HLTH 230 Fall 2024 Lecture 6 (for posting) PDF

OBJECTIVES By the end of this section of the course, students will: Understand the general principles of vitamins including bioavailability and how the fat soluble and water soluble vitamins differ from one another. List fat soluble and water soluble vitamins. List the properties of the v...

OBJECTIVES By the end of this section of the course, students will: Understand the general principles of vitamins including bioavailability and how the fat soluble and water soluble vitamins differ from one another. List fat soluble and water soluble vitamins. List the properties of the vitamins including roles in the body, deficiency diseases, toxicity and deficiency symptoms as well as reason these may occur. Describe the interaction between some medications and vitamins and describe how some vitamins may be used as medications List types of people who may benefit from a supplement, which one and why Discuss the reasons for taking supplements and the possible risks and benefits of using supplements. Copyright © 2024 Jeffrey Lalonde 1 CHAPTER 7 The Vitamins  DEFINITIONS & CLASSIFICATION OF VITAMINS Vitamins Organic compounds Do not yield energy Micronutrients Vital to life Indispensable to body functions Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 3 Copyright © 2024 Jeffrey Lalonde  DEFINITIONS & CLASSIFICATION OF VITAMINS Precursors = provitamins Transform chemically to one or more active vitamin forms Measure of vitamin in a food, generally includes: vitamin and the vitamin activity potential from its precursors example: beta-carotene Bioavailability – the rate and extent to which a nutrient is absorbed and used Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 4 Copyright © 2024 Jeffrey Lalonde  Definitions o Malnutrition – “any condition caused by excess or deficient food energy or nutrient intake or by an imbalance of nutrients” o Undernutrition – “deficient in energy or nutrients” o Overnutrition – “excess energy or nutrients” o Primary deficiency- “a nutrient deficiency caused by inadequate dietary intake of a nutrient” o Secondary deficiency- “a nutrient deficiency caused by something other than inadequate intake such as a disease condition or drug interaction that reduces absorption, accelerates use, hastens excretion or destroys the nutrient” o Subclinical deficiency- “a deficiency in the early stages, before the outward signs have appeared” Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca​ 5 Whitney, E., & Rolfes, S. (2013). Understanding nutrition (13th ed). Wadsworth Cengage Learning. Copyright © 2024 Jeffrey Lalonde  DEFINITIONS & CL ASSIFICATION OF VITAMINS Fat-soluble vitamins: A, D, E, K General Characteristics Absorbed into the lymph Require bile for absorption Travel in blood in association with protein carriers Stored in tissues – Liver and fatty tissues May be toxic in excess Water-soluble vitamins: B vitamins, vit C General Characteristics Absorbed directly into bloodstream Travel freely in bloodstream Most are not stored to any great extent Excess excreted in urine Lower risk of toxicity than fat-soluble vitamins Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 6 Copyright © 2024 Jeffrey Lalonde  THE FAT-SOLUBLE VITAMINS A, D, E, K Found in fats & oils of foods Require bile for absorption Stored in liver & fatty tissues until needed Body can survive weeks without eating these vitamins When diet provides average amounts that meet recommendations Excess vitamin A & D from supplements can easily reach toxic levels Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 7 Copyright © 2024 Jeffrey Lalonde  THE FAT-SOLUBLE VITAMINS Deficiency Likely if consistently low in fat-soluble vitamins Fat malabsorption Mineral oil laxatives can cause vitamin loss Extraordinarily low-fat diets interfere with absorption Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 8 Copyright © 2024 Jeffrey Lalonde  VITAMIN A 3 forms active in the body: Plant-derived Retinol precursor: Retinal beta-carotene Retinoic acid 9 Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca Copyright © 2024 Jeffrey Lalonde  VITAMIN A Roles: Vitamin A is a versatile vitamin Vision Gene expression Maintenance of body linings and skin Immunity Growth of bones and of the body Normal development of cells Critical importance to reproduction Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 10 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Eyesight Light passes through the cornea before striking the retina Retina contains light-sensitive nerve cells Light bleaches the vitamin A-containing pigment rhodopsin