Supplements Flashcards
1
Q
What is a food supplement defined as?
A
Concentrated source of vitamin, mineral or other substance with a nutritional or physiological effect, alone, or in combination, sold in dose form.
2
Q
Do herbal products have food supplement status?
A
No. Classed as medicines.
3
Q
Why use supplements?
A
- Deficiency (eg vitamin D)
- Insufficiency (therapeutic eg vit C - bleeding gums)
- Preventative (eg orthomolecular to maintain health)
NB Most disease starts and progresses due to an insufficiency of specific vitamins or minerals.
4
Q
FIVE reasons why supplements being needed.
A
- Soil depletion due to intensive farming
- Pesticides and fertilisers reduce phytonutrients (secondary metabolites)
- Food processing kills nutrients esp additives, often toxic.
- Weakened digestion eg IBS
- Stress depletes minerals and vit C and reduces gastric secretions.
- Long-distance transport: Crops lose much of their nutritional value.
5
Q
Which organisation is responsible for licensing medicines in UK?
A
MHRA
Medicines and Healthcare Products Regulatory Agency
NB We do not prescribe these products. We prescribe supplements covered by food laws ie unlicenced.
6
Q
Which organisation regulates medicinal products, medical devices and cosmetics?
A
HPRA
Health Products Regulatory Authority
7
Q
How are herbal products regulated?
A
Many herbal ingredients classified as medicines. Herbal products are regulated by Traditional Herbal Medicines Directive, administered in UK by MHRA.
8
Q
What claims are prohibited on food supplement labels?
A
- Medicinal claims: we cannot say it will prevent, treat or cure - not allowed.
- Weight loss.
- Individual doctors or health professionals endorsements
- Health claim on alcoholic beverages.
- Claims which suggest that health could be affected by not consuming supplement.
9
Q
Name TWO animal-based supplements
A
- Fish oils as anti-inflammatory
- Collagen for gut integrity (bovine)
Carefully regulated for contamination, traceability. EU. Receive an approval number.
10
Q
GM ingredients allowed in supplements?
A
Yes but only if authorised under Regulation on genetically modified food and feed.
Needs to be included on label.
NB accidental presence of GM material may still occur in a non-GM crop via transference eg windborne pollen.
11
Q
Are companies required to be GMP-approved?
A
Supplement companies required to manufacture with due diligence ie guidelines.
Legal requirement that all products must be fit for purpose.
Many companies are GMP compliant (self-regulated) but not GMP approved (very few).
NB Herbals are required to be approved.
12
Q
Tests carried out by regulatory agencies to check supplements?
A
High or unacceptable levels of:
1. Heavy metals
2. Solvent residue
3. Aflatoxins
4. Herbicides
5. Pesticides.
Regular testing required.
13
Q
What is overage?
A
Overage = ingredients may degrade over a supplement’s shelf life.
Reputable supplement companies will add extra so that amount left at end of its shelf life still meets label claim.
14
Q
Fish oil supplementation guidance?
A
Fish oil and omega plant oils need to be cold-pressed to minimise oxidation.
Cheaper extraction and processing methods reduce effectiveness of supplement and affects its safety profile.
15
Q
Why protein suppplementation guidance?
A
Needs to be specially filtered to remove lactose, hormones, etc.
Cheaper extraction and processing methods reduce effectiveness of supplement and affects its safety profile.
16
Q
What are considerations when choosing between tablets to capsules in terms of supplementation.
A
Tablets: cheaper, easier to produce large quantities. Generally contain more excipients so try to avoid esp for IBS or elderly reduction in digstive power.
Capsules: Fewer excipients but not efficient for large doses - fewer ingredients in there so will need many capsules.
Excipients bind ingredients together
17
Q
Compare powders to liquids as forms of supplementation.
A
Powders: Good for bigger doses eg glutamine or protein powders.
Not suitable for sticky ingredients, ones that attract moisture eg phosphatdylserine or fruit powders, where there is a toxicity risk, or where ingredients are unstable.
Liquids: excellent absorption but more expensive and less stable.
Many, such as fish oils, need antioxidants such as vitamin E added to prevent oxidation.
18
Q
Why put Vit C in with fish oil supplement?
A
Great antioxidant and prevents oxidation. Also vit E.
Fats put in with vitamin A to aid absorption (dropper)
19
Q
What are advantages of enteric formulations?
A
Excipients, such as shellac or cellulose acetate phthalate (CAP) ensure tablets survive stomach acid so that they don’t release contents until small intestine. Commonly used for good garlic capsules in SIBO clients so reach small intestine.
20
Q
Spore form?
A
Probiotics to survive stomach acid and reactivate in intestines - dysbiosis.
