Trans-Fatty Acids (TFAs)

Trans-Fatty Acids (TFAs)

• Fats undergoing partial hydrogenation to improve shelf life and texture are TFAs
• TFAs are implicated as a risk factor for heart disease by increasing LDL and decreasing HDL
• Naturally found TFAs are in beef, lamb, and dairy products
• Artificially added TFAs are found in commercially baked goods, chips, crackers, deep-fried foods, stick margarine, and shortenings
• There are artificial (industry) and natural forms
• Natural TFAs are produced in ruminant animals by bacterial transformation of unsaturated fatty acids
• Conjugated linoleic acid (CLA) is the most common
• Artificial TFAs are created during partial hydrogenation with hydrogen gas and a metal catalyst, or when vegetable oils are chemically altered to stay at room temperature
• Natural TFAs are found in small amounts in animal products
• Hydrogenated vegetable oils have serious health consequences
• Industrial TFAs are banned, though TFAs can still form during frying at high temperatures

Vitamins

• Vitamins are organic, essential nutrients required in small amounts that promote growth, reproduction, and the maintenance of health and life
• Vitamins can be fat-soluble or water-soluble
• Fat-soluble vitamins are stored in the body more slowly
• There is a greater potential for toxicity with fat-soluble vitamins
• Water-soluble vitamins: Excess intake is excreted because most are not stored
• Water-soluble vitamins: Deficiencies may appear more quickly
• Fat-soluble vitamins include Vitamins A, D, E, and K
• Water-soluble vitamins include B-Vitamins and Vitamin C

Minerals

• Minerals are inorganic, essential nutrients required in varying amounts
• Minerals function primarily as structural components or regulators of body processes
• Examples of minerals include Ca, Mg, K, Fe, Zn, F, and Chromium

Vitamins in the diet

• They can be found naturally in food, or from enriched foods where nutrients are added back in after being lost during food processing
• They can also come from fortified foods, where nutrients are added that were not originally present
• Natural Health Products (NHPs) are an additional source

Vitamin and Mineral Supplementation

• Supplementation has been marketed for years, even though deficiencies are rare
• People take vitamins as an "insurance policy"; some may over-supplement and cause harm
• Vitamin and mineral needs should be met by eating a balanced diet with a variety of foods
• Health Canada fortifies many foods to prevent nutritional deficiencies, like Vitamins A+D in milk and margarine, and iodine in table salt
• Food is the best way to obtain nutrients

Circumstances when supplements might be recommended

• Requirements are increased, making it difficult to get enough from diet alone (e.g., pregnant and lactating women needing folic acid and iron)
• Drug-nutrient interactions can necessitate supplementation
• Smokers may need more Vitamin C
• When intake from diet is likely inadequate, such as in people on low-calorie diets, those who avoid entire food groups, those with chronic substance abuse, the elderly with a poor diet, or those with lactose intolerance
• Malabsorption is a risk after bariatric surgery or due to GI diseases, or decreased malabsorption in the elderly
• Therapeutic uses, such as correcting a deficiency or preventing/treating a disease/condition unrelated to deficiency (e.g., Niacin for CV disease, Vitamin C for cold)

Discussing Nutrients

• Be able to discuss each nutrient's chemical name of active substances, physiological function in the body, symptoms of deficiency, adverse effects of excess intake, and therapeutic use and evidence
• List at least 2 major sources from which each vitamin can be obtained
• Anti-oxidant vitamins include Vitamin A and Beta-carotene, Vitamin E, and Vitamin C
• Nutrients for metabolism include B vitamins
• Nutrients for bone health include Ca

Vitamin A/Beta-Carotene

• Dietary sources for Vitamin A include animal products, as well as from plant carotenoids
• Carotenoids (most potent is B-carotene) which are converted to vitamin A in the body
• Vitamin A is a group of retinoids that includes retinol (reproduction), retinal (vision), and retinoic acid (growth regulation)
• Beta-carotene is not always converted to vitamin A (retinol), making animal sources more efficient