This breaks off the vitamin, initiating an impulse to the optic center in the brain The vitamin reunites with the pigment, & there is a little vitamin A destruction Vitamin A must regenerate the supply If vitamin A supply runs low – night blindness a lag occurs before the eye can see again after a flash of bright light. difficultly seeing in the dark Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 11 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Eyesight Keratin accumulation (keratinization) of the cornea can occur with vitamin A deficiency Can lead to xerosis (drying) & then to dryness and thickening (xerophthalmia) causing permanent blindness If detected early - can be reversed with vitamin A supplementation or regular consumption of vegetables and fruit Skin & Body Linings Vitamin A is needed by all epithelial tissues These tissues serve as protection from pathogens as well as to other damage Vitamin A promotes cell differentiation Each type of cell develops to perform a specific function Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 12 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Control of Gene Expression Retinoic acid activates or deactivates certain genes thereby affecting protein production Immunity Plays a role in the regulation of genes that produce immune system proteins Deficiency can lead to a spiral of malnutrition and infection Growth Assists in growth of bone & teeth - needed in the dismantling step of old bone structure Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 13 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Deficiency Cell differentiation & maturation are impaired failure of mucus-producing cells to produce mucus a subsequent increase in keratin-producing cells tissues more vulnerable to infection ie: respiratory infection Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 14 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Vitamin A Deficiency around the World Severe vit A deficiency in up to 10 million children world-wide Xerophthalmia and blindness Diarrhea and reduced food intake worsens condition Approximately 275 million more children suffer milder deficiency Impaired immune system & increased infection risk Supplemental vitamin A cuts childhood death rates Vitamin A supplementation may benefit those suffering complications from diseases such as malaria, lung diseases & HIV Goal of UNICEF Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 15 Copyrightand WHO © 2024 Jeffrey Lalonde  VITAMIN A Vitamin A Toxicity Supplements or fortified foods May weaken bones, bone and joint pain, abdominal pain, stunted growth, liver damage Early symptoms: loss of appetite, blurred vision, headache, skin itching Long-term symptoms: bone weakening and hip fracture Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 16 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Vitamin A Toxicity Pregnant women Fetal malformation - teratogenic Chronic use of supplements exceeding recommendation Single large dose (100x need) Children who mistake chewable vitamin pills for candy Adolescents who take large doses for acne Accutane is derived from vitamin A Vitamin A supplements do not help with Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 17 acne Copyright © 2024 Jeffrey Lalonde  VITAMIN A Toxicity Healthy people can eat large amounts of vitamin A- rich foods without risking toxicity Liver may be a possible exception to this Polar bear liver especially high Beta-carotene will not cause vitamin A toxicity Can turn yellow/orange due to deposition in subcutaneous fat Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 18 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Beta-Carotene Most abundant of the carotenoid precursors Vitamin A activity for vitamin A precursors is measured is retinol activity equivalents (RAE) ≈12 mcgs of beta-carotene ≈ 1 microgram RAE Does Eating Carrots Really Promote Good Vision? Bright (deep) orange fruits & vegetables and dark green vegetables - rich in beta-carotene - have a role in healthy eyesight. Does not improve vision if vitamin A intake is already adequate Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 19 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Carotenoids & Diseases Lack of foods rich in beta-carotene increases the risk of the macular degeneration Beta-carotene from foods & elevated beta-carotene in the blood are associated with reduced cancer risk Benefit not seen with supplements Beta-carotene supplements associated with increased risk of cancer in smokers Beta-carotene is one of the major dietary antioxidants Along with vitamin