Thiamin (Vitamin B1) and Phytochemicals

Thiamin (Vitamin B1)

• Water-soluble vitamin
• Functions as a coenzyme in energy metabolism
• Plays a role in nerve function related to muscle action
• Requirements increase with metabolic rate
• Recommended Daily Allowance (RDA) for men is 1.2 mg, and for women is 1.1 mg
• Sources include lean pork, whole or enriched grains/flours, legumes, seeds, and nuts
• Deficiency can lead to Beriberi
  • Symptoms of Beriberi include ataxia (muscle weakness/loss of coordination)
  • Symptoms of Beriberi also include tachycardia (rapid heartbeat)
• Deficiency can also cause Wernicke-Korsakoff Syndrome, a severe condition affecting the central nervous system (CNS)
  • Wernicke-Korsakoff Syndrome is associated with chronic alcohol use and risk in severe GI disease, HIV, and improper glucose solutions
  • Neurological/psychiatric effects of Wernicke-Korsakoff Syndrome include loss of memory, extreme mental confusion, and ataxia

Phytochemicals

• Non-nutritive substances in plant-based foods
• Appear to have disease-fighting properties
• Found in fruits, vegetables, whole grains, legumes, herbs, and teas
• Provide additional health benefits, such as antioxidant effects, beyond basic nutrition

Vitamin B12

• Cobalamin, cyanocobalamin in supplement form also
• It modifies folate coenzymes into active forms
• Important for DNA & RNA synthesis
• Needed for metabolism of fatty acids and amino acids
• Maintains myelin sheaths around nerve fibers
• Recommended Daily Allowance (RDA) is 2.4 µg daily
• Absorption requires intrinsic factor produced by stomach mucosa
• Storage occurs in the liver
• Naturally found only in animal-derived foods (meat, fish, poultry, eggs, dairy)
• Vegans should supplement their diets or consume fortified products
• Deficiency is usually secondary, results in megaloblastic or pernicious anemia
• Neurologic/neuropsychiatric effects includes damage to the spinal cord as myelin sheath synthesis affects brain, optic, and peripheral nerves
• Older adults are at risk due to reduced production of the intrinsic factor by the stomach mucosa
• Can be masked by folate levels
• Toxicity is unknown

Vitamin C

• Ascorbic Acid
• Water-soluble
• Functions as an antioxidant and coenzyme
• Also involved in collagen formation and wound healing
• Enhances absorption of nonheme iron
• Supports thyroid and adrenal hormone synthesis
• May reduce cancer risk
• Supplements may decrease the duration and severity of cold symptoms
• Involved in conversion processes like tryptophan to serotonin, cholesterol to bile, and folate to active form
• Recommended Daily Allowance (RDA) is 90 mg for men, 75 mg for women, +35 mg for smokers
• Minimum intake of 10 mg/day prevents scurvy
• Sources include citrus fruits, red/green peppers, strawberries, tomatoes, potatoes, broccoli, leafy greens, and fortified foods
• Sensitive to light, heat, air, and cooking methods
• Extreme deficiency can cause Scurvy in which gingivitis, joint/limb aches, bruising, hemorrhages, and plaques may occur, can cause death if untreated
• Marginal deficiency can cause poor wound healing, gingivitis, inadequate tooth/bone growth and maintenance, and increased infection risk
• At-risk populations include chronic alcohol/drug users, smokers, and older adults
• The Tolerable Upper Intake Level (UL) is 2000 mg/day for adults and 400-1800 mg/day for children
• Megadoses (1–15 g) can cause cramps, diarrhea, nausea, kidney stones, gout, and may interfere with anticoagulants
• Rebound may occur as a protective mechanism, scurvy symptoms may manifest
• Withdrawal from megadoses should be gradual over 2 to 4 weeks.

