NUIP 2250 1nd EditionExam # 2 Study Guide Lectures: 9 - 15Lecture 9 (February 17)Vitamins Part 1What are vitamins? What is the DSHEA? What are some concerns about vitamin supplements? Vitamins receive more attention than any other aspect of nutrition and are a billion dollar per year industry. Vitamins were thought to have been proteins and were discovered in the first halfof 1900s. Vitamins are organic. They are classified based on solubility – water vs. fat and provide no calories (or energy). Absorption is related to the body’s needs. DSHEA is the Dietary Supplement Health & Education Act, which was created in 1994 and defined “dietary supplements” as vitamins, minerals, herbs, amino acids, and any combination of all of these. There is no proof of safety or efficacy to FDA required. However, manufactures are supposed to report “serious” adverse effects. FDA is required to prove a supplement wasn’tsafe or effective. FDA only uses 4% of resources to monitor dietary supplements and only 4% of people taking supplements report adverse events. There is a great concern in reference to supplement/drug interaction. People often don’t tell their MD about their supplement use. There aren’t many resources to check about supplements and their facts, but consumerlab.com is a good site. What are some signs of deficiencies? What are some symptoms in general? What are the water-soluble vitamins? Some signs of deficiencies include mucous membrane changes, alopecia (protein & zinc), nail changes, rashes, and other organ system involvement. When a patient has a rash, one should check the location, interiginous (place where skin touches), perioral (mouth), acral (peripheral body parts), and seborrheic distribution of the face (oily parts) may be important places to look.Anything wrong in the mouth should be a warning sign for vitamin deficiencies. Some symptoms of vitamin deficiencies in general include weakness, anorexia, confusion, dementia, depression, neuropathy, reduced immune function, and diarrhea. The water-soluble vitamins are the B complex and C vitamins. The B vitamins are co-enzymes in many metabolic processes. Excess is absorbed and excreted in urine. Body stores small amounts and few are toxic if taken in high amounts. These vitamins are sensitive to heat, light,and water, meaning that some of the vitamins could be gone if you wait to consume the products. What does thiamine (B1) do? What is the deficiency disease called? What are the symptoms of Wernicke’s encephalopathy and Korsakoff syndrome?Thiamine or B1’s functions include carbohydrate, fat, and protein metabolism and CNS maintenance. The deficiency disease is called beriberi, with dry beriberi, wet beriberi, and infantile beriberi. The dry beriberi is defined by polyneuropathy with sever muscle wasting. Wet beriberi is characterized by anorexia, muscle weakness, edema, mental confusion, and heart failure. Infantile beriberi is characterized by the sudden appearance of vomiting, convulsions, abdominal distention, and anorexia. Wernicke – Korsakoff syndrome results from a combination of factors including inadequate intake, decreased absorption, and increased requirements. The symptoms of Wernicke’s encephalopathy include confusion, loss of muscle coordination (leg tremors), and vision changes, including abnormal eye movements, double vision, and eyeliddrooping. The symptoms of Korsakoff syndrome include the inability to form new memories, loss of memory, making up stories (confabulation), and seeing or hearing things that isn’t really there (hallucination). What are some of the sources of thiamine? Who is at risk for a deficiency? What is cheilosis?Some of the great sources of thiamine include meat, fish, poultry, nuts, wheat germ, whole grains and legumes. Those who are at risk of deficiency include alcoholics and those with anorexia nervosa. Alcoholics who come into the hospital are given a “rally pack,” which includes thiamine, folic acid, and magnesium, since it’s very likely that they are deficient. Cheilosis is the cracking of lips that is caused by a riboflavin deficiency.What are the functions of riboflavin (B2)? What are some of the signs of a deficiency and what is the diagnosis? Where is riboflavin found in foods? Riboflavin (B2) is metabolized to flavin adenine dinucleotide (FAD), which helps with energy production and epithelial maintenance. Some of the signs of deficiency include changes in oral mucous membranes, eyes, skin, chelilosis, dermatitis, and magenta tongue. The diagnosis would be erythrocyte reductase activity or plasma riboflavin. In order to confirm the diagnosis, there would be a therapeutic trail of riboflavin.Riboflavin is found in protein rich foods, such as milk, cheese, meat, and eggs as well as whole grains and green, leafy vegetables. What are the functions of niacin (B3)? What are the signs of niacin deficiency? What is the UL and sources of Niacin? Some of the functions of niacin (B3) include carbohydrate, fat, and protein metabolism. Some of the signs of deficiency include pellagra (rough skin) and the 3D’s (dermatitis (sun exposed skin), diarrhea, and dementia). Deficiency can be caused by malabsorption with GI disease or anorexia nervosa. The diagnosis can be made by rapid response to niacin supplementation.The Upper Tolerable Limit of niacin is 35 mg/day because in excess it can cause liver problems.Within certain amounts, niacin can be used to lower cholesterol and LDL and increase HDL. Some side effects of taking too much niacin can include flushing and liver problems. Some sources include meat, fish, poultry, legumes, peanuts, enriched grain products, and coffee. What are the functions of pyriodoxine (B6)? What are the signs of deficiency? What is the UL? Some of the functions of pyriodoxine include DNA/RNA production, fat and protein metabolism, CNS maintenance, and RBC formation. Some of the signs of deficiency, although uncommon, include peripheral neuropathy, anemia, dermatitis, confusion, and convulsions. The diagnosis of deficiency is pyridoxal phosphate level in blood or serum. The UL is 100 mg/day and some side effects include sensory neuropathy and photosensitivity. What are some of the sources of pyriodoxine (B6)? What conditions has it been used to alleviate? Some sources of B6 include meat, fish, poultry, brewer’s yeast, green leafy vegetables, nuts, andwhole grains. Pyriodoxine has been used to treat PMS, morning sickness and