E, vitamin C, selenium & many other phytochemicals Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 20 Copyright © 2024 Jeffrey Lalonde  VITAMIN A Vitamin A Recommendations Vitamin A is found in foods of animal origin Beta-carotene is found in plants Good Food Sources Liver and fish oil Fortified milk and milk products Eggs Beta-carotene Dark green leafy foods (spinach, bok choy) Rich yellow and deep orange foods (carrots, sweet potato, pumpkin and apricots) Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 21 Copyright © 2024 Jeffrey Lalonde  VITAMIN D Not essential (in some areas) The body can make all it needs with the help of sunlight Many people may border on vitamin D insufficiency Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 22 Copyright © 2024 Jeffrey Lalonde  VITAMIN D Roles of vitamin D Regulation of blood calcium & phosphorus levels & therefore maintains bone integrity When more calcium is needed, vitamin D acts to raise blood calcium levels: Promotes calcium absorption Promotes calcium retention by the kidneys Draws calcium from bone Functions as a hormone Plays a role in the brain, heart, stomach, pancreas, skin, reproductive organs, some cancer cells, stimulates cell maturation (including immune system cells) Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 23 Copyright © 2024 Jeffrey Lalonde  VITAMIN D It is possible that deficiency promotes: High blood pressure, some cancers, type 1 diabetes, heart disease, rheumatoid arthritis, inflammatory bowel disease and multiple sclerosis Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 24 Copyright © 2024 Jeffrey Lalonde  VITAMIN D Deficiency: Rickets Vitamin D deficiency disease in children Characterized by abnormal bone growth Bowed legs, outward-bowed chest, knobs on ribs Health Canada recommends all breastfed healthy term infants receive a 400 IU Vitamin D supplement each day. Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 25 Copyright © 2024 Jeffrey Lalonde  VITAMIN D Risk for bone loss later in life due to potential lack of vitamin D in adolescents who: consume beverages with no vitamin D, rather than vitamin D- fortified milk or alternatives prefer indoor to outdoor activities Older individuals may have painful joints & muscles due to low vitamin D levels Osteomalacia, the adult form of rickets Most often occurs in women with all three of the following: low calcium intake little exposure to the sun who go through repeated pregnancies & periods of lactation Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 26 Copyright © 2024 Jeffrey Lalonde  VITAMIN D Too Much Vitamin D - A Danger to Soft Tissues Most toxic of all vitamins in excess Toxicity symptoms include appetite loss, nausea, vomiting, increased urination and increased thirst, severe psychological depression (effects on the CNS) Continued overdoses cause dangerously high blood calcium level, forcing calcium to be deposited in soft tissues Such as the heart, blood vessels, lungs, kidneys Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 27 Copyright © 2024 Jeffrey Lalonde  VITAMIN D How Can People Make a Vitamin from Sunlight? (figure 7-6) UV exposure to a cholesterol compound in the skin transforms it into a vitamin D precursor which is absorbed into the blood The liver & kidneys then convert precursor to active form of vitamin D Skin synthesis of vitamin D poses no risk of toxicity The sun begins breaking down excess vitamin D made in the skin Generally, just being outdoors when the sun is overhead, even in lightweight clothing, promotes sufficient skin synthesis of vitamin D Factors affecting sun exposure & vitamin D synthesis: Skin colour, air pollution, city living, clothing, geography, indoor lifestyle, season, sunscreen, time of day Sunscreens with SPFs of 8 or above can reduce sun risks, but also prevent vitamin D synthesis Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 28 Copyright © 2024 Jeffrey Lalonde  VITAMIN D Canadian Cancer Society “Your body makes vitamin D when your skin is exposed to ultraviolet (UV) rays from sunlight, but sun exposure increases your risk for skin cancer. It is safer to get vitamin D from the foods you eat or by taking a vitamin supplement.” Health Canada Canadians over 50: 400 IU supplement/day (Canada’s food guide 2007) Osteoporosis Canada: “Vitamin D, the “sunshine vitamin,” is produced when the sun’s rays interact with our skin but in Canada we don’t get as much sun as we need to produce adequate vitamin D.” “The best way of getting vitamin D is through food and supplements. Health Canada recommends that all Canadians over age 50 years and older supplement