Nutrition are chemical substances required by the body to sustain basic functions and are optimally obtained by eating a balanced diet. There are six major classes of nutrients essential for human health: carbohydrates, lipids, proteins, vitamins, minerals, and water. Carbohydrates, lipids, and proteins are considered macronutrients and serve as a source of energy. Water is required in large amounts but does not yield energy. Vitamins and minerals are considered micronutrients and play essential roles in metabolism. Vitamins are organic micronutrients classified as either water-soluble or fat-soluble. The essential water-soluble vitamins include vitamins B1, B2, B3, B5, B6, B7, B9, B12, and C. The essential fat-soluble vitamins include vitamins A, E, D, and K. Minerals are inorganic micronutrients. Minerals can classify as macrominerals or microminerals. Macrominerals are required in amounts greater than 100 mg per day and include calcium, phosphorous, magnesium, sodium, potassium, and chloride. Sodium, potassium, and chloride are also electrolytes. Microminerals are those nutrients required in amounts less than 100 mg per day and include iron, copper, zinc, selenium, and iodine. This article will review the following biochemical aspects of the essential nutrients: fundamentals, cellular, molecular, function, testing, and clinical significance.[rx][rx]
Digestive Systems and Nutrition
Animals use the organs of their digestive systems to extract important nutrients from food they consume, which can later be absorbed.
Key Points
Animals obtain lipids, proteins, carbohydrates, essential vitamins, and minerals from the food they consume.
The digestive system is composed of a series of organs, each with a specific, yet related function, that work to extract nutrients from food.
Organs of the digestive system include the mouth, esophagus, stomach, small intestine, and the large intestine.
Accessory organs, such as the liver and pancreas, secrete digestive juices into the gastrointestinal tract to assist with food breakdown.
Key Terms
digestion: the process, in the gastrointestinal tract, by which food is converted into substances that can be utilized by the body
macromolecule: a very large molecule, especially used in reference to large biological polymers (e.g. nucleic acids and proteins)
alimentary canal: the organs of a human or an animal through which food passes; the digestive tract
All living organisms need nutrients to survive. While plants can obtain the molecules required for cellular function through the process of photosynthesis, most animals obtain their nutrients by the consumption of other organisms. At the cellular level, the biological molecules necessary for animal function are amino acids, lipid molecules, nucleotides, and simple sugars. The food consumed consists of protein, fat, and complex carbohydrates, but the requirements of each are different for each animal.
Balanced human diet: For humans, fruits and vegetables are important in maintaining a balanced diet. Both of these are an important source of vitamins and minerals, as well as carbohydrates, which are broken down through digestion for energy.
Animals must convert these macromolecules into the simple molecules required for maintaining cellular functions, such as assembling new molecules, cells, and tissues. The conversion of the food consumed to the nutrients required is a multi-step process involving digestion and absorption. During digestion, food particles are broken down to smaller components which will later be absorbed by the body.
Digestive System
The digestive system is one of the largest organ systems in the human body. It is responsible for processing ingested food and liquids. The cells of the human body all require a wide array of chemicals to support their metabolic activities, from organic nutrients used as fuel to the water that sustains life at the cellular level. The digestive system not only effectively chemically reduces the compounds in food into their fundamental building blocks, but also acts to retain water and excrete undigested materials. The functions of the digestive system can be summarized as follows: ingestion (eat food), digestion (breakdown of food), absorption (extraction of nutrients from the food), and defecation (removal of waste products).
The digestive system consists of a group of organs that form a closed tube-like structure called the gastrointestinal tract (GI tract) or the alimentary canal. For convenience, the GI tract is divided into upper GI tract and lower GI tract. The organs that make up the GI tract include the mouth, the esophagus, the stomach, the small intestine, and the large intestine. There are also several accessory organs that secrete various enzymes into the GI tract. These include the salivary glands, the liver, and the pancreas.
Generalized animal digestive system: This diagram shows a generalized animal digestive system, detailing the different organs and their functions.
Challenges to Human Nutrition
One of the challenges in human nutrition is maintaining a balance between food intake, storage, and energy expenditure. Imbalances can have serious health consequences. For example, eating too much food while not expending much energy leads to obesity, which in turn will increase the risk of developing illnesses such as type-2 diabetes and cardiovascular disease. The recent rise in obesity and related diseases means that understanding the role of diet and nutrition in maintaining good health is more important than ever.
Carbohydrates: Sources, Uses in the Body, and Dietary Requirements
Carbohydrates, which break down to glucose, are a major source of energy for humans but are not essential nutrients.
Key Points
Carbohydrates include such items as fruits, grains, beans, and potatoes, along with sugars and sugared foods.
While fat is a better source of energy, the brain cannot burn fat and instead requires glucose.
Polysaccharides (complex carbs) are difficult for humans to break down but are useful as fiber to enhance the digestive process.
Government agencies recommend a dietary intake of 45–65% or 55–75% of carbohydrates to meet daily energy needs.
Of daily carbohydrate intake, only 10% should be simple carbs or sugars.
Key Terms
glucose: A simple monosaccharide (sugar) with a molecular formula of C6H12O6; it is a principle source of energy for cellular metabolism.
carbohydrate: A sugar, starch, or cellulose that is a food source of energy for an animal or plant; a saccharide.
saccharide: The unit structure of carbohydrates, of general formula CnH2nOn. Either the simple sugars or polymers such as starch and cellulose. The saccharides exist in either a ring or short chain conformation, and typically contain five or six carbon atoms.
EXAMPLES
Daily food intake that includes 8–10 fruit and vegetable servings (not starchy potatoes or grains, such as corn and rice) will not only provide plenty of energy but will also keep glucose levels in balance.
Carbohydrates are a class of macromolecule: Grain products are rich sources of carbohydrates.