Vitamins That Are Antioxidants

• Vitamin C (ascorbic acid)
• Vitamin E (alpha-tocopherol)
• Beta-carotene (a precursor to Vitamin A)

Foods Rich in Antioxidants

• Vitamin C–rich foods: citrus fruits, peppers, strawberries, tomatoes, potatoes, broccoli, leafy greens
• Vitamin E–rich foods: vegetable oils (corn, soy, safflower, cottonseed), margarine, whole grains, seeds, nuts, wheat germ, green leafy vegetables
• Beta-Carotene–rich foods: deep green, yellow, and orange fruits and vegetables (carrots, sweet potatoes, spinach, broccoli, cantaloupe)

Vitamin D

• Fat-soluble vitamin
• It is only produced by the body through skin exposure to UV light
• Important for intestinal absorption of calcium and phosphorus
• Helps regulate blood calcium levels
• Supports bone mineralization and overall bone health
• Recommended Daily Allowance (RDA) is ~15 µg (600 IU) for most adults
• Adequate Intake (AI) for newborns is 10 µg / 400 IU
• Adequate Intake (AI) for adults ≥70 is 20 µg / 800 IU
• Synthesized in the skin from 7-dehydrocholesterol with UV to cholecalciferol
• Dietary sources include animal foods like butter, egg yolks, fatty fish, liver, and fortified milk
• Vegans may need supplements
• Synthesis can be limited by length of exposure to ultraviolet radiation, atmospheric conditions, skin pigmentation, sunscreen, clothing, and age
• Deficiency in children causes Rickets, which can result in bowed legs, malformed skeleton, and abnormal teeth
• Deficiency in adults causes Osteomalacia, which can result in soft bones, fractures, weakness, and rheumatism-like pain
• Can contribute to osteoporosis risk
• Adults at higher risk with diminished vitamin D and calcium intake, and/or limited sun exposure, as well as medication-food interactions such as sedatives, tranquilizers, and anticonvulsants
• It may increase risk of CAD, rheumatoid arthritis, cancers, type 1 diabetes, and multiple sclerosis
• Assessment of dietary intake and blood levels reveals that many Americans have marginal levels of vitamin D
• The Tolerable Upper Intake Level (UL) is 100 µg (4000 IU)
• Most toxic vitamin
• Excess intake can lead to hypercalcemia, hypercalciuria, and kidney/cardiovascular damage

Vitamin Toxicity

• Vitamins from natural food intake typically do not cause toxicities
• Fat-soluble vitamins (A, D, E, K) are more likely to cause toxicity if taken in large supplemental doses because they are stored in the body
• Water-soluble vitamins (B-complex, Vitamin C) are generally excreted if taken in excess, but megadoses can still cause adverse effects (e.g., B6 neuropathy, very high vitamin C can cause leading to GI distress)

Ensuring Adequate Vitamin Intake

• Best achieved through a balanced diet that includes a variety of whole foods.
• Synthetic vitamins/supplements perform the same function but may lack other benefits of whole foods like phytochemicals and fiber.
• Elderly individuals, pregnant women, and those with chronic diseases may need supplementation.

Vitamins at Risk to Be Deficient

• Populations at risk include pregnant women, older adults, people with low income, chronic alcohol and drug abusers, those with long-term chronic disorders (AIDS, liver/kidney disorders), and individuals undergoing cancer (CA) treatment
• Water-soluble vitamins have less risk of building toxic levels but can still be deficient if intake is poor or absorption is compromised
• Fat-soluble vitamins (especially D) can also be deficient in those with limited sun or dietary intake.

Vitamin K

• Fat-soluble menaquinone
• Functions as a cofactor in synthesis of blood-clotting factors
• Recommended Daily Allowance (RDA) is 120 µg for men and 90 µg for women
• Sufficient liver storage occurs with recommended intake
• Synthesized by gut bacteria in GI tract
• Dietary sources include dark green leafy vegetables (spinach, kale, broccoli), dairy, cereals, meats, and fruits
• Deficiency may be caused by malabsorption disorders, long-term antibiotic use, and drug-nutrient interactions
• Affects blood coagulation
• Newborns are given IM vitamin K to prevent hemorrhagic disease
• Possible role in osteoporosis
• Toxicity is rare from foods
• Excess supplementation can decrease the effectiveness of anticoagulant medications such as Warfarin