their diet with 400 IU (10 µg) of vitamin D to help meet their daily vitamin D requirements.” “Include a variety of foods to help get the Recommended Daily Allowance (RDA).” Canadian Cancer Society. (2024). Eating well extras to consider. http://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-healthy-choices/eat-well/should-i-take-a-vitamin-d-supplement/?re gion=on Osteoporosis Canada. (2024). Vitamin D. https://osteoporosis.ca/vitamin-d/  VITAMIN D Recommendations for vitamin D intake increases with age. Why? Sources: Sunlight Small amounts from butter, cream, fortified margarine Fortified milk Egg yolks, liver, fatty fish (eg. mackerel and almon) and fish oil Only certain fortified plant sources exist: margarines & some plant-based beverages (i.e. soy beverage) Mushrooms Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 30 Copyright © 2024 Jeffrey Lalonde  VITAMIN E Consists of 4 tocopherol compounds: Alpha, Beta, Gamma, Delta Alpha-tocopherol is the gold standard for vitamin E activity Antioxidant Activity Antioxidant defending the body against oxidative damage Vitamin E is preferentially oxidized, thus protecting cells Oxidative damage results from free radicals Formed during normal metabolism disrupt the structure of cellular lipids, DNA and proteins Free radical activity may contribute to development of cancer, heart disease, or other diseases Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 31 Copyright © 2024 Jeffrey Lalonde  VITAMIN E Vitamin E’s antioxidant effect especially crucial in the lungs - cells are exposed to high oxygen concentrations protects red blood cells, white blood cells Vitamin E’s other roles may play other roles in immunity plays a role in nerve development Supplements generally do not provide health benefits unless deficient Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 32 Copyright © 2024 Jeffrey Lalonde  VITAMIN E Deficiency Infants born before transfer of vit. E from the mother to the infant Erythrocyte hemolysis is a rupturing of the red blood cells which results in anemia Adults: Nerve damage (loss of muscle coordination & reflexes with impaired movement, vision & speech) Associated with fat malabsorption diseases: damaged liver, gallbladder or pancreas Low intake with extremely-low-fat diet for years People who rely solely on fat replacers rather than fat Vitamin E is destroyed by food processing & heating Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 33 Copyright © 2024 Jeffrey Lalonde  VITAMIN E Toxicity No toxicity has been seen with natural food sources Large doses may increase the effects of anticoagulant medications May be an increased risk of death in those taking greater than 400IU from a supplement Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 34 Copyright © 2024 Jeffrey Lalonde  VITAMIN E Food Sources Destroyed by heat processing & oxidation Widespread in foods Vegetable oils (including salad dressing, shortening) Avocados are a good source Wheat germ is a good source Smaller amounts from meat, poultry, fish, eggs, milk products, nuts, seeds Animal fats have almost no vitamin E Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 35 Copyright © 2024 Jeffrey Lalonde  VITAMIN K Functions: Synthesis of blood clotting proteins Interferes with the function of certain anticoagulant medications (blood thinners) Warfarin/Coumadin Consistent intake of vitamin K rich foods Avoid drastic changes and self-prescription of vitamin K supplements Synthesis of normal form of bone proteins that bind minerals to bone Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 36 Copyright © 2024 Jeffrey Lalonde  VITAMIN K Sources: Intestinal bacteria (cannot meet the body’s need) Leafy green vegetables – dark green generally richest Spinach, collard greens, beet greens, Swiss chard Lettuce, broccoli, Brussels sprouts, cabbage and other members of the cabbage family Canola & soybean oils Eggs and milk contain small amounts Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 37 Liver is the only rich animal source Copyright © 2024 Jeffrey Lalonde  VITAMIN K Newborns are given a dose of vitamin K Sterile GI tract Vitamin K-producing bacteria will establish themselves Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 38 Copyright © 2024 Jeffrey Lalonde  VITAMIN K Deficiency Unlikely in adults At risk: Newborns Antibiotic treatment: kills both the beneficial & harmful bacteria in their intestinal tract Fat malabsorption Toxicity – No UL Rare among healthy adults Infants & pregnant women: toxicity can result from over- supplementation with synthetic vitamin K Leads to jaundice and bilirubin