Foods high in carbohydrates include fruits, sweets, soft drinks, bread, pasta, beans, potatoes, bran, rice, and cereals. Carbohydrates are a common source of energy in living organisms, however, carbohydrate is not an essential nutrient in humans.
Carbohydrates are not necessary building blocks of other molecules, and the body can obtain all its energy from protein and fats. The brain and neurons generally cannot burn fat for energy but use solely glucose or ketones. Humans can synthesize some glucose (in a set of processes known as “gluconeogenesis”) from specific amino acids or from the glycerol backbone in triglycerides and, in some cases, from fatty acids. Carbohydrates and protein contain 4 kilocalories per gram, while fats contain 9 kilocalories per gram. In the case of protein, this is somewhat misleading as only some amino acids are able to undergo conversion into useful energy forms.
Organisms typically cannot metabolize all types of carbohydrates to yield energy. Glucose is a nearly universal and accessible source of calories. Many organisms also have the ability to metabolize other monosaccharides and disaccharides, though glucose is preferred. Polysaccharides are also common sources of energy. Even though these complex carbohydrates are not very digestible, they may comprise important dietary elements for humans. Called “dietary fiber,” these carbohydrates enhance digestion, among other benefits.
Glucose Molecule: Image of a glucose molecule containing a fixed ratio of carbon, hydrogen and oxygen.
Based on the effects on risk of heart disease and obesity, the Institute of Medicine (IOM) recommends that American and Canadian adults get between 45–65% of dietary energy from carbohydrates. The Food and Agriculture Organization (FAO) and World Health Organization (WHO) jointly recommend that national dietary guidelines set a goal of 55–75% of total energy from carbohydrates, but only 10% directly from sugars (their term for simple carbohydrates).
Lipids: Sources, Uses in the Body, and Dietary Requirements
Fats store energy, facilitate absorption of fat-soluble vitamins, aid brain growth and development, and protect against many diseases.
Key Points
Vitamins A, D, E, and K should be taken with some dietary fat in order to facilitate their absorption and activity.
Humans cannot synthesize omega-6 and omega-3 fatty acids, so these fats must be obtained from the diet.
Omega-6 fatty acids are found in many foods, while omega-3 fatty acids are found in walnuts and are especially abundant in fatty fish.
Omega-3 fatty acids have many positive health benefits including reduced rates of cancer, cardiovascular disease, mental illness, and dementia.
Studies of dietary fat intake have found no link between the percentage of calories obtained from fats and the risk of cancer, heart disease, or obesity.
Trans fats, such as those present in partially hydrogenated vegetable oils, are a risk factor for cardiovascular disease.
Key Terms
phospholipids: Phospholipids are a class of lipids that are a major component of all cell membranes as they can form lipid bilayers.
trans fats: Trans fats are unsaturated fats generated by physical agents such as heat or pressure that can lead to a variety of health problems.
fatty acid: Fatty acids can be saturated or unsaturated and are usually derived from triglycerides or phospholipids.
EXAMPLES
College students require optimal brain function, which is supported by fatty fish and walnuts.
Most of the fats found in food are triglycerides, cholesterol, and phospholipids. Some dietary fat is necessary for the absorption of fat-soluble vitamins (A, D, E, and K) and carotenoids. Humans and other mammals require fatty acids such as linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (an omega-3 fatty acid), because they cannot be synthesized from simple precursors in the diet.
Both omega-6 and omega-3 are 18-carbon polyunsaturated fatty acids that differ in the number and position of their double bonds. Most vegetable oils (safflower, sunflower, and corn oils) are rich in linoleic acid. Alpha-linolenic acid is found in the green leaves of plants, selected seeds, nuts, and legumes, and particularly in flax, rapeseed, walnut, and soy. Fish oils are especially rich in the longer-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Numerous studies have shown that the consumption of omega-3 fatty acids has positive benefits in terms of infant development, cancer, cardiovascular disease, and mental illnesses such as depression, attention-deficit hyperactivity disorder, and dementia. In contrast, the consumption of trans fats, such as those present in partially hydrogenated vegetable oils, are now known to be a risk factor for cardiovascular disease.
Omega-3 Fatty Acid: Docosahexaenoic acid (DHA) is an omega-3 fatty acid. It is essential for the proper functioning of the brain in both adults and infants. DHA concentrations in breast milk ranged from 0.07-1.0% of total fatty acids and are influenced by the amount of fatty fish in the mother’s diet. In the U.S., infant formula has been supplemented with DHA since 2001. Research suggests that DHA contributes to numerous nervous system functions such as visual acuity, neurogenesis, and synaptogenesis and that it lowers the risk for cardiovascular disease. It is highly concentrated in the brain and eye.
Several studies have suggested that total dietary fat intake is linked to obesity and diabetes. However, influential studies like the Women’s Health Initiative Dietary Modification Trial (an eight-year study of 49,000 women), as well as the Nurses’ Health Study and the Health Professionals Follow-up Study, have revealed no such link between the percentage of calories from fat and risk of cancer, heart disease, or weight gain. The Nutrition Source, a website maintained by the Department of Nutrition at the Harvard School of Public Health, summarizes the current evidence on the impact of dietary fat as follows: “Detailed research—much of it done at Harvard—shows that the total amount of fat in the diet isn’t really linked with weight or disease.”
Salmon: Salmon is an excellent source of omega-3 fatty acids.
Proteins: Sources, Uses in the Body, and Dietary Requirements
Proteins are composed of 20 different amino acids, about half of which are essential, meaning they must be obtained from the diet.
Key Points
Protein-based foods (plant and animal) provide amino acids; however, the best source of essential amino acids is animal.
If the diet does not provide adequate protein, the body will obtain what it needs from itself, especially from its own muscles.
While adequate protein is required for building skeletal muscle and other tissues, there is ongoing debate regarding the use and necessity of high-protein diets in anaerobic exercise, in particular weight training and bodybuilding.
