· Web viewMedical Nutrition Therapy Nutrient. What is the nutrient? Biotin is a B vitamin that is...

Medical Nutrition Therapy Nutrient

1. What is the nutrient?Biotin is a B vitamin that is a co-enzyme involved in gluconeogenesis (formation of glucose from excess amino acids, fats or other non-carbohydrate sources) and fat synthesis (used for energy production). It is commonly found in egg yolk, peanut butter, liver, kidney, cauliflower, and yeast.

2. What is the RDA/DRI for the nutrient?There is no recommended dietary allowance (RDA) established for biotin, instead Adequate Intake values are used, which are summarized in the table below.

3. How is the nutrient metabolized?About half of biotin undergoes metabolism before excretion from the body. There are two principal pathways of biotin catabolism that have been identified in mammals. The first being that side chain of biotin is degraded by oxidation leading to the formation of bisboiotin methyl ketones and tetranorbiotin methyl ketones, which appear in the urine.The second pathway, the sulfur in biotin is oxidized leading to the formation of biotin L-sulfoxide, biotin D-sulfoxide, and biotin sulfone.

4. What are food sources of the nutrient?The ultimate source of biotin appears to be de novo synthesis by bacteria, primitive eukaryotic organisms such as yeast, molds, and algae and some plant species. Biotin is widely distributed in natural foods, but the absolute content of even the richest sources is low when compared with the content of most other water-soluble vitamins. Foods relatively rich in biotin include egg yolk, liver and some vegetables.

5. What disease states alter the nutrients metabolism?

Life-Stage AIsmicro g/d

Infants0-6 months 57-12 months 6Children1-3 years 84-8 years 12Males9-13 years 2014-18 years 2519-70+ years 30Females9-13 years 2014-18 years 2519-70+ years 30Pregnancy18+ 30Lactation18+ years 35

Although not considered a disease state, biotin has been shown to break down more rapidly during pregnancy, resulting in a decline of an individual’s nutritional status.

It has also been shown in a few studies that biotin levels were significantly lower in patients with non-insulin dependent diabetes mellitus than in non-diabetic subjects, and lower fasting blood glucose levels were associated with higher blood biotin levels.

6. What are the tests or procedures to assess the nutrient level in the body?Biotin levels may be assayed and the individuals’ blood and urine will be tested to check biotin levels. In cases with confusing findings, laboratory studies including: serum ammonia levels, urine ketones levels, quantitative plasma amino acid levels, plasma carnitine levels and a routine serum chemistry panel may be run.

7. What is the drug –nutrient interactions?There is no current evidence that biotin interacts with any medication, but there are some medications, which may lower biotin levels, including antibiotics and anti-seizure medications. Antibiotics used long-term my lower biotin levels by destroying the bacteria in the gut that produces biotin. Anti-seizure medications may lower levels of biotin, causing a deficiency. In many cases it is important to consult a doctor about supplements being used in accompaniment with anticonvulsant medications.

8. How is the nutrient measured?Biotin levels are measured in the units of micrograms.

9. What is the Upper Tolerable Limits?Due to the lack of research on biotin, there is not sufficient data on which to base a Tolerable Upper Intake Level for biotin.

10. What are the physical signs of deficiency?Although it is rare for a deficiency to occur, it has been shown to result in cases of prolonged intravenous feeding (parenteral feeds) without biotin supplementation and consumption of raw egg white for a prolonged period. Signs of a deficiency include:

Hair loss Scaly red rash around eyes, nose, mouth and genital area Depression Lethargy Hallucination Numbness & Tingling of the extremities

11.What are physical signs of toxicity?There are currently no reported incidents of biotin toxicity. Resources:http://www.ncbi.nlm.nih.gov/books/NBK114297/

http://umm.edu/health/medical/altmed/supplement/vitamin-h-biotin

http://lpi.oregonstate.edu/infocenter/vitamins/biotin/

http://www.nlm.nih.gov/medlineplus/druginfo/natural/313.html

Modern Nutrition in Health and Disease

Tabor’s Cyclopedic Medical Dictionary

Bryn WilkinKNH 413

Medical Nutrition Therapy Nutrient – Cadmium

1. What is the nutrient?

Cadmium: This is released into the environment from mining and metal processing operation, burning fuels, making and using phosphate fertilizers, and disposing of metal products. Cadmium usually enters the body by eating or drinking cadmium-contaminated food or water or by breathing cadmium-contaminated air.

2. What is the RDA/DRI for the nutrient?

There is no established RDA/DRI for cadmium. Typically, humans consume about 0.0004 mg/kg/day of cadmium. This is about ten times lower than the level of cadmium that causes kidney damage from eating contaminated food.

3. How is the nutrient metabolized?

Cadmium is most efficiently absorbed by the lungs, but can also be absorbed in small amounts by the gastrointestinal tract. Once cadmium enters the body, it becomes widely distributed and binds mainly to red blood cells. It then accumulates mostly in the kidneys and liver and induces the production of metallothionein, which binds nearly 80-90% of cadmium in the body. There is little to no metabolism of cadmium by the body, although it is able to bind in small amounts to various macromolecules and proteins. Cadmium is excreted through both urine and feces.

4. What are food sources of the nutrient?

Cadmium is most often found in shellfish, liver, and kidney meats. Plants also can absorb cadmium from the soil. However, the amount that they take up from the ground does not provide enough exposure to be of great concern. Smoking cigarettes also drastically increases a person’s inhalation of cadmium.


People with low body store of iron will have increased intestinal absorption of cadmium. Low intake of calcium or protein may also increase cadmium absorption. This could be seen in individuals with PEM or other metabolic stress. An individual with pre-existing kidney or liver disease would also be negatively affected by cadmium exposure. Respiratory complications of smoking cigarettes can also be worsened over time because of the cadmium present in cigarettes. Cadmium exposure from cigarettes increases a person’s cancer risk due to cadmium’s carcinogenic properties.

6. What are the tests or procedures to assess the nutrient level in the body?

Urine or blood tests can be used to measure cadmium levels in the body. Tests used to check the health of the liver and kidneys can also be used to indirectly measure the effect of cadmium in the body.

7. What is the drug –nutrient interactions?

Because zinc and cadmium often occur together in nature, zinc-containing drugs can often contain levels of cadmium, putting people at risk for prolonged cadmium exposure. Drugs that contain metallothioneins can help protect against cadmium absorption. Individuals who experience negative effects of cadmium may be treated with EDTA. This drug decreases cadmium in the body by urinary excretion.

8. How is the nutrient measured?

Cadmium levels can be expressed in micrograms or milligrams, depending on nutrient concentration.

9. What is the Upper Tolerable Limits?

There are no defined Upper Tolerable Limits for cadmium. However, breathing 0.01 mg/m3 of cadmium-contaminated air over the long-term can result in chronic lung disease and kidney disease in humans. In addition food or drink exposure to cadmium in amounts greater than 0.05 mg/kg/day can lead to stomach irritation. Long-term food or drink exposure in the amount of 0.005 mg/kg/day is the safest amount, leading to little risk of kidney damage.

10.What are the physical signs of deficiency?

Because cadmium has been determined to be a probable or suspected carcinogen by the U.S. Department of Health and Human Services, it is not recommended to seek out exposure to cadmium.

11.What are physical signs of toxicity?

High exposure to cadmium through eating and drinking contaminated foods and beverages can severely irritate the stomach, causing vomiting or diarrhea. Breathing in too much cadmium can also cause damage to the lungs. If a person is exposed to cadmium over a long period of time, they can experience kidney damage. This damage can lead to the formation of kidney stones and affect the bones, which can become painful and debilitating. Eventual renal failure due to chronic oral exposure is characterized by proteinuria. The accumulation of cadmium in the kidney affects renal vitamin D metabolism, leading to osteomalacia and osteoporosis.

References:

Agency for Toxic Substances & Disease Registry. (2011). Cadmium Toxicity. Retrieved from:

Rehttp://www.atsdr.cdc.gov/csem/csem.asp?csem=6&po=15

Better Health Channel. (2013). Camium. Retrieved from:

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cadmium

Environmental Protection Agency. (2010). Cadmium. Retrieved from:

http://epa.gov/waste/hazard/wastemin/minimize/factshts/cadmium.pdf

Health Protection Agency. (2010). Cadmium: Toxicological Overview. Retrieved from:

http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947375856

Medical Nutrition Therapy Nutrient-ChlorideLynne RollerKNH 413April 21, 2014

1. What is the nutrient?Chloride is an electrolyte that is present in the blood and urine. The role of chloride is to maintain fluid balance around the cells, as well as maintain blood volume, blood pressure, and the pH of body fluids.

2. What is the RDA/DRI for the nutrient?No RDA or DRI amounts exist for chloride. However, there is an Adequate Intake (AI)

given for chloride.

Age AI (g/d) for males and females

Infants 0-6 mo 0.18 g/dInfants 7-12 mo 0.57 g/dChildren 1-3 yr 1.5 g/dChildren 4-8 yr 1.9 g/d

Adolescents 9-13 yr 2.3 g/dYoung Adults 14-18 yr 2.3 g/d

Adults 19-30 yr 2.3 g/dAdults 31-50 yr 2.3 g/dAdults 51-70 yr 2.0 g/dAdults 70+ yr 1.8 g/d

Pregnant 14-18 yr 2.3 g/dPregnant 19-50 yr 2.3 g/dLactating 14-18 yr 2.3 g/dLactating 19-50 yr 2.3 g/d

3. How is the nutrient metabolized?Chloride is absorbed in the small intestines and eliminated by the kidneys during urination.

Some chloride can be reabsorbed in the intestine and transferred back to the bloodstream.4. What are food sources of the nutrient?

Table salt, sea salt, seaweed, tomatoes, celery, olives, potassium chloride, lettuce, rye.5. What disease states alter the nutrients metabolism?

http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947375856

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cadmium

Chloride can be altered through excess amounts of sweating, vomiting, diarrhea, or eating small amounts of salt. Therefore, any disease the causes excesses amounts of these symptoms, or requires a low salt diet will result in altered chloride amounts in the body.

6. What are the tests or procedures to assess the nutrient level in the body?A urine test can be done to determine how much chloride is leaving the body. A serum chloride

test may also be done. This will look at the body’s fluid level and acid-base level by drawing blood. 7. What is the drug –nutrient interactions?

Lithium and Tolvaptan cause unwanted nutrient interactions. Lithium will alter the flow of sodium through nerve cells, and Tolvaptan can reduce hormone levels used to balance water and salt within the body.

8. How is the nutrient measured?Chloride can be measured by measuring an individual’s salt intake. Amounts can also be

measured through assessing blood, urine, and sweat. 9. What is the Upper Tolerable Limits?

Age UL (g/d)Infants 0-12 mo Not DeterminedChildren 1-3 yr 2.3 g/dChildren 4-8 yr 2.9 g/dAdolescents 9-13 yr 3.4 g/dAdults 14+ yr 3.6 g/dPregnant 14-50 yr 3.6 g/dLactating 14-50 yr 3.6 g/d

10.What are the physical signs of deficiency?Hypochoremia (chloride blood levels are too low), loss of appetite, muscle weakness,

lethargy, dehydration. 11.What are physical signs of toxicity?

A build up of fluid may indicate toxicity. This can be seen in patients with congestive heart failure or kidney disease.

Maria ChamebrsApril 24, 2014

Medical Nutrition Therapy Nutrient1. What is the nutrient?

Choline is not considered a vitamin by definition, but it is an essential nutrient. Choline found in the body is found mostly in phospholipids, the most common is called lecithin (Higdon, 2003).