21
Q
Why do we need chewable formulations of supplements?
A
As vitamins and minerals may taste unpleasant, most vitamin and mineral powders are coated before they are compressed into tablets. Great for clients with compliance issues, elderly, children!!
22
Q
Cheaper slow-release tablets contain ______________ to hold tablets together longer.
A
Hydrogenated fats.
23
Q
What are liposomal supplements and their advantages?
A
Liposomal supplements have a protective phospholipid bi-layer protecting active ingredients.
- High bioavailability and absorption (good for elderly clients with lower gastric juices, meds and B12 a big issue so liposomal will get there).
- Increased oral uptake in mouth.
- Increased uptake into target cells (body recognises it)
- Easier to take than large tablets.
- Suitable for water- and fat-soluble nutrients.
24
Q
What are excipients and why are they used in a supplement?
A
Excipients are INACTIVE additives used in forming tablets and capsules to bind active ingredients together and keep them active (potentially harmful).
25
Give FIVE examples of excipients in supplements.
1. *Capsule shells*: Made from gelatine or from plant cellulose. NB Beware for vegans if gelatine.
2. *Flow agents*: Help formulations flow easily through machinery but no nutritional benefit. Avoid magnesium stearate.
3. *Binding agents*: Help to bind ingredients together to make a tablet eg maltodextrin (IBD, IBS).
4. *Fillers*. Help to fill capsules, particularly when small amounts of an active nutrient is needed eg B12 or vit D.
5. *Natural fillers*: fossilised seaweed; vegetable powder; new form of rice flour that is inert.
6. *Emulsifiers*. Used to mix oily and watery ingredients together.
7. *Flavours*. Avoid MSG or sugar (could be the supplement that is driving or causing the issue!).
8. *Colours*: riboflavin, beet extract, turmeric.
9. *Sweeteners*: glycerine, xylatol.
10. *Preservatives*: vitamin E, ascorbic acid.
26
What does naturopathic approach to supplementing involve?
1. Addressing underlying cause of any dysfunction ie **individual basis**.
2. Treating whole person, rather than disease.
3. Vital that supplements are taken under best conditions to achieve maximum absorption, assimilation and utilisation.
4. Everyone is unique and that many factors must be considered to ensure that appropriate supplements are used in correct dosage for optimal efficacy. Why we do a full case study.
27
Where does absorption occur?
Mostly occurs in *duodenum* and *jejunum*
Chemical bonds are broken in stomach.
28
Give THREE examples of nutrients absorbed in duodenum and jejunum. What nutrient is absorbed in ileum?
Both: Ca, Mg
*Duodenum*: Fe, Zn, selenium, chromium, imanganese
*Jejunum*: B and C viits , choline, inositol,
*Ileum*: Vitamin B12.
29
Best way to take water-soluble vitamins ie with or without food?
(Vits B and C)
Most B vitamins and vitamin C: take with food otherwise travel through digestive tract quickly and won't be absorbed.
B vitamins: Contraindicated in evening as they may trigger or exacerbate insomnia (B6 is exception) due to ATP role.
30
Why B6 in the evening?
Facilitates synthesis of melatonin so take at night. Also co-factor in Mg absorption.
31
Best way to take fat-soluble nutrients.
Take with food containing fat: need **bile salts** for absorption.
Eg vitamins A, D, E, K and CoQ10: Take with food containing fat as they transport it via micelles to enterocytes.
32
Best way to take EFAs?
With food. Preferable not to take with high amounts of their opposing fat; if taking omega-3 then avoid high amounts of omega-6 in same meal.
33
Best way to take amino acids
Ideally on an empty stomach for max absorption.
But if have client with weak digestion take with carbohydrate food - if take with protein-rich will have absorption competition.
34
When are protein shakes useful?
Protein shakes: take any time of day, Can pack in lots of protein.
1. Children: to build strength and way of getting nutrients in if difficulty chewing and swallowing.
2. Often used post-surgery to repair and rebuild tissue.
3. Exercise: Protein shakes take about 30 minutes to reach muscle after ingestion so are quicker to digest than solid food.
4. Absorption of amino acids in liquid shakes depends on **transit time through gut, stomach acid, proteolytic enzymes**, etc. NB proteins can be difficult to digest.
35
What is best way to take minerals and what is their digestion dependent on? What time would you recommend taking Ca, Mg and Zn?
Minerals are best taken with food.
**Adequate stomach acid is needed for their digestion**.
**Ca and Mg** [insomnia, relax]
Take in evening to aid restful sleep.
a) Ca required for synthesis of melatonin from tryptophan.
b) Mg binds with GABA receptors in brain which leads to inhibitory effect... parasympathetic state for optimal night's sleep.
