Vitamins, Minerals, Trace Elements, & Herbal Supplements

Vitamins, Minerals, Trace Elements, & Herbal Supplements

Objectives• Explain the difference between vitamins, minerals,

trace elements, and supplements.• List the water soluble vitamins.• List the fat soluble vitamins.• List common minerals and trace elements

required for proper cellular functioning.• Explain common drug interactions involving

nutritional supplements.• Identify common diseases or conditions caused to

excess or deficiency of required nutrients.

More Objectives• Explain the function or role of various vitamins,

minerals, electrolytes, and nutritional supplements.

• List the common chemical abbreviations used for the most common trace elements and minerals.

• Demonstrate familiarity with both the common and scientific names for common vitamins and nutrients.

So, what are they?• Vitamins, minerals, trace elements, and many

supplements are required for normal cellular function.

• Can function as cofactors, hormones, growth factors, and much more.

Why Care?Nutritional deficiencies can cause:

• Nonspecific complaints• Abnormal bone function• Neurological damage• Inability to build, repair

tissue• Change in energy level• Intellectual impairment• Muscle wasting

• Obesity• Emaciation• Loss of hair• Delayed healing of

wounds

What’s the Difference?Vitamins & Herbals• Organic• Found in living organisms.• Can sometimes be

synthesized by body.• Required for normal cellular

functioning.

Minerals, Electrolytes, & Trace Elements• Inorganic• Found in living and

nonliving sources.• Can NOT be produced by

the body.• Also required for normal

cellular functioning.

Regulation of Vitamins, Minerals, & Supplements

• The FDA does regulate vitamins and other supplements.

• Vitamins & Minerals must meet standards of purity and potency.

• Nutritional combinations and herbal supplements are regulated as FOOD, they do not have to comply with the same standards of purity and potency.

• READ THE LABEL

Vitamins

Why do we need vitamins?• Vitamins are essential for our body to do what it

needs to and to build and maintain the various structures of our body.

• B12

– Myelin Sheath– Blood cell development

• B6

– Metabolism– Neurotransmitter Development

• And many other functions & vitamins

Vitamins General Facts• Regulated by FDA• Monitored for purity.• RDA (Recommended Daily Allowance)– Average amount needed daily to prevent

deficiencies. • Drug Interactions• Toxicities & Side Effects• Pregnancy

Classification of VitaminsFat Soluble

• A, D, E, and K• Hepatic & Renal Elimination• Stored in the body.• More toxicities than water

soluble.• Intracellular Receptors• Drug interaction:

– Mineral Oil– HMG-CoA Reductase Inh– Laxatives– Lipase Inhibitors

Water Soluble• B vitamins and C• Renal Elimination• Generally fewer toxicities• Not typically stored in the

body.• Extracellular Receptors• Drug interactions with

diuretics.

Fat Soluble Vitamins

A, D, E, & K

Vitamin A• Vitamin A—beta-carotene or retinol• Four functions:– Visual pigment for rods in retina of eye– Protects against cancer in skin, respiratory and

digestive tracts, bladder, breast – Stimulates immune system to fight against

infections – Antioxidant; soaks up free radicals.

Vitamin A (cont’d)

• Vitamin A necessary for bone growth, renal function, digestive activity, normal reproductive function.

• Sources: dairy products, liver, fish, yellow and green fruits and vegetables.

Hypervitaminosis A• Symptoms: headache, vomiting, skin peeling,

loss of appetite, irritability, wasting away of bone mass

• Fatal cases: destruction of the liver• Birth defects: mother ingests large amounts of

Vitamin A during first 3 months of pregnancy

Vitamin D• Two precursors:– Cholecalciferol (D3): produced by skin in UV light – Ergocalciferol (D2): result of UV radiation on yeast

ergosterol found in bread and milk

• Calciferol converts to calcitriol in kidney

Vitamin D (cont’d)

• Calcitriol—increases phosphorus absorption and calcium intake

• Sources—dairy food:– Milk, eggs, cheeses (ergocalciferol)

• Deficiency: rickets, osteomalacia, osteoporosis

Hypervitaminosis D• May cause hypercalcemia.• Toxic effects include: calcium deposits,

convulsions, even death.• Drug interactionsm include: digitalis, thiazide

diuretics, mineral oil.