2. What is the RDA/DRI for the nutrient?The Food and Nutrition Board of the Institute of Medicine felt the existing scientific evidence was not sufficient in order to calculate an RDA for choline, so instead they set an Adequate Intake level. The Adequate Intake for Choline includes:

Life stage Age Males (mg/day) Females (mg/day)Infants 0-6 months 125 125Infants 7-12 months 150 150Children 1-3 years 200 200Children 4-8 years 250 250Children 9-13 years 375 375

Adolescents 14-18 years 550 400Adults 19 years and older 550 425Pregnancy All ages - 450Breast-feeding All ages - 550

(Higdon, 2003).

3. How is the nutrient metabolized?I could not find any information about how choline is metabolized in the body, but I found information on the various functions of choline in the body. It helps with structural integrity of cell membranes, cell signaling, nerve impulse transmission, lipid transport and metabolism, and is also a major source of methyl groups. It is used in the synthesis of phospholipids, phosphatidylcholine, and sphingomyelin all of which are structural components of human cell membranes. Choline is also a precursor for acetylcholine, which is a neurotransmitter that is involved with muscle control and memory. Choline can also be oxidized in the body to form betaine (Higdon, 2003).

4. What are food sources of the nutrient?Food sources including milk, eggs, liver, and peanuts are all rich sources of choline (Higdon, 2003).

5. What disease states alter the nutrients metabolism?There is a relationship between folate and choline metabolism in the liver and so if there is a deficiency of folate that will most likely affect choline metabolism. Celiac disease, other malabsorption syndromes and congenital disorders can affect the absorption of folate, which would then affect the absorption of choline. (Caudill, 2008).

6. What are the tests or procedures to assess the nutrient level in the body?A blood test for your liver enzymes is done in order to assess the choline levels in the body. If the liver enzymes, AST and ALT, are elevated, it is a sign of a fatty liver indicating a choline deficiency (Kim, 2014).

7. What are the drug-nutrient interactions?Choline is affected by its relationship with methyl donors such as folate and S-adenosyl methionine (Higdon, 2003).

8. How is the nutrient measured?The markers of liver dysfunction and plasma concentrations have been used to assess the choline requirements. The phosphocholine concentration in the liver is highly correlated with dietary choline and is very sensitive to small changes in the dietary intake, but this is not easy to measure (Nutrient Reference Values, 2014).

9. What is the Upper Tolerable Limits?The Upper Tolerable Limit for choline is 3.5 g per day for an adult (Caudill, 2010).

10. What are physical signs of deficiency?Deficiencies may result in excessive fat build up in the liver, high blood pressure, gastric ulcers, kidney and liver dysfunction, and stunted growth (Drug Bank, 2005).

11. What are the physical signs of toxicity?

Signs of toxicity include fishy body odor, vomiting, increased salivation, increased sweating, and decreased blood pressure (Caudill, 2008).

Resources

Caudill, M. 2008. Choline. Choline Info.org. Retrieved from http://www.cholineinfo.org/for_media/expert_q_a.aspDrug Bank, 2005. Choline. Retrieved from http://www.drugbank.ca/drugs/DB00122

Caudill, M. 2010. Choline. American Society for Nutrition. Retrieved from http://advances.nutrition.org/content/1/1/46.full

Choline. Nutrient Reference Values. Retrieved from http://www.nrv.gov.au/nutrients/choline

Higdon, J. 2003. Choline. Linus Pauling Institute. Retrieved from http://lpi.oregonstate.edu/infocenter/othernuts/choline/

Kim, B. 2014. Choline. Retrieved from http://drbenkim.com/nutrient-choline.html


1. What is the nutrient?Cobalt

2. What is the RDA/DRI for the nutrient?There is no DRI for cobalt, but the suggestion is 10-20mcg/day. (Cobalt, 2014)

Daily intake from food and water is estimated to be between 5 and 40 mcg/day, contained in Vit B12. (Cobalt, 2014)

3. How is the nutrient metabolized?Cobalt in the human diet is contained within Vit B12 and is initially metabolized as part of Vit B12. Cobalt makes up the central atom contained in a corrin ring made up of a tetrapyrrole ring system resembling the porphyrin ring system of hemoglobin.Vit B12 is split from its source by HCL in the stomach. It then binds with a glycoprotein – intrinsic factor – and is absorbed in the ileum and is transported through the bloodstream bound to transcobalamin – a specific protein. It is taken up by the liver where it is converted into co-enzyme forms – methionine synthase and methylmalonyl-CoA mutase,

http://drbenkim.com/nutrient-choline.html

http://lpi.oregonstate.edu/infocenter/othernuts/choline/

http://www.nrv.gov.au/nutrients/choline

http://advances.nutrition.org/content/1/1/46.full

http://www.drugbank.ca/drugs/DB00122

to be used in reactions throughout the body. (Metal Ions in Life Science)

4. What are food sources of the nutrient?Since cobalt is part of Vit B12, if you are getting adequate amounts of Vit B12, you are getting adequate cobalt. Vit B12 is found in animal products – meat, eggs and dairy.

5. What disease states alter the nutrients metabolism?Disease states that alter the metabolism of Vit B12 will, by default, alter the metabolism of cobalt. Pernicious anemia, food bound VitB12 malabsorption, atrophic gastritis and surgical resection of the stomach or small intestine where absorption occurs can alter the absorption of Vit B12 and therefore, cobalt.Pernicious anemia is thought to be caused by the inactivation of methionine synthase – an enzymatic cofactor which requires cobalt. (Linus Pauling Institute)

6. What are the tests or procedures to assess the nutrient level in the body?The nutrient can be measured in the body by analyzing blood and/or urine (Public Health)

7. What is the drug –nutrient interactions?As cobalt is contained within Vit B12, anything that causes an interaction with Vit B12 will interact with cobalt as well. Vitamin B12 is known to react with Chloromycetin as this drug decreases red blood cell production and Vit B12 increases it. Prilosec and Previcid, Tagamet, Pepcid, Zantac and Metformin all decrease the rate of absorption of B12. (NIH.gov)

8. How is the nutrient measured?As cobalt is part of Vit B12, the status of Vit B12 can determine the status of cobalt. Adequate cobalt status can be determined by measuring serum MMA (methylmalonic acid – a degradation

product of methylmalonyl CoA, an enzyme cofactor of which cobalt is an important part) (FAO)

9. What is the Upper Tolerable Limits?250mcg per day is the UL for cobalt (Acu-cell)

10.What are the physical signs of deficiency?The signs of cobalt deficiency are related to Vit b12 deficiency

and include pernicious (or megaloblastic) anemia. This is caused by a decreased availability of methionine synthase which prevents the body from using folate. (Linus Pauling Institute)

11.What are physical signs of toxicity?High levels of cobalt can lead to polycythemia. Information about

dietary cobalt toxicity comes from animal studies which show that long term exposure to low (but above DRI) levels of cobalt may result in damage to heart (angina, cardiomyopathy, congestive heart failure), and blood (polycythemia). (Public Health, Acu-cell)

ReferencesCobalt, 2014, http://www.acu-cell.com/nico2.htmlCobalt, 2014, Viva Life Science; http://www.vivalife.com/cobaltCorrin Ring, http://medical-dictionary.thefreedictionary.com/Corrin+ringCobalt, http://medical-dictionary.thefreedictionary.com/cobalt+nutritional+deficiencyCobalt; http://www.nutritionalhq.com/minerals/what-is-cobalt/ Dr. Dean Ravenscroft

Cobalt; Its role in health and disease; K. Yamada, Metal Ions in Life Science, Volume: 13(2013-01-01), p 295-320

Public health statement for Cobalt. http://www.atsdr.cdc.gov/phs/phs.asp?id=371&tid=64Linus Pauling Institute , Vit B12 http://lpi.oregonstate.edu/infocenter/vitamins/vitaminB12/Assessment of Vit b12 status. http://www.fao.org/docrep/004/y2809e/y2809e0b.htmVit B12 absorption; http://ods.od.nih.gov/factsheets/VitaminB12-QuickFacts/#h9

Medical Nutrition Therapy Nutrient1. What is the nutrient?

Vitamin B9-Folic acid (man-made)/ folate (plant source)Like all B-vitamins, folate assists in converting food into a usable source of energy. B complex vitamins promote nervous system function, healthy hair, skin, eye and liver function. Folate

http://ods.od.nih.gov/factsheets/VitaminB12-QuickFacts/#h9

http://www.fao.org/docrep/004/y2809e/y2809e0b.htm

http://lpi.oregonstate.edu/infocenter/vitamins/vitaminB12/

http://www.atsdr.cdc.gov/phs/phs.asp?id=371&tid=64

http://www.nutritionalhq.com/minerals/what-is-cobalt/

http://medical-dictionary.thefreedictionary.com/cobalt+nutritional+deficiency

http://medical-dictionary.thefreedictionary.com/Corrin+ring

http://www.vivalife.com/cobalt

http://www.acu-cell.com/nico2.html

contributes to brain function, mental and emotional health, and is especially important during periods of rapid growth such as infancy, adolescence, and pregnancy. It plays a role in the production of DNA and RNA, and works with vitamin B12 to produce healthy red blood cells. In conjunction with vitamins B6 and B12, folate regulates blood levels of the amino acid, homocysteine, which has been linked to heart disease at high levels.

2. What is the RDA/DRI for the nutrient?All adults need 0.4 mcg (400mg) per day. Women who are pregnant or breastfeeding should aim for up to 0.8 mcg per day. Because pregnancies may be unplanned, it is recommended that all women who could become pregnant take in 0.4-0.8 mcg of folic acid each day. Adequate levels of folic acid are needed before, as well as during pregnancy.

3. How is the nutrient metabolized?Folate is a water-soluble vitamin, which means that if more than what the body needs is consumed or supplemented, the excess will be excreted in the urine. It cannot be stored in the body so it must be consumed or supplemented on a regular basis. Absorption occurs in the small intestine.

4. What are food sources of the nutrient?All grains and cereals in the United States are fortified with folic acid. Whole foods that provide folate include dark leafy greens like spinach and mustard greens, beets, turnips, asparagus, soybeans, lima beans, Brussels sprouts, root vegetables, bulgur, wheat germ, white beans, mung beands, kidney beans, salmon, avocado, milk, and orange juice.

5. What disease states alter the nutrients metabolism?Some individuals may have increased need for folic acid due to various disease states such as celiac disease, sickle cell disease, liver disease, kidney disease, or high alcohol intake. Dialysis or medications used to treat epilepsy, Type 2 diabetes, rheumatoid arthritis, lupus, asthma, psoriasis, and inflammatory bowel disease may also alter folic acid metabolism.


Basic information about nutrient status is evaluated using patient history and a physical exam. A blood test is used to assess the amount of folic acid in the body. Sometimes it is difficult to differentiate between folate deficiency and vitamin B12 deficiency. Measuring RBC folate levels in the blood can be used to confirm folate deficiency. It is important to confirm that the issue is folate before beginning supplementation due to the fact that high levels of folic acid can mask Vitamin B12 deficiency.

7. What is the drug –nutrient interactions?Very high doses of NSAIDs (such as used in the clinical setting), anti-convulsants such as phenytoin, phenobarbital, and primidone, some cholesterol-lowering drugs, methotrexate (used to treat psoriasis and rheumatoid arthritis), some antibiotics, triamterene (blood pressure medication), Sulfasalazine (ulcerative colitis), and oral contraceptives that deliver high doses of estrogen, have all been shown to compromise folate status to varying degrees. Folic acid may increase the effects of chemotherapy drugs to dangerous levels.

