Vitamins, Minerals, Trace Elements, & Herbal Supplements
Objectives• Explain the difference between vitamins, minerals,
trace elements, and supplements.• List the water soluble vitamins.• List the fat soluble vitamins.• List common minerals and trace elements
required for proper cellular functioning.• Explain common drug interactions involving
nutritional supplements.• Identify common diseases or conditions caused to
excess or deficiency of required nutrients.
More Objectives• Explain the function or role of various vitamins,
minerals, electrolytes, and nutritional supplements.
• List the common chemical abbreviations used for the most common trace elements and minerals.
• Demonstrate familiarity with both the common and scientific names for common vitamins and nutrients.
So, what are they?• Vitamins, minerals, trace elements, and many
supplements are required for normal cellular function.
• Can function as cofactors, hormones, growth factors, and much more.
Why Care?Nutritional deficiencies can cause:
• Nonspecific complaints• Abnormal bone function• Neurological damage• Inability to build, repair
tissue• Change in energy level• Intellectual impairment• Muscle wasting
• Obesity• Emaciation• Loss of hair• Delayed healing of
wounds
What’s the Difference?Vitamins & Herbals• Organic• Found in living organisms.• Can sometimes be
synthesized by body.• Required for normal cellular
functioning.
Minerals, Electrolytes, & Trace Elements• Inorganic• Found in living and
nonliving sources.• Can NOT be produced by
the body.• Also required for normal
cellular functioning.
Regulation of Vitamins, Minerals, & Supplements
• The FDA does regulate vitamins and other supplements.
• Vitamins & Minerals must meet standards of purity and potency.
• Nutritional combinations and herbal supplements are regulated as FOOD, they do not have to comply with the same standards of purity and potency.
• READ THE LABEL
Vitamins
Why do we need vitamins?• Vitamins are essential for our body to do what it
needs to and to build and maintain the various structures of our body.
• B12
– Myelin Sheath– Blood cell development
• B6
– Metabolism– Neurotransmitter Development
• And many other functions & vitamins
Vitamins General Facts• Regulated by FDA• Monitored for purity.• RDA (Recommended Daily Allowance)– Average amount needed daily to prevent
deficiencies. • Drug Interactions• Toxicities & Side Effects• Pregnancy
Classification of VitaminsFat Soluble
• A, D, E, and K• Hepatic & Renal Elimination• Stored in the body.• More toxicities than water
soluble.• Intracellular Receptors• Drug interaction:
– Mineral Oil– HMG-CoA Reductase Inh– Laxatives– Lipase Inhibitors
Water Soluble• B vitamins and C• Renal Elimination• Generally fewer toxicities• Not typically stored in the
body.• Extracellular Receptors• Drug interactions with
diuretics.
Fat Soluble Vitamins
A, D, E, & K
Vitamin A• Vitamin A—beta-carotene or retinol• Four functions:– Visual pigment for rods in retina of eye– Protects against cancer in skin, respiratory and
digestive tracts, bladder, breast – Stimulates immune system to fight against
infections – Antioxidant; soaks up free radicals.
Vitamin A (cont’d)
• Vitamin A necessary for bone growth, renal function, digestive activity, normal reproductive function.
• Sources: dairy products, liver, fish, yellow and green fruits and vegetables.
Hypervitaminosis A• Symptoms: headache, vomiting, skin peeling,
loss of appetite, irritability, wasting away of bone mass
• Fatal cases: destruction of the liver• Birth defects: mother ingests large amounts of
Vitamin A during first 3 months of pregnancy
Vitamin D• Two precursors:– Cholecalciferol (D3): produced by skin in UV light – Ergocalciferol (D2): result of UV radiation on yeast
ergosterol found in bread and milk
• Calciferol converts to calcitriol in kidney
Vitamin D (cont’d)
• Calcitriol—increases phosphorus absorption and calcium intake
• Sources—dairy food:– Milk, eggs, cheeses (ergocalciferol)
• Deficiency: rickets, osteomalacia, osteoporosis
Hypervitaminosis D• May cause hypercalcemia.• Toxic effects include: calcium deposits,
convulsions, even death.• Drug interactionsm include: digitalis, thiazide
diuretics, mineral oil.
Vitamin E• Essential for normal metabolism and
protection of skin, eyes, tissues, muscles• Protects red blood cells from damage• Sources—whole grains: – Wheat, rice, nuts, corn, vegetables, dairy products
Vitamin E (cont’d)
• Deficiency: anemia, cardiovascular disease• Hypervitaminosis E: cases have not been
documented in literature• Drug interactions: mineral oil
Vitamin K• Phytonadione• Forms blood coagulation factors• Sources:– Wheat, legumes, egg yolks, milk, broccoli, spinach– Produced by certain intestinal bacteria
• Deficiency—increased tendency to bleed
Water Soluble Vitamins
Vitamins B & C
Vitamin B• Sources:– Vitamin B is in peas, beans, red meats, flour,
yeasts.• Deficiencies can go unnoticed for years.• Vitamin B enables cellular functioning of body
system.