Beta-Carotene Absorption and Supplements

• Beta-carotene from supplements is better absorbed than from food
• Some carotenoids (e.g., Lutein, lycopene) have no Vitamin A activity
• Vitamin A: Promotes vision, especially night vision
• Retinal makes rhodopsin, which carries visual information to the brain
• It maintains the health of epithelial tissue and skin via protein synthesis and cell differentiation
• Vitamin A aids in fetal development, growth and cell differentiation, and reproduction
• Vitamin A supports overall immune function
• Vitamin A (Beta-carotene) can be converted to Vitamin A in the intestinal mucosa and liver, and if unconverted, it has anti-oxidant properties

Vitamin A Deficiencies

• Deficiencies can be very rare in North America but common in undeveloped countries in association with malnutrition
• Night blindness occurs without Vitamin A because there is not enough retinol in the retina to regenerate rhodopsin
• A decrease in the ability to see in low light results

Vitamin A Toxicity

• Intake of >1500 mcg (approx. 2x the RDA) results in decreased bone density and increased risk of fracture in adults
• Teratogenic effects may occur if excess of 10,000IU or 3000 mcg/d are taken during the first 2 months of pregnancy; avoid individual supplements
• Beta-carotene is not harmful

Vitamin E

• There are 8 naturally occurring anti-oxidant forms (tocopherols); Alpha-tocopherol is the only form, found in circulation and tissues
• Alpha-tocopherol and vitamin E are used interchangeably

Vitamin E Sources and Forms

• Dietary sources of vitamin E include vegetable oils, nuts, meat, poultry, eggs, and whole grains (foods high in fat)
• The natural form (d-alpha-tocopherol) provides twice the biological activity of the synthetic form
• Supplements usually express content as IU
• Synthetic Vitamin E contains less of the active form, sometimes sold in higher doses

Vitamin E Functions, Deficiencies, and Toxicity

• There is no metabolic function, but the lipid-soluble anti-oxidant protects cell membranes and lipids from oxidative damage
• Vitamin E deficiencies are very rare, but may be found with diseases of fat malabsorption, especially CF
• Toxic effects result in Risk of bleeding at high doses, especially with the synthetic form, so Vitamin E and warfarin used together should be used with caution
• High doses (>800IU) may increase the risk of bleeding

Vitamin E Therapeutic Uses

• Synthetic form may slow the progression of Alzheimer’s Disease by 6 months (2000 IU)
• Cardiovascular disease can produce negative results, even harmful outcomes, especially increased risk of heart failure, mortality, or stroke with 400 IU

Vitamin C

• Vitamin C is also known as ascorbic acid; ⅓ of Canadians take a Vitamin C supplement
• Smokers require an extra 35 mg/d
• Vitamin C acts as a coenzyme involved in collagen synthesis, carnitine production, and neurotransmitter formation.
• It also acts as an anti-oxidant by defending against free-radicals, protecting tissues from oxidative damage, and regenerating other antioxidants
• Scurvy results from Severe Vitamin C deficiency; 50% of 20-29 year old's do NOT get adequate intake
• People with substance use disorders, smokers, and others with poor diet may also be deficient

Vitamin C Toxicity and Therapeutic Use

• Generally well-tolerated, though higher doses (>2g/d) can lead to diarrhea and GI upset
• The UL in adults is 2g/d
• Vitamin C Deficiency: Some studies support the use of high-dose IV vitamin C (able to raise plasma levels >1000x that of oral dose)
• Used to prevent and treat the common cold; up to 2g/d does not decrease colds in the average person; May provide some benefit in people under physical stress rather than normal conditions
• Some evidence indicates it can increase (shorten) duration by 8% (adults) & 14% (children) - by 1-1.5 days; 2g/day more effective than 1g/d

Macular Degeneration

• Discuss the clinical implications of the AREDs studies
• Anti-oxidants are used for Macular Degeneration (AMD), the leading cause of vision loss
• AMD reduces central vision, reduces visual discrimination, and alters ability to read, drive, recognize faces, etc
• Age-related Eye Disease Study (AREDs) studied if antioxidants can help with AMD in people with median Age of 69 yrs
• Participants were assigned to one of four categories based on severity of AMD
• Intervention groups were put into four groups 1) Anti-oxidants* (alone), 2) Anti-oxidants* + Zn 80 mg + Copper (2mg), 3) Zn + Copper alone, 4) Placebo
• The components of the anti-oxidants formula was - *Vitamin C (500 mg), Vitamin E (400IU), B-cartene (15 mg)