8. How is the nutrient measured?Folic acid is measured in micrograms for dosing purposes. Blood tests are used to determine levels within the body.

9. What is the Upper Tolerable Limits?It is not necessary or recommended to exceed 800-1000mg per day.

10.What are the physical signs of deficiency?Low levels of folate are associated with anemia, irritability, forgetfulness, mental sluggishness, poor growth, gingivitis, shortness of breath, pallor, poor appetite, and tongue inflammation. Inadequate intake of folate before and during pregnancy is linked to serious birth defects including Spina bifida, cleft palate, and brain damage.

11.What are physical signs of toxicity?It is difficult to take in too much folate from plant sources. Also, because folic acid is a B-vitamin it is water soluble, meaning that it is excreted daily rather than stored in the body. In rare cases, excessive supplementation of folic acid could lead to toxicity. Signs of toxicity include rash, abdominal cramps, nausea/stomach upset, diarrhea, sleep disorders, confusion, behavior changes, or seizures. Too much folic acid may also mask vitamin B12 deficiency, which could result in nerve damage.

Taylor Pond



Iodine is a non-metallic trace mineral. It is regularly added to all table salt. Other

sources of iodine are saltwater and freshwater fish. Iodine is a component of thyroid

hormones, and thus plays a very important role in thyroid function (Higdon, 2003).


The RDA for iodine is 150 mcg/day for adults (National Institutes of Health, 2011). The

UL is 1,100 mcg/day.


Iodine must be converted to iodide before it can absorbed. Iodide ion is absorbed

completely, and is therefore 100% bioavailable. Iodide enters the circulation was plasma

inorganic iodide. This is then removed from circulation by the thyroid and kidney. In the

thyroid gland, iodide is used for the synthesis of thyroid hormones, and in the kidney,

excess iodine is excreted in urine. (WHO, 2000)


The iodine levels of certain foods can vary greatly based on the environment in which

they were grown/raised. For instance, seaweed-eating reef fish have high levels of

iodine due to their the high levels of iodine that are absorbed by seaweed, however the

amount of iodine in seaweed varies from source to source. The amount that this varies is

from 19-2984 mcg per serving. Other food sources are yogurt, cod, milk, enriched

bread, and shrimp (National Institute of Health, 2011).


There are no disease states that directly effect iodine metabolism. Pregnancy is a time

when iodine consumption is crucial. Fetal development is highly dependent on iodine,

and if the mother does not consume enough, it is likely that the fetus or baby will

develop thyroid problems.

http://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/


Urinary iodine measurements. Levels should be higher than 100 mcg/L.



Iodine consumed with anti-thyroid medications can have an additive effect and lead to

hypothyroidism.

Potassium iodide take with ACE inhibitors to treat high blood pressure can lead to

hyperkalemia.

Consumption of iodide with potassium-sparing diuretics can lead to hyperkalemia.

(National Institutes of Health, 2011).


Mcg/L (urine)

http://lpi.oregonstate.edu/infocenter/minerals/iodine/


The UL for male and female adults is 1100 mcg/day.

(National Institutes of Health, 2011).


Iodine deficiency disorders (IDD):

Mental retardation

Hypothyroidism

Goiter

30% of worlds population has iodine deficiency.



Goiter, elevated TSH levels, and hypothyroidism.

REFERENCES:


http://www.dietitians.ca/Nutrition-Resources-A-Z/Factsheets/Minerals/Food-Sources-of-Iodine.aspx


http://ods.od.nih.gov/factsheets/Iodine-QuickFacts/

http://fnic.nal.usda.gov/dietary-guidance/dri-reports/vitamin-vitamin-k-arsenic-boron-chromium-

copper-iodine-iron-manganese

https://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables

https://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables

http://fnic.nal.usda.gov/dietary-guidance/dri-reports/vitamin-vitamin-k-arsenic-boron-chromium-copper-iodine-iron-manganese

http://fnic.nal.usda.gov/dietary-guidance/dri-reports/vitamin-vitamin-k-arsenic-boron-chromium-copper-iodine-iron-manganese

http://ods.od.nih.gov/factsheets/Iodine-QuickFacts/


http://www.dietitians.ca/Nutrition-Resources-A-Z/Factsheets/Minerals/Food-Sources-of-Iodine.aspx


http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/

RDA%20and%20AIs_Vitamin%20and%20Elements.pdf

http://whqlibdoc.who.int/publications/2004/9241546123_chap16.pdf

Medical Nutrition Therapy Nutrient: Iron


Infants (AI):

0 - 6 months: 0.27 mg

Children (RDA):

7-12 months: 11 mg

1-3 years: 7 mg

4-8 years: 10 mg

9-13 years: 8 mg

Adolescents and Adults (RDA):

Males 14-18 years: 11 mg

Females 14-18 years: 15 mg (pregnancy: 27 mg, lactation: 10 mg)

Males 19-50 years: 8 mg

Females 19-50 years: 18 mg (pregnancy: 27 mg, lactation: 9 mg)

Males and Females 51+ years: 8 mg


Iron is a mineral that is necessary for many synthetic and enzymatic reactions in the body. Iron

is recycled and stored by the body. Most of the iron in the body is a part of hemoglobin, a protein that

transports oxygen from the lungs to the tissues. The remaining iron is stored in the form of ferritin or

hemosiderin. It is stored in the liver, spleen, and bone marrow. It can also be found in myoglobin in

muscle tissue.


Highest iron content to lowest iron content:

Breakfast cereals fortified with 100% of the DV for iron

Oysters

White beans

http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/RDA%20and%20AIs_Vitamin%20and%20Elements.pdf


Dark chocolate

Lentils

Spinach

Tofu

Kidney beans

Chickpeas

Tomatoes

Beef

Baked potatoes, flesh and skin

Cashews

Green peas

Roasted chicken, meat and skin

Roasted turkey, breast meat and skin

White rice, enriched

Bread, whole wheat

Spaghetti, whole wheat

Broccoli

Eggs

22. What disease states alter the nutrient’s metabolism?

Diseases states that alter the iron’s metabolism are chronic heart failure, gastroinstestinal

disorders, some cancers, and hemachromatosis. Individuals with heart failure could have iron

deficiency due to inadequate nutrition, malabsorption, defective iron storage, cachexia, and drug-

nutrient interactions. Individuals with gastrointestinal disorders such as, Celiac disease or Crohn’s

disease could have iron deficiency due to malabsorption or blood loss through the GI tract. Individuals

with some cancers could have iron deficiency due to chemotherapy-induced anemia or chronic blood

loss. Individuals with hemachromatosis could have iron toxicity because the disease is associated with

excessive build-up of iron in the body.


There are several blood tests that can be conducted. The two most common tests are the Hemoglobin

test and the Hematorcrit test.

Hemoglobin test: measures hemoglobin (protein in the blood that carries oxygen)

Hematocrit test: measures the percentage of red blood cells in the body

Other tests include the Complete Blood Count, Serum Ferritin, and Serum Iron.

24. What are the drug –nutrient interactions?

Levodopa- used to treat Parkinson’s disease or restless leg syndrome

Iron reduces the absorption of Levodopa

Levothyroxine- used to treat hypothyroidism, goiter, and thyroid cancer

Simultaneous intake of iron and Levothyroxine reduces the absorption of Levothyroxine

Proton pump inhibitors- used to reduce acidity in stomach

Can reduce iron absorption

Antibiotics

Iron can reduce the absorption of antibiotics


The nutrient is measured in milligrams.

26. What is the Upper Tolerable Limit?

The UL for iron is 45 mg/day. Exceeding this limit can cause constipation and nausea.


Brittle nails

Swelling or soreness of the tongue

Cracks in the side of the mouth

Frequent infections, the individual’s immune system is compromised

Mild to moderate iron deficiency anemia may have no signs. Severe iron deficiency anemia can have

signs such as, fatigue, shortness of breath, dizziness, coldness in hands and feet, pale skin, and chest

pain.


Upset stomach

Constipation

Nausea

Abdominal pain

Vomiting

Faintness

In severe cases of iron toxicity, multiple organ systems can fail. This can cause a coma, convulsions,

and even death.

.

References

Medline Plus: http://www.nlm.nih.gov/medlineplus/ency/article/002411.htm>.

NIH: http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

CDC: http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html

Iron Disorders Institute: http://www.irondisorders.org/recommended-daily-allowance/

NHLBI: http://www.nhlbi.nih.gov/health/health-topics/topics/ida/signs.html

Carolyn KlempayKNH 413

Nutrient Information

Medical Nutrition Therapy NutrientMagnesium

1. What is the nutrient?Magnesium is a mineral that is found in the body and is presented naturally in foods.

Magnesium works with other enzyme systems that collaborate to regulate bodily reactions including protein synthesis, muscle function, and blood pressure regulation. This nutrient assists in the process of glycolysis, contributes to the structural development of bone, helps the active transport of calcium and potassium, and contributes to normal heart rhythms.

2. What is the RDA/DRI for the nutrient?Magnesium intake is based on the Dietary Reference Intake (DRI) information that describes a

general set of reference values used to assess the nutrition of healthy individuals. These standards for the Recommended Daily Allowance (RDA) for magnesium differ based on age and gender. A table which breaks down recommendations in a visual way is displayed below.

Age Male Female Pregnancy LactationBirth to 6 months 30 mg* 30 mg*7–12 months 75 mg* 75 mg*

1–3 years 80 mg 80 mg4–8 years 130 mg 130 mg9–13 years 240 mg 240 mg14–18 years 410 mg 360 mg 400 mg 360 mg19–30 years 400 mg 310 mg 350 mg 310 mg31–50 years 420 mg 320 mg 360 mg 320 mg51+ years 420 mg 320 mg

3. How is the nutrient metabolized?On average, an adult body will contain about 25 grams of magnesium, the larger portion being

present in the bones, and the remaining in the soft tissues. About 30%-40% of the dietary magnesium that is taken into the body is typically absorbed. The regulation of magnesium levels in the body is highly controlled by proper kidney functioning which allows excess mineral to be excreted in the urine or decreases excretion when magnesium reserves are low. Magnesium levels, although very difficult to gain an accurate and precise measurement of mineral status, can be measured through serum concentration evaluations.

4. What are food sources of the nutrient?This mineral is common in many plant and animal sources of food, as well as various

beverages. Good sources of magnesium include green leafy vegetables such as spinach in addition to whole grains, nuts, seeds, and legumes. A general rule states that foods which are good sources of dietary fiber also tend to be good magnesium sources as well. Foods such as breakfast cereals may be fortified with magnesium and contrarily, heavily processed foods may be lower in magnesium due to the removal of nutrient-rich portions during the refining of certain grains. Water that is from the tap or bottled may possess magnesium, however, the amount varies greatly depending on water source and brand. Specific foods that are high in magnesium include almonds, spinach, cashews, peanuts, cereal, soymilk, black beans, edamame, peanut butter, whole wheat bread, avocado, brown rice, and plain low-fat yogurt. It is not required by the FDA to list the magnesium content of foods in the nutrition facts label unless the food has been fortified with the mineral.

5. What disease states alter the nutrients metabolism?Individuals with gastrointestinal diseases are at risk for magnesium depletion over time. These

diseases can include Crohn’s disease, gluten-sensitive enteropathy (Celiac disease), or enteritis. Instances in which the small intestine, particularly the ileum, is bypassed can usually lead to loss of magnesium through malabsorption.