This use of protein as a fuel is particularly important under starvation conditions as it allows the body’s own proteins to be used to support life.
Key Terms
amino acid: Any of the twenty naturally occurring α-amino acids (having the amino, and carboxylic acid groups on the same carbon atom), and a variety of side chains, that combine, via peptide bonds, to form proteins.
denaturation: Denaturation is a process in which proteins or nucleic acids lose their tertiary and secondary structure which is present in their native state, by application of some external stress or compound such as a strong acid or base, a concentrated inorganic salt, an organic solvent (e.g., alcohol or chloroform), or heat.
protein: Any of numerous large, complex naturally-produced molecules composed of one or more long chains of amino acids, in which the amino acid groups are held together by peptide bonds.
Most microorganisms and plants can biosynthesize all 20 standard amino acids, while animals (including humans) must obtain some of the amino acids from the diet. The amino acids that an organism cannot synthesize on its own are referred to as essential amino acids. Key enzymes that synthesize certain amino acids are not present in animals. One example is aspartokinase, which catalyzes the first step in the synthesis of lysine, methionine, and threonine from aspartate.
Amino Acid: Ball-and-stick model of the cystine molecule, an amino acid formed from two cysteine molecules.
In animals, amino acids are obtained through the consumption of foods containing protein. Ingested proteins are then broken down into amino acids through digestion, which typically involves denaturation of the protein through exposure to acid and hydrolysis by enzymes called proteases. Some ingested amino acids are used for protein biosynthesis, while others are converted to glucose through gluconeogenesis, or fed into the citric acid cycle. This use of protein as a fuel is particularly important under starvation conditions as it allows the body’s own proteins to be used to support life, particularly those found in muscle. Amino acids are also an important dietary source of nitrogen.
Protein: Muscle meat, such as steak, is an excellent source of the essential amino acids the body needs to create all necessary proteins.
A high-protein diet is often recommended by bodybuilders and nutritionists to help efforts to build muscle and lose fat. It should not be confused with low-carb diets, such as the Atkins Diet, which are not calorie-controlled and which often contain large amounts of fat. While adequate protein is required for building skeletal muscle and other tissues, there is ongoing debate regarding the use and necessity of high-protein diets in anaerobic exercise in particular weight training and bodybuilding. Extreme protein intake (in excess of 200g per day), coupled with an inadequate intake of other calorie sources (fat or carbohydrates), can cause a form of metabolic disturbance and death commonly known as rabbit starvation.
Relatively little evidence has been gathered regarding the effect of long-term high intake of protein on the development of chronic diseases. Increased load on the kidney is a result of an increase in the reabsorption of NaCl. This causes a decrease in the sensitivity of tubuloglomerular feedback, which, in turn, results in an increased glomerular filtration rate. This increases pressure in glomerular capillaries. When added to any additional renal disease, this may cause permanent glomerular damage.
Food Requirements and Essential Nutrients
Essential nutrients are those that cannot be created by an animal’s metabolism and need to be obtained from the diet.
Key Points
The animal diet needs to be well-balanced in order to ensure that all necessary vitamins and minerals are being obtained.
Vitamins are important for maintaining bodily health, making bones strong, and seeing in the dark.
Water-soluble vitamins are not stored by the body and need to be consumed more regularly than fat-soluble vitamins, which build up within body tissues.
Essential fatty acids need to be consumed through the diet and are important building blocks of cell membranes.
Nine of the 20 amino acids cannot be synthesized by the body and need to be obtained from the diet.
Key Terms
nutrient: a source of nourishment, such as food, that can be metabolized by an organism to give energy and build tissue
catabolism: destructive metabolism, usually including the release of energy and breakdown of materials
vitamin: any of a specific group of organic compounds essential in small quantities for healthy human growth, metabolism, development, and body function
Food Requirements
A balanced diet: For humans, a balanced diet includes fruits, vegetables, grains, and protein. Each of these food sources provides different nutrients the body cannot make for itself. These include vitamins, omega 3 fatty acids, and some amino acids.
What are the fundamental requirements of the animal diet? The animal diet should be well balanced and provide nutrients required for bodily function along with the minerals and vitamins required for maintaining structure and regulation necessary for good health and reproductive capability.
Organic Precursors
The organic molecules required for building cellular material and tissues must come from food. Carbohydrates or sugars are the primary sources of organic carbons in the animal body. During digestion, digestible carbohydrates are ultimately broken down into glucose and used to provide energy through metabolic pathways. The excess sugars in the body are converted into glycogen and stored in the liver and muscles for later use. Glycogen stores are used to fuel prolonged exertions, such as long-distance running, and to provide energy during food shortages. Excess digestible carbohydrates are stored by mammals in order to survive famine and aid in mobility.
Another important requirement is that of nitrogen. Protein catabolism provides a source of organic nitrogen. Amino acids are the building blocks of proteins and protein breakdown provides amino acids that are used for cellular function. The carbon and nitrogen derived from these become the building block for nucleotides, nucleic acids, proteins, cells, and tissues. Excess nitrogen must be excreted, as it is toxic. Fats add flavor to food and promote a sense of satiety or fullness. Fatty foods are also significant sources of energy because one gram of fat contains nine calories. Fats are required in the diet to aid the absorption of fat-soluble vitamins and the production of fat-soluble hormones.
Essential Nutrients
While the animal body can synthesize many of the molecules required for function from the organic precursors, there are some nutrients that need to be consumed from food. These nutrients are termed essential nutrients: they must be eaten as the body cannot produce them.
Vitamins and minerals are substances found in the food we eat. Your body needs them to be able to work properly and for growth and development. Each vitamin has its own special role to play. For example, vitamin D (added to whole milk or naturally occurring in sardines), helps make bones strong, while vitamin A (found in carrots) helps with night vision. Vitamins fall into two categories: fat-soluble and water-soluble. The fat-soluble vitamins dissolve in fat and can be stored in your body, whereas the water-soluble vitamins need to dissolve in water before your body can absorb them; therefore, the body cannot store them.