B Vitamins—Sources, Function, and Deficiency States
Vitamin Chemical Name Food Sources Function DeficiencyB1 ThiamineGrains, cereals, Metabolism Beriberi
beans, pork, (wet and/or and liver dry forms)
B2 Riboflavin Cereals, eggs, Maintains Discolored dark green mucous tongue and
vegetables, membranes, dry scaling milk, liver metabolic and fissuring energy of
the lipspathways
B3 Nicotinic Nuts, beans, Fat synthesis, Diarrhea, acid pea, wheat, protein dementia, rice, grainsmetabolism depression, and electron skin
transport discolorationB5 Pantothenic Vegetables, Coenzyme Fatigue, acid
cereals, headaches,yeast, liver nausea,
muscle spasms
B Vitamins—Sources, Function and Deficiency States (cont’d)
Vitamin Chemical Name Food Sources Function DeficiencyB6 Pyridoxine Meat, liver, Amino acid Skin
chicken, and fatty acid disorders,salmon, trout, metabolism depression,
beans, rice, nausea,whole grains impaired
vision and nerve functionB9 Folic acidGreen Production Nerve vegetables of red blood damage
and liver cellsB12 Cyanocobalamin Meats, liver, Formation of Pernicious
chicken, red blood anemia,dairy products cells megaloblastic
anemia
Vitamin B1
• Thiamine important for:– Maintenance of body system– Carbohydrate metabolism– Well-being of nervous and cardiovascular system
• Deficiency: beriberi, anorexia, constipation, nausea, mental confusion, depression
Vitamin B2
• Riboflavin important for:– Metabolism of carbohydrates– Proper growth and maintenance of the body
Vitamin B2 (cont’d)
• Deficiency: anemia; depression; tongue, mouth, eyes, skin may dry out; headaches; burning sensations in skin; cracking in corners of mouth; seborrheic dermatitis
Vitamin B3
• Nicotinic acid (niacin)• Used in tissue respiration and metabolism• Reduces low-density lipoproteins (LDLs)• Releases histamine and causes vasodilation• Necessary for lipid metabolism, proper nerve
functioning, maintenance of cells
Vitamin B3 (cont’d)
• Deficiency: pellagra• Symptoms:– Diarrhea, weakness, lethargy, dermatitis,
dementia, sores in mouth, GI problems
Vitamin B5
• Pantothenic acid• Affects body metabolism.• Used to synthesize fatty acids, steroid
hormones, molecules for carbohydrate and protein processes.
• Produced by bacteria in GI tract of animals.• Deficiency causes headache, sleep
disturbances, muscle cramps, fatigue.
Vitamin B6
• Pyridoxine• For metabolism of carbohydrates, proteins,
fats in diet• Absorption of B12, production of amino acids• Deficiency: skin problems, stomatitis, seizures;
causes dwarfism, blindness, dementia, depression, osteoporosis
Vitamin B6 (cont’d)
• Agents that may cause pyridoxine deficiency include penicillamine and isoniazid.
• Drug interaction:– Levodopa (L-DOPA) for Parkinson’s disease
Vitamin B7
• Biotin• Important for activities of enzymes.• Break down fatty acids and carbohydrates to
convert them into energy.• Sources are beans, egg yolks, liver, nuts, and
cauliflower.
Vitamin B7 (cont’d)
• Deficiency: lethargy, weakness or easily fatigued and hair loss; eczema, swelling of the tongue
Vitamin B9
• Folic acid• Essential for DNA synthesis and creation of
cells with high growth turnover (bone marrow, white blood cells)
• Found in:– Green vegetables, broccoli, avocado, beets,
orange juice, liver
Vitamin B9 (cont’d)
• Deficiency: diarrhea, weight loss, weakness, sore mouth, irritability, behavior disorders
• Drug interactions:– Phenytoin, estrogen, nitrofurantoin
Vitamin B12
• Cyanocobalamin • Obtained from dietary intake• Required for red blood cell and myelin sheath
production, synthesis of nucleic acids• Deficiency: anemia, dementia, depression,
hair loss, poor growth rate in children, loss appetite
Vitamin B12 (cont’d)
• Deficiency:– Red cell anemia seen in pernicious anemia
(megaloblastic anemia)– Red cells abnormally form
Vitamin C• Ascorbic acid• Antioxidant• For formation of connective tissue found in
bones, teeth, gums; aids in healing wounds
Vitamin C• Deficiency:– Scurvy; causes excessive bleeding in skin
and gums; teeth become loose– Decrease in immune system’s ability to produce
T cells• Found in citrus fruits and vegetables
Minerals & Electrolytes
Minerals• Minerals, as opposed to vitamins, are
inorganic molecules found in a variety of substnaces.
