Supplements In Practice Flashcards
(86 cards)
1
Q
What is a food supplement?
A
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
Are herbal products classified as supplements?
A
No, they’re classified as medicines
3
Q
Why use supplements?
A
- For deficiency states
- For therapeutic uses of lutein
- For preventative health
4
Q
Why may food not be enough to acquire all the nutrients, making supplements more necessary?
A
- Food processing reducing nutrients
- Food additives deplete nutrients
- Weak digestion
- Stressful lifestyle
- Depleted soil
- Fertilisers/pesticides
5
Q
What is the positive list?
A
A list approved by the EFSA with vitamins and minerals considered safe
6
Q
What nutrients can be made in supplements and don’t need to be on the positive list?
A
EFAs, amino acids, botanicals,…
7
Q
Who licenses medicines in the UK?
A
The medicines and healthcare products regulatory agency (MHRA)
8
Q
Under what laws do food supplements fall?
A
Food laws
9
Q
Are laws on medicines harmonised across the EU?
A
No : what’s safely sold as food in a state may be classified as medicine in another state
10
Q
Who regulates herbal products?
A
The Traditional Herbal Medicines (THM) directive -> administered in the UK by MHRA
11
Q
Are claims allowed on supplement labels?
A
No MEDICINAL claims permitted -> no presentation/labelling allowed that infers that a supplement can prevent/treat/cure human disease
12
Q
What are the requirements for animal based supplements?
A
Any facility involved in their manufacture needs to be registered and approved by the European Commission
13
Q
What type of checks does the European Commission run on animal based supplements?
A
- Where animal was caught, farmed, handled, manufactured, extracted and packed (approval number must be on label)
- Contaminants (PCB, dioxins, heavy metals) -> need do be within EU acceptable levels
14
Q
What is GMP?
A
The Good Manufacturing Practice = minimum standard that a medicine’s manufacturer must meet in its production process
15
Q
What class of supplements require GMP?
A
Licensed medicines and herbal medicines
16
Q
What is the requirement for UK companies that manufacture supplements?
A
Required to manufacture with “due diligence” = all products must be “git for purpose”
17
Q
What does it mean that many companies are GMP compliant but not GMP approved?
A
Those companies are self-regulated : supplement may be produced to GMP standards with rigorous quality control, production and distribution procedures but without actual GMP approval
18
Q
What forms of supplements are there? (8)
A
- Tablets
- Capsules
- Powders
- Liquids
- Enteric formulations
- Spore form
- Chewable formulations
- Slow-release formulations
19
Q
What are liposomal supplements?
A
Supplements with a protective phospholipid bilayer protecting the active ingredients
20
Q
What are the benefits of a liposomal supplement?
A
- High bioavailability and absorption
- Increased uptake to target cell
- Easier to take than larger tablets
- Suitable for water and fat soluble nutrients
21
Q
What are excipients and fillers in supplements?
A
The glue (non-active ingredients) which bind and stabilise the active principles
22
Q
What is the naturopathic approach to supplementation?
A
- Addressing underlying cause of dysfunction, rather than the disease
- Must be taken under best conditions to achieve max absorption, assimilation and utilisation
- Everybody is unique and many factors must be considered to ensure that appropriate supplements are used in correct dosage for optimal efficiency
23
Q
Where does most supplement absorption occurs?
A
Duodenum and jejunum (B12 in ileum)
24
Q
Which are water-soluble vitamins?
A
Most Bs and C -> take with food
25
What are facto-soluble nutrients?
A, D, E, K, CoQ10 -> take with fat
26
How should amino acids be taken?
Ideally with carbohydrates OR on an empty stomach
27
What does amino acids absorption from protein shakes depend on?
Transit time through gut, stomach acid, proteolytic enzymes,…
28
What things should you consider when working out a supplement’s dosage?
1. Age (old -> higher dose)
2. Digestive capability (absorb? Excrete?)
3. State of health (optimum health or disease?)
4. Therapeutic doses (evidence from clinical trials)
5. Dietary deficiency or insufficiency (what symptoms?)
6. Lab test results (what do they indicate?)
7. Safe therapeutic range (age group)
29
What is the “elemental mineral” stated on supplements label?
The amount of mineral in a supplement that is actually USED by the body
30
What contributes to supplements high cost?
- Market hype / company used
- High quality source of ingredients
- GMP-approved or compliant procedures
31
What percentage of product must be natural for company to be allowed to call it a “natural” supplement?
10% -> rest may be synthetic
32
What different supplement sources are there? (4)
1. Natural source, e.g. vit D from fish oils
2. Synthetic -> manufactured with identical molecular structure to natural nutrients
3. Food cultured
4. Food based -> mix of isolated nutrients with a food base
33
When are high-quality, clean synthetic supplements recommended?
A) food-state supplements may not meet HIGH NUTRITIONAL REQUIREMENT due to poor diet/lifestyle, environmental factors or chronic conditions
B) sensitivities to foods/fillers in food-based products -> isolates synthetic nutrient may work better for sensitive ppl
34
What does it mean to have a holistic - rather than scientific - approach to supplementation?