Fat-soluble vitamins are found primarily in foods that contain fat and oil, such as animal fats, vegetable oils, dairy foods, liver, and fatty fish. Your body needs these vitamins every day to enable it to work properly. However, you do not need to eat foods containing these every day. If your body does not need these vitamins immediately, they will be stored in the liver and fat tissues for future use. This means that stores can build up; if you have more than you need, fat-soluble vitamins can become harmful. Some fat-soluble vitamins include vitamin A, vitamin K, vitamin D, and vitamin E. Unlike the other fat-soluble vitamins, vitamin D is difficult to obtain in adequate quantities in a normal diet; therefore, supplementation may be necessary.
Water-soluble vitamins are not stored in the body; therefore, you need to have them more frequently. If you have more then you need, the body rids itself of the extra vitamins during urination. Because the body does not store these vitamins, they are generally not harmful. Water-soluble vitamins are found in foods that include fruits, vegetables, and grains. Unlike fat-soluble vitamins, they can be destroyed by heat. This means that sometimes these vitamins can often be lost during cooking. This is why it is better to steam or grill these foods rather then boil them. Some water-soluble vitamins include vitamin B6, vitamin B12, vitamin C, biotin, folic acid, niacin, and riboflavin.
The omega-3 alpha-linolenic acid and the omega-6 linoleic acid are essential fatty acids needed to synthesize some membrane phospholipids. Many people take supplements to ensure they are obtaining all the essential fatty acids they need. Sea buckthorn contains many of these fatty acids and is also high in vitamins. Sea buckthorn can be used to treat acne and promote weight loss and wound healing.
Minerals are inorganic essential nutrients that must also be obtained from food. Among their many functions, minerals help in cell structure and regulation; they are also considered co-factors. In addition to vitamins and minerals, certain amino acids must also be procured from food and cannot be synthesized by the body. These amino acids are the “essential” amino acids. The human body can synthesize only 11 of the 20 required amino acids. The rest must be obtained from food.
Amino Acids: There are 20 known amino acids. Animals can make only 11, so the others must be obtained through the diet. Meats are the best source of amino acids, although some amino acids can also be obtained from vegetables and grains.
Fundamentals Nutrition
Carbohydrates
Carbohydrates are essential macronutrients that are the primary source of energy for humans; 1 gram of carbohydrate contains 4 kcal of energy.[rx] Carbohydrates also play roles in gut health and immune function. Carbohydrates are present in plant-based foods like grains, fruits, vegetables, and milk. Carbohydrates are ingested in the form of simple carbohydrates, like monosaccharides and disaccharides, or complex carbohydrates, like oligosaccharides and polysaccharides. Monosaccharides are the basic building blocks of all carbohydrates and include glucose, fructose, and galactose. Glucose is the primary form to which carbohydrates become metabolized in humans. Disaccharides contain two sugar units and include lactose, sucrose, and maltose. Lactose is a carbohydrate found in milk, and sucrose is basic table sugar. Oligosaccharides consist of 3 to 10 sugar units and include raffinose and stachyose, which are in legumes. Polysaccharides include greater than ten sugar units and consist of starches, glycogen, and fibers, like pectin and cellulose. Starches like amylose are in grains, starchy vegetables, and legumes and consist of glucose monomers. Glycogen is the storage form of glucose in animals and is present in the liver and muscle, but there is little to none in the diet. Fibers are plant polysaccharides like pectin and cellulose found in whole grains, fruits, vegetables, and legumes but are not digestible by humans. However, they play a major role in gut health and function and can be digested by microbiota in the large intestine.[rx] For healthy children and adults, carbohydrates should make up approximately 45 to 65% of energy intake based on the minimum required glucose for brain function. The recommended fiber intake is greater than 38 g for men and 25 g for women, which is the intake that research has observed to lower the risk of coronary artery disease. Some carbohydrates are more nutritious than others. Optimal carbohydrate intake consists of fiber-rich, nutrient-dense whole grains, fruits, vegetables, legumes, and added sugar.[rx]
Proteins
Proteins are essential macronutrients that contribute to structural and mechanical function, regulate processes in the cells and body, and provide energy if necessary. Proteins are composed of amino acids and are available in food sources like meats, dairy foods, legumes, vegetables, and grains.[rx] 1 gram of protein contains 4 kcal of energy.[rx] The recommended protein intake is 0.8 to 1 gram per kilogram of body weight per day.[7] For healthy children ages 1 to 3, ages 4 to 18, and adults, approximately 5 to 20%, 10 to 30%, and 10 to 35% of daily energy intake should come from protein, respectively, based on the adequate amount needed for nitrogen equilibrium.[rx]
Lipids
Lipids are essential macronutrients that are the main source of stored energy in the body, contribute to cellular structure and function, regulate temperature, and protect body organs. Lipids are found in fats, oils, meats, dairy, and plants and consumed mostly in the form of triglycerides.[rx] One gram of fat contains 9 kcal of energy.[rx] For healthy children ages 1 to 3, ages 4 to 18, and adults, approximately 30 to 40%, 25 to 15%, and 20 to 35% of daily energy intake should come from fat, respectively. Approximately 5 to 10% and 0.6 to 1.2% of the daily fat energy intake should consist of n-6 polyunsaturated fatty acids (linoleic acid) and n-3 polyunsaturated fatty acids (α-linolenic acid), respectively.[rx]
Vitamin