in the brain of an infant can cause brain damage or death Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 39 Copyright © 2024 Jeffrey Lalonde  THE WATER-SOLUBLE VITAMINS Vitamin C & the B Vitamins Cooking & washing with water leaches them out of food Easily absorbed Excess readily excreted in urine General advice for meeting needs Choose foods daily that are rich in water-soluble vitamins to achieve the recommended intakes regularly 4 0 Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca  THE WATER-SOLUBLE VITAMINS Toxicity Not from food Can occur from the large doses concentrated in some vitamin supplements expensive urine Vitamins for Athletes Athletes with an appropriate diet generally don’t need vitamin supplements Increased energy needs therefore more food Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 41 Copyright © 2024 Jeffrey Lalonde  VITAMIN C Over 200 years ago the crew on ships had a 50% chance of dying Short trips near the Mediterranean Sea = no scurvy High death rate on long voyages Fruits & vegetables were used up early on long trips James Lind, a British doctor, performed the first nutrition experiment on humans in the mid 1700s to find a cure for scurvy Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 42 Copyright © 2024 Jeffrey Lalonde  VITAMIN C Early Experiment Sailors were divided into groups Each group received a supplemental ration cider, vinegar, sulfuric acid, seawater, oranges or lemons Those who received the citrus quickly recovered Scurvy Vitamin C (ascorbic acid) deficiency To avoid scurvy, British sailors were given lime juice Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 43 Copyright © 2024 Jeffrey Lalonde  VITAMIN C Roles of Vitamin C Maintenance of connective tissues Formation & maintenance of collagen Component of bones, teeth, skin, tendons, scar tissue, capillaries Antioxidant Protects substances found in foods & the body Protects iron from oxidation promoting its absorption Protects blood constituents from oxidation and helps protect vitamin E and return it to its active form Research generally shows supplements have not been proven to protect against heart disease, cancer, other diseases Supplements are useful to treat a deficiency disease Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 44 Copyright © 2024 Jeffrey Lalonde  VITAMIN C Deficiency Symptoms Most scurvy symptoms are due to collagen breakdown Loose teeth, bleeding gums, pinpoint hemorrhages, anemia, tenderness to touch, weakness, swollen ankles & wrists, loss of appetite, growth cessation Risk of scurvy low in North America. Exceptions: Some elderly people: Low intakes of veg/fruit and a poor appetite People experiencing food insecurity People with drug or alcohol addictions Infants fed cow’s milk who do not receive breast milk or formula - Breast milk & infant formula supply vit. C Scurvy can be cured with 100 milligrams of vitamin C per day for 5 days – easily done with food Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 45 Copyright © 2024 Jeffrey Lalonde  VITAMIN C & COLDS Vitamin C supports immune system function Vitamin C has not been shown to prevent colds and results are inconsistent in benefitting a cold One group of researchers have found the following: Some small benefit from vitamin C in high doses (1 gram) taken at the onset of a cold May shorten the duration of colds by about 1/2 day & reduce the severity of symptoms by about 40% Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 46 Copyright © 2024 Jeffrey Lalonde  VITAMIN C & COLDS 2 grams per day for 2 weeks seems to reduce blood histamine The substance responsible for sneezing, runny or stuffy nose, swollen sinuses At these doses, vitamin C may work like a weak antihistamine Its antioxidant or other activities may improve the body’s immunity The placebo effect In one study, half the experimental subjects received a placebo but thought they were receiving vitamin C and the other half received vitamin C, but thought they were receiving the placebo This group receiving placebo reported having fewer colds Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 47 Copyright © 2024 Jeffrey Lalonde  VITAMIN C & COLDS Is Too Much Vitamin C Hazardous to Health? Vitamin C from food is safe Adverse effects include digestive upsets, such as nausea, abdominal cramps, excessive gas, diarrhea Massive doses may interfere with medications to prevent blood clotting May be dangerous for people with an overload of iron Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 48 Copyright © 2024 Jeffrey Lalonde  VITAMIN C Smoking introduces oxidants that deplete vitamin C RDA set high 35 mg higher for smokers Sizer, F. S., Whitney, E. N, & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Nelson Education. 