AREDs Results

• Progression from intermediate to advanced AMD was lowered in all formulations
• Zinc+ copper helped the most, and Vision loss and Cataract surgery was minimially reduced in the groups

AREDs 2

• Removed B-carotene (increased lung cancer in smokers in AREDS)
• Added 2 other carotenoids (lutein, zeaxanthin), Lowered the dose of zinc, Added Omega-3 FAs (1000 mg), Only studied people with intermediate or advanced AMD

AREDs 2 Results

• No benefit in adding Omega-3
• Adding lutein/zeaxanthin and removing beta-carotene slight benefit over original formula (also beneficial to prevent harm in former smokers)
• Lowering the dose of Zn no change in efficacy

AREDs Takeaways

• Taking AREDS or AREDS2 supplements reduces progression from intermediate to advanced AMD by about 25%
• AREDS and AREDS2 supplements do not prevent AMD onset or effect cataract or improve it
• Omega-3 FA supplements have not been shown to effect cataract or AMD
• Current and former smokers should take the AREDS2 formula and avoid the AREDSformula with B-carotene, which increases lung cancer risk

Clinical Takeaways

• Best source of vitamin A is from animal sources, supplements are not needed unless deficient in Vitamin A (very rare)
• B-carotene from supplements is better absorbed than from diet, and Bacrotene should be avoided in smokers
• The natural form of Vitamin E (d) is more active than the synthetic
• Taking large doses of Vit E with anticoagulant or antiplatelet medications, like warfarin, can increase the risk of bleeding
• Supplementing may do more harm than good

Additional Information

• B Vitamins help the body use energy-yielding nutrients (Carbs, fats, proteins) and they can work individually or independently
• B vitamins help to lowers homocysteine levels and assists red blood cell production and its found in animal products

Thiamine and Riboflavin

• Make sure to tell your patients who smoke that they need more vitamin C, and >2 g per day can cause upset stomach
• Treating or preventing colds is a very popular use of vitamin C
• AREDS formulations can reduce the risk of progression from intermediate to advanced AMD, and Smokers need the aRES 2 formulation
• There are 8 essential B vitamins and they can work individually and interdependently
• Includes Thiamine (B1), Riboflavin (B2), Niacin (B3), Pantothenic acid (B5) *, Vitamin B6 (Pyridoxine), Biotin (B7), Folic acid (B9) *, and Vitamin B12 (Cobalamin)
• Mandatory Enrichment (added to white flour and pasta) of B Vitamins includes Folate, Riboflavin, Niacin, Thiamine
• Active form of Thiamine is thiamine pyrophosphate- TPP and its a co-enzyme used in CHO and aa metabolism and it Helps the body to metabolize CH, fats, and PRO
• Riboflavin’s Dietary sources are from Wholegrain products, legumes (eg. beans and lentils), nuts, meat (esp pork) and yeast

B Vitamins Deficiencies

• Mainly in developing countries and are Rare in Wester countries due to consumption of whole grain products

Thiamine Deficiency

-Beriberi is a condition that can occur after prolonged deficiency which can result in both neurological and cardiac Sxs

• It does help to reduce blood loss but this does not translate to increased energy levels
• B12 assists HgB and it lower homocysteine

Niacin

• Dietary sources can be found in many different foods in small amounts: milk, yogurt, fortified cereal, beef, enriched gains
• B12 is known to lower homocystine and helps lowers homocysteine levels

Vitamin B12

• Meat, Fish, Poultry, animal products are B12 Sources
• Our ability to absorb vitamin B12, you should recommend to eating food that is fortified vitamin and vitamin products has no beneficial for B12 deficits

B6 Defficiency

• B6 Defficiences
• B6 function with B12 folate works towards lowering lowers homocysteine level