Dehydration

• Water is vital for chemical reactions, nutrient transport, waste removal, temperature regulation, and structure for cells
• Humans can only survive a few days without water
• Adequate Intake (AI) for water is ~13 cups/day for men and ~9 cups/day for women
• Hard water contains high levels of calcium and magnesium
• Soft water has high sodium levels
• Intracellular fluid contains K+ and phosphates
• Interstitial fluid contains Na+ and Cl–
• Extracellular fluid includes interstitial fluid and plasma
• Signs include thirst, dry skin/mouth, low urine output (dark yellow/amber), headaches, dizziness, reduced skin turgor, sudden weight loss, and slow or rapid breathing
• At-risk populations include infants, older adults, and individuals with increased losses (fever, diarrhea, sweating, vomiting, excessive urination, skin jury, burns)

Sodium

• Major extracellular cation
• 75% is found in processed food
• 15% is added to foods at table/cooking
• 10% is found naturally in foods
• The Salty Six: cold cuts/cured meats, pizza, soup, breads/rolls, chicken, burritos/tacos
• It maintains water balance, acid-base balance, nerve transmission, and muscle contraction
• Sources include table salt (NaCl) and processed foods
• Adequate Intake (AI) is 1500 mg/day for adults
• Tolerable Upper Intake Level (UL) is 2300 mg/day
• AI recommended 1500mg/day for adults 51 older, African Americans, HTN, chronic kidney, and Diabetes
• Average intake is 3300mg/day
• Excess can contribute to hypertension
• Deficiency can occur from vomiting, diarrhea, and heavy sweating
• Symptoms of deficiency include muscle cramps, mental apathy, and loss of appetite
• Hyponatremia is low blood sodium and can cause headache, muscle cramps, and weakness
• Patients with acute hyponatremia are often athletes, and patients with chronic hyponatremia include patients with secondary disorders like neuro or kidneys
• Treatment for hyponatremia includes drugs and diet

Potassium

• Primary intracellular cation
• Maintains fluid levels inside cells
• Important in normal function of nerves and muscles
• Adequate Intake (AI) is 4700 mg/day for adults
• Sources: unprocessed foods such as potatoes, tomatoes, bananas, oranges, fruits, vegetables, dairy, and legumes
• Deficiency (Hypokalemia) can be from dehydration, vomiting/diarrhea, diuretics, and laxative misuse
• Deficiency leads to muscle weakness, confusion, appetite loss, and cardiac dysrhythmias
• Toxicity (Hyperkalemia) can be from dehydration or supplement use as well as certain kidney conditions
• Can cause muscle weakness, vomiting, and if severe, cardiac arrest

Edema and Protein

• Edema is excess accumulation of fluid in interstitial spaces caused by seepage from the circulatory system
• Fluid volume excess: a condition in which a person experiences increased fluid retention and edema
• Can occur with low albumin (protein)
• Low albumin can cause reduced oncotic pressure
• Occurs due to fluid shifts into tissues
• Occurs in heart, liver, kidney diseases, or severe infection
• Adequate protein intake helps maintain proper fluid balance.

Calcium

• Most abundant mineral in the body.
• 99% of calcium is in bone structure/storage
• 1% is in body fluids, extracellular fluid, muscle contraction/relaxation, nerve functioning CNS, blood clotting, and blood pressure regulation
• Dietary intake influences the amount of calcium stored in bones
• Parathormone (parathyroid hormone), calcitriol (active vitamin D hormone), and calcitonin affect blood levels
• Absorption depends on bodies physiological need
• RDA ~1000–1300 mg/day
• Dairy products (milk, cheese, yogurt), leafy greens, and fortified cereals/juices are sources
• Deficiency primarily affects bone health (risk of osteoporosis)
• Factors affecting bone density include, race, gender, and FHx
• Factors affecting absorption include lack of stomach acid, vitamin D status, and high fiber diet
• Presence of binders like oxalates (beet greens, collard greens, rhubarb, spinach, swiss chard, and sweet potatoes). Phytates (in legumes and grains), and high phosphorus intake
• High toxicity, leading to elevated blood calcium, constipation, and interference with absorption of other minerals
• Increased risk of kidney stone formation, usually from supplements only