49 Copyright © 2024 Jeffrey Lalonde  VITAMIN C Food Sources of Vitamin C Citrus fruits, dark green vegetables (bell peppers and broccoli), cabbage type vegetables, strawberries, cantaloupe, lettuce, tomato, papaya, mangos, red bell pepper Potatoes contain vit C - scurvy became evident in Ireland during the potato famine Vitamin C in fruits & vegetables are prone to destruction by heat & oxygen Fresh, raw & quickly cooked are best Store properly & consume promptly Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 50 Copyright © 2024 Jeffrey Lalonde  THE B VITAMINS IN UNISON B vitamins act as part of coenzymes Coenzyme combines with & activates an enzyme B Vitamins’ Role in Metabolism Metabolism of carbohydrates, lipids & amino acids Thiamin, riboflavin, niacin, pantothenic acid & biotin all help release the energy stored in the energy-yielding nutrients Vitamin B6 helps the body make protein Folate & vitamin B12 help cells to multiply Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 51 Copyright © 2024 Jeffrey Lalonde  THE B VITAMINS IN UNISON B Vitamin Deficiencies Every cell is affected Cell renewal depends on energy & protein which depend on the B vitamins Digestive tract & blood are damaged In children, full recovery may be impossible A thiamin deficiency during growth can cause permanent brain damage Deficiency of any one B vitamin rarely shows up alone, because people eat foods that contain mixtures of nutrients Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 52 Copyright © 2024 Jeffrey Lalonde  THIAMIN Role Energy metabolism Nerve processes and their responding tissues (muscle) Deficiency: beriberi First observed with polishing of rice in Asia Loss of sensation in the hands & feet, muscular weakness, advancing paralysis, abnormal heart action Wet beriberi: Edema present Dry beriberi: No edema Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 53 Copyright © 2024 Jeffrey Lalonde  THIAMIN Deficiency: Wernicke-Korsakoff Syndrome Alcohol abuse with severe thiamin deficiency Alcohol displaces food in the diet, impairs thiamin absorption, promotes thiamin excretion in the urine Symptoms: mental confusion, disorientation, loss of memory, jerky eye movements, staggering gait, apathy, irritability Treatment: thiamin by IV or orally (alcohol withdrawal protocol in hospitals) Sources Widespread in healthy foods Pork products, sunflower seeds, whole grain cereals, legumes are rich sources Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 54 Copyright © 2024 Jeffrey Lalonde  RIBOFL AVIN Role Energy metabolism of all cells Deficiency Usually accompanies other vitamin deficiencies (especially thiamin deficiency) as a result of a very poor diet Ariboflavinosis: deficiency disease Inflammation of the membranes of the mouth, skin, eyes and GI tract; smooth, purplish red tongue May go undetected because thiamin def. symptoms more severe Children who lack milk products & meat are at risk Treatment: A diet that treats a riboflavin deficiency also resolves a thiamin deficiency Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 55 Copyright © 2024 Jeffrey Lalonde  RIBOFL AVIN Sources Widespread in healthy foods Milk & milk products Leafy green vegetables Whole-grain breads Enriched/fortified grain products Some meats & eggs Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 56 Copyright © 2024 Jeffrey Lalonde  NIACIN Role Energy metabolism Deficiency Pellagra – called the 4 Ds Diarrhea, Dermatitis, Dementia and Death At risk for pellagra: Poorly nourished people living in poverty Particularly those with alcohol addiction Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 57 Copyright © 2024 Jeffrey Lalonde  NIACIN Sources Tryptophan, which is abundant in almost all proteins, can be converted to niacin If eating adequate protein, will not be deficient in niacin Niacin in the diet - niacin equivalents (NE) 1 milligram of niacin is made from 60 milligrams of tryptophan (Niacin Equivalents) ex. Food containing 1 mg niacin and 60 mg tryptophan would contain 2 mg NE Significant sources: milk, eggs, meat, poultry, fish, whole grains, fortified and enriched grains, nuts and seeds Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 58 Copyright © 2024 Jeffrey Lalonde  NIACIN Toxicity Large doses can cause niacin flush – painful tingling, flush and hives – niacin supplements 2- 3x RDA Large doses of niacin can injure the liver and cause blurred vision Large doses of a form of niacin (nicotinic acid) may be prescribed