**Zinc**:
Take on an empty stomach before bed - Zn can complete with Cu and Fe for absorption.
Caution: Some people may suffer stomach discomfort after taking zinc.
36
What should we consider to work out dosage for a client?
1. **Age**: May need a **higher dose** with increasing age - lower HCL and enzymes.
Kids much lower.
2. **Digestive capability**: Ability to absorb and excrete? Constipated?
3. **State of health**: Dosing for optimum health (maintenance) or for disease state? Keep on top of clinical trials for dosage. Boullardi for candida.
4. **Therapeutic doses**: Evidence of dosages that are shown in clinical trials to be effective for certain disease states.
5. **Dietary deficiency or insufficiency**: What symptoms are there?
6. **Lab test results**: What do these indicate? Fe have to get iron levels tested first.
7. **Safe therapeutic range**: Age group of client?
37
What is an 'elemental mineral' in a supplement?
**Amount of mineral available for absorption** ie when it has been freed from its carrier molecule. Elemental mineral is amount of mineral that is actually used by body.
Proteins slightly different: look at amount of protein per 100g
Fish oils: focus on amount of EPA/DHA.
38
What is a natural supplement?
Natural or synthetic? Word natural can be deceptive: can be used even if only **10% of product is natural**. Other 90% could be synthetic isolates.
a) Food paste and grown into a more nutritious food matrix.
b) Synthetic nutrients being biochemically incorporated into yeast or algae.
39
Why is it better to choose vitamins from whole foods over manufactured synthetic isolates?
1. Body recognises when nutrients are derived from food and **includes necessary co-factors**. May not recognise synthetic isolates.
2. Natural supplements usually have **better bowel tolerance** than synthetic ones so they are **retained longer in body**.
NB Food labelling very confusing... need to look for active ingredients that are from wholefood stage eg acelerola cherry. Grown from a paste with all the co-factors.
40
Give an example of a supplement from a natural source.
Nutrients from vegetable, animal or mineral sources.
1. Vitamin D from fish liver oils,
2. vitamin E from vegetable oils,
3. natural betacarotene.
4. Vitamin K.
41
What forms can supplement be grown in?
Algaes or yeasts
42
Give an example of a supplement from a synthetic source.
Vitamin C: As this is a weak acid, many supplements use salt forms (calcium or magnesium ascorbate) to decrease acidity.
Sometimes used preferentially by practitioners when trying to use higher doses.
43
Give an example of a supplement from a food cultured source. How are they made?
Whole food multivitamins, minerals and other nutrients.
CULTURING can make nutrients more bioavailable. Often grown in *yeast* or *algae* and contain nutrients they are fed in a whole food complex form.
Same process behind cultured foods like yoghurt, kefir, miso, and sauerkraut.
44
What is hydroponics?
Growing of plants in nutrient solutions with or without an inert medium (such as soil).
45
Downside of natural food supplements?
Natural may have better efficacy than synthetic forms, although are **generally not available in higher doses**.
Natural examples:
a) Vit D from fish liver oils
b) Vit E from vegetable oils and
C) Natural beta-carotene
d) Natural vitamin K
46
Give an example of when a synthetic form of a supplement can be more useful or / and a natural form cannot be used.
**Ascorbic acid** = most common synthetic form of vitamin C.
Rapidly excreted from body but will take a significant amount of ROS (free radicals) with it. Ideal if detoxification is desired outcome.
**Vitamin B9** labelling laws insist that companies use folic acid or methylfolate as product descriptor. Food state folate is not same as traditional folic acid. It's not methylfolate either as this does not occur in plants.
Methylation only takes place in human body or in a laboratory process - hence methylfolate, only can be made in lab, can be very helpful.
47
Name TWO reasons why synthetic supplements may be preferential to food-state.
1. Food-state supplements may not be enough to supply **optimal dosage** when someone has a *high nutritional requirement* due to:
a) poor dietary habits and lifestyle
b) environmental factors
c) chronic health conditions eg psoriasis and needed to reduce symptoms quickly.
2. **Sensitivities** to foods or fillers in food-based products eg gluten or nightshades can cause mild to severe reactions. Goji berries part of nightshades. Can excacerbate an arthritic conditon.
Isolated, synthetic nutrient products may work better for some sensitive people.
48
What is a naturopathic approach to supplementation?
Backed up by science, research and trials but with an holistic approach.
1. Favour use of whole, unadulterated botanicals and phytonutrient-rich foods optimally combined with vitamins, minerals, enzymes, coenzymes and amino acids.
2. Try to avoid preservatives, colourants, fillers or binding agents to allow activity of, and synergy between, vitamins, minerals, plant enzymes, phytonutrients without physiological or biochemical interference.