1. Favour use of whole, unadulterated botanicals and phytonutrients combined with vitamins, minerals, enzymes, coenzymes and amino acids
2. Try to avoid preservatives, colourants, fillers … -> to allow the synergy between nutrients without biochemical interference
35
What are common mineral carriers in supplements?
1. ORGANIC ACID SALTS : natural, effectively absorbed, e.g. citrate, malate, ascorbate
2. INORGANIC SALTS : simple mineral compounds, e.g. oxide, sulphates, chloride, phosphates
3. AMINO ACID CHELATES : best form for mineral absorption -> specific mineral chelate best with specific amino acids
36
Often recommended mineral carrier : CITRATES
Bioavailable -> acidic form (+) requires less stomach acid to free mineral for absorption
E.g. Ca2+, Zn2+, Mg2+
37
Mineral carrier often recommended : PICOLINATE
Natural chelator for absorption of certain minerals in the small intestine -> high absorption in gut = high serum levels
Zinc and chromium mostly
38
What is a chelate?
Chelator + mineral atom
39
What is a chelator?
Substance binding tightly to mineral atoms and forcing it to go wherever the chelator goes
40
What are advantages of using chelates?
1. Bypass competitive absorption with other minerals (absorbed as protein instead of mineral = amino acid disguise)
2. Body treats it as peptide -> efficient at absorbing it
3. Extends length of absorption site
41
What are possible disadvantages of chelates?
1. Amino acid complex may be too tightly bonded
2. Amino acid chelate complexes often too large for capsules = low dosage
3. Quality and price limitations -> may be expensive
42
Why should CALCIUM be supplemented with K2 and D3?
Can cause kidney stones and soft tissue calcification if D and K don’t regulate uptake in bones
43
What are ORGANIC forms of CALCIUM supplements?
1. Calcium ASPARTATE : new, marketed for high absorption
2. Calcium GLYCINATE : most bioavailable and soluble
3. Calcium CITRATE : easily assimilated
4. Calcium GLUCONATE : low elemental calcium levels
44
What are INORGANIC forms of calcium supplements?
1. Calcium CARBONATE : cost-effective
2. Calcium ASCORBATE : buffered source of vit. C
3. Calcium PANTOTHENATE : B5 supplement
4. CALCIUM CITRATE MALATE : exceptional absorption
45
What are calcium nutrient interactions?
1. Magnesium (same absorption pathways)
2. Zinc and iron (reduce absorption)
3. Lysine (enhances absorption and reduces excretion)
4. Excess phosphorus/caffeine/dietary fat (increase excretion)
5. Excess fibre (slow absorption)
6. Salt overload (Ca binds with sodium -> excreted)
46
What are calcium DRUG interactions?
1. Corticosteroids (reduce abs.)
2. Levothyroxine (compete x abs.)
3. Oestrogen and progesterone therapy (increase abs.)
4. Quinolone
5. Tetracyclines
47
What nutrients does MAGNESIUM require for absorption?
Selenium, B6, D
48
What inhibits magnesium absorption?
Phytates, fibre, alcohol, excess saturated fat, high Zn, Ca, phosphorus
49
What are supplemental forms of magnesium?
1. Mg ASPARTATE : high absorption
2. Mg CHLORIDE : transdermal form
3. Mg CITRATE : excellent absorption + utilisation
4. Mg GLUCONATE : good absorption, avoid laxative eff.
5. Mg MALATE : energy production
6. Mg GLYCINATE : insomnia
7. Mg SULPHATE (Epsom salts) : osmotic laxative
8. Mg OROTATE : heart energy
9. Mg OXIDE : cheapest form
50
What DRUG interactions are there with MAGNESIUM?
1. Antibiotics (reduce absorption)
2. BP meds / calcium channel blockers (adverse effects)
3. HRT/OCP, diuretics, penicillamine (decrease Mg)
51
Forms of iron supplementation
1. Ferrous CITRATE : well absorbed and tolerated
2. Ferrous FUMARATE : well absorbed
3. Ferrous SULPHATE : higher dosage needed
4. Ferrous BISGLYCINATE : highly bioavailable
5. Ferrous LACTATE : in fortified foods/formula
52
Why should one be careful with iron supplementation?
- Overdose fatal for kids
- Pro-oxidative effect
- Feeds bacteria
Always check serum ferretin before supplementing
Beware of haemochromatosis
53
IRON drug interactions
Thyroxine, levodopa, tetracyclines, fluoroquinolones, penicillamine
54
Iron adverse reactions
Nausea, diarrhoea, constipation, heartburn, upper gastric pain
55
What is the risk of iron toxicity?
