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Nutrition 1 semester 2 > Supplements in practice > Flashcards

Supplements in practice Flashcards

1
Q

What are the three classifications of supplements and who are they regulated by

A
  1. licensed medicines:
    the Medicines and healthcare products Regulatory Agency (MHRA) licenses medicines used in the UK.
    Food supplements are covered by food laws.

DIETARY SUPPLEMENTS ARE CONSIDERED SAFE UNTIL PROVEN OTHERWISE

  1. Unlicensed preparations
    The DoH has responsibility for national and EU legislation of food supps in England. Local trading standards monitors and enforces. Anything pharmacologically active sent to MHRA for assessment
  2. Herbal products.
    Regulated by the Traditional Herbal Medicines (THM) directive, administered by the MHRA.
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2
Q

What are you not allowed to claim on a supplement label

A

No claims that it can prevent, treat or cure human disease

No reference to rate or amount of weight loss

no recommendations of dr or health professional

No health claims on alcohol

Can’t claim that health could be affected by NOT consuming the food.

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3
Q

Animal based supplements - what body must approve them

A

The European Commission

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4
Q

What checks are carried out on animal based supplements

A

where the animal was caught, farmed, manufactured, handled, extracted and packaged.
Contaminants (heavy metals etc) must be within acceptable EU levels.

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5
Q

What are the regulations on GM food in supplements

A

Ingredients from GM organisms are only permitted in supplements if authorised under a Regulation on GM food and feed. - Must declare the presence of GM materials on teh label

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6
Q

What is the name of the minimum standard that a medicines manufacturer must meet in its production processes

A

Good Manufacturing Process (GMP)

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7
Q

To meet “Good Manufacturing Practice”, what standards must medicines meet

A
  • be of consistent high quality
  • appropriate to their intended use
  • meet the requirements of teh marketing authorisation (MA) or product spec
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8
Q

Unlike Australian or American companies, supplement companies in the UK do not have to be GMP approved (Good manufacturing practice). What does it mean to be GMP compliant

A

companies are required to manufacture with ‘due dilligence’ and can be GMP compliant

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9
Q

How can manufacturing processes affect the quality of supplements and provide 2 examples

A

Fish and omega plant oils need to be COLD pressed to minimise oxidation.

Whey protein needs to be specially filtered to remove lactose, hormones etc

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10
Q

What is “overage”

A

extra ingredients added to the supplements so the amount left at the end of its shelf life still meets the label claim

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11
Q

Name 4 different types of supplement forms and why that type might be preferable, and any drawbacks

A

tablets - cheap, easy to produce in large quantities. Generally contain more excipients

capsules - fewer excipients but not efficient for large dose

powders - good fo bigger doses, eg glutamine

liquids - excellent absorption but more expensive and less stable. Fish oils need antioxidant such as vit E added to prevent odxidation

enteric - Excipient (eg shellac or cellulose) used to ensure tablets surive stomach acid and don’t release until the SI.

spore form - enables Probiotics to survive the stomach and reactivate in the SI

chewable

slow release - cheaper slow release tables contain hydrogenated fats to to hold the tablet together for longe

Liposomal - protective phospholipid bilayer protects the active ingredients - high bioavailability and absorption, increased uptake into target cells, easier to take, suitable for water and fat soluble nutrients.

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12
Q

Why are liposomal supplements so effective

A

they have a protective phospholipid bilayer protecting the active ingredients.

high bioavailability and absorption, increased uptake into target cells, easier to take, suitable for water and fat soluble nutrients

Liposomal vit C is significantly higher absorption rate.

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13
Q

Provide examples of why excipients are used in supplements

A

The therapeutically active component of a supp can be as low as 2% of the total content.

