol hexanicotinate (INH) suggested to be ineffective for?
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Which of the following is a natural source of Vitamin B5?
Which of the following is a natural source of Vitamin B5?
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Which statement about Vitamin B6 is true?
Which statement about Vitamin B6 is true?
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Which of the following is NOT a symptom of Vitamin B5 toxicity?
Which of the following is NOT a symptom of Vitamin B5 toxicity?
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Which uses of Vitamin B6 have been noted with only some evidence?
Which uses of Vitamin B6 have been noted with only some evidence?
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Which name can Vitamin B5 also be referred to as?
Which name can Vitamin B5 also be referred to as?
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Study Notes
Vitamins and Minerals: Introduction
- The vitamin and supplement industry is a $36+ billion industry
- The use of vitamins and supplements is increasing
- Over a third of the US population uses a multivitamin daily
- It's recommended to obtain vitamins and minerals from a healthy diet
- There is a risk of not seeking medical help when treating with OTC supplements
- There is a risk of worsening a poor diet by relying on supplements instead of a healthy diet
Objectives
- List all the names of different vitamins.
- Identify uses and interactions associated with each vitamin.
- Determine the requirement of vitamin supplementation for a given patient based on data.
- Explain the symptoms of vitamin excess or deficiency for each vitamin.
- Describe key counseling points, contraindications, and warnings for each vitamin.
- List the percentage of elemental substances in products.
- Identify common brand names of vitamins.
Reading
- Required reading is Chapter 23, in the Handbook of Nonprescription Drugs
- Suggested resource is the Natural Medicines database for information on vitamins and minerals.
The Impact
- Vitamins are important components of metabolic reactions in the body.
- Some nutrients cannot be synthesized in the body, and must be obtained through the diet.
- Deficiencies and excesses of vitamins can lead to health issues.
- Vitamins can be involved in drug-drug, drug-food, and drug-lab test interactions.
The Industry
- The Vitamin and supplement industry is a $36+ billion dollar industry
- The use of vitamins and supplements is increasing
- Over a third of the US population uses a multivitamin daily
- Getting your necessary vitamins and minerals from a healthy diet is encouraged.
- There is a risk of not seeking medical help if treating issues with over the counter supplements
- There is a risk of worsening a poor diet by relying exclusively on supplements instead of balanced nutrition
Risk Factors for Nutritional Deficiencies
- Inadequate dietary intake
- Poor diet
- Decreased absorption or synthesis of vitamins
- Inability to purchase or prepare adequate meals
- Eating disorders like Anorexia
- Issues or diseases with metabolism
- Increased metabolic needs
- Medications
Dietary Reference Intakes (DRI)
- Estimated Average Requirement (EAR): Measures the intake level required for 50% of a specific age and gender population
- Recommended Dietary Allowance (RDA): Measures average intake of nutrients that prevents deficiency in 98% of the population.
- Adequate Intake (AI): Used when sufficient evidence is unavailable to calculate RDA.
- Tolerable Upper Intake Level (UL): Highest level of a nutrient likely to cause no adverse effects in 98% of the population
Vitamins
- Vitamins are non-energy producing substances
- Vitamins are crucial to maintaining normal metabolic function
- Almost all vitamins must come from dietary sources
Water-Soluble Vitamins
- Vitamin B
- Vitamin C
Fat-Soluble Vitamins
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K
Vitamin A
- Retinoids are found in animal sources (retinol)
- Carotenoids are found in plants (alpha-carotene, beta-carotene, beta-cryptoxanthin)
- Active vitamin A includes retinal and retinoic acid
- Plant-based carotenoids include lycopene, lutein, and zeaxanthin.
- Very important to growth and development of teeth, bones, mucous membranes, and organs
- Vitamin A is crucial for eye health
- Recommended Intake: 3,000 IU (max: 10,000 IU/day).
- Dose in deficient adult: 100,000 IU for 3 days, then 50,000 IU for 14 days.
- Deficiency symptoms: dermatitis, poor growth, night blindness, infections, blindness, dry eyes
- Excess symptoms: liver toxicity, cheilosis, nausea/vomiting, bone fractures, congenital birth defects.
- Uses: night blindness, dry eye, wound healing.
- 90% of vitamin A is stored in the liver.
Vitamin A: Retinol Activity Equivalents (RAE)
- 1 RAE = 1 retinol equivalent
- 1 mcg of retinol = 12 mcg of beta-carotene
- 1 mcg of retinol = 24 mcg of alpha-carotene
- 1 mcg of retinol = 24 mcg of beta-cryptoxanthin
Vitamin D
- Cholecalciferol (D3) is the naturally occurring form.