Type 2 Diabetes is another disease state that can alter the metabolism of magnesium due to increased magnesium excretion. Because of increased glucose concentrations in the kidneys, urinary magnesium output is increased as well, creating a mineral imbalance.

Alcoholism is a third disease state in which magnesium absorption and metabolism is highly affected. Poor nutritional intake and dietary magnesium consumption, chronic vomiting, diarrhea, and steatorrhea can lead to renal dysfunction and excessive magnesium excretion. Vitamin D deficiency, alcoholic ketoacidosis, and liver disease are all contributing factors to a decreased magnesium status in those who have alcohol dependence.

Lastly, older adults, even without diagnosis of a particular disease state, have lower dietary intake of magnesium and higher risk for inadequate mineral metabolism. Absorption of magnesium in the gut decreases with age and chronic illness or additional medications taken by older adults create increased potential for disrupted magnesium metabolism.

6. What are the tests or procedures to assess the nutrient level in the body?Assessing the nutrient magnesium in the body is somewhat difficult because most of this

mineral is housed inside cells or bone. Measuring the serum magnesium concentration is the most commonly used method of mineral assessment. Although serum magnesium has very little correlation to total bodily and specific tissue magnesium concentration, this method is most readily available for use.

Additional testing procedures to evaluate magnesium concentration in the body include measuring concentrations of magnesium in erythrocytes, saliva, urine, blood, plasma, and serum magnesium through magnesium-loading or “tolerance” testing. Some researchers consider the tolerance test to be the most accurate method of magnesium concentration assessment. In this test, a parenteral infusion of a magnesium dosage is given and after, urinary magnesium is measured to assess excretory properties. Ultimately, a combination of clinical and laboratory assessments are needed to get the most accurate measurement of this mineral’s presence in the body.

7. What are the drug-nutrient interactions?Magnesium status has the potential to be affected when in combination with particular

medications and it is important that those who take these medications speak with a physician about the possibility of medical concerns. Bisphosphatates used to treat osteoporosis may be altered in effectiveness due to magnesium-containing supplements. Separate magnesium supplements and bisphosphatate intake by at least two hours to prevent interactions. Antibiotics and diuretics should also be taken several hours after or before taking magnesium supplements due to the potential of interactions and increasing magnesium deficiency risks. Proton pump inhibitors, when taken consistently for long periods of time, also have the ability to cause hypomagnesemia. If this medication is necessary, regular measurements of magnesium status should be taken and monitored for substantial changes.

8. How is the nutrient measured?This nutrient is measured in grams or mmols in the body. Measurements are gained through

evaluation of serum magnesium levels in saliva, urine, and blood plasma. Additionally, studying the results of concentrated magnesium intake, and excretory magnesium measurements can assist in the measurement of this nutrient.

9. What is the Upper Tolerable Limit?Tolerable upper limits for magnesium for infants, children, and adults apply only to magnesium

supplementation, not to dietary consumption. A table to display these Upper Tolerable Limits is displayed below.

Age Male Female Pregnant LactatingBirth to 12 months None established None established1–3 years 65 mg 65 mg4–8 years 110 mg 110 mg9–18 years 350 mg 350 mg 350 mg 350 mg19+ years 350 mg 350 mg 350 mg 350 mg

10. What are the physical signs of deficiency?Physical signs of a magnesium deficiency include loss of appetite, nausea, vomiting, fatigue,

and weakness. These beginning signs can worsen as the deficiency increases and additional physical signs are numbness, tingling sensations, muscle contractions, muscle cramps, seizures, abnormal heart

rhythms, coronary spasms, and changes in personality. Extremely severe cases in the deficiency of this mineral may result in low serum calcium and low serum potassium levels (hypocalcemia and hypokalemia respectively) due to the imbalance and disruption in mineral homeostasis.

11. What are the physical signs of toxicity?High magnesium levels due to excessive magnesium supplementation can result in physical

signs of diarrhea, nausea, and abdominal cramping. It is quite unlikely that magnesium toxicity can result from dietary intake because of the kidney’s process of mineral regulation and excretion. Severe cases of magnesium toxicity, when serum concentrations exceed 1.74-2.61 mmol/L, will ultimately lead to hypotension, nausea, vomiting, facial flushing, urine retention, depression, and lethargy. These initial signs can worsen to muscle weakness, difficulty breathing, extreme hypotension, irregularities in heartbeat, and even cardiac arrest.

Resources:

NIH. (2013, November 4). Magnesium. — Health Professional Fact Sheet. Retrieved April 21, 2014, from http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/

Lauren ArnettKNH 4134-24-14Niacin

Medical Nutrition Therapy Nutrient27.What is the nutrient?

The nutrient is niacin which is a water soluble type B vitamin. Niacin aids in the digestive system, skin and nerve function as well as the conversion of food to energy for the body from carbohydrates. Niacin can be reached solely through dietary sources. Typically, people in third world countries have niacin deficiency and people in the US do not; however, when they do it is usually caused by alcoholism. Niacin is mainly used for high cholesterol, but it can also be used for acne, memory loss, arthritis and circulation problems.

http:// www.nlm.nih.gov/medlineplus/ency/article/002409.htm

28.What is the RDA/DRI for the nutrient?Factors that affect the amount of niacin include age, gender, and pregnancy. The Recommended Dietary Allowance (RDA) is the average daily intake that is enough to meet the nutrient requirements of nearly all (97 - 98%) healthy people. The daily recommended intakes are listed below in the chart.


29.How is the nutrient metabolized?Niacin is well absorbed when taken by mouth due to being water-soluble. When taken in a physiologic dose it is metabolized in the liver into niacinamide, and when a therapeutic dose is taken only a portion is converted. It is widely distributed throughout the body and eventually gets excreted through the urine. People with liver problems need to be careful when consuming high doses of niacin because this can cause even more problems to arise.

Niacin is dose rate specific and one pathway is through a simple conjugation step with glycine. Another pathway forms nicotinamide adenine dinucleotide. It is further metabolized into other compounds and there is a nonlinear relationship between niacin dose and plasma concentrations after multiple dose administration.

http://www.rxmed.comwww.webmd.comhttp://www.rxlist.com/niaspan-drug/clinical-pharmacology.htm

30.What are food sources of the nutrient?Food sources of niacin include dairy products, eggs, enriched breads and cereals, fish, lean meats, legumes, nuts and poultry. Specifically, beets, beef liver, sunflower seeds, and peanuts are great sources. Food Serving Niacin (mg)Chicken (light meat) 3 ounces* (cooked without skin) 7.3-11.7Tuna (light, canned, packed in water) 3 ounces 8.6-11.3Turkey (light meat) 3 ounces (cooked without skin) 10.0

Salmon (chinook) 3 ounces (cooked) 8.5Beef (90% lean) 3 ounces (cooked) 4.4-5.8Cereal (unfortified) 1 cup 5-7Cereal (fortified) 1 cup 20-27Peanuts 1 ounce (dry-roasted) 3.8Pasta (enriched) 1 cup (cooked) 1.9-2.4Lentils 1 cup (cooked) 2.1Lima beans 1 cup (cooked) 0.8-1.8Bread (whole-wheat) 1 slice 1.3Coffee (brewed) 1 cup 0.5http://lpi.oregonstate.edu/infocenter/vitamins/niacin/http://umm.edu/health/medical/altmed/supplement/vitamin-b3-niacinhttp://www.nlm.nih.gov/medlineplus/ency/article/002409.htm

31.What disease states alter the nutrients metabolism?Niacin is affected by diseases states such as defective tryptophan absorption, long term use of chemotherapeutic treatment, people with Hartnups disease, increased serotonin levels, drugs given for Parkinson’s disease, people with chronic alcoholism and with HIV.

http://lpi.oregonstate.edu/infocenter/vitamins/niacin/#deficiency_causes

32.What are the tests or procedures to assess the nutrient level in the body?A niacin skin flush test can be conducted as well as a urine test to assess niacin metabolites in the urine.

33. What is the drug –nutrient interactions?These are a list of some of the drug interactions as specified by the University of Maryland Medical Center. Antibiotics, Tetracycline -- Niacin should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. All vitamin B complex supplements act in this way and should be taken at different times from tetracycline.Aspirin -- Taking aspirin before taking niacin may reduce flushing from niacin, but take it only under your doctor's supervision.Anti-seizure Medications -- Phenytoin (Dilantin) and valproic acid (Depakote) may cause niacin deficiency in some people. Taking niacin with carbamazepine (Tegretol) or mysoline (Primidone) may increase levels of these medications in the body.Anticoagulants (blood thinners) -- Niacin may make the effects of these medications stronger, increasing the risk of bleeding.Blood Pressure Medications, Alpha-blockers -- Niacin can make the effects of medications taken to lower blood pressure stronger, leading to the risk of low blood pressure.Cholesterol-lowering Medications -- Niacin binds the cholesterol lowering medications known as bile-acid sequestrants and may make them less effective. For this reason, niacin and these medications should be taken at different times of the day. Bile-acid sequestrants include colestipol (Colestid), colesevelam (Welchol), and cholestyramine (Questran).

Statins -- Some scientific evidence suggests that taking niacin with simvastatin (Zocor) appears to slow down the progression of heart disease. However, the combination may also increase the likelihood for serious side effects, such as muscle inflammation or liver damage.Diabetes Medications -- Niacin may increase blood sugar levels. People taking insulin, metformin (Glucophage), glyburide (Dibeta, Micronase), glipizide (Glucotrol), or other medications used to treat high blood glucose levels should monitor their blood sugar levels closely when taking niacin supplements.Isoniazid (INH) -- INH, a medication used to treat tuberculosis, may cause a niacin deficiency.Nicotine Patches -- Using nicotine patches with niacin may worsen or increase the risk of flushing associated with niacin.

These are a list of medications that may lower levels of niacin in the body: Azathioprine (Imuran) Chloramphenicol (Chloromycetin) Cycloserine (Seromycin) Fluorouracil Levodopa and carbidopa Mercaptopurine (Purinethol)

University of Maryland Medical. Center http://umm.edu/health/medical/altmed/supplement/vitamin-b3-niacin#ixzz2zk4w434C

34. How is the nutrient measured?Niacin is measured by the urinary excretion of niacin metabolites. Urine is tested to help tell niacin levels through niacin elimination. http://lpi.oregonstate.edu/infocenter/vitamins/niacin/

35.What is the Upper Tolerable Limits?This is based on skin flushing which is a common side effect of niacin.

http://www.nrv.gov.au/nutrients/niacin

10.What are the physical signs of deficiency?Symptoms of deficiency include indigestion, fatigue, canker sores, vomiting, depression, and if niacin deficiency because extremely bad then pellagra may occur. Pellagra includes signs of scaly skin, and diarrhea. Other signs such as a swollen red tongue may present.

http://umm.edu/health/medical/altmed/supplement/vitamin-b3-niacin

11.What are physical signs of toxicity?Signs of niacin toxicity include severe skin flushing, rapid heart beat, itching, nausea and vomiting, abdominal pain, diarrhea, and severe liver damage. More severely niacin overdose can lead to hepatotoxicity. This occurs when doses above 500mg are taken which is rare.

http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/niacin-overdose/faq-20058075

Medical Nutrition Therapy Nutrient- Nickel

1. What is the nutrient?Nickel is classified as an “ultratrace” mineral, meaning that it is present in very low quantities in human tissues (Mahan & Escott-Stump, 2004).