Vitamin E• Essential for normal metabolism and

protection of skin, eyes, tissues, muscles• Protects red blood cells from damage• Sources—whole grains: – Wheat, rice, nuts, corn, vegetables, dairy products

Vitamin E (cont’d)

• Deficiency: anemia, cardiovascular disease• Hypervitaminosis E: cases have not been

documented in literature• Drug interactions: mineral oil

Vitamin K• Phytonadione• Forms blood coagulation factors• Sources:– Wheat, legumes, egg yolks, milk, broccoli, spinach– Produced by certain intestinal bacteria

• Deficiency—increased tendency to bleed

Water Soluble Vitamins

Vitamins B & C

Vitamin B• Sources:– Vitamin B is in peas, beans, red meats, flour,

yeasts.• Deficiencies can go unnoticed for years.• Vitamin B enables cellular functioning of body

system.

B Vitamins—Sources, Function, and Deficiency States

Vitamin Chemical Name Food Sources Function DeficiencyB1 ThiamineGrains, cereals, Metabolism Beriberi

beans, pork, (wet and/or and liver dry forms)

B2 Riboflavin Cereals, eggs, Maintains Discolored dark green mucous tongue and

vegetables, membranes, dry scaling milk, liver metabolic and fissuring energy of

the lipspathways

B3 Nicotinic Nuts, beans, Fat synthesis, Diarrhea, acid pea, wheat, protein dementia, rice, grainsmetabolism depression, and electron skin

transport discolorationB5 Pantothenic Vegetables, Coenzyme Fatigue, acid

cereals, headaches,yeast, liver nausea,

muscle spasms

B Vitamins—Sources, Function and Deficiency States (cont’d)

Vitamin Chemical Name Food Sources Function DeficiencyB6 Pyridoxine Meat, liver, Amino acid Skin

chicken, and fatty acid disorders,salmon, trout, metabolism depression,

beans, rice, nausea,whole grains impaired

vision and nerve functionB9 Folic acidGreen Production Nerve vegetables of red blood damage

and liver cellsB12 Cyanocobalamin Meats, liver, Formation of Pernicious

chicken, red blood anemia,dairy products cells megaloblastic

anemia

Vitamin B1

• Thiamine important for:– Maintenance of body system– Carbohydrate metabolism– Well-being of nervous and cardiovascular system

• Deficiency: beriberi, anorexia, constipation, nausea, mental confusion, depression

Vitamin B2

• Riboflavin important for:– Metabolism of carbohydrates– Proper growth and maintenance of the body

Vitamin B2 (cont’d)

• Deficiency: anemia; depression; tongue, mouth, eyes, skin may dry out; headaches; burning sensations in skin; cracking in corners of mouth; seborrheic dermatitis

Vitamin B3

• Nicotinic acid (niacin)• Used in tissue respiration and metabolism• Reduces low-density lipoproteins (LDLs)• Releases histamine and causes vasodilation• Necessary for lipid metabolism, proper nerve

functioning, maintenance of cells

Vitamin B3 (cont’d)

• Deficiency: pellagra• Symptoms:– Diarrhea, weakness, lethargy, dermatitis,

dementia, sores in mouth, GI problems

Vitamin B5

• Pantothenic acid• Affects body metabolism.• Used to synthesize fatty acids, steroid

hormones, molecules for carbohydrate and protein processes.

• Produced by bacteria in GI tract of animals.• Deficiency causes headache, sleep

disturbances, muscle cramps, fatigue.