Vitamin B1 (Thiamin) – Thiamin, or vitamin B1, is an essential water-soluble vitamin that acts as a coenzyme in carbohydrate and branched-chain amino acid metabolism. Thiamin is in food sources such as enriched and whole grains, legumes, and pork. The RDA (Recommended Dietary Allowance) of thiamin for adults is 1.1 mg/day for women and 1.2 mg/day for men.[rx]
Vitamin B2 (Riboflavin) – Riboflavin, or vitamin B2, is an essential water-soluble vitamin that acts as a coenzyme in redox reactions. Riboflavin is present in food sources such as enriched and whole grains, milk and dairy products, leafy vegetables, and beef. The RDA of riboflavin for adults is 1.1 mg/day for women and 1.3 mg/day for men.[rx]
Vitamin B3 (Niacin) – Niacin, or vitamin B3, is an essential water-soluble vitamin that acts as a coenzyme to dehydrogenase enzymes in the transfer of the hydride ion and an essential component of the electron carriers NAD and NADP. Niacin is present in enriched and whole grains and high protein foods like meat, milk, and eggs. The RDA of niacin for adults is 14 mg/day of NEs (niacin equivalents) for women and 16 mg/day of NEs for men.[rx]
Vitamin B5 (Pantothenic Acid) – Pantothenic acid, or vitamin B5, is an essential water-soluble vitamin that acts as a key component of coenzyme A and phosphopantetheine, which are crucial to fatty acid metabolism. Pantothenic acid is widespread in foods. The AI (adequate intake) of pantothenic acid for adults is 5 mg/day.[rx]
Vitamin B6 (Pyridoxine) – Vitamin B6, or pyridoxine, is an essential water-soluble vitamin that acts as a coenzyme for amino acid, glycogen, and sphingoid base metabolism. Vitamin B6 is widespread among food groups. The RDA for vitamin B6 for adults is 1.3 mg/day.[rx]
Vitamin B7 (Biotin) – Biotin, or vitamin B7, is an essential water-soluble vitamin that acts as a coenzyme in carboxylation reactions dependent on bicarbonate. Biotin is found widespread in foods, especially egg yolks, soybeans, and whole grains. The AI of biotin for adults is 30 mcg/day.[rx]
Vitamin B9 (Folate) – Folate, or vitamin B9, is an essential water-soluble vitamin that acts as a coenzyme in single-carbon transfers in nucleic acid and amino acid metabolism. Folate is in enriched and fortified grains, green leafy vegetables, and legumes. The RDA of folate for adults is 400 mcg/day of DFEs. The recommendation is that women of childbearing age consume an additional 400 mcg/day of folic acid from supplements or fortified foods to decrease the risk of neural tube defects.[rx]
Vitamin B12 (Cobalamin) – Vitamin B12, or cobalamin, is an essential water-soluble vitamin that acts as coenzymes for the crucial methyl transfer reaction in converting homocysteine to methionine and the isomerization reaction that occurs in the conversion of L-methylmalonyl-CoA to succinyl-CoA. Vitamin B12 is only present in animal products because it is a product of bacteria synthesis. Many foods are also fortified with synthetic vitamin B12. The RDA of vitamin B12 for adults is 2.4 mcg/day. It is recommended for older adults to meet their RDA with fortified foods or supplements because many are unable to absorb naturally occurring vitamin B12.[rx]
Vitamin C (Ascorbic Acid) – Vitamin C, or ascorbic acid, is an essential water-soluble vitamin that acts as a reducing agent in enzymatic reactions and nonenzymatically as a soluble antioxidant. Vitamin C is found primarily in fruits and vegetables, except for animal organs like the liver and kidneys. The RDA of vitamin C for adult women and men is 75 mg/day and 90 mg/day, respectively. Smokers require an additional 35 mg/day of vitamin C.[rx]
Vitamin A (Retinol) – Vitamin A, or retinol, is an essential fat-soluble vitamin that plays numerous roles in vision, cellular differentiation, gene expression, growth, the immune system, bone development, and reproduction. Vitamin A is found primarily in animal products. Fruits and vegetables are a source of provitamin A carotenoids that can be converted to retinol in the body at a lesser amount. The RDA for vitamin A for adults is 900 mcg/day for males and 700 mcg/day for females.[rx]
Vitamin D (Cholecalciferol) –Vitamin D, or cholecalciferol, is an essential fat-soluble vitamin that plays an essential role in calcium metabolism, cell growth and development, and bone health. Vitamin D can be found in fish oils and in small amounts in plants in its less biologically active form. Interestingly, vitamin D synthesis occurs in the skin with exposure to UV light making dietary sources unnecessary in certain cases. The RDA for vitamin D for adults is 10 to 15 mcg/day.[rx]
Vitamin E (Tocopherol) – Vitamin E, or tocopherol, is a fat-soluble vitamin that is an antioxidant and may play roles in cell signaling, platelet aggregation, and vasodilation. Vitamin E, in the form of α-tocopherol, is found in certain vegetable oils, including sunflower, safflower, canola, and olive oil, whole grains, nuts, and green leafy vegetables. The RDA for vitamin E for adults is 15 mg/day.[rx]
Vitamin K (Phylloquinone; Menaquinone) – Vitamin K is an essential fat-soluble vitamin that is the coenzyme in the carboxylation of glutamic acid to form γ-carboxyglutamic acid reaction, which is essential to the proteins involved in blood coagulation. Vitamin K is present in green leafy vegetables, canola oil, and soybean oil. The RDA of vitamin K for adults is 120 mcg/day for men and 90 mcg/day for women.[rx]
Mineral
Calcium – Calcium is an essential macromineral responsible for numerous structural components such as bones and teeth and physiological mechanisms in the body. Calcium exists in dietary sources such as dairy, cereals, legumes, and vegetables. The RDA for calcium for adults is 1,000 mg/day.[rx][rx]
Magnesium – Magnesium is an essential macromineral responsible for numerous functions in the body, including signaling pathways, energy storage, and transfer, glucose metabolism, lipid metabolism, neuromuscular function, and bone development. Magnesium is present in food sources such as fruits, vegetables, whole grains, legumes, nuts, dairy, meat, and fortified foods like cereal. The adult RDA for magnesium is 400 mg/day.[rx][rx]
Phosphorus – Phosphorus is an essential macromineral that is a structural component of bones and teeth, DNA, RNA, and plasma membrane of cells. It is also critical metabolically to produce and store energy. Phosphorus is pervasive throughout food sources, with the greatest contributors being milk, dairy, meat, and poultry. Phosphorus is also an additive in processed foods as a preservative. The RDA for phosphorus for adults is 700 mg/day.[rx]