  • Excipients and fillers are the glue which bind and stabilise and keep nutrients active
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14
Q

Provide examples of what excipients might be

A
  • capsule shells - made from gelatine or plant cellulose
  • Flow agents - help formulation flow through machinery. Avoid Mg Stearate
  • Binding agents - bind to make tablet

Fillers - esp when only small amount of nutrient needed

natural fillers

Emulsifiers - to mix oily and watery ingredients

Flavours - avoid MSG

Colours - beetroot

Sweeteners - glycerine

Preservatives - Vit E

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15
Q

Provide examples of which nutrients are absorbed in the :
Duodenum
Jejunum
Ileum

A

Duodenum: Ca, Se, Mg, Ch, Fe, Mn, Zn
Jejunum: Bs, biotoin, Vit C, Choine, Ca, Mg
Ileum: B12

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16
Q

How should water soluble vitamins be taken (b/c)

A

with food.

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17
Q

Why should Bs not be taken in the evening and with what exception

A

B6 can be taken in the evening as it stimulates melatonin synthesis

Bs can trigger insomnia

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18
Q

How should fat soluble nutrients be taken (adek and CoQ10) and what guidance should be given for EFAs

A

with food containing fat

EFAs - don’t take with high amounts of opposing fat.

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19
Q

How should amino acids be taken, specifically protein shakes

A

Ideally with Carb food/drink or on empty stomach

Protein shakes - any time of day. Good fo post surgery or after extreme exercise. Takes 30 mins to reach muscle after ingestion.

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20
Q

What does the absorption of amino acids depend upon

A

transit time through gut
stomach acid
proteolytic enzymes
etc

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21
Q

How should minerals be taken

When should Mg and Ca be taken

A

with food as adequate stomach acid is needed

Mg and Ca - in evening to aid sleep

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22
Q

When working out dosage of supplements, what factors should be taken into consideration

A

age of client (higher dose with increasing age)

Digestive capability (constipated?)

State of health (for optimum health or disease)

Therapeutic dose

Dietary deficiency or insufficiency

Lab test results

Safe therapeutic range (age group of client)

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23
Q

What does the “elemental” amount of a mineral mean when stated on a supplement label

A

the amount of mineral available for absorption when it has been freed from its carrier molecule. This is the amount USED by the body.

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24
Q

Just how “natural” are supposed natural supplements

A

10%+ must be natural
May contain synthetic nutrients
can involve synthetic nutrients being biochemically incorporated into yeast or algae

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25
Q

what is drawback of creating a supplement from a natural source

A

although they may have better efficacy, they are generally not available in higher doses

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26
Q

What is a food cultured supplement

A

Nutrient supplements that are often grown in yeast or algae.

culturing makes nutrients that are more bioavailable.

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27
Q

Natural vs synthetic supplementation - which is best. Use vit C as example

A

It depends on the client and the reason for supplementing.

Natural have better bowel tolerance and retained longer in the body. With VIt C it’s good to build collagen. But if using it for detox, then ascorbic acid will be rapidly excreted taking free rads with it.

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28
Q

When are high quality clean synthetic supplements recommended

A

Food-state supplements may not be enough to supply the optimal dosage for someone with high nutritional requirements - eg chronic health condition/poor diet/lifestyle

Sensitivities to foods or fillers

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29
Q

As a naturopath - what is our philosophy on using supplements

A

Use formuations that have a scientific but holisitic approach

Use phytonutrient rich food combined with vits, minerals, enzymes, co enzymes or amino acids

Avoid preservatives, colourants, fillers, binding agents, GMO and irridated products

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30
Q

Mineral supplement - what dose of macro minerals is required and what might cause a mineral imbalance in the body

A

macro minerals require an intake of over 100mg/day

Imbalances are usually caused by overloads from supps, not food sources

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31
Q

Mineral carriers:

organic acid salts
- where are they found
- are they more or less effectively absorbed than inorganic salts
- name 3

A

found in living organisms
The bond between a mineral and organic acid is generally weak - therefore more effectively absorbed than inorganic salts.