Vitamin B6

• Pyridoxine• For metabolism of carbohydrates, proteins,

fats in diet• Absorption of B12, production of amino acids• Deficiency: skin problems, stomatitis, seizures;

causes dwarfism, blindness, dementia, depression, osteoporosis

Vitamin B6 (cont’d)

• Agents that may cause pyridoxine deficiency include penicillamine and isoniazid.

• Drug interaction:– Levodopa (L-DOPA) for Parkinson’s disease

Vitamin B7

• Biotin• Important for activities of enzymes.• Break down fatty acids and carbohydrates to

convert them into energy.• Sources are beans, egg yolks, liver, nuts, and

cauliflower.

Vitamin B7 (cont’d)

• Deficiency: lethargy, weakness or easily fatigued and hair loss; eczema, swelling of the tongue

Vitamin B9

• Folic acid• Essential for DNA synthesis and creation of

cells with high growth turnover (bone marrow, white blood cells)

• Found in:– Green vegetables, broccoli, avocado, beets,

orange juice, liver

Vitamin B9 (cont’d)

• Deficiency: diarrhea, weight loss, weakness, sore mouth, irritability, behavior disorders

• Drug interactions:– Phenytoin, estrogen, nitrofurantoin

Vitamin B12

• Cyanocobalamin • Obtained from dietary intake• Required for red blood cell and myelin sheath

production, synthesis of nucleic acids• Deficiency: anemia, dementia, depression,

hair loss, poor growth rate in children, loss appetite

Vitamin B12 (cont’d)

• Deficiency:– Red cell anemia seen in pernicious anemia

(megaloblastic anemia)– Red cells abnormally form

Vitamin C• Ascorbic acid• Antioxidant• For formation of connective tissue found in

bones, teeth, gums; aids in healing wounds

Vitamin C• Deficiency:– Scurvy; causes excessive bleeding in skin

and gums; teeth become loose– Decrease in immune system’s ability to produce

T cells• Found in citrus fruits and vegetables

Minerals & Electrolytes

Minerals• Minerals, as opposed to vitamins, are

inorganic molecules found in a variety of substnaces.

• Found in living and nonliving substances.• The body can NOT make minerals and

electrolytes.• Mineral dissolved in water = electrolyte

Calcium• Needed for bone and tooth formation, muscle

contraction and relaxation, blood clotting, nervous system transmission, insulin secretion

• Calcium carbonate (tums) and os-cal good sources• Postmenopausal women need vitamin D for effective

calcium absorption

Phosphorus

• Needed for bone and tooth formation, energy• Helps in storage of fats and metabolism

Zinc• Essential component of DNA and

RNA• Necessary for sexual development,

wound healing, normal taste and smell

Zinc Excess• Side effects: nausea, vomiting, diarrhea,

pulmonary edema, hypotension, tachycardia• Drug interactions: – Penacillamine (binds to metals), treat metal

toxicity– Penacillamine binds to zinc and increases renal

excretion

Iron• Ferrous sulfate, ferrous fumarate, ferrous

gluconate• Transport oxygen in blood• In red blood cells, iron in hemoglobin binds to

oxygen molecule, transports it throughout body (red color)

• Stored in liver

Iron (cont’d)

• Deficiency: anemia• Symptoms: hair loss, shortness of breath,

lethargy, heart palpitations• Toxic effects of overdose: acidosis, liver and

kidney impairment, coma• DDI: Do not mix antacids and iron supplements.• Liquid oral iron supplements can discolor tooth

enamel (use of a straw can help prevent this).• Use of iron supplements can cause constipation.