- Comes from dietary cholesterol exposure to sunlight or from an endogenous source.
- Ergocalciferol (D2) is used as a food additive.
- Activated by hydroxylation in the liver to 25-hydroxycholecalciferol (or calcidiol) then to 1,25-dihydroxycholecalciferol (or calcitriol)
- Important to the role of the liver and the kidneys
Vitamin D: Functions
-
Functions as a hormone and in bone growth and remodeling
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A part of the parathyroid hormone, phosphate, and calcitonin in maintaining serum calcium
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Plays a role in immune and gut health
Vitamin D: Deficiency
- Results from inadequate intake, Gl disease, renal failure, insufficient sunlight exposure, genetic disorders, medications, obesity, or bypass surgery
- Symptoms: Rickets, osteoporosis, osteomalacia, muscle weakness, hypocalcemia, high risk of cardiovascular disease
- Hypervitaminosis D: may cause, hypercalcemia (arrhythmias), anorexia, constipation, dehydration, irritability, vomiting, kidney damage
Vitamin D: Intake
- Recommended intake (ages 19-70): 600 IU daily.
- Additional 800 IU daily for ages >70
- Up to 10,000 IU daily in many cases, though not all sources agree, consult with doctor.
- 30 minutes of full body sun exposure can supply 10,000 IU
Vitamin D: Supplementation
- Vitamin D supplements must undergo hydroxylation in the liver and kidneys to become calcitriol
- People with liver or kidney dysfunction may require calcitriol (prescription only).
- Recommended supplementation is 400 IU recommended for exclusively breastfed infants.
- Deficiency: 5,000-7,000 IU daily or 50,000 IU weekly.
- May be needed to obtain adequate levels in many, and monitoring may be crucial for serum levels
Vitamin D: Monitoring
- Laboratory classification of serum 25(OH)D levels: - <31.9 ng/mL = deficient - 32-100 ng/mL = normal - >40 ng/mL = optimal - 60-80 ng/mL is the accepted range for optimal health - >100 ng/mL = potential for toxicity.
Vitamin E
- Also known as Tocopherols
- Role: Antioxidant; important for heme biosynthesis, steroid metabolism, and collagen formation
- Deficiency: Hemolytic anemia, peripheral neuropathy, and muscle weakness
- Excess: Hemorrhagic toxicity, congestive heart failure, and prostate cancer
- Potential CVD risk with high doses
- Potential uses: Alzheimer's disease, cardiovascular disease, hot flashes, burns, anti-aging creams
Vitamin E: Intake
- Recommended intake: 15 IU (max: 1,000 IU)
- Do not recommend more than 400 IU daily
- Natural Sources: Leafy vegetables, eggs, milk, avocado, nuts, and grains
- Drug interaction: Antagonizes vitamin K. Be aware of clotting time in patients with warfarin.
Vitamin K
- Also known as Phylloquinone or phytonadione (K1), menaquinone (K2 or MK), menadione (K3)
- Role: Blood clotting
- Deficiency: Bleeding (ecchymosis, petechiae, hematomas)
- Possible causes of deficiency include: low intake of vitamin K-rich foods and medications (e.g., antibiotics, warfarin).
- Excess: No known problems
- Recommended intake: 90-120 mcg
- May be administered with injection or other forms
Water-Soluble Vitamins
- Vitamin B1
- Also known as Thiamine
- Role: Substrate for enzymes; greatest effect on heart and nervous system
- Deficiency symptoms: Beriberi, Wernicke-Korsakoff syndrome, fatigue, lactic acidosis, wasting
- Excess symptoms: Irritability, headache, tremor
- Natural sources: Yeast, pork, grains, oatmeal, brown rice, asparagus, kale
- Vitamin B2
- Also known as Riboflavin
- Role: Metabolism of proteins, carbohydrates, fats, and ketone bodies
- Deficiency symptoms: Dermatitis, stomatitis, cheilosis, glossitis, photophobia, normocytic anemia
- No notable excess symptoms, but high doses could cause bright yellow urine.
- Natural sources: Milk, meats, leafy green vegetables, legumes, eggs, mushrooms, almonds.