2. What is the RDA/DRI for the nutrient?There is no specified RDA/DRI for this nutrient, as it is needed in uncertain amounts in the human body (Mahan & Escott-Stump, 2004). It has been hypothesized to be essential for the breakdown of amino acids leucine, valine, and isoleucine and odd-chain-length fatty acids (Medeiros & Wildman, 2000).

3. How is the nutrient metabolized?The nutrient is absorbed in the gut, and absorption depends on the amounts of copper, iron, and zinc present (Medeiros & Wildman, 2000). It binds to form ligands and is then transported throughout the body. It is best absorbed through the lungs, GI tract, and the skin, and is then excreted in the urine and feces (Das, Das, & Dhundasi, 2008).

4. What are food sources of the nutrient?Food sources of nickel include mainly plants as more concentrated sources. Nuts are the best source of nickel, as well as grains, cured meats, and vegetables. Fish, milk, and eggs also contain nickel, but in smaller amounts (Medeiros & Wildman, 2000). Nickel can also be obtained in varying amounts from drinking water (Das, Das, & Dhundasi, 2008).

5. What disease states alter the nutrient’s metabolism?Myocardial infarctions and acute strokes, as well as burn injuries have been shown to alter the transport and serum concentration of nickel in the body (Das, Das, & Dhundasi, 2008).


Nickel is assessed for toxicity by testing the urine for nickel concentration. A serum nickel concentration can also be obtained from a blood sample (Mayo Medical Laboratories, 2014).

7. What are the drug–nutrient interactions?Zinc may affect the amounts of copper, iron, and zinc that are absorbed into the gut (Medeiros & Wildman, 2000).

8. How is the nutrient measured?The nutrient is measured in micrograms, with a level of 1,000 micrograms specified as the tolerable upper limit (Medeiros & Wildman, 2000).

9. What is the Upper Tolerable Limits?For adults ages 19-70, the Tolerable Upper Intake Level for Nickel is 1.0 mg/day (Nelms, Sucher, Lacey, & Roth, 2011).

10. What are the physical signs of deficiency?Based on the current evidence, there are no known signs of nickel deficiency, due to the very low requirements for humans (Anke, Groppel, Kronemann, & Grun, 1984).

11. What are physical signs of toxicity?Physical signs of toxicity include nausea, vomiting, diarrhea, abdominal pain, headache, cough, shortness of breath, and giddiness (Young, 1995).

ReferencesAnke, M., Groppel, B., Kronemann, H., & Grun, M. (1984). Nickel- an essential element. JARC Sci

Publ. , 53, 339-65.

Das, K. K., Das, S. N., & Dhundasi, S. A. (2008). Nickel, its adverse health effects & oxidative stress.

Indian J Med Res (128), 412-425.

Mahan, L. K., & Escott-Stump, S. (2004). Krause's Food, Nutrition, and Diet Therapy (11th Edition

ed.). Philadelphia, PA: Saunders.

Mayo Medical Laboratories. (2014). Nickel, Serum. Retrieved April 21, 2014, from Mayo Clinic:

Mayo Medical Laboratories:

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8622

Medeiros, D. M., & Wildman, R. E. (2000). Advanced Human Nutrition (2nd Edition ed.). Sudbury,

MA, United States of America: Jones & Bartlett Learning.

Nelms, M., Sucher, K. P., Lacey, K., & Roth, S. L. (2011). Nutrition Therapy & Pathophysiology (2nd

Edition ed.). Belmont, CA, USA: Wadsworth.

Young, R. A. (1995, July). Formal toxicity summary for nickel and nickel compounds. Retrieved

April 21, 2014, from The Risk Assessment Information System:

http://rais.ornl.gov/tox/profiles/nickel_and_nickel_compounds_f_V1.html#t31

Rachael HuntKNH 413

Medical Nutrition Therapy Nutrient – Calcium

36. What is the nutrient?Calcium is the most abundant mineral in the body. Required for vascular contraction and vasodilatation, muscle function, nerve transmission, intracellular signaling, and hormonal secretion. Most of the calcium in our bodies is stored in the bones and teeth here it supports structure and function of bone tissue.

37. What is the RDA/DRI for the nutrient?Life Stage Group Calcium (mg/d)0-12 months 200-2601-3 years 7004-8 years 800Males & Females9-18 years 1,30019-70 years 1,000>70 years 1,200Pregnancy & Lactation14-18 years 1,30019-50 years 1,000

38. How is the nutrient metabolized?There are multiple entities involved in the metabolism of calcium: the hormones parathyroid (PTH), calcitonin (thyrocalcitonin or TCT), 1,25-dihydroxycholecalciferol (1,25-DHCC, a biologically active form of vitamin D3), and the intestine, kidney, liver, thyroid gland, parathyroid gland, and bone. Calcium needs some assistance to cross through cell membranes. While very small amounts of calcium can be absorbed through cellular membranes throughout the small intestine. Calcium absorption is also affected by the degree to which it is soluble and thus usable. Acidic levels of the ingested food, and the presence of substances such as oxalates bind to the calcium, rendering it unusable. Diets high in fat can also impede calcium absorption.


o Cows Milko Yogurto Cheeseo Fortified Orange juiceo Soy Milko Tofuo Sardineso Cabbageo Kaleo Broccolio Spinacho Fortified grains

40. What disease states alter the nutrients metabolism? Hypoparathyroidism Hyperparathyroidism Low vitamin D Cancer Renal Failure GI diseases and surgical treatments


A blood calcium test is ordered to screen for, diagnose, and monitor a range of conditions relating to the bones, heart, nerves, kidneys, and teeth. It measures how much calcium is in the body but not in the bones.

Other test: urine calcium, vitamin d, and parathyroid hormone.


Calcium can decrease absorption of the following drugs when taken together: biphosphonates (to treat osteoporosis), the fluoroquinolone and tetracycline classes of antibiotics, levothyroxine, phenytoin (an anticonvulsant), and tiludronate disodium (to treat Paget's disease).Thiazide-type diuretics can interact with calcium carbonate and vitamin D supplements, increasing the risks of hypercalcemia and hypercalciuria.Both aluminum and magnesium containing antacids increase urinary calcium excretion. Laxatives decrease calcium absorption. Glucocorticoids, such as prednisone, can cause calcium depletion and eventually osteoporosis when they are used for months.

43. How is the nutrient measured? Calcium can be measured through a blood or urine test.

44. What is the Upper Tolerable Limits?Life Stage Group UL Calcium (mg/d)

Males & Females0-6 months 1,0007-12 months 1,5001-8 years 2,5009-18 years 3,0009-50 years 2,500>50 years 2,000Pregnancy & Lactation9-18 years 3,00019-50 years 2,500

10. What are the physical signs of deficiency? Numbness and tingling of fingers Muscle cramps Convulsions Lethargy Poor appetite Abnormal heart rhythms Osteoporosis Bone fractures Rickets

11. What are physical signs of toxicity?Excessively high levels of calcium in the blood known as hypercalcemia can cause:

Renal insufficiency Vascular and soft tissue calcification Hypercalciuria (high levels of calcium in the urine) and kidney stones Constipation

Resources

1. Melissa Kaplan. Calcium metabolism and metabolic bone disease. http://www.anapsid.org/mbd2.html 2002.

2.U.S. Department of Health and Human Services. NIH. Office of Dietary Supplements. Dietary Supplements Fact Sheet. Web. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

3. Munro Peacock. Calcium Metabolism in Health and DiseaseThe American Society of Nephrology. Article. 2010. Web. http://cjasn.asnjournals.org/content/5/Supplement_1/S23.full

Bridgitte CarrollKNH 413Gretchen Matuszak 24 April 2014

Pantothenic Acid

http://cjasn.asnjournals.org/content/5/Supplement_1/S23.full

http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

http://www.anapsid.org/mbd2.html

Pantothenic acid, also known as vitamin B5, is one of 8 B complex vitamins that are critical in the conversion of carbohydrates into glucose and producing energy. They also are critical in fat and protein utilization. Additionally, pantothenic acid is needed for the manufacture of red blood cells, sex and stress-related hormones. It also helps maintain a healthy digestive tract and synthesizes cholesterol. It can help the body use other vitamins like vitamin B2 and riboflavin. The small intestine is the major site of vitamin absorption and specifically this vitamin. It is absorbed via blood capillaries and lymph fluids through the processes of active transport, diffusion and osmosis.

Pantothenic acid is in many things, making deficiency rare. However, if it does occur, symptoms include fatigue, insomnia, depression, irritability, vomiting, stomach pains, burning feet, and upper respiratory infections. The best sources include brewer's yeast, corn, cauliflower, kale, broccoli, tomatoes, avocado, legumes, egg yolks, organ meats and poultry. It can also be found in B complex supplements and a multivitamin. The RDA for adults is 5 mg and is decreased in children and increased in pregnant and breastfeeding women. Up to 10 mg have been recommended via supplementation and toxicity is usually not a problem, however, a very high dose (amount not specified) can cause diarrhea and may increase the risk of bleeding.

Like the other B complex vitamins, it interferes with the effectiveness and absorption antibiotic tetracycline. It also interacts with cholinesterase inhibitors that are used to treat Alzheimer’s disease. Pantothenic acid may also reduce the absorption of thiamin and produce deficiency symptoms. A blood test can check the nutrient levels in the body and a value of 10 to 36 mg/dL is considered normal.

References

Ehrlich, S.D. (2012). Vitamin B5: Pantothenic acid. University of Maryland Medical Center. Retrieved from: http://umm.edu/health/medical/altmed/supplement/vitamin-b5-pantothenic-acid#ixzz2zlL7PgFJ.

Nelms, M., Sucher, K. P., Lacey, K., & Long Roth, S. (2011). Nutrition therapy & pathophysiology. (2nd ed. ed.). Belmont, CA: Wadsworth, Cengage Learning.

Julia KaesbergPhosphorus


a. Phosphorus is the sixth most abundant element in the body and the second most mineral

behind calcium. Approximately 85% of phosphorus in the body is found in bone. It is

almost exclusively found in the form of PO4- (Medeiros, 313).


http://umm.edu/health/medical/altmed/supplement/vitamin-b5-pantothenic-acid#ixzz2zlL7PgFJ

http://umm.edu/health/medical/altmed/supplement/vitamin-b5-pantothenic-acid#ixzz2zlL7PgFJ

Infants 0-6 months 100 mg/d

Infants 7-12 months 275 mg/d

Children 1-3 years 460 mg/d

Children 4-8 years 500 mg/d

Males 9- 18 years 1,250 mg/d

Males >18 years 700 mg/d

Females 9- 18 years 1,250 mg/d

Females >18 years 700 mg/d

Pregnancy <18 years 1,250 mg/d

Pregnancy >18 years 700 mg/d

Lactation <18 years 1,250 mg/d

Lactation >18 years 700 mg/d

(Medeiros).


a. Most phosphorus is absorbed in the inorganic form and therefore must be liberated by

digestive enzymes. Phosphorus absorption takes place throughout the small intestine

and about 50-70% is absorbed. There are two mechanisms that are involved in

phosphorus absorption. The first is a carrier- mediated process and the second is a

diffusion system that is linear (Medeiros, 314).