• Found in living and nonliving substances.• The body can NOT make minerals and
electrolytes.• Mineral dissolved in water = electrolyte
Calcium• Needed for bone and tooth formation, muscle
contraction and relaxation, blood clotting, nervous system transmission, insulin secretion
• Calcium carbonate (tums) and os-cal good sources• Postmenopausal women need vitamin D for effective
calcium absorption
Phosphorus
• Needed for bone and tooth formation, energy• Helps in storage of fats and metabolism
Zinc• Essential component of DNA and
RNA• Necessary for sexual development,
wound healing, normal taste and smell
Zinc Excess• Side effects: nausea, vomiting, diarrhea,
pulmonary edema, hypotension, tachycardia• Drug interactions: – Penacillamine (binds to metals), treat metal
toxicity– Penacillamine binds to zinc and increases renal
excretion
Iron• Ferrous sulfate, ferrous fumarate, ferrous
gluconate• Transport oxygen in blood• In red blood cells, iron in hemoglobin binds to
oxygen molecule, transports it throughout body (red color)
• Stored in liver
Iron (cont’d)
• Deficiency: anemia• Symptoms: hair loss, shortness of breath,
lethargy, heart palpitations• Toxic effects of overdose: acidosis, liver and
kidney impairment, coma• DDI: Do not mix antacids and iron supplements.• Liquid oral iron supplements can discolor tooth
enamel (use of a straw can help prevent this).• Use of iron supplements can cause constipation.
Magnesium• Helps synthesize proteins, stimulates muscle
contraction and nerve transmission, activates enzymes, aids in bone formation
• Supplements found in combinations with other minerals (calcium)
• Excess Mg can lead to diarrhea.• Slow Mag, MOM, Epsom salts
Common Minerals and Trace Elements (TE), Their Actions, and Deficiencies
Mineral/TE Indication Deficiency OverdosageCalcium Bone formation, Osteoporosis, Kidney stones cell transport, rickets or damage nerve and muscle functionsCopper Iron utilization, Poor bone growth,Jaundice
skin pigmentation, nausea, nervous nervous system system disorders,functionspoor response of
immune systemMagnesium Normal muscle High blood
and heart function; pressure, kidney necessary for and heart problems, vitamin C and mental confusion calcium metabolism
Mineral/TE Indication Deficiency OverdosagePhosphorous Necessary for Muscle weakness,
healthy bones defective boneand teeth; function, arthritis
component ofphospholipids*
Potassium Cellular transport, Muscle weakness, Cardiac normal muscle, lethargy, poor arrhythmias; heart, kidney
and growth, and cardiac cardiac arrest nervous system disturbance functionsIron Hemoglobin/ Anemia, poor GI oxygen transport growth, confusion, disturbance, loss of appetite
black stoolsSelenium Proper immune Heart and bone GI functioning and
disease disturbance, growth liver damage
Common Minerals and Trace Elements (TE), Their Actions, and Deficiencies
(cont’d)
Mineral/TE Indication Deficiency OverdosageManganese Necessary for bone Poor hair growth, None known formation and for nails, andmetabolism of osteoporosis amino acids, lipids,
cholesterolZinc Proper growth and Decreased vitamin D Blurred vision, reproduction; absorption, nausea, decreased helps heal wounds
hair loss, birth consciousness, defects, decreased tachycardia immune response,
decreased sperm count
GI, gastrointestinal*Phospholipids are required for the formation of cell membranes.
Common Minerals and Trace Elements (TE), Their Actions, and Deficiencies
(cont’d)
Other Minerals & Electrolytes
• Fluoride– Protect against dental caries, contribute to bone formation – Present in fluorinated water, tea, seafood– Do not take fluoride drops with milk or dairy products
• Chloride– Serves as buffer, enzyme activator, component of gastric HCl
• Sodium– regulates body fluid and acid-base balance– found in table salt
Herbal Remedies
Origins of Drug Therapy• Historically medical treatment derived from
nature.• First drugs were plant compounds.• Today, many medications are synthesized to
simulate the original plant compound.• Some compounds from plants can not be
synthesized.– Example: Foxglove – digitalis, digoxin
Herbal Medicine• Historical:– Allegorical Evidence
• Not regulated as drugs. • Considered food according to the FDA• Current:– Identifiable chemical compounds– Purity– Drug Interactions, Toxicities– Drug Targets– Synthetic Analogs
Placebo Effect• Placebo: A treatment or dosage form that
simulates the appearance and administration of an active treatment but provides no physiologic effect.
• Placebo Effect: The psychosomatic response from the administration of a placebo du e to the belief by the patient (and/or healthcare providers) that the placebo is a treatment and that a benefit will be observed.
A rose by any other name…….
• One herb many names.• Taxonomy: The science of naming and
classification.• Taxonomic classifications/names usually based
upon Latin.
Home and Folk Remedies• Treatment devised at home without
professional medical advice• Passed down from generation to generation• Questionable therapeutic value
Some Home and Folk Remedies
More Home and Folk Remedies
Federal Regulations of Herbal Products
• Considered dietary supplements; not regulated by FDA
• Always ask patients about their use of herbal supplements
• Instruct patients to purchase herbs from a reputable source
• Inform physician of herbal therapy to avoid drug interactions
Top-Selling Herbs
Leading Uses for Herbal Products
More Uses for Herbal Products
Basics of Herbal Pharmacology
• Herbs are NOT pure compounds.• Allergies
• Drug Interactions– Example:• NSAIDs antagonize the effect of feverfew.
American Herbal Products Association Herb Safety Rating
Potential Herbal Toxic Effects
More Potential Herbal Toxic Effects
Questions?