3. avoid GMO and irradiated products.
49
What letters indicate a synethetic form of a vitamin?
dl
eg dl-alpha tocopherol
50
Why is it better to avoid irradiated (ionised radiation) supplements? Is there an alternative?
1. Used to destroy pathogens.
2. Destroys nutrients and disrupts their natural frequencies.
3. Less damaging technologies include **dry steam sterilisation**.
51
Give THREE examples of what supplement types may contain GM organisms in supplements.
Low-quality supplements are often filled with GMOs - often added to compensate for poor-quality ingredients. Choose organic. Often in cheaper products.
May be GMO:
1. citric acid
2. corn syrup or corn starch
3. maltodextrin
4. MSG (flavour)
5. soy lecithin
6. xanthan gum (binder)
52
Which vitamin use for constipation?
Vitamin C can speed up the bowel ie ascorbic acid.
53
Example of macro and micro mineral?
Ca (macro = >100mg per day). Ca citrate (carbonate is cheap form). Lower dose but way more bioavailable. Carbonate can produce IBS although looks like higher supplement.
Selenium
NB Fe for heavy menstruation
54
Mineral carriers: what is difference between organic and inorganic **acid salts **? Give THREE examples of each.
A. **Organic acid salts**
Natural, found in living organisms.
1. Bond between mineral and organic acid generally weak.
2. Cleaved apart more easily
3. More effectively absorbed than inorganic salts
4. Body can also use carrier molecule.
5. Eg citrate, picolinate, ascorbate, malate,
Also: fumarate, gluconate, glycinate, acetate, lactate, , aspartate, succinate, orotate (some feed into **Krebs cycle** so can be used by body).
Eg GALA: gluconate (or glycinate), acetate, lactate, aspartate
B. **Inorganic acid salts**
Simple mineral compounds important for electrolyte balance.
Inorganic supplement forms tend to cause more adverse effects (esp. GI).
Eg. CON: carbonate, oxide, nitrates
Also: sulphates, chloride, phosphates, nitrates, carbonates.
55
Which forms of organic acid salts used in Krebs?
1. Malate: Malic acid
2. Citrate: Citric acid
3. Fumarate: fumaric acid
56
What is best form for mineral absorption?
*Amino acid chelates.*
Specific minerals chelate best with specific amino acids.
Survives stomach where absorbed in small intestine through dipeptide channels.
57
What are benefits of citrate as a mineral carrier?
Excellent carrier as:
1. Bound to citric acid (Krebs cycle): Ca2+,, Mg2+ ( Zn2+)
2. More bioavailable
3. Acidic form **requires less stomach acid to break bonds** and free mineral for absorption.
4. Absorption of calcium citrate is 2.5 times better than calcium carbonate (great for over 50s and menopausal women or highly stressed people with lower HCL)
58
What mineral carrier would be preferable for zinc and chromium?
**Picolinates**.
1. Bound to picolinic acid (metabolite of tryptophan) allows Zn to **travel to small intesine**.
2. Natural chelator.
3. High absorption
4. Superior carrier: eg if have limited window to heal eg pre-diabetes
59
What is wrong with orotate?
Specific chelate with B13 (orotic acid).
Excellent absorption into cells.
Caution: **Can overdose** as it bypasses normal regulatory controls.
60
Advantages of amino acid chelates?
1. Bypasses competitive absorption that can occur between different minerals (amino acid disguise); absorbed as a protein instead of as a mineral.
2. Body treats it as a peptide and is efficient at absorbing amino acids.
3. Extends length of absorption sites to large portion of small intestine.
61
What is a chelate?
Chelator + mineral atom = chelate
1. Chelator = Substance that binds tightly to mineral atoms and forces mineral to go wherever the chelator goes.
2. Mineral ion attached by covalent bonds to two or more amino acids in same molecule.
62
What are amino acid chelates limitations?
1. May be *too tightly bonded*. Minerals may not be released from this tight bond with carrier eg if cellular energy is poor (don't use for people with fatigue).
2. Often **too large** for capsules so **dosage can end up too low**; it is beneficial to combine with other forms of minerals.
3. **Expensive**
63
x3 considering factors before supplementing?
1. Why insufficiency?
2. Absorption
3. Depleting factors: alcohol, caffeine and meds
64
Name nutrients best taken at same time if supplementing Calcium for bone density.
1. Magnesium (also needed for bone mineral density)
2. D3 (abosrption)
3. K2 (takes Ca into bones)
65
What might be side effects of calcium supplementation?
Calcium supplementation may be ineffective at preserving bone density when dietary intake is sufficient; it can cause *kidney stones* and *soft tissue calcification*, especially if low vitamin D / K.