Iron

• Distributes oxygen as a part of hemoglobin (RBCs) and myoglobin (muscles)
• It is required for energy metabolism, growth, and immune support
• Vitamin C enhances absorption of nonheme iron, and Chronic excessive alcohol use can aggravate deficiency
• Blood loss (menstruation, ulcers) also increases deficiency risk
• Heme Iron comes from animal foods (meat, poultry, fish, egg yolks); more bioavailable
• Nonheme Iron comes from vegetables, legumes, whole grains, enriched grains, cooking in cast-iron pans
• Can prevent Iron-Deficiency Anemia: Fatigue, weakness, pallor, irritability, cognitive/learning problems, and immune impairment
• Pica (craving nonfood substances like ice/clay) may appear in severe deficiency
• Heme sources (animal foods)
• Nonheme sources (plant foods, absorption improved by vitamin C)
• Toxicity: Hemochromatosis or hemosiderosis if too much iron is stored
• Damage to tissues may lead to possible lethal effect if large amounts are ingested by children
• Recommended Daily Allowance (RDA) men: 8 mg/day; women: 18 mg/day (27 mg if pregnant) Lower for women post-menopause (8 mg/day)

Iodine

• Component of thyroid hormones that regulates growth/development, metabolic rate, and temperature
• Goitrogens (cassava, vegetables) can suppress thyroid if consumed in large amounts
• Reduces thyroxine
• Deficiency can cause goiter (enlarged thyroid gland), weight gain, and sluggishness
• Maternal deficiency during pregnancy leads to cretinism in the fetus
• Sources include iodized salt, seafood, dairy, and eggs
• Slides mention Salt fortified with iodine
• Toxicity if excessive: UL is 1100 µg/day

Interstitial vs. Intracellular vs. Extracellular

• Intracellular fluid (ICF): inside the cells with concentrations of potassium and phosphates
• Interstitial fluid: fluid between cells as a component of extracellular with concentrations of sodium and chloride.
• Extracellular fluid (ECF): interstitial and/or all fluids outside the cell including plasma, the watery components of body organs, and substances

Prevention of Osteoporosis

• Adequate calcium and vitamin D intake throughout life
• Weight-bearing exercises such as walking, and resistance training can maintain bone density
• Avoiding excessive protein or caffeine intake, excess alcohol, and smoking
• Maintaining healthy body weight and balanced nutrition

Normal Level of Sodium Intake

• Adequate Intake (AI) = 1500 mg/day for adults
• Tolerable Upper Intake Level (UL) = 2300 mg/day for adults
• Recommended daily intake is 1500 mg/day for patients with diabetes
• Average sodium intake is 3300 mg/day
• 1 tsp of salt has about 6 grams of salt

Obesogenic Environment

• Describes environmental factors that promote weight gain or obesity.
• Related to overabundance of inexpensive processed, energy-dense foods
• Large portion sizes
• Sedentary behaviors and minimal daily activity.
• "Globesity" is a term used to describe worldwide obesity epidemic.

Anaerobic vs. Aerobic Pathways

• Anaerobic pathway (glycolysis):
  • It does not require O2.
  • Fuels short bursts of high-intensity exercise (sprinting).
  • Breakdown of Glucose becomes Pyruvate then Lactic acid if no O2
  • Limited exertion – O2 not available to continue.
  • Pyruvic acid converted to lactic acid, results in muscle soreness/stiffness
• Aerobic pathway
  • Requires oxygen
  • Primary for longer-duration or lower/moderate-intensity activities of at least 5 mins
  • Uses both carbs and fats for energy
  • aerobic metabolism predominates after several minutes of sustained activity

Muscle Uses for Energy in Long-Term, Moderate-Intensity Exercise

• It uses glycogen (stored carbohydrate) initially
• The body uses increasingly uses fat for energy as exercise continues
• Fat becomes the primary energy source once glycogen stores become low
• Protein is generally a minor fuel unless energy intake is very low or exercise is extremely prolonged