Magnesium• Helps synthesize proteins, stimulates muscle

contraction and nerve transmission, activates enzymes, aids in bone formation

• Supplements found in combinations with other minerals (calcium)

• Excess Mg can lead to diarrhea.• Slow Mag, MOM, Epsom salts

Common Minerals and Trace Elements (TE), Their Actions, and Deficiencies

Mineral/TE Indication Deficiency OverdosageCalcium Bone formation, Osteoporosis, Kidney stones cell transport, rickets or damage nerve and muscle functionsCopper Iron utilization, Poor bone growth,Jaundice

skin pigmentation, nausea, nervous nervous system system disorders,functionspoor response of

immune systemMagnesium Normal muscle High blood

and heart function; pressure, kidney necessary for and heart problems, vitamin C and mental confusion calcium metabolism

Mineral/TE Indication Deficiency OverdosagePhosphorous Necessary for Muscle weakness,

healthy bones defective boneand teeth; function, arthritis

component ofphospholipids*

Potassium Cellular transport, Muscle weakness, Cardiac normal muscle, lethargy, poor arrhythmias; heart, kidney

and growth, and cardiac cardiac arrest nervous system disturbance functionsIron Hemoglobin/ Anemia, poor GI oxygen transport growth, confusion, disturbance, loss of appetite

black stoolsSelenium Proper immune Heart and bone GI functioning and

disease disturbance, growth liver damage

Common Minerals and Trace Elements (TE), Their Actions, and Deficiencies

(cont’d)

Mineral/TE Indication Deficiency OverdosageManganese Necessary for bone Poor hair growth, None known formation and for nails, andmetabolism of osteoporosis amino acids, lipids,

cholesterolZinc Proper growth and Decreased vitamin D Blurred vision, reproduction; absorption, nausea, decreased helps heal wounds

hair loss, birth consciousness, defects, decreased tachycardia immune response,

decreased sperm count

GI, gastrointestinal*Phospholipids are required for the formation of cell membranes.

Common Minerals and Trace Elements (TE), Their Actions, and Deficiencies

(cont’d)

Other Minerals & Electrolytes

• Fluoride– Protect against dental caries, contribute to bone formation – Present in fluorinated water, tea, seafood– Do not take fluoride drops with milk or dairy products

• Chloride– Serves as buffer, enzyme activator, component of gastric HCl

• Sodium– regulates body fluid and acid-base balance– found in table salt

Herbal Remedies

Origins of Drug Therapy• Historically medical treatment derived from

nature.• First drugs were plant compounds.• Today, many medications are synthesized to

simulate the original plant compound.• Some compounds from plants can not be

synthesized.– Example: Foxglove – digitalis, digoxin

Herbal Medicine• Historical:– Allegorical Evidence

• Not regulated as drugs. • Considered food according to the FDA• Current:– Identifiable chemical compounds– Purity– Drug Interactions, Toxicities– Drug Targets– Synthetic Analogs

Placebo Effect• Placebo: A treatment or dosage form that

simulates the appearance and administration of an active treatment but provides no physiologic effect.

• Placebo Effect: The psychosomatic response from the administration of a placebo du e to the belief by the patient (and/or healthcare providers) that the placebo is a treatment and that a benefit will be observed.

A rose by any other name…….

• One herb many names.• Taxonomy: The science of naming and

classification.• Taxonomic classifications/names usually based

upon Latin.

Home and Folk Remedies• Treatment devised at home without

professional medical advice• Passed down from generation to generation• Questionable therapeutic value

Some Home and Folk Remedies

More Home and Folk Remedies

Federal Regulations of Herbal Products

• Considered dietary supplements; not regulated by FDA

• Always ask patients about their use of herbal supplements

• Instruct patients to purchase herbs from a reputable source

• Inform physician of herbal therapy to avoid drug interactions

Top-Selling Herbs

Leading Uses for Herbal Products

More Uses for Herbal Products

Basics of Herbal Pharmacology

• Herbs are NOT pure compounds.• Allergies

• Drug Interactions– Example:• NSAIDs antagonize the effect of feverfew.

American Herbal Products Association Herb Safety Rating

Potential Herbal Toxic Effects

More Potential Herbal Toxic Effects

Questions?