66
What form of calcium is commonly recommended? Is there another form that is easier to absorb?
Calcium carbonate (CON) is commonly recommended but calcium citrate (GALA) is easier to absorb.
67
What is maximum absorption of calcium?
Maximum absorption of calcium is usually 500 mg at one time.
68
Name FOUR organic forms of calcium supplements. Which would you recommend to your clients and why?
*Calcium aspartate* - a new type of calcium, is being marketed as having a higher absorption rate than other calcium supplements. Lacks scientific studies to support this or any of other claims made for this form of calcium.
*Calcium glycinate* - is presently regarded as most bio-available and most soluble form of supplemental calcium. Very soluble and easy to break down (reduces gastric upsets_/
*Calcium citrate* - is easily assimilated by body; most nutritional companies tend to use this form.
*Calcium gluconate* - low elemental level of calcium
69
Inorganic calcium forms: which TWO you would NOT recommend and why?
**Calcium carbonate** - Ca bound with carbonic acid. It is usually derived from coral or limestone. Used by pharmaceutical industry. Not very bioavailalbe so amounts used are high
- Most cost-effective form.
- Can cause adverse effects (nausea, gas, constipation).
- Requires more HCl for absorption than other forms eg antacids, PPIs.
*Calcium oxalate* - Ca bound to oxalic acid (oxalate).
- Never use as a supplement - may lead to formation of calcium oxalate kidney stones.
70
Inorganic calcium forms: which ones you would recommend and why?
*Calcium ascorbate* - Used as buffered source of vitamin C (gentle on GIT). CONTAINS Mg.
*Calcium pantothenate* - Is a supplemental form of pantothenic acid (vit. B5).
*Calcium citrate malate* (new form) - Exceptional absorption; can be consumed with or without food (other forms should be taken with food).
71
Name THREE Calcium Nutrient Interactions.
1. **Magnesium**: competes for same absorption pathway.
Separate by two hours to achieve highest serum levels.
2. **Zinc** and **iron** - may reduce absorption.
3.. Excess intake of **phosphorus** (soft drinks),
4. **Caffeine** and **dietary fat** increase calcium excretion if Ca supplements are taken.
5. **Excess fibre** - eg constipated therefore on supplement. May slow absorption. Leave two hours apart.
6. **Salt overload** - Ca binds with excess sodium (eg processed foods, table salt); excreted when body's levels must be lowered.
7. **Lysine** - enhances intestinal absorption and reduces excretion. Useful to take alongside.
72
Name THREE Calcium Drug Interactions.
Corticosteroids and the Change: CC for Ca.
Separate by min 4 hours : meds and Ca supplementation.
1. **Corticosteroids**
Long-term use can lead to reduced absorption, increased secretion and inhibition of osteoblasts.
2. **Levothyroxine** - competes for absorption with Ca; separate doses by** >4 hours**.
3. **Oestrogen and progesterone** therapy - increases absorption; may be a beneficial interaction.
4. **Quinolone**: Antibiotics bioavailability hindered by calcium supplements. Take 2 hours before, or 4-6 hours after calcium supplementation.
5. **Tetracyclines** - Separate from supplements by at least 2 hours.
Other: Cardiac glycosides and calcium channel blockers.
73
Nutrients are required for Magnesium absorption?
1. Selenium
2. B6
3. D.
Co-factors for Mg absorption.
Take Mg with food.
74
Magnesium absorption is inhibited by:
1. Phytates
2. Fibre
3. Alcohol
4. Excess saturated fat.
5. High levels of zinc, calcium and phosphorus taken concurrently or within two hours of Each other. **Not an issue at low levels**.
75
TRUE or FALSE:
different forms of magnesium supplements have varying clinical applications.
TRUE
76
Magnesium adverse reactions:
Diarrhoea. Possible gastric irritation. Less common side effects with organic form.
77
Crohn's disease preferred Mg source?
Mg aspartate (amino acid) as has great absorption.
78
What form of Magnesium would you recommend for insomnia?
Magnesium glycinate. Mg - nature's tranquiliser.
Amino acid chelate. Glycine can cross blood-brain barrier and activate GABA receptors to enhance relaxation.
79
What form of Magnesium would you recommend for use in bath?
Magnesium sulphate (Epsom salts)
Magnesium chloride - transdermal form, higher absorption than oral.
80
What form of Magnesium would you recommend for energy production, particularly in fibromyalgia?
Magnesium malate:
Malic acid is an intermediary in Krebs cycle.
Fibromyalgia.
81
What form of Magnesium would you recommend for cardiovascular support?
Magnesium orotate: orotic acid enhances energy production in heart.