4. What are the food sources of the nutrient?

a. The foods with the highest content of phosphorus are meat, poultry, eggs, fish, milk and

milk products, cereals, legume, grains and chocolate. Soft drinks also contain

phosphorus in the form of phosphoric acid as well as coffee and tea. Phosphorus can

also be in foods in the form of phospholipids, phosphoproteins and phosphorylated

sugars (Medeiros, 313).


a. While there are no disease states that directly decrease the absorption of phosphorus, the

medications used to treat disease states such as diabetes or hypertension may cause

interactions. However, individuals with an abnormally high intake of fructose in their

diet may have an increased loss of phosphorus from their urine. Abnormally low

intakes of calcium or Vitamin D can also cause a decrease in phosphorus absorption

because their mechanisms and serum levels are interrelated (Higdon, 2003).


a. Phosphorus levels are tested through serum phosphorus levels. About 70% of the

phosphorus in the blood circulates as phospholipids and the other 30% is dissolved as

inorganic phosphates. The range for inorganic phosphate levels in the blood is about

2.5-4.5 mg per 100 ml. A large portion of dietary phosphorus is absorbed and as much

of 2/3 of dietary phosphorus is excreted in urine (Medeiros, 314).

7. What are the drug- nutrient interactions?

a. Aluminum- containing antacids reduce the absorption of phosphorus by forming

aluminum phosphate, which they body cannot absorb, as well as increased urinary

calcium loss. High doses of caclitrol (Vitamin D) may result in hyperphosphatremia.

Taking potassium supplements in conjunction with phosphate may result in increased

levels of potassium in the blood, which can create life threatening heart rhythm

abnormalities (Higdon, 2003).


a. The nutrient is measured through serum phosphorus levels and the range for inorganic

phosphate levels in the blood are usually 2.5-4.5 mg per 100 ml (Medeiros, 314).

9. What are the Upper Tolerable Limits?

a. There is no data on Upper Tolerable limits for infants. For children ages 1-8, the Upper

Tolerable limit is 3 grams per day. For males and females ages 9- 70, it is 4 grams per

day but only 3 grams per day for males and females over 70. For pregnancy, the Upper

Tolerable limit is 3.5 grams per day and for lactation it is 4 grams per day (Medeiros).

10. What are the physical signs of deficiency?

a. Inadequate phosphorus intake can result in hypophosphatremia which can cause loss of

appetite, anemia, muscle weakness, bone pain, rickets (in children), osteomalacia (in

adults), increased susceptibility to infection, numbness and tingling in extremities, and

difficulty walking (Higdon, 2003). If the hypophoshatremia is severe enough, it can

result in death. However, because there are many sources of phosphorus in the average

person’s diet, a deficiency is rarely seen in cases other than starvation (Higdon, 2003).

11. What are the physical signs of toxicity?

a. The most serious effect of hyperphosphatremia is the calcification of non- skeletal

tissues, usually the kidneys. This can lead to organ damage and kidney failure of

hypoparathyrodism (Higdon, 2003).

Resources

Higdon, J. (2003, April ). Phosphorus. Retrieved from

http://lpi.oregonstate.edu/infocenter/minerals/phosphorus/

Medeiros, D. (2012). Advanced human nutrition. (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

Emily RohanKNH 413 – MNT II

April 22, 2014Nutrient Data: Potassium

1. What is the nutrient?Potassium, plays many roles in order for the body to function properly. It plays a role in nerve and muscle communication, removing waste products from cells, regulating fluids and mineral balance, and balancing sodium levels. It may also reduce risk of recurrent kidney stones and possibly bone loss as we get older. Increased levels of sodium have a negative effect on blood pressure and diets high in potassium help keep blood pressure levels lower.

Infants0-0.5

Infants0.5-1

Children1-3

Children4-8

Children9-13

Boys14-70

Girls14-70

Pregnancy Lact-ation

Potassium(mg/day)

400 700 3000 3800 4500 4700 4700 4700 5100

2. What is the RDA/DRI for nutrient?

3. How is the nutrient metabolized?Potassium is well absorbed from the small intestine, with about 90 percent absorption, but is one of the most soluble minerals, so it is easily lost in cooking and processing foods. Most excess potassium is eliminated in the urine; some is eliminated in the sweat. The kidneys are the chief regulators of our body potassium, keeping the blood levels steady even with wide variation in intake. The adrenal hormone aldosterone stimulates elimination of potassium by the kidneys.

4. What are food sources of the nutrient? Leafy green vegetables including spinach and collards Vine fruits like grapes and blackberries Root vegetables like carrots and potatoes Citrus fruits like oranges and grapefruit Peaches Pears Squash Bananas Broccoli Beans and Nuts Meats and Fish Yogurt Milk

Tomatoes Cantaloupe Whole grains Coffee Tea

Nutrition Therapy and Pathophysiology

5. What disease states alter the nutrients metabolism?Kidney disease can cause hyperkalemia (increased potassium in the blood). Several drugs are also known to decrease potassium excretion and cause hyperkalemia. Hypokalemia (decreased potassium in the blood can be caused by vomiting, diarrhea, and excessive sweating. Diuretics can also increase the excretion of potassium in the body. On rare occasions hypokalemia can be caused by lack of potassium intake. Alcoholic liver disease is also related to hypokalemia.Kidneyatlas.org

6. What are the tests or procedures to assess the nutrient level in the body?A potassium test can be ordered to assess the amount of potassium in the body. Increased potassium levels in the blood can indicate kidney failure, diabetes, infection, dehydration, and injury. Decreased potassium can be the result of GI disorders, hyperaldosteronism, low potassium intake, diabetes, and the use of diuretics.Labtestsonline.org

7. What are the drug-nutrient interactions?The use of diuretics and laxatives can cause more potassium to be excreted. Other medications that can cause interactions include ACE Inhibitors, Heparin, Cyckisporine, Trimethoprimand sulfamethoxazole, and Beta-blockers can cause potassium levels to rise. Corticosteriod Medications, CyclosporineInsulin, Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Thiazine diuretics, Loop diuretics, Antacids, Insulin, Theophylline-containing Medications can cause potassium levels to decrease. If you are taking any of these medications, it is important for your doctor to test your potassium levels to see whether or not you need a supplement since these medications tend to cause potassium levels to rise.

8. How is the nutrient measured?Most commonly potassium is measured in milligrams.

9. What is the Upper Tolerable Limit?There is no established Upper Tolerable Limit for Potassium at the current time.

10.What are the physical signs of deficiency? Abnormal heart rhythms (dysrhythmias), especially in people with heart disease Constipation Fatigue Muscle damage Muscle weakness or spasms Paralysis

Tingling or numbness

A large drop in potassium level may slow your heartbeat. This can cause you to feel lightheaded or faint. A very low potassium level can even cause your heart to stop.

http://www.nlm.nih.gov/medlineplus/ency/article/000479.htm

11.What are the physical signs of toxicity?The two main signs of hyperkalemia or potassium toxicity are muscle weakness and vomiting.

Katie ArlinghausKNH 413; Matuszak

Nutrient Fact SheetApril 24, 2014

Medical Nutrition Therapy Nutrient: Riboflavin


Riboflavin (vitamin B2)


Infants (AI):

0 - 6 months: 0.3* milligrams per day (mg/day)

7 - 12 months: 0.4* mg/day

Children (RDA):

1 - 3 years: 0.5 mg/day



Adolescents and Adults (RDA):

Males age 14 and older: 1.3 mg/day

Females age 14 to 18 years: 1.0 mg/day

Females age 19 and older: 1.1 mg/day


Riboflavin is absorbed in the small intestine and undergoes ATP-dependent phosphorylation

catalyzed by cytosolic flavokinase to form FMN, which is further converted to FAD to enable it

to enter the plasma. In the plasma, free riboflavin is bound to albumin and immunoglobulins

for transport. Riboflavin is important for metabolism in the form of cofactors FMN and FAD.


Riboflavin is found in:

dairy products, milk

eggs

leafy green vegetables

lean meats

legumes

nuts

fortified breads and cereals

*Riboflavin is destroyed by exposure to light. Therefore, it is important to store foods

containing riboflavin in containers that prevent light exposure (not glass).

49. What disease states alter the nutrient’s metabolism?

Riboflavin deficiency interferes with the metabolism of other B vitamins, especially B12, B6,

and folate. Promising research is being done on its role in potentially preventing cardiovascular

diseases, cancers, and impairments in vision.


Riboflavin deficiency can be diagnosed with a test on the red blood cells that measures the

activity of glutathione reductase. A riboflavin derivative is added to the red blood cells. In

normal riboflavin levels, the stimulation from the riboflavin derivative is less than 20%.

Anything higher than 20% is considered to be characteristic of a riboflavin deficiency.


There are no major known drug interactions with riboflavin to be concerned about. Minor

reactions include:

Drying medications might increase the amount of riboflavin that is absorbed

Depression medications might decrease the amount of riboflavin in the body

Phenobarbital may increase the rate that riboflavin is broken down

Probenecid may increase the amount of riboflavin in the body.


Riboflavin is measured in mg.


Riboflavin is a water-soluble vitamin so any excess is excreted through the urine. Therefore, an

Upper Tolerable Limit has not been established.


Deficiency symptoms include:

anemia

mouth or lip sores

skin disorders

sore throat

swelling of mucus membranes


Riboflavin is a water-soluble vitamin so any excess is excreted through the urine. There is no

known toxicity of riboflavin. Urine may be yellow with excess riboflavin consumption.

Resources:

Powers, Hilary. "The American Journal of Clinical Nutrition." Riboflavin (vitamin B-2) and health.

N.p., n.d. Web. 14 Apr. 2014. <http://ajcn.nutrition.org/content/77/6/1352.full>.

"Riboflavin (Vitamin B2) Effectiveness, Safety, and Drug Interactions on RxList." RxList. N.p., n.d.

Web. 14 Apr. 2014. <http://www.rxlist.com/riboflavin_vitamin_b2/supplements.htm>.

"Riboflavin: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National

Library of Medicine, n.d. Web. 13 Apr. 2014.

<http://www.nlm.nih.gov/medlineplus/ency/article/002411.htm>.

1. What is the nutrient?Selenium.

2. What is the RDA/DRI for the nutrient?Recommended Dietary Allowances (RDAs) for Selenium

Age Male Female Pregnancy Lactation

Birth to 6 months 15 mcg* 15 mcg*

7–12 months 20 mcg* 20 mcg*

1–3 years 20 mcg 20 mcg



14–18 years 55 mcg 55 mcg 60 mcg 70 mcg


51+ years 55 mcg 55 mcg

3. How is the nutrient metabolized?Absorption of selenium occurs in the duodenum and jejunum of the small intestine and occurs more

readily in conditions of deficiency. Excess selenium is excreted via urine. In the body, selenium is

stored as selenomethionine, and selenocysteine is the active form. Selenium is transported bound to

albumin and then later to α2-globulin.

4. What are food sources of the nutrient? Foods Rich in Selenium

Food Cals DRI/DV

Tuna (4oz) 147 223%

Shrimp (4oz) 135 102%

Sardines (4oz) 189 86.9%

Salmon (4oz) 158 78.3%

Turkey (4oz) 167 62.2%

Cod (4oz) 96 57.7%

Chicken (4oz) 187 56.9%

Lamb (4oz) 350 50.7%

Scallops (4oz) 126 44.7%

Beef (4oz) 133 43.5%

5. What disease states alter the nutrients metabolism?Crohn’s disease, Celiac disease, and other GI tract conditions, as well as the resection or surgical

removal of parts of the GI tract can impair the absorption of Selenium.

6. What are the tests or procedures to assess the nutrient level in the

body?Measure selenium or glutathione peroxidase amounts in serum, platelets, or erythrocytes or in whole

blood. Urine samples and toenail clippings may also aid in selenium level assessment.

7. What is the drug –nutrient interactions?Using dimercaprol together with selenium can cause injury to the kidneys. Selenium may slow blood

clotting. Taking selenium along with anticoagulant medications might increase the chances of bruising

and bleeding. Taking selenium, beta-carotene, vitamin C, and vitamin E together might decrease the

effectiveness of some medications used for lowering cholesterol.