to lower blood lipids Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 59 Copyright © 2024 Jeffrey Lalonde  FOLATE Role DNA synthesis Part of coenzymes for new cell synthesis Deficiency “Because immature red & white blood cells & cells of the GI tract divide rapidly, they are most vulnerable to a deficiency” Anemia - megaloblastic anemia or macrocytic anemia Large, immature red blood cells Related to anemia of vitamin B12 deficiency Diminished immunity Abnormal digestive function Folate deficient diet may increase risk of CVD, colon and cervical cancer Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 60 Copyright © 2024 Jeffrey Lalonde  FOLATE Neural tube birth defects (NTDs) Problems with spinal cord, mental delay, severely diminished brain size or even d eath shortly after birth Arise in the first few days or weeks of pregnancy Most women eat too few fruits & vegetables to supply folate needed All bleached white grain products are fortified with folic acid since late 1990s Since fortification began, folate intakes have increased In Ontario, neural tube defects dropped from 1.13/1000 pregnancies to 0.58/1000 after fortification Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 61 Copyright © 2024 Jeffrey Lalonde  FOLATE Toxicity Folate can mask vitamin B12 deficiency Excess folate may be antagonistic to the actions of some anticancer drugs Unit of measure Synthetic folate in enriched foods & supplements is absorbed more readily than naturally occurring folate Dietary Folate Equivalent (DFE) converts all forms of folate into units that are equivalent to the folate in food Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 62 Copyright © 2024 Jeffrey Lalonde  FOLATE Bioavailability ranges from approx 50% to 100% 50% (foods) 100% (supplements taken on an empty stomach) Folate from foods is given full credit Fortified foods and supplements are given extra credit (1.7 times more available) DFE (dietary folate equivalents) are calculated as follows 100 micrograms from food and 100 micrograms from supplements =100 + (100x1.7) =100+ 170 =270 micrograms of DFE Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 63 Copyright © 2024 Jeffrey Lalonde  FOLATE Sources Leafy green vegetables Fresh, uncooked vegetables & fruits The heat of cooking & oxidation that occurs during storage destroy much of the folate in foods Eggs Orange juice & legumes RDA Healthy adults: 400 mcg DFE/day Pregnancy: 600 mcg DFE/day Heath Canada recommends women who could become pregnant: 400 mcg/day of folic acid from supplements plus a healthy diet https://www.canada.ca/en/public-health/services/pregnancy/folic-acid.html Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 64 Copyright © 2024 Jeffrey Lalonde  https:// www.youtube.com/watch? v=5gD6FLdc HfM&t=26s 6 5  VITAMIN B 1 2 Role Close relationship with folate Vitamin B12 is activated by folate Folate is activated by vitamin B12 Maintenance of the sheaths that surround & protect nerve fibers Deficiency Damaged nerve sheaths Creeping paralysis General malfunctioning of nerves & muscles Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 66 Copyright © 2024 Jeffrey Lalonde  VITAMIN B 1 2 Deficiency results in failure of folate to make red blood cells Vitamin B12 deficiency same anemia as folate Large, immature red blood cells (macrocytic or megaloblastic anemia) Folate will clear up anemia Vitamin B12 deficiency continues Give vitamin B12 as well if there is are symptoms of folate deficiency – incase of B12 deficiency Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 67 Copyright © 2024 Jeffrey Lalonde  VITAMIN B 1 2 Deficiency Risk The elderly Absorption problems Decreased stomach acidity and decreased intrinsic factor Atrophic gastritis Inherited gene defect for intrinsic factor production – mid- adulthood Vegans deficiency symptoms take time: body stores up to 6 years’ worth of the vitamin All strict vegetarians (vegans) must be sure to use vitamin B12-fortified products or supplements Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 68 Copyright © 2024 Jeffrey Lalonde  VITAMIN B 1 2 Absorption Requires intrinsic factor A compound made by the stomach The stomach’s acid liberates vitamin B12 from food; intrinsic factor then binds to the vitamin The complex is then absorbed from the small intestine into the blood Pernicious Anemia – “a vitamin B12 – deficiency disease, caused by a lack of intrinsic factor and characterized by large, immature red blood cells” Treatment: B12 injections Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 69 Copyright © 2024 Jeffrey Lalonde  VITAMIN B 1 2 Sources Animal