82
TRUE or FALSE
Magnesium aspartate, Magnesium citrate, Magnesium gluconate and Magnesium oxide - all provide good absorption by body.
FALSE.
All except Magnesium oxide - cheapest form available / commonly used. An osmotic laxative.
83
Magnesium drug interactions and contraindications. Name TWO.
1. **Antibiotics**:Mg may reduce absorption of some antibiotics. Supplements should be taken one hour before, or two hours after these.
2. **Blood pressure medications, calcium channel blockers**: Magnesium maylower BP too much.
3. **HRT**, **OCP**, **diuretics* and **penicillamine* *
May decrease magnesium levels; concomitant supplementation may be beneficial.
**Contraindications**:
1. Heart block (unless there is a pacemaker present).
2. Renal failure.
84
Most common mineral deficiency in UK?
Fe.
NB Need to test Fe levels before supplementing.
85
What are best absorbed iron supplements?
Ferrous salts (ferrous fumarate, ferrous sulphate, and ferrous gluconate).
86
Orthodox form of iron supplement and its common side effects?
What form would we recommned?
Orthodox, most studied form - *Ferrous sulphate*:
- Can cause nausea and constipation.
- May interfere with vitamin E absorption.
- Higher dosages may be given than other forms.
Instead
1. *Ferrous bisglycinate*: Chelated iron that is claimed by its manufacturers to be highly bioavailable and without adverse effects of ferrous sulphate
2. *Ferrous citrate*: Well absorbed and generally tolerated well.
3. *Ferrous fumarate*: Well absorbed but may inhibit absorption of vitamin E.
*Ferrous lactate* (Iron II lactate): Derived from action of lactic acid on iron fillings; can be vegan or animal derived. In fortified foods and baby formula.
87
Why should we always check serum ferritin levels before supplementing?
TOXICITY
1. Overdosing iron is toxic in children; can be fatal.
2. Has pro-oxidant effects - can cause free radical damage.
3. It also feeds bacteria eg Hpylori - avoid in GI bacterial overgrowth.
4. With males, beware of haemochromatosis (excess Fe; similar symptoms to anaemia ie fatigue).
88
Name TWO drug interactions with iron supplements.
1. Fluoroquinolones, tetracyclines, penicillamine
2. Thyroxine, levodopa, .
89
What are adverse reactions of iron supplementation?
1. Nausea
2. Diarrhoea
3. Constipation
4. Heartburn
5. Upper gastric pain.
Taking with food seems to decrease adverse effects.
Toxicity: **Organ damage and death**.
1. Haemosiderosis (iron overload in organs or tissues).
-2. Haemochromatosis (often genetic condition, causes body to absorb more iron than normal and cause tissue damage)
3. Thalassaemia (inherited blood disorders that result in abnormal hemoglobin)
4. Sideroblastic anaemia (a disorder where body produces enough iron but is unable to put it into haemoglobin)
90
Uses for chromium x3?
1. Metabolic syndrome
2. PCOS
91
What form(s) of chromium supplementation would you consider for T2DM?
1. Chromium picolinate: readily absorbed with high serum levels.
2. *Chromium malate*: improves insulin sensitivity
NB B3 (niacin) provides optimal glucose tolerance factor along with chromium.
92
What is hexavalent form of chromium?
Emitted from industry and associated with toxicity. It is not used in nutritional supplements (Erin Brokovitch)
93
Chromium supplementation interactions and contraindications.
1. Some diabetes drugs may have an additive effect. Careful monitoring is required.
2. Oral corticosteroids may deplete chromium levels.
94
Most common form of over-the-counter forms zinc(often used in cold remedies, such as lozenges and nasal spray)?
Zinc gluconate or zinc acetate (speeds it up)
95
What form(s) of zinc would you recommend in clinic?
1. **Zinc picolinate**: Best assimilation and absorption but more expensive than citrate or gluconate.
2. **Zinc citrate**: Absorbed as well as gluconate form but less bitter, with a more appealing taste (good for children).
96
What form of inorganic zinc may cause stomach irritation and nausea?
Zinc sulphate.
97
How is it best to take zinc supplementation?
1. At night on an empty stomach ideally.
2. If cause stomach upset can be taken at least one hour before, or two hours after meals.
98
Name a mineral that zinc interacts with
Cu but only in high doses (100-150 mg daily)
99
Zinc adverse reactions
Nausea, vomiting, diarrhoea.
Nasal sprays may be linked with loss of smell (anosmia) - irritate olfactory epithelium
100
Zinc drugs interactions
1. Antibiotics (take antibiotic at least two hours before or four-six hours after taking zinc)
2. Penicillamine
3. Aspirin (3gr / day) and PPIs reduce zinc absorption
4. Thiazide diuretics* increase excretion of zinc by at least 60%.
101
What is potassium used for?