Sodium – Sodium is an essential macromineral and electrolyte that plays critical roles in cellular membrane transport, water balance, nerve innervation, and muscle contraction as the most abundant extracellular cation. Sodium is available in dietary sources such as salt, processed foods, meat, milk, eggs, and vegetables. The AI for sodium for adults is 1,500 mg/day; however, the average sodium intake in industrialized nations is 2 or 3 fold by comparison, at 3,000 to 4,500 mg/day.[rx][rx][rx]
Potassium – Potassium is an essential macromineral and electrolyte that plays critical roles in muscle contraction, nerve innervation, blood pH balance, and water balance as the most abundant intracellular cation. Potassium is obtainable in dietary sources such as fruits and vegetables. The AI for potassium is for adults is 4,700 mg/day.[rx][rx][rx]
Chloride – Chloride is an essential macromineral and electrolyte that plays critical roles in digestion, muscular activity, water balance, and acid-base balance as the most abundant extracellular anion in the body. Dietary chloride is almost always present in dietary sources associated with sodium in the form of NaCl or table salt. Chloride is in processed foods, meat, milk, eggs, and vegetables. The AI for chloride for adults is 1,500 mg/day.[rx][rx][tx]
Iron – Iron is an essential trace mineral that has a critical role in oxygen transport and energy metabolism. Dietary iron is from sources such as meat, fortified grains, and green leafy vegetables. Animal foods contain a more bioavailable form of iron called heme iron, while plant foods and fortified grains contain a less bioavailable form called non-heme iron. The RDA for iron for adults is 8 to 18 mg/day.[rx][rx]
Zinc – Zinc is an essential trace mineral that functions structurally in proteins and catalytically as a component of over 300 different enzymes. Zinc appears in a variety of foods, especially shellfish and red meat. The RDA for zinc for adults is 10 mg/day.[rx]
Copper – Copper is an essential trace mineral that acts as a component of numerous proteins, including many important enzymes. Copper is in a variety of food sources but the highest concentrations in organ meats, nuts, seeds, chocolate, and shellfish. The RDA for copper for adults is 1 mg/day.[rx][rx]
Iodine – Iodine is an essential trace mineral necessary for thyroid hormone synthesis. Iodine is present in meats and plant foods based on the soil content of the food production region. Otherwise, iodized salt is the main food source of iodine in regions with low soil iodine content. The adult RDA for iodine is 150 mcg/day.[rx]
Selenium – Selenium is an essential trace mineral that is an essential component of selenoproteins that play biological roles in antioxidant defense and anabolic processes in the human body. Selenium occurs in grains and vegetables, but the amounts vary based on the selenium content in the soil that the grains and vegetables were grown in. Brazil nuts are known for having high concentrations of selenium. The RDA for selenium for adults is 55 mcg/day.[27]
Cellular
Carbohydrates
Carbohydrate digestion occurs in the mouth and small intestine with salivary amylase, pancreatic amylase, and brush border enzymes. Human carbohydrate digesting enzymes catalyze hydrolysis reactions that break the bonds between monomers. However, given fibers have beta bonds, they are indigestible by human enzymes, so some end up getting digested by bacterial enzymes in the large intestine, and the remainder is excreted in the feces. In the mouth, salivary amylase begins to break down the polysaccharide starch into the disaccharide maltose, which both contain monomers of glucose. Carbohydrate digestion bypasses the stomach and continues in the small intestine via pancreatic amylase and brush border enzymes on the microvilli. Pancreatic amylase continues to break down starches into maltose. The brush border enzymes include maltase, sucrase, and lactase. Maltase hydrolyzes maltose into two glucose monomers. Sucrase hydrolyzes sucrose into glucose and fructose. Lactase hydrolyzes lactose into glucose and galactose.[rx]
Monosaccharides pass through intestinal epithelial cells via facilitated diffusion and active transport to enter the bloodstream. Fructose is absorbed via facilitated diffusion by GLUT5 and released via facilitated diffusion by GLUT2. Glucose and galactose are absorbed along with sodium via active transport by the symporter sodium-glucose transporter 1 and are released via facilitated diffusion by GLUT2. The monomers enter the portal vein and travel to the liver. When fructose and galactose enter the liver, they must first be converted to glucose to be metabolized for energy. These can be converted into intermediates of the glycolysis pathway, glucose-6-phosphate or fructose-6-phosphate, to directly enter the glycolysis pathway or the substrate of glycogenesis, glucose-1-phosphate, to be stored as glycogen.[rx]
Glucose metabolism requires the following B vitamins to act as coenzymes: thiamine (B1), riboflavin (B2), and niacin (B3). Glucose metabolism begins in the cytoplasm of cells with the anaerobic process of glycolysis when one 6-carbon glucose molecule is partially oxidized into two 3-carbon pyruvate molecules. During the process, there is a net yield of two ATP and two NADH, where they will carry the electrons to the electron transport chain, eventually producing ATP. NADH is derived from niacin. ATP is the main source of cellular energy due to its high energy bonds between phosphate groups, which are released when broken via hydrolysis.[rx]
In the absence of oxygen, which can happen during strenuous exercise or in cells without mitochondria, lactate dehydrogenase catalyzes the conversion of pyruvate to lactate, which can then go back to the liver to be converted back to pyruvate and undergo gluconeogenesis to create glucose. Then, the glucose can go back to the muscle cells and go through glycolysis, again releasing two ATP molecules. This is called the Cori cycle and shows how lactate, the waste product of skeletal muscles, can be converted to glucose in hepatocytes and then be used for energy back in the skeletal muscles.[rx]