sources are the only significant sources Bioavailability greatest in milk and fish Fortified plant foods – ex – soy beverage Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 70 Copyright © 2024 Jeffrey Lalonde  VITAMIN B 6 Role 100+ reactions in the tissues assists in conversion of one amino acid to another needed amino acid – protein synthesis Aids in the conversion of tryptophan to niacin Neurotransmitter synthesis: conversion of tryptophan to serotonin Hemoglobin synthesis Assists in release of stored glucose from glycogen, contributing to the regulation of blood glucose Immune function Steroid hormonal activity Fetal brain & nervous system development Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 71 Copyright © 2024 Jeffrey Lalonde  V ITAM IN B 6 Deficiency General symptoms Weakness Psychological depression Confusion Irritability Insomnia Other symptoms Anemia Greasy dermatitis Advanced cases of deficiency convulsions May weaken the immune system Evidence that low intakes may be related to increased risk of heart disease Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 72 Copyright © 2024 Jeffrey Lalonde  VITAMIN B 6 Toxicity Seen in women took 2+ g/day for 2+ months Numb feet Lost sensation in their hands Eventually became unable to walk or work Recovered after they stopped taking the supplements Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 73 Copyright © 2024 Jeffrey Lalonde  VITAMIN B 6 A single B6 supplement can deliver 2 g of the vitamin, the equivalent of 3,000 bananas 1,600+ servings of liver or 3,800+ servings of chicken breast Stick with food. Need Due to its roles in protein metabolism, need is proportional to protein intake Unlike other water soluble vitamins it is stored extensively in muscle tissues Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 74 Copyright © 2024 Jeffrey Lalonde  VITAMIN B 6 Sources Protein-rich foods: meats, fish, poultry Legumes & peanut butter Potatoes, leafy green vegetables, some fruits Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 75 Copyright © 2024 Jeffrey Lalonde  B VITAMINS AND HEART DISEASE? Homocysteine Elevated homocysteine may be an indicator of CVD risk Deficiencies of folate, vitamin B12 or vitamin B6 cause excess homocysteine to build up in the blood Supplements of these vitamins lead to a significant drop in homocysteine level It is unknown how this affects a person’s CVD risk Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 76 Copyright © 2024 Jeffrey Lalonde  BIOTIN Role Energy metabolism Cofactor for several enzymes in the metabolism of carbohydrate, fat, protein Deficiency My occur with some rare diseases Consumption of dozens of raw egg whites per day, which contain a protein that binds biotin (avidin), will result in a deficiency Cooking eggs denatures this protein Sources Widespread in foods Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 77 Copyright © 2024 Jeffrey Lalonde  PANTOTHENIC ACID Role Energy metabolism Coenzyme that plays a role in the release of energy from the energy nutrients Plays a role in 100+ steps concerned with the synthesis of lipids, neurotransmitters, steroid hormones & hemoglobin Deficiency My occur with some rare diseases Sources Widespread in foods Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 78 Copyright © 2024 Jeffrey Lalonde  CONTROVERSY: VITAMIN SUPPLEMENTS: WHO MAY BENEFIT? Sizer, F. S., Whitney, E. N, & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Nelson Education. 79  VITAMIN AND MINERAL SUPPLEMENTS Approximately 46% of the What the Experts Are Saying: Canadian population take a vitamin supplement Some say healthy people might benefit from a multiple vitamin supplement taken every day or two Others say potential risks outweigh the unproven benefits - supplements should only be taken when there is a risk of deficiency Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 80 Copyright © 2024 Jeffrey Lalonde  VITAMIN AND MINERAL SUPPLEMENTS Who may likely need supplements? People with nutrient deficiencies Habitual dieters Vegans or those with atrophic gastritis Lactose intolerance or milk allergy People in certain stages of the life cycle Infants need iron Newborn- vitamin K Women who could become pregnant need folate Pregnant women need Iron and Folate Elderly need B12 and Vitamin D Injuries or infections that impair intake, absorption, excretion or metabolism of nutrients People taking medications that interfere with nutrient absorption Sizer, F. S., Whitney, E., & Piche, L. A. (2021). Nutrition: Concepts and controversies (5th ed.). Cengage. https://www.cengage.ca 81 Copyright © 2024 Jeffrey Lalonde