1. Heart health - keeping heart pumping
2. Nerve function, cell function
3. Muscle function
Tightly regulated by aldosterone and the kidneys.
Electrolyte.
Rare deficiency or insufficiency.
102
Readily absorbed and most commonly found form of potassium in supplements?
Potassium citrate
Electrolyte form
103
What inorganic form of potassium increases HCl production?
Potassium chloride. Only found in tissue salts and celloids (inorganic mineral compounds in cation:anion forms). Increases HCL. Used to support weak digestion (tissue salts).
104
What form of potassium is found in nature e.g. fruit, vegetables?
Potassium bicarbonate
105
Potassium supplementation toxicity causes what?
- *Tachycardia*: In doses greater than 15g daily.
- *Cardiac arrest*: In doses greater than 18g per day. It is still given as lethal injection in some parts of America.
106
x4 factors increase our need for vitamin C?
1. Pollution exposure
2. Chronic stress - needed to make adrenal hormones.
3. Illness
4. Infection
5. Wound healing (collagen)
107
Less desirable forms of vit C and why?
Avoid:
1. Tablets
2. Chewables
3. Fizzy powders
*Contain sweeteners, artificial colourings / additives, excipients!*.
108
Preferred supplement form of vit C
1. Liposomal
2. Capsules
3. Powders
109
What forms of vitamin C would you choose for:
- health maintenance
- detoxification
Maintenance: Food forms eg rose hip and acerola in low doses; body recognises these as food.
Detoxification: High dose *ascorbic acid* acts as an antioxidant; is quickly excreted from body but takes free radicals with it.
110
What are positives and negatives of ascorbic acid form of vitamin C supplementation?
Ascorbic acid found **naturally in food** with good bioavailability. Acidic so may be harsh on GIT.
Detox.
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Benefits of Bioflavonoids (vit C)?
Secondary metabolites in plants. Beneficial plant compounds such as hesperidin, quercetin and rutin, often added; work synergistically to deliver extra immune benefits and may help to increase vit Cbioavailability.
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What are advantages of liposomal vitamin C?
Increased bioavailability due to **phospholipid outer casing** protecting vitamin C inside from damage.
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What are benefits of time-release vitamin C?
1. Great bioavailability
2. Time-release formulas maximise total absorption of vitamin C over a prolonged period.
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Why are ascorbates (vit C, Ca, Mg, S, K) good?
If client can't tolerate ascorbic acid ascorbates are good.
They are buffered ie buffered vitamin C - Ester-C (good if acidity not tolerated).
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What is 'buffered vitamin C, and what are its benefits?
Mineral ascorbates: Such as calcium, magnesium, sodium, potassium ascorbate are often called ‚buffered vitamin C (Ester-C)
- Joined to alkaline mineral to cause less GI upset.
- Body absorbs carrier molecule as well as ascorbate.
Important to consider accompanying dose of mineral (calcium, magnesium, etc.) when taking higher levels.
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Vit C advere reactions
1. Bowel tolerance: Can cause diarrhoea in high doses. Low and slow.
2. Haemochromatosis: vit C increases Fe absorption; pro-oxidant effect.
3. Lab tests: Vit C can alter results (avoid 10 hours before taking test) eg bilirubin, glucose, nitrites, leukocytes.
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Vitamin C interactions
1. Cancer: high levels of antioxidants can become pro-oxidant ie injections but remain cautious.
2. Statins: May affect lipid levels ie not producing HCL.
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Who can benefit from vitamin A supplementation?
1. **Poor or limited diet**
2. increased need eg **pancreatic disease, eye disease or measles**.
3. Eye health
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RAE?
Retinol activity equivalents
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What forms of vitamin A can be found in supplementation?
Both:
1. **Provitamin A**: beta-carotene - most common synthetic form. Converted in body as needed; prevents vitamin A toxicity.
2. **Pre-formed vitamin A**: retinol acetate or retinyl palmitate - both stable and highly bioavailable.
Droppers good. Contain fat for better absorption.
Find in gut health supplementation - mucosal layer.
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What caution should be considered with Vitamin A supplementation?
1. **Smokers:** current or previous (beta-carotene esp synethetic form) - accelerates lung cancer growth. High dietary intake does not have same effect. Avoid.
2. Doses greater than 100,000 IU long term may be **toxic**.
3. High-dose therapy is only recommended short term; caution with:
a) liver disease (vit A recylced/stored in liver so toxicity poss)
b) renal disease
c) alcoholism
d) pregnancy
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What increases vit D risk of deficiency?