- Recommended Intake: 0.9-1.3 mg/day
- Vitamin B3
- Also known as Niacin or Niacinamide
- Role: Involved in DNA repair and steroid synthesis
- Deficiency: Pellagra (4 D's: dermatitis, diarrhea, dementia, death)
- Causes of deficiency: Alcoholism, poor diet, excessive corn intake in the diet
- Use caution when prescribing large doses to patients with: liver disease, active peptic ulcer disease, gastritis, gout, diabetes
- Natural sources: Liver, fish, milk, beans, avocado, dates, tomatoes, nuts, mushrooms
- Vitamin B5
- Also known as Pantothenic acid
- Precursor to Coenzyme A (CoA)
- Essential to the metabolism of carbohydrates, fats, and proteins
- Toxicity: Diarrhea, heartburn (rare)
- Natural sources: Meats, whole grains, broccoli, avocado, eggs, and legumes
- Recommended Intake: 5 mg per day
- Vitamin B6
- Also known as Pyridoxine
- Role in amino acid metabolism, gene expression, gluconeogenesis, lipid metabolism, and neurotransmitter synthesis
- Deficiency symptoms: Dermatitis (especially on face), glossitis, convulsions, anemia, peripheral neuropathy
- Excessive usage may increase the metabolism of some anticonvulsants
- Natural sources: Meats, vegetables, whole grains, nuts
- Recommended Intake: 1.0-1.7 mg (max: 100mg, aim for 50 mg)
- Vitamin B7
- Also known as Biotin
- Role in metabolism of fatty acids and carbohydrates
- May cause laboratory test interactions (some taking up to 650 times the recommended intake)
- Natural sources: Cooked eggs, yeast, nuts, and legumes
- Recommended Intake: 20-30 mcg
- Vitamin B9
- Also known as Folate/folic acid (synthetic version)
- Role: DNA synthesis and repair, RBC production, brain and spinal cord development
- Deficiency: Megaloblastic anemia, irritability, diarrhea, neural tube defects, sores in mouth
- Causes of deficiency: increased intake of drugs (such as oral contraceptives, dihydrofolate reductase inhibitors, antibiotics) and/or a restricted diet.
- Natural sources: Leafy vegetables, fortified cereals and breads, beans, liver
- Recommended Intake: 300-400 mcg (Pregnancy/Pre-conception: 400-800 mcg)
- Vitamin B12
- Also known as cyanocobalamin or cobalamins
- Role: Normal brain and nervous system functions, RBC development, DNA synthesis, fatty acid synthesis, and energy production.
- Deficiency: pernicious anemia, macrocytic anemia, mental confusion, peripheral neuropathy, jaundice, glossitis
- Deficiency causes include: Inability to absorb B12, atrophic gastritis, reduced intestinal motility, achlorhydria, use of gastric acid-lowering agents, metformin and vegetarian diet.
- Natural sources: Meat, shellfish, milk, eggs, cheese
- Recommended Intake: 1.8-2.4 mcg (Deficiency dose: 1000 mcg IM/SC once weekly, then 1000mcg monthly)
Minerals
-
Calcium
- Commonly used; 43% population, and 70% of older females
- Essential for muscle function, nerve transmission, and hormone secretion
- Pharmacologic uses: bone health, antacids
- Deficiency: rare as bones act as a storage for calcium
- Recommended intake varies by age.
- Side effects: bloating, gas, constipation
- Toxicity: kidney stones, renal toxicity, nausea/vomiting
-
Fluoride
- Form: Sodium fluoride (45% fluoride ion), acidulated phosphate fluoride, stannous fluoride (24% fluoride ion)
- Role: Increases enamel resistance to acids produced by bacteria in the mouth
- Deficiency: Unknown, except tooth decay
- Excess: Increase salivation, GI upset, muscle weakness, tremor, seizures, fluoride binds calcium, lead to calcium depletion (tetany)
- Recommended Intake: 2-4mg daily
-
Iron
- Role: Oxygen and electron transport
- Deficiency: Pallor, fatigue, spoon-shaped nails, sore tongue, SOB, cold/numb extremities
- Excess: Abdominal pain, v/d, electrolyte imbalance, shock
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Zinc
- Role: Cofactor in DNA/RNA synthesis, normal immune function, and spermatogenesis
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Deficiency: Slow wound healing, slow growth in children, impaired taste and smell
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Chromium
- Trace element; important for bone formation and many enzymatic reactions
- Some evidence for use in Diabetes, Bipolar, Cardiovascular disease, Cognitive dysfunction, Depression, Parkinson's, and Schizophrenia
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Magnesium
- Role: needed for bone formation and many enzymatic reactions
- Deficiency: constipation, muscle cramps, migraines/headaches, fatigue, insomnia, palpitations/angina, anxiety, menstrual cramps, kidney stones
- May be caused by Gl or renal disorders
- Forms: (high bioavailability) Chloride, lactate, aspartate, glycinate, gluconate, threonate, malate, poor absorption: Citrate, carbonate, oxide, and hydroxide
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Description
Test your knowledge on the roles and effects of various vitamins in the body. This quiz covers essential information about vitamins A through K, their deficiencies, and dietary sources. See how much you know about the importance of these nutrients for health and well-being.