Citrate
malate
ascorbate
gluconate
picolinate
aspartate
succinate
orotate
fumarate

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32
Q

Mineral carriers:

inorganic salts
- what are they important for the balancing of
- are they more or less effectively absorbed than inorganic salts
- what adverse effects are they likely to have
- name 3

A

Important for the balancing of electrolytes
less effectively absorbed than organic acid salts
Adverse effects on the GIT

Oxide
sulphates
chloride
phosphates
nitrates
carbonates

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33
Q

What are the best form of mineral carriers for absorption

A

amino acid chelates - specific minerals chelate best with specific amino acids

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34
Q

What minerals are picolinate carriers best for

A

superior carrier for chromium, zinc, manganese
High absorption in gut giving high serum levels

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35
Q

What three mineral carriers are used in the krebs cycle so can be used by the body

A

citrates
malates
fumarate

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36
Q

Why are citrates recommended as a mineral carrier

A

more bioavailable - the positive acidic form requires less stomach acid to break bonds and free the mineral for absorption

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37
Q

Why are citrate mineral carriers helpful for post-menopausal women/elserly/stressed

A

Low stomach acid is often present in these groups resulting in absorption problems if a strong inorganic supp is used.

Ca Citrate is 2.5 times better than calcium carbonate with doses of 500mg in post menopausal women.

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38
Q

Name three minerals bound to citric acid/citrates

A

Ca2+, Mg2+, Zn2+

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39
Q

What is a chelator

A

a substance that binds tightly to mineral atoms and forces the mineral to go wherever the chelator goes.
Makes it more readily absorbed by the body

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40
Q

What is a mineral acid chelate

A

chelator + mineral atom = chelate

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41
Q

What are the advantages of using amino acid chelates

A

bypass competitive absorption that can occur between different minerals (amino acids disguise) - absorbed as a protein instead of a mineral.

Body treats it as a peptide and is efficient at absorbing amino acids

Extends length of absorption sites to large portion of SI

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42
Q

Most minerals are available in chelated form - what chelates do they typically use and provide examples of minerals that are available in chelated form

A

amino acid or organic acid chelates

Mg, Ca, Zn, Cu, K,

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43
Q

Provide 3 examples of minerals bound to amino acid chelates

A

Aspartic acid - zinc aspartate, Mg aspartate

Methionine - Cu methionine, Zn…

Lysine - Ca lysinate

Glycine - Mg glycinate

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44
Q

Provide 3 examples of minerals bound to organic acids

A

Acetic acid - Zn acetate, Ca acetate

Citric acid - Mg citrate

Orotic acid - Mg orotate

Gluconic acid - Fe gluconate

Fumaric acid - Fe fumarate

Picolinic acid - Chromium picolinate

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45
Q

What are the possible drawbacks of amino acid chelates

A

the complexes might be too tightly bonded and minerals may not be released if cellular energy is poor, eg chronic fatigue

Amino acid chelate complexes often too large for capsules so dosage can be too low - it’s beneficial to combine with other forms of minerals

Quality and price limitations as expensive

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46
Q

What does “dl” in front of a supplement mean

A

it’s synthetic

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47
Q

why should orotates be used with caution

A

they bypass the normal regulatory controls and therefore may be easy to absorb too much

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48
Q

Who are citrates good for

A

those with low levels of stomach acid - eg post menopausal, the elderly, high stress

It requires less stomach acid

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49
Q

Calcium - what nutrients should it be taken with

A

Mg, D3 K2

50
Q

What can calcium supplementation cause if over prescribing

A

kidney stones
soft tissue calcification, esp if low vit D

51
Q

What is the max absorption of Ca

A

500mg at any one time

52
Q

If dietary intake of calcium is sufficient, what health concerns can calcium supplementation cause

A

kidney stones and soft tissue calcification

53
Q

What are the preferred forms of calcium supplementation - name 3

A

Ca glycinate - these are organic forms and reduce the potential for gastric upset. Most bioavailability and soluble.

Ca citrate - easily assimilated. Most nutritional companies use this form.

Ca citrate malate - new inorganic form but provides exceptional absorption. Can be consumed with or without coke.