In the presence of oxygen, pyruvate will travel to the mitochondrial matrix, where pyruvate dehydrogenase will catalyze the oxidation and decarboxylation of two 3-carbon molecules of pyruvate from glycolysis into two 2-carbon molecules of acetyl-CoA. Pyruvate dehydrogenase uses thiamine pyrophosphate, or TPP, as a coenzyme. In addition, two carbon dioxide molecules and two NADH molecules are produced, and the NADH molecules will carry electrons to the electron transport chain to ultimately produce ATP. Pyruvate decarboxylation is the link between glycolysis and the citric acid cycle.[rx]
The citric acid cycle, also known as the TCA cycle and the Krebs cycle, occurs in the mitochondrial matrix where the 2-carbon acetyl-CoA will join 4-carbon oxalate to produce 6-carbon citrate, which gets degraded to produce the energetic molecules GTP, NADH, and FADH2. The cycle will continue so long as there is an input of acetyl-CoA because citrate eventually gets converted back to oxalate. Two pyruvates from glycolysis will release 2 GTP, 6 NADH, and 2 FADH molecules. FADH is derived from riboflavin. NADH and FADH2 will travel to the electron transport chain, where ATP will be synthesized via oxidative phosphorylation.[rx]
Oxidative phosphorylation begins at the electron transport chain along the inner membrane of the mitochondrion. Four protein complexes I-IV are embedded along the membrane and function to pump protons from the mitochondrial matrix to the intermembrane space to create an electrochemical gradient through a chain of redox reactions. Protein complex I receive electrons from NADH to pump hydrogen across the inner membrane. FADH2 drops electrons off at protein complex II, and protons get pumped across at protein complex III. One molecule of NADH generates three ATP molecules, while one molecule of FADH2 only generates two molecules of ATP. When enough protons fill up the intermembrane space, an electrochemical gradient occurs. At protein complex IV, oxygen acts as the final electron acceptor, forming water. Through chemiosmosis, protons will flow from the intermembrane space through the hydrophilic tunnel of ATP synthase back to the matrix. The proton motive force generates energy that allows ATP synthase to condense ADP + Pi into high-energy ATP. Overall, this process generates 34 ATP molecules per molecule of glucose and is by far the most efficient way to produce energy.[rx]
Proteins
Protein digestion begins in the stomach, where they are broken down by the protease enzyme pepsin. First, gastric parietal cells will release hydrochloric acid, which will denature proteins and convert inactive pepsinogen to active pepsin. Pepsin digests proteins by hydrolyzing peptide bonds between amino acids to form large polypeptides or oligopeptides. Protein digestion continues in the small intestine. In response to the acidic chyme from the stomach, the hormones cholecystokinin and secretin are synthesized in the duodenum. These hormones trigger pancreatic cells to secrete bicarbonate and proenzymes into the intestine. The proenzymes trypsinogen, procarboxypeptidase, and chymotrypsinogen are converted into their active enzyme forms trypsin, carboxypeptidase, and chymotrypsin in a cascade of enzymatic reactions. Trypsin, carboxypeptidase, and chymotrypsin digest polypeptides into tripeptides, dipeptides, and free amino acids that can be absorbed in the small intestine.[rx]
Peptide and amino acid absorption occur across epithelial cells in the small intestine via transporters. Some amino acids can travel across the epithelium paracellularly, while others require amino acid transporters that vary based on the specific amino acid and mechanism in which they transport. Tripeptides and dipeptides are transported into the epithelial cell via PEPT1 coupled with the electrochemical gradient produced by the Na+/H+ exchanger on the brush border membrane. Intracellular peptides finish breaking down tripeptides and dipeptides into free amino acids. Free amino acids will exit the basolateral membrane of the epithelial cell and enter the bloodstream at the portal vein to the liver.[rx]
Amino acids can be metabolized via transamination for amino acid interconversion or deamination for the oxidation of the carbon skeleton for energy or excretion. For amino acid interconversion, pyridoxine (B6), cobalamin (B12), and folate (B9) are required. For amino acid oxidation, pyridoxine (B6), cobalamin (B12), and biotin (B7) are required. Amino acids can undergo transamination to enter the TCA cycle in glucose metabolism. Certain amino acids like alanine can be transaminated by an aminotransferase enzyme with the coenzyme PLP, which is derived from pyridoxine, to form pyruvate. Other amino acids can be transaminated by an aminotransferase enzyme with PLP to form α-ketoglutarate, an intermediate in the TCA cycle. Some amino acids can be transaminated by an aminotransferase enzyme with PLP to form oxaloacetate, which is an intermediate in the TCA cycle. Other amino acids can be oxidized with enzymes that require biotin and vitamin B12 as coenzymes or from succinyl-CoA, which is an intermediate in the TCA cycle. When the carbon skeletons of amino acids become degraded for energy, they are deaminated, and the nitrogen group is excreted in the form of urea.[rx][rx][rx]
Lipids
Limited digestion of lipids occurs in the mouth and stomach with the enzymes lingual lipase and gastric lipase, respectively. However, most ingested lipids arrive at the duodenum of the small intestine undigested. The presence of lipids in the duodenum stimulates the release of enzymes from the pancreas and bile from the gallbladder. Bile emulsifies that lipids preparing them for digestion by pancreatic lipase. Pancreatic lipase hydrolyzes triglycerides to monoglycerides and free fatty acids. Lipids are absorbed via simple diffusion. Short-chain fatty acids and glycerol move directly into the portal circulation and bind to albumin. Long-chain fatty acids, mono/diglycerides, cholesterol, and phospholipids combine with bile to form micelles allowing them to be soluble in the hydrophilic environment and then leave the micelle and enter the intestinal mucosa cell. In the intestinal cell, long-chain fatty acids are re-esterified to form triglycerides. Triglycerides combine with cholesterol, phospholipids, and other proteins to form chylomicrons. The chylomicrons will leave the intestinal cell and enter the lymph system, eventually entering the bloodstream through the thoracic duct.[rx]