Increase Energy Expenditure

• Physical activity (exercise) increases daily calorie expenditure beyond basal metabolism
• Both aerobic (cardio) and resistance exercises help weight management
• resting energy expenditure, the energy a person expends in everyday life
• Energy balance %: 70% REE, 10% thermic effect of food (TEF), 20% physical activity

Calculating Total Number of Kcal

• Carbs = 4 kcal/g
• Protein = 4 kcal/g
• Fat = 9 kcal/g
• Proximate composition means to multiply the grams of each nutrient by its energy value and sum them up. For example 4 g of rice is 16 kcal total energy content

Ergogenic Drinks

• They are used by athletes to maintain hydration as well as fluid and electrolyte balance
• They provide some carbohydrates
• Can delay fatigue in prolonged exercises by helping maintain glycogen stores
• Sports drinks should be used sensibly and are not necessary for short, low-intensity workouts
• Drugs or dietary regimens may increase strength, power, and/or endurance, health and efficacy concerns

Weigh Hospitalized Patients

• Consistency is key
• Use same calibrated scale
• Weigh at the same time of day
• Use similar clothing or gown
• Weigh after the patient has voided
• Accurately tracks fluid balance and nutritional status changes

Record Food Intake of a Hospitalized Patient

• Document as “percent (%) eaten.”
• Water, tea, coffee, and condiments are not counted. Butter counts with bread and all give food items, one could divide points eaten by the total items on the tray to determine a percentage
• If there are 5 items and the patient finishes 3 completely and half of the other 2, that might total 4 out of 5 “units” = 80%
• Nurses or diet aides estimate fractions to gauge actual intake

Meal/Nutrient wound healing:

• Protein is essential for tissue building and repair
• Vitamin C is necessary for collagen formatio
• Zinc is important for protein synthesis and tissue repair
• Total calories are needed for protein to be used for healing and not energy

Warfarin Food Interaction

• Vitamin K counteracts Warfarin, reducing vitamin K-dependent clotting factors
• Patients on Warfarin must have a consistent take of Vitamin K
• Large intakes of Vitamin K, can interfere with the effectiveness of Warfarin

Patients on High Nutrition Risk

• Important risk factors for malnutrition include both a high percentage of for unplanned and unintentional weightloss as well has having a decreased appetite and also being too young or being an older adult
• Key risk factors for malnutrition:
  • Unintentional weight loss
  • % of unplanned weight loss in the past 3-6 months
  • <5% is considered low risk
  • 5-10% is considered moderate risk

  • 10% is considered high risk

  • Decreased appetite.
  • Age or an extended NPO (nothing by mouth)
• Those who weigh over 1lb and Significant lab abnormalities are also considered high risk
• Weight gain of over 1 lb in one week may mean fluid retention from heart, kidney or liver failure
• Screening must happen within 48 hours of hospital admission or 14 days for long-term care.

Other Important Vitamins

• All vitamins are organic molecules needed in small amounts for cellular metabolism and these are all either water or fat soluble
• Be aware toxicity is more like from fat-soluble vitamins from supplements and to find these Vitamins always make sure to have a varied diet as well as remember the benefits of phytochemicals in plant foods

Important Minerals

• Water compromises 50%-60% body weight and needs proper regulation
• Sodium is extracellular while Potassium is intracellular
• There are many major minerals needed but some include
• Phosphorous is important in many things especially DNA and RNA
• Sodium and Potassium are important for fluid, nerve, and muscle
• Proper assessment of each is important because too much of one will create some new problems, so it is worth mentioning some of the Key mineral's deficiences and toxicity

Important for Fitness

• Energy is measured in kcal and they are all either anarobic or aerobic
• BMR, is the basal metabolic rate and this is the largest energy component

Note for Patient Care

• Screen patience for nutrition risk and if you are concerned assess, anthropometric, biochemical, clinically and do a dietary review
• Also be aware of drug interaction like grapefruit with some medications