8. How is the nutrient measured?The most commonly used measures of selenium status are plasma and serum selenium concentrations.

Concentrations in blood and urine reflect recent selenium intake. Analyses of hair or nail selenium

content can be used to monitor longer-term intakes over months or years.

9. What is the Upper Tolerable Limits? Tolerable Upper Intake Levels (ULs) for Selenium

Age Male Female Pregnancy Lactation

Birth to 6 months 45 mcg 45 mcg

7–12 months 60 mcg 60 mcg





19+ years 400 mcg 400 mcg 400 mcg 400 mcg

10. What are the physical signs of deficiency?

Keshan disease, congestive cardiomyopathy caused by a combination of dietary deficiency of selenium

and the presence of a mutated strain of Coxsackievirus.

11. What are physical signs of toxicity?Acute selenium toxicity can cause severe gastrointestinal and neurological symptoms, acute respiratory

distress syndrome, myocardial infarction, hair loss, muscle tenderness, tremors, lightheadedness, facial

flushing, kidney failure, cardiac failure, and, in rare cases, death.

Works Cited

Draper, Richard. "Selenium | Doctor | Patient.co.uk." Patient.co.uk. N.p., n.d. Web. 23 Apr.

2014. <http://www.patient.co.uk/doctor/Selenium.htm>.

"Selenium." The World's Healthiest Foods. N.p., n.d. Web. 20 Apr. 2014.

<http://www.whfoods.com/genpage.php?

dbid=95&tname=nutrient#deficiencysymptoms>.

"Selenium." Dietary Supplement Fact Sheet: â€” Health Professional Fact Sheet. N.p., n.d.

Web. 23 Apr. 2014. <http://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/>.

"Selenium Effectiveness, Safety, and Drug Interactions on RxList." RxList. N.p., n.d. Web. 23

Apr. 2014. <http://www.rxlist.com/selenium-page3/supplements.htm#Interactions>.

Haley RobertsonKNH 413- Spring


54.What is the nutrient?

a. Sodium (salt)

55.What is the RDA/DRI for the nutrient?

a. The Adequate Intake level for healthy adults is 1,500 mg/day of sodium in the diet. The Upper Limit (UL) of Sodium is 2,300 mg/day of sodium in the diet. This is the highest amount that can be taken without posing a threat to the health of adults.

56.How is the nutrient metabolized?

a. Sodium is absorbed in the intestine by…i. It is freely permeable across the interstitial cell

http://www.rxlist.com/selenium-page3/supplements.htm#Interactions

http://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/

http://www.whfoods.com/genpage.php?dbid=95&tname=nutrient#deficiencysymptoms

http://www.whfoods.com/genpage.php?dbid=95&tname=nutrient#deficiencysymptoms

http://www.patient.co.uk/doctor/Selenium.htm

ii. The most prominent method is by co-transport with glucose and amino acids. (the absorption of sodium depends on the absorption of glucose and amino acids)

b. Once absorbed it leaves the cell through the sodium pumps i. Depending on how much sodium is taken in will depend on how much is

pumped out 1. When a lot is absorbed a lot is pumped out, creating high

osmolarity in the intercellular spaces c. The sodium is later diffused into the blood in the capillaries d. It is excreted in order to determine sodium balance

i. It is then reabsorbed in 3 main regions of the nephron ii. Also in the cortical and medullary collecting ducts

e. Excretion is regulated by i. Aldosterone

ii. Circulating numbers of ANP iii. Amount of AT-II and PGE2 levels in the kidneyiv. Tubular secretion regulated by secretion of K+ H+

57.What are food sources of the nutrient? Sodium Chloride is the most common form of sodium and is also known as “table

salt” Sodium is something that occurs naturally in a lot of foods including

o Milko Beatso Celery o Water (depending on the source)

There are also added forms of sodium such as monosodium glutamate, sodium nitrite, sodium saccharin, sodium bicarbonate, and sodium benzoate

o These are added in sauces and processed foods such as canned foods Processes meats also contain sodium

o Bacono Sausageo Ham o Salami

Fast food

58.What disease states alter the nutrients metabolism? People who are “salt sensitive” have a greater reaction in blood

pressure as a result of sodium consumption than the average person. Most people who are “salt sensitive” include the aging population, African Americans, already have high blood pressure, diabetics, or have chronic kidney disease.

59.What are the tests or procedures to assess the nutrient level in the body?

a. Venipuncturei. Blood is taken from the vein to test for serum sodium levels

ii. Normal range for Sodium is 135-145 mEq/L


a. These drugs have been associated with the increased risk of low blood concentrations of sodium

i. Diureticsii. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

iii. Opiate derivativesiv. Phenothiazinesv. Serotonin-Reuptake Inbihibitors (SSRIs)

vi. Tricyclic Antidepressants


a. The nutrient is typical measured in milligrams, but can sometimes be listed in grams.

62.What is the Upper Tolerable Limits?

Upper Tolerable Limits


Patients complain of…o Lack of energyo Fatigueo Drowsinesso Lack of concentrationo Pale faceo Sharp wrinkleso Deep eyes, sunken in orbitso Absent-minded looko Irregular tongue borderso Low blood pressure o High daytime urinationo Salty food cravingso Nauseous o Thirstyo Drinking water and other liquids all the time


Toxicity can also lead to excess extracellular fluid volume because water is pulled into the cells to keep normal concentrations of sodium.

Excess amounts of sodium can lead to o Nauseao Vomitingo Diarrheao Abdominal cramps

High concentrations of sodium are often a result of excess fluid loss through sweat or physical activity or lack of water intake in general

o This can often cause Dizziness or fainting Low blood pressure Diminished urine production

Some of the more serious side effects of high concentrations of sodium include

o Edemao Rapid heart rateo Difficulty breathingo Convulsionso Comao Death

Resources

Americans consume too much sodium (salt) . (2011, February 24). Center for Diseases Control and Prevention . Retrieved , from http://www.cdc.gov/features/dssodium/

Bowen, R. (1995, October 22). Absorption of water and electrolytes. The Small Intestine: Introduction and Index . Retrieved , from http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/absorb_water.html

David, Z. (2014, February 26). Sodium in diet. Medline Plus. Retrieved , from http://www.nlm.nih.gov/medlineplus/ency/article/002415.htm

Hertoghe, T. (2014, January 1). Sodium deficiency complaints and signs . Hertoghe Consultation. Retrieved , from http://www.hertoghe.eu/patients/index.php?option=com_content&view=article&id=123:sodium-deficiency-complaints-and-signs&catid=38&Itemid=162&lang=en

Higdon, J., Drake, V., & Obarzanek, E. (2008, November 1). Micronutrient information center: Sodium (chloride) . Oregon State University Linus Pauling Institute . Retrieved , from http://lpi.oregonstate.edu/infocenter/minerals/sodium/

Verma, S. (2013, March 19). Electrolyte balance and sodium metabolism. SlideShare. Retrieved , from http://www.slideshare.net/medicinedoctorinchd/sodium-metabolism

Jessica Anderson KNH 413

4/24/14Medical Nutrition Therapy Nutrient


-Thiamin is a vitamin, also known as vitamin B1, which helps the body’s cell change carbohydrates into energy (carbohydrate metabolism). Thiamin is involved in many other body functions, including the nervous system and muscle function, the flow of electrolytes in and out of the nerve and muscle cells, as well as digestion (Thiamine 2013; Thiamin 2014).


-Thiamin is likely to be safe when taken by mouth daily in amounts considered to be RDA: in adults 19 and older, 1.2mg for males and 1.1mg for females; and in pregnant or breastfeeding women of any age, 1.4mg. In adults, thiamin is likely safe to supplement when taken by mouth daily in doses of 1-2mg. In those with a thiamin deficiency, such doses may be as high as 50mg per day. For children, the following doses of thiamin are likely safe when taken by mouth daily: 0.2mg in infants 0-6 months old; 0.3mg in infants 7-12 months old; 0.5mg in children 1-3 years old; 0.6mg in children 4-8 years old; 0.9mg

http://www.slideshare.net/medicinedoctorinchd/sodium-metabolism

http://lpi.oregonstate.edu/infocenter/minerals/sodium/

http://www.hertoghe.eu/patients/index.php?option=com_content&view=article&id=123:sodium-deficiency-complaints-and-signs&catid=38&Itemid=162&lang=en



http://www.nlm.nih.gov/medlineplus/ency/article/002415.htm

http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/absorb_water.html

http://www.cdc.gov/features/dssodium/

in children 9-13 years old; 1.2mg in males 14-18 years old; and 1.0mg in females 14-18 years old.

-Additionally, the following doses of thiamin are considered to be possibly safe: 50-100mg taken by mouth daily for 3-6 months; 50-100mg injected into vein 3-4 times daily; and 5-200mg injected into the muscle in five divided doses over two days (Thiamine 2013).

-Eating a well-balanced diet that contains a wide variety of foods is the best way to get the daily requirement of essential vitamins (Thiamin 2014).


-Thiamin helps to maintain a normal metabolism and helps burn carbohydrates. Thiamin, in the form of thiamin pyrophosphate, plays an essential role as a cofactor in key reactions within carbohydrate metabolism. Additionally, this vitamin is involved in the metabolism of branch-chained amino acids and may have non-coenzyme roles in excitable cells. Vitamin B1 is needed to process carbohydrates, fat, and protein. Every cell of the body requires this vitamin to form the fuel that the body runs on – ATP. Nerve cells require thiamin in order to function normally. Additionally, thiamin assists in blood formation, carbohydrate metabolism and the production of HCl – important for proper digestion. Thiamin is also responsible for enhancing appetite, learning capacity, and is needed for muscle tone of the intestines, stomach and heart. In humans, thiamin can be synthesized within the large intestines as thiamin pyrophosphate (TPP), while the main circulating form of thiamin within the red blood cells is thiamin diphosphate (TDP). TDP is a cofactor for several enzymes – pyruvate dehydrogenase and transketolase as well as thiamin triposphate – thought to be important in nerve conduction (Vitamin B1).


-Thiamin is found in enriched, fortified, and whole grain products including bread, cereals, rice, pasta, and flour. Beef liver and pork, dried milk, eggs, legumes and peas, as well as nuts and seeds, are additional sources of thiamin. Dairy products, fruits and vegetables are not very high in thiamin, but when eaten in large amounts, they become a significant source (Thiamin 2014).


-Thiamin is one of the B vitamins that play an important role in energy metabolism and tissue building. When there is not enough thiamin in the diet, basic energy functions are disturbed, leading to problems throughout the body.

-Specific situations can increase the body’s thiamine requirements and lead to symptoms of deficiency such as over-active metabolism, prolonged fever pregnancy, and breastfeeding. Extended periods of diarrhea or chronic liver disease can result in the body’s inability to maintain normal levels of many nutrients, including thiamin. Other

populations at risk of thiamin deficiency include patients with kidney failure on dialysis and those with chronic digestive problems who are unable to absorb nutrients. Alcoholics are susceptible to thiamin deficiency due to frequent substitution of alcohol for food. Excessive intake of alcohol decreases the body’s ability to absorb thiamin (Beriberi). Severe deficiency can result in congestive heart failure (wet beriberi), peripheral neuropathy (dry beriberi), Wernicke encephalopathy (medical emergency that can progress to coma and death), and Korsakoff syndrome (irreversible memory loss and dementia that can follow) (Test ID: TDP).