1. Only small amounts are available from food
2. Lack of sunlight exposure
3. Excessive sunscreen use
4. Genetic polymorphisms
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Name TWO forms of vitamin D. What form is suitable for vegans?
1. D3: cholecalciferol (active, most effective form).
2. D2: ergocalciferol (inactive vegetarian form).
Vegan form of D3 from lichen is suitable for vegetarians / vegans.
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Preferable ways to administer vitamin D in supplementation.
*Oral spray*
Forms an effective method of delivering active D3 directly into bloodstream, bypassing digestive system.
Supplement vitamin D3 alongside vitamin K2.
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Name TWO forms of vitamin E as supplements.
**D-alpha-tocopherol** = natural and most commonly used. 1.4 times more biologically active than synthetic form and retained in body more efficiently.
**DL* or *dl-alpha-tocopherol** (petrochemical source). **Synthetic dl form may inhibit natural d form of vit E entering cells**.
NB Useful for menopause as well as antioxidant.
Esterification - increases shelf-life.
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When would you consider using selenium supplementation?
1. Immune system health (potent antioxidant)
2. Hypothyroidism (supporting conversion from T4 to T3)
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TWO forms of supplemental selenium. Which form is most bioavailable?
1. Food form: **L-selenomethionine** - selenium chelated to methionine.
2. Supplement forms: Inorganic selenite and selenate; organic selenomethionine, selenocysteine and selenium-enriched yeast. Beware clients with candida.
Higher bioavailability of selenium in *selenomethionine* (90%) compared to about 50% from selenite. Most bioavailable and easily assimilated form of selenium.
Optimal form of supplemental selenium:
Combination of selenomethionine, selenodiglutathione and sodium selenate.
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Vitamin B1 supplemental forms and risk factors.
**Thiamine hydrochloride**, thiamine mononitrate.
Stable and water-soluble.
Deficiency is rare; thiamine deficiency is usually easy to reverse with supplementation.
Risk factors: Alcoholism (B-vit depleting or advanced age.
Insufficiency in stressed clients eg exams - glossitis (red tongue), cheilosis or angular cheilitis (corners of the mouth chapping).
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Vitamin B2 supplemental forms. Advise for best bioavailability and absorption.
Riboflavin, riboflavin 5'-phosphate (FMN).
Modified-release capsules may be best for bioavailability.
High doses have lower bioavailability.
Colours urine bright yellow.
Riboflavin is absorbed best if taken between meals (to avoid competition for absorption with foods)
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Vitamin B3 supplemental forms. Adverse effects and use in practice.
1. Nicotinic acid can cause non-allergic flushing and prickly heat sensation. Tolerance to flushing develops quickly.
2. Niacin: Use for cholesterol and triglyceride levels. Raynaud's disease.
3. Niacinamide: diabetes and blood sugar control. Combined with vit C, Mg, Chromium, Myoinositol.
4. Niacin and niacinamide: used for cognitive and mental health; to combat deficiency (pellagra).
Take niacin with meals to avoid irritation of stomach.
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When prescribe B12?
Clients with low levels of HCL ie elderly. Vegans. Deficiency common.
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Vitamin B12 (cobalamin) supplemental forms.
1. Methyl-cobalamin (used for methylation - active)
2. Adenosyl-cobalamin (used in mitochondria - active).
3. Cyano-cobalamin (most B12 supplements are this **inactive form** ie need to be converted to active form in body (via many micronutrients).
4. Hydroxy-cobalamin. Injectable form.
B12 supplements do not need stomach acid or digestive enzymes to release it from protein
but **absorption still requires intrinsic factor**.
Sublingual form is beneficial if digestive issues are present.
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Two supplemental forms of EFAs
EPA / DHA
Relatively high levels are needed for therapeutic effect.
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Caution with EFA supplementation?
1. **Pollutants may be present in oils made from fish livers.
2. Check if fish oils are from body or liver of fish.
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What EFA form is more efficiently absorbed?
**Krill oil** n-3
Carried into cells in **phospholipid form**.
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What form of EFA would you offer a vegan?
1. Vegan forms are now available derived from plant marine algae.
2. Flaxseed oil is a good plant source of omega-3 (high in ALA).
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Why add lemon oil to EFA supplement?
1. Lemon taste to mask fish oils
2. Vit C slows oxidation of highly vulnerable EFAs (heat, light, oxygen).
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What supplement for acne and hair loss
Zn and vit A
BUT consider hair loss could be iron deficiency (when with fatigue)
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Gut lining and skin require same supplements. What are they?
Vit A, Zn, L-glutamine, vit C (collagen),
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Anti-parasitic supplement?
Oregano.
Then probiotics to restore her gut.
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How to approach supplements?
Don't look just at symptoms. Try to take a step back and look at the cause.