54
Q

What forms of Ca supplementation are not recommended

A

Ca aspartate - no credible studies yet
Ca carbonate - lack of bioavailability and can’t use with low HCl
ca ascorbate
Ca oxolate

55
Q

What nutrients should Ca be taken with

A

D3, K2, Mg

56
Q

What is the max absorption of Ca

A

500mg at one time

57
Q

What nutrients does Ca interact with

A

Mg - leave two hours between
Zn and Fe - may reduce absorption
Lysine - enhances absorption
Excess fibre and salt
Excess of phosphorous and caffeine

58
Q

What drugs does calcium interact with

A

corticosteroids - long term use leads to reduced absorption
Levothyroxine - competes for absorption
Oestrogen and progesterone therapy - may increase absorption
Quinolone (abtibiotic) - take 4-6 hours apart.

59
Q

Magnesium - is it best taken on empty stomach or with food

A

with food to aid absoprtion

60
Q

What is Mg inhibited by an excess of

A

fibre, phytates, alcohol, sat fat

61
Q

What drugs may decrease MG levels

A

OCP, HRT, diuretics, penilillamine

62
Q

What is the cheapest form of Mg supplementation

A

Oxide

63
Q

What is Mg chloride good for

A

transdermal application

64
Q

What is Mg citrate good for

A

maintenance dose

65
Q

What is Mg gluconate good for

A

good absorption, not laxative

66
Q

What is Mg malate good for

A

good for energy production

67
Q

What is Mg Glycinate good for

A

insomnia

68
Q

What is Mg sulphate/epsom salts good for

A

laxative and rleaxing

69
Q

What is Mg orotate good for

A

enhances energy production in the heart. Good for CV support.

70
Q

Iron - What are the recommended forms of iron supplementation and what is the most common prescribed

A

ferrous salts - fumarate, sulphate, gluconate are the best absorbed

Citrate also well absorbed and tolerated. Bisglycinate highly bioavailability without adverse side effects of sulphate.

Ferrous sulphate is the orthodox and most studied form but causes nausea and constipation. Higher dose given, may interfere with vit E absorptive.

71
Q

What drugs can iron supplementation interfere with

A

thyroxine
levodopa
tetracyclines
penicillamine
FluroQUINOLONES

72
Q

What is the preferred supplemental form of chromium and for diabetics

A

picolinate - readily absorbed

Chromium malate for diabetic clients - improves action of insulin

73
Q

What is Chromium GTF and how bioavailable is it

A

Cr + nicotinic acid + glutamic acid + cysteine + glycine

it’s not as readily available as using the nutrients separately

74
Q

What drugs should be cautioned with chromium supplementation

A

diabetic drugs may have an additiive effect

Oral corticosteriods my deplete chormium levels

75
Q

Zinc - which should be recommended for colds

A

Zinc gluconate
Zinc Acetate

76
Q

Why would zinc pilolinate be recommended

A

for those with absorption issues

77
Q

WHen should zinc be taken

A

on empty stomach at night,
1 hour before or 2 hours after meal

78
Q

When should antibiotics be taken if supplementing with zn

A

2 hours before or 4-6 hours after taking zn

79
Q

What medications might reduce zn absorption

A

PPIs and aspirin (3g/day)

80
Q

What zinc supplement is not recommended

A

sulphate - may cause stomach irritation and nausea

81
Q

What is the TUL for zinc

A

40mg day
If over 100mg may inhibit cu absorption

82
Q

What effect might excess potassium have on the body

A

tachycardia - if dose greater than 15mg/day
TOxicity - hyperkalaemia

83
Q

What Vitamin C might be prescribed for maintenance

A

low dose food form such as rose hip, acerola

84
Q

What vit C might be prescribed for detox and why

A

high dose ascorbic acid - it’s excreted quickly taking free rads with it

85
Q

Name supplemental forms of vitamin C

A

ascorbic acid - naturally in food, good bioavailability but may be harsh on GIT

bioflavonoids - beneficial plant compounds are added, working synergestically to increase bioavailability