-A lack or deficiency of thiamin can result in weakness, fatigue, psychosis, and nerve damage. In the US, thiamin deficiency is most often seen in people who abuse alcohol (alcoholism). Excess alcohol makes it more difficult for the body to absorb thiamin from foods. Unless those with alcoholism are receiving higher-than-normal amounts of thiamin to make up for the difference, the body will not be able to absorb enough for its needs. Thus, this can lead to a disease called beriberi (Thiamin 2014). The gastrointestinal system, nervous system, cardiovascular system, as well as the musculoskeletal system, are most affected in those with beriberi (Beriberi).


-In assessing thiamin status, whole blood thiamin testing is superior. Serum or plasma thiamin testing has poor sensitivity and specificity, and <10% of blood thiamin is contained in plasma. Transketolase determination, once considered the most reliable method of assessing thiamin status, is now considered inadequate. Because transketolase activity requires thiamin, decreased activity is presumed to be due to the decreased thiamin. This test has been considered inadequate, since the test is somewhat nonspecific, as other factors may decrease transketolase activity, is less sensitive than HPLC, has poor precision, and specimen stability concerns.

-Thiamin diphosphate is the active form of thiamin and most appropriately measured in assessing thiamin status. Thiamin disphosphate is present within the circulating blood of animal cells (erythrocytes), but is unable to be detected in the plasma or serum due to very low levels. HPLC analysis of thiamin diphsophate in whole blood or erythrocytes is the most sensitive, specific, and precise method of determining the nutritional status of thiamin and is a reliable indicator of total body stores. This test specifically targets and shows how much vitamin B1 is present; thus, being a reliable indicator of vitamin B1 status (Test ID: TDP).


-Thiamin is known to cause low blood pressure; thus, in patients who are taking drugs to lower blood pressure, the intake of thiamin should be done with caution. Caution is advised when using medications that lower blood sugar, such that those who take drugs for diabetes by mouth or insulin should be monitored closely. Additionally, thiamin may

interact with agents that affect the immune system, agents that enhance athletic performance, agents that promote urination, agents that treat HIV, agents that widen blood vessels, agents used for heart disorders, alcohol, Alzheimer’s agents, antacids, antibiotics, anticancer agents, barbiturates, birth control taken by mouth, dextrose, dichloroacetate, flumazenil, heart rate-regulating agents, ifosfamide, metformin, naloxone, nervous system agents, neuromuscular blocking agents, pain relievers, phenytoin, thyroid, hormone, tobacco, and weight loss agents (Thiamine 2013).

-In regards to nutrient interactions, caution is advised when using herbs and supplements to lower blood sugar and blood pressure. Thiamine may interact with Alzheimer’s herbs and supplements, antacids, antibacterials, anticancer herbs and supplements, benfotiamine, betel nuts, birth control taken by mouth, heart rate-regulating herbs and supplements, herbs and supplements that affect the immune system, herbs and supplements that enhance athletic performance, herbs and supplements that promote urination, herbs and supplements that widen blood vessels, herbs and supplements used for heart disorders, horsetail, nervous system herbs and supplements, neuromuscular herbs and supplements, pain relievers, polyphenols, sedatives, thyroid herbs and supplements, tobacco, vitamins, and weight loss herbs and supplements (Thiamine 2013).


-The most widely used test of thiamin status is measurement of the activity of the dependent enzyme transketolase in red blood cells and its increase when additional thiamin is added. With these two measurements, an activation coefficient can be obtained – showing the normal range for erythrocyte transketolase activity (<1.25). Other tests of thiamine include red cell thiamin pyrophosphate, RBCTPP and the normal range is 165-286nmol/l (Acute Thiamine Deficiency).

-Such tests listed above may not identify all of those with or at risk of deficiency; thus, in an emergency, thiamin may be administered based on a clinician’s judgment. Additionally, the National Diet and Nutrient Surveys assessed thiamin status by measurement of both intake as well as red cell transketolase activation coefficient. Inadequate intake is classified as below the Lower Reference Nutrient Intake - <1.25, and biochemical deficiency is considered to be a transketolase activation coefficient greater than 1.25 (Acute Thiamine Deficiency).


-The upper tolerable limit of thiamin is unknown. According to the DRIs for upper intake levels of thiamin, such values cannot be determined due to lack of adverse effects in all age groups and populations and concerns with regard to lack of ability to handle excess amounts. It is recommended for most, unless directed by a physician, to consume thiamin primarily from food sources in order to prevent high levels of intake (Mitchell, M. K., 2008).


-Signs and symptoms of mild-to-moderate thiamin deficiency are nonspecific and may include poor sleep, malaise, weight loss and confusion (Test ID: TDP). Additionally, there are two major types of thiamin deficiency: wet beriberi - affecting the cardiovascular system, and dry beriberi and Wernike-Korsakoff syndrome – affecting the nervous system (Beriberi 2014). The physical signs of each thiamin deficiency are further explained below:

-Physical signs associated with wet beriberi include, awakening at night with shortness of breath, increased heart rate, shortness of breath with activity, and swelling of the lower legs (Beriberi 2014).

-Physical signs associated with dry beriberi include, difficulty walking, loss of feeling in hands and feet, loss of muscle function or paralysis of the lower legs, mental confusion/speech difficulties pain, strange eye movements (nystagmus), tingling, as well as vomiting (Beriberi 2014).


-Thiamin is a water-soluble vitamin; therefore, it is least likely to reach toxic levels. There is little danger of thiamin when taken by mouth; although, when taken intravenously, it has been reported to cause anaphylactic shock in some. Symptoms of thiamin overdose may include a feeling of warmth, weakness, sweating, nausea, restlessness, difficulty breathing, tightness of throat, blush colored skin, and death (Vitamin B1).

Works Cited

Acute Thiamin Deficiency. (n.d.). Retrieved April 23, 2014, from stewartnutrition.co.uk website: http://www.stewartnutrition.co.uk/nutritional_emergencies/acute_thiamine_defici

ency.html

Beriberi. (2014, February 26). Retrieved April 23, 2014, from Medline Plus website: http://www.nlm.nih.gov/medlineplus/ency/article/000339.htm

Beriberi. (n.d.). Retrieved April 23, 2014, from The Free Medical Dictionary website: http://medical-dictionary.thefreedictionary.com/Thiamine+deficiency

Mitchell, M. K. (2008). Nutrition across the Lifespan (2nd ed.). Long Grove, IL: Waveland Press, Inc.

Test ID: TDP. (n.d.). Retrieved April 23, 2014, from Mayo Clinic Mayo Medical Laboratories website: http://www.mayomedicallaboratories.com/test- catalog/Clinical+and+Interpretive/85753

Thiamin. (2014, February 26). Retrieved April 23, 2014, from Medline Plus website: http://www.nlm.nih.gov/medlineplus/ency/article/002401.htm

Thiamine. (2013, November 1). Retrieved April 23, 2014, from Mayo Clinic website: http://www.mayoclinic.org/drugs-supplements/thiamine/background/hrb- 20060129

Vitamin B1. (n.d.). Retrieved April 23, 2014, from Vitamins & health supplement guide website:

http://www.vitamins-supplements.org/vitamin-B1-thiamine.php

Kelsey Conrad

KNH 413 Spring 2014

Professor Matuszak

April 15, 2014

Medical Nutrition Therapy Nutrient Data: Vitamin D

Vitamin D is a fat-soluble vitamin, which is stored in the body’s fatty tissue (National

Institutes of Health, 2011). It is known to promote calcium absorption in the gut and helps to

http://www.mayoclinic.org/drugs-supplements/thiamine/background/hrb-

http://www.mayomedicallaboratories.com/test-%09catalog/Clinical+and+Interpretive/85753

http://www.mayomedicallaboratories.com/test-%09catalog/Clinical+and+Interpretive/85753

http://medical-dictionary.thefreedictionary.com/Thiamine+deficiency

http://www.stewartnutrition.co.uk/nutritional_emergencies/acute_thiamine_defici%09ency.html

http://www.stewartnutrition.co.uk/nutritional_emergencies/acute_thiamine_defici%09ency.html

maintain serum calcium and phosphate concentrations. This is important for bone mineralization

and the prevention of hypocalcemic tetany (National Institutes of Health, 2011). The

Recommended Daily Allowance for vitamin D is 400 IU for males and females age 0 to 12

months, 600 IU for males and females age 1 to 70 years, 600 IU for all pregnant and lactating

females, and 800 IU for males and females over the age of 70 (National Institutes of Health,

2011). The Upper Tolerable Limit for vitamin D is 25 micrograms/d in infants 0 to 6 months

old, 38 micrograms/d in infants 6 to 12 months old, 63 micrograms/d in children 1 to 3 years old,

75 micrograms/d in children 4 to 8 years old, and 100 micrograms/d in all other populations

(Food and Nutrition Board, 2011). This nutrient is typically measured in units of UI or

micrograms (National Institutes of Health, 2011). Vitamin D can be obtained from sunlight,

food, and supplements. The metabolism of vitamin D begins with the entrance of the vitamin

into circulation from the skin or from the lymph via the thoracic duct. It accumulates in the liver

within a few hours and undergoes hydroxylation at the 25th carbon in the mitochondria. After

this, it appears in circulation as 25-hydroxyvitamin D. This form must be hydroxylated in the

kidney on the 1-carbon position in order for it to be biologically active. The production of 1,25

(OH)2D is tightly regulated by the action of PTH in response to serum calcium and phosphorus

levels (United States Department of Agriculture, 2010).

Vitamin D is found naturally in very few foods. The best sources of this vitamin are fatty

fish such as tuna and salmon and fish liver oil. Smaller amount are found in beef liver, egg yolk,

mushrooms, and cheese. Most of the dietary vitamin D comes from fortified foods. Milk,

margarine, ready-to-eat breakfast cereals, orange juice, and yogurt are foods commonly fortified

with vitamin D.

Chronic kidney disease appears to be linked to vitamin D deficiency due to the kidney’s

role in the vitamin’s metabolism (Al-Badr et al., 2008). Similarly, liver disease can lead to low

rates of 25-hydroxyvitamin D synthesis and vitamin D deficiency (Nair, 2010). Both of these

affect the metabolism of the vitamin and can lead to complications such as rickets and

octeomalacia (National Institutes of Health, 2011). Other causes of vitamin D deficiency are low

dietary intake of vitamin D, limited sun exposure, malabsorption problems, and minimal

amounts in human breast milk (National Institutes of Health, 2011).

Some medications interact with vitamin D metabolism, including steroid medications, the weight

loss drug orlistat, the cholesterol lowering drug cholestyramine, the seizure drugs Phenobarbital

and Dilantin, and anti-tuberculosis drugs (DeNoon, 2009). The physical signs of a vitamin D

deficiency related to rickets and octeomalacia are bone weakness bone pain, and muscle

weakness (National Institutes of Health, 2011). The physical signs of vitamin D toxicity are

related to an increased absorption of calcium. They include calcium deposits in soft tissues,

confusion, disorientation, kidney stones, nausea, vomiting, constipation, poor appetite, weakness,

and weight loss (National Institutes of Health, 2011). Toxicity, however, does not occur from too

much sun exposure and is very unlikely to happen with normal food consumption. It is most

likely to occur with high intakes of dietary supplements containing vitamin D (National Institutes

of Health, 2011).

To assess the level of vitamin D in the body, a blood test must be performed to measure

the level of serum 25 (OH)D. If these levels are low, it can be concluded that vitamin D levels

are low (National Institutes of Health, 2011).

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