Organ damage and death
- Haemosiderosis = iron overload in organs/tissues
- Haemochromatosis = iron overload (genetic condition)
- Thalassamia and sideroblastic anaemia
56
Forms of CHROMIUM supplementation
1. Chromium PICOLINATE : good absorption
2. Chromium POLYNICOTINATE : safer long-term BUT currently not on safe list
3. Chromium MALATE : better at treating T2DM
57
Chromium contraindications
Additive effect to diabetes drugs -> careful monitor
58
Different forms of ZINC supplementation
1. Zinc GLUCONATE : used in cold remedies (nasal spray)
2. Zinc ACETATE : reduce cold symptoms
3. Zinc PICOLINATE : best assimilation and absorption but most expensive
4. Zinc CITRATE : good absorption
5. Zinc SULPHATE : inorganic -> may cause stomach irritation/nausea
59
What are zinc adverse reactions?
1. High doses (100-150 mg daily) = low copper
2. Nausea, vomit, diarrhoea
60
Drug interactions with ZINC
1. Antibiotics
2. Aspirin and PPI reduce zinc
3. Thiazide diuretics increase excretion
61
Forms of POTASSIUM
1. Potassium BICARBONATE : found in nature
2. Potassium CHLORIDE : increase HCL (inorganic)
3. Potassium CITRATE : readily absorbed
62
Can potassium be toxic?
Yes : hyperkalaemia
Tachycardia -> 15g + daily
Cardiac arrest -> 18g + daily
63
What increases our need for vitamin C?
Pollution exposure, chronic stress, illness, infection
64
What form vitamin C to choose and why?
- Health maintenance : low dose forms (e.g. acerola)
- Detox : high dose ASCORBIC acid -> quickly excreted drags free radicals along
65
Preferred forms of vit. C supplements
Capsules, liposomal, powder
66
Less desirable forms of vit. C supplementation
Tablets, chewable, fizzy powders/tablets
67
Depending on needs, different forms of vit. C include :
1. Ascorbic acid : high bioavailability
2. Bioflavonoids : beneficial plant compounds -> work synergistically = extra immune benefits
3. Liposomal : increased bioavailability
4. Time-release : better if taken small doses throughout day -> maximise tot absorption
68
What is a “buffer” vitamin C?
Mineral ascorbates : calcium, magnesium, sodium, potassium ascorbates
69
Adverse reactions of vit. C supplementation
- Bowel tolerance
- Haemochromatosis (may increase iron absorption)
- Lab tests (can alter results) -> bilirubin, glucose, …
70
Vit. C supplementation interactions
- Cancer : efficacy during treatment is controversial
- Statins : affect lipid levels
71
Who benefits from vit. A supplementation?
- Those with poor diet
- Increased-need conditions : pancreatic disease, eye disease, measles
72
What forms of vit. A supplementation are there?
1. RETINOL ACETATE or RETINAL PALMITATE (preformed vit. A) = stable and highly bioavailable
2. Beta-carotene (provitamin A) = most common synthetic form -> converted in body as needed, prevents toxicity
73
What is the dosage range for vit. A supplementation?
750-3000 mcg RAE = 2500-10000 IU
74
Careful with vit. A supplementation if …
- Current/previous smoker
- 100000 + IU (toxic long term)
- High dose only recommended short term
75
Can vit. A levels reach toxicity?
Yes : stored and recycled in liver
76
Forms of vit. D supplementation
1. D3 : cholecalciferol (active forms) -> most effective
2. D2 : ergocalciferol (inactive veg form)
3. Found in cod liver oil
4. Spray : directly absorbed in blood stream bypass liver
77
What forms of vit. E supplementation (2)
1. Natural form : D-alpha-tocopherol -> most biologically active and best retained
2. Synthetic form : dl-alpha-tocopherol -> in dietary supplements and fortified foods (prolong shelf life) -> well absorbed
78
Food form of selenium
L-selenomethionine = selenium chelated to methionine
79
Supplement forms of selenium
Inorganic : selenite and selenate
Organic : selenomethionine, selecocysteine, selenium enriched yeast
80
What selenium form has highest bioavailability ?
Selenomethionine
81
B1 supplementation
Thiamine hydrochloride, thiamine mononitrate
- Stable and water soluble
- Def. rare, insuff. more common
Risk factors : alcoholism, advanced age
82
B2 supplementation
Riboflavin, riboflavin 5-phosphate (FMN)
- Modified release caps. may be best for bioavailability
- Colours urine bright yellow
- Best absorbed if taken between meals
83
B3 supplementation
Niacin, niacinaminde (nicotinamide), nicotinic acid
- Nicotinic acid -> non-allergenic flushing
- Niacin -> cholesterol and triglyceride levels
- Niacinamide -> diabetes and blood sugar control
- Niacin and niacinamide -> cognitive and mental health uses
- Take with meals
84
B12 supplementation
Active forms : methylcobalamin, adenosyncobalamin
- Methyl form used for methylation
- Adenosyl form used for mitochondria
- Most supplements are cyanocobalamin (inactive)
- Hydroxycobalamin (also inactive -> good for who doesn’t tolerate methyl groups)
- B12 supp. needs IF
- Sublingual beneficial for digestive issues
85
EFAs supplementation
Needed due to reduction in intake of fatty acids -> source of EPA and DHA
86
Ideally, why are supplements used?
As a tool to support body’s healing process, providing nutrients needed to make up for shortfalls -> but should be at the correct levels and effective forms