86
Q

why are liposomal vit C supplements beneficial

A

increased bioavailability due to phospholipid outer casing

87
Q

Why are mineral ascorbates a beneficial Vit C supplement. Name one that has been patented

A

eg Ca, Mg, Na, K
called buffered vit C as gentler and better tolerated. The mineral is also absorbed

Ester-C - better tolerated by those who can’t eat acidic foods/can’t tolerate vit C

88
Q

Vitamin A - why should Vit A supplementation not be recommended to smokers

A

some evidence that it can trigger lung cancer

89
Q

What is the recommended dose of Vit A

A

varies greatly - 750-3000mcg RAE
100,000 long term may be toxic, especially to the liver where it is stored

90
Q

What type of vit A is found in multi vitamins

A

both pre and pro formed vitamin A

91
Q

What are the preformed vitamin A called

A

retinol acetate and retinyl palmitate
both are stable and highly bioavailable

92
Q

What is the most common synthetic form for vitamin A

A

beta carotene/pro vitamin A. It’s converted as needed therefore reducing possibility of toxicity

93
Q

What might cause vit D def

A

lack of sunlight
excessive sunscreen

94
Q

what is the most effective form of vit D supplementation

A

D3 - cholecalciferol
Active form

95
Q

what is the inactive vegetarian form of vit D

A

D2 ergocalciferol

96
Q

What for of D3 is suitable for vegetarians

A

D3 from lichen

97
Q

Vitamin E - what is the natural form available in supplements

A

D-alpha-tocopherol
1.4 times more biologically active than synthetic form

98
Q

Vitamin E - what is the synthetic form available in supplements

A

dl-alpha tocopherol
may inhibit natural form from entering cells

99
Q

what are selenium supplements used for

A

immune system
T3 production - hypothyroidism

100
Q

Which selenium supplement has the greater bioavailability - the food form: selenomethionine, or inorganic selenite

A

selenomethionine (selenium chelated to methionine) is 90% compared to 50% from selenite.

101
Q

What is the optimal form of selenium supplementation

A

a combination of selenomethionine (food form), selenodiglutathione and sodium selenate

102
Q

B1 - how common is thiamine deficiency

A

very rare and easy to reverse with supplementation

103
Q

What are the B1 supplements

A

thiamine hydrochloride
thiamine mononitrate

104
Q

B2 - what are the best form of supplementation

A

modified release capsules. High doses have lowered bioavailability

105
Q

when should riboflavin be taken

A

between meals

106
Q

B3 - what reaction can B3 supplementation cause

A

niacin flush, prickly heat sensation

107
Q

Name the B3 supplement forms

A

Niacin
Niacinamide
Nicotonic acid

108
Q

What is niacin used for

A

cholesterol and triglyceride levels. Raynauds

109
Q

what is Niacinamide used for

A

diabetes and blood sugar control

110
Q

Niacin and niacamide

A

cognitive and mental health

111
Q

When should niacin be taken

A

with meals to avoid stomach irritation

112
Q

B12 - what are the active forms of B12

A

methylcobalamin - used for methylation
adenosylcobalamin - form in mitochondria

113
Q

what form are most B12 supplements and are they active or inactive

A

cyanocobalamin - inactive. Need activating in the body

114
Q

What B12 supplement might be recommended for those who don’t tolerate methyl groups or if both folate and B12 deficiency

A

Hydroxycobalamin - it’s inactive but with high affinity for plasma proteins

115
Q

What form of B12 is needed if digestive issues

A

sublingual

116
Q

How much EPA/DHA is required as a therapeutic dose

A

4g/day for minimum four months for arthritis

117
Q

How are the oils prevented from oxidising

A

antioxidants are added

118
Q

WHy is krill oil a better form of Omega 3

A

its more efficiently absorbed as carried into the cells in phospholipid form.

119
Q

Where is vegan forms of EPA/DHA derived from

A

plant marine algae

120
Q

Name a good plant source of omega-3

A

flaxseed oil (high in ALA).

Nutrition 1 semester 2 (11 decks)

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