Lipoproteins carry lipids throughout the bloodstream, and the enzyme lipoprotein lipase frees up fatty acids to be taken up by cells. In the bloodstream, the chylomicrons can deliver the dietary fatty acids to body cells, where they will form triglycerides and the remaining lipids to the liver to travel to other cells or be excreted. In the liver, triglycerides, cholesterol, phospholipids, and proteins will combine to form VLDL, which will leave the liver to deliver lipids, mainly in the form of triglycerides, to cells in the bloodstream. As VLDL delivers triglycerides to cells, it begins to shrink and become LDL. LDL continues to carry lipids to cells, but the lipids are mainly in the form of cholesterol. LDL binds to LDL receptors of cells for cholesterol to be taken up. The remaining lipids will leave cells in the form of HDL, where they will carry lipids back to the liver for either reuse or excretion. In the cells, lipids can be metabolized for energy by entering at different points of the glucose metabolism pathway. Triglycerides are broken down into glycerol and free fatty acids. Glycerol can be converted to pyruvate and catabolized for energy. Free fatty acids can be oxidized to acetyl-CoA to enter the citric acid cycle.[rx][rx]
Vitamin B1 (Thiamin) – Thiamin absorption occurs mainly in the jejunum of the small intestine. Higher concentrations are absorbed via passive diffusion, while lower concentrations are absorbed via an active, carrier-mediated system that involves phosphorylation. In the blood, thiamin is transported in the erythrocytes and plasma. A small percentage of thiamin is absorbed, while the remainder is excreted in the urine.[rx]
Vitamin B2 (Riboflavin) – Thiamin is mainly consumed as FMN and FAD bound to a food protein. In the stomach, the acidic environment releases the coenzymes FMN and FAD from the protein. Most absorption of riboflavin occurs in the small intestine via an active or facilitated transport system. FMN and FAD must first be hydrolyzed to riboflavin by nonspecific pyrophosphatases to be absorbed. Riboflavin is transported in the plasma mainly bound to albumin and is excreted in the urine.[rx]
Vitamin B3 (Niacin) – At low concentrations, niacin is absorbed in the small intestine via sodium-ion-dependent facilitated diffusion. At high concentrations, niacin is absorbed in the small intestine via passive diffusion. Niacin can be transported freely in the blood in the forms of nicotinic acid or nicotinamide. Cells and tissues can take up niacin via passive diffusion or with the use of transporters. Niacin is excreted in urine as 1-methyl nicotinamide or NAM.[rx]
Vitamin B5 (Pantothenic Acid) – Pantothenic acid is absorbed via active transport at low concentrations and passive transport at high concentrations in the small intestine. Pantothenate kinase catalyzes the synthesis of CoA from pantothenate. CoA plays an important role in the citric acid cycle in the forms of acetyl-CoA and succinyl-CoA. CoA can be hydrolyzed to pantothenate for excretion. Pantothenic acid is excreted in the urine.[rx]
Vitamin B6 (Pyridoxine) – The main dietary form of vitamin B6 is pyridoxal phosphate or PLP. For PLP to be absorbed in the small intestine, it must first undergo phosphatase-mediated hydrolysis to enter the small intestine in its nonphosphorylated form. Pyridoxal, or PL, crosses the enterocyte via passive diffusion to enter the bloodstream to the liver. In the liver, PL is converted back to PLP by the enzyme PL kinase. PLP is the main circulating form of vitamin B6 and is transported in the blood bound to albumin. The majority of PLP in the body is found in the muscle. Vitamin B6 is excreted in the urine in the form of 4-pyridoxic acid.[rx]
Vitamin B7 (Biotin) – Biotin can be ingested as free biotin or protein-bound biotin. In the small intestine, an enzyme called biotinidase releases biotin from its covalent bond to the protein allowing it to be absorbed. Biotin is absorbed in the small intestine through a sodium-dependent transporter. Biotin is transported through the bloodstream to the liver, mostly unbound as free biotin. Biotin and biotin metabolites are excreted in the urine.[rx]
Vitamin B9 (Folate) – Food folates are polyglutamate derivatives and must be hydrolyzed to the monoglutamate forms before absorption. The monoglutamate form of folate is absorbed in the small intestine via active transport. Pharmacological doses of folic acid from supplements or fortified foods are absorbed via passive transport. Folate is transported in the bloodstream to the liver in the form of 5-methyl-tetrahydrofolate. Folate is mostly bound to albumin in the bloodstream. Most ingested folate is used or stored. Any dietary folate not absorbed is excreted in feces.[rx]
Vitamin B12 (Cobalamin) – Small amounts of vitamin B12 are absorbed through a coordinated process of the GI tract, given naturally occurring B12 is bound to a protein that must be released for absorption. First, in the stomach, the presence of acid and pepsin causes the dissociation of food-bound vitamin B12 from its proteins. Then R-proteins or haptocorrins, secreted by the salivary glands, bind to vitamin B12 to protect it from stomach acid. In the small intestine, pancreatic proteases degrade R-proteins to allow B-12 to bind to intrinsic factor, which is secreted by gastric parietal cells. Intrinsic factor attaches B12 to specific ileal mucosa receptors allowing the complex to be internalized by endocytosis into the enterocyte and released into the bloodstream where it is bound to transcobalamin I, II, or III. 50% of transcobalamin II bound B12 is taken up by the liver, where it is stored while the remainder is transported to other tissues. B12 is excreted in bile, but most of it ends up reabsorbed.[rx]
Vitamin C (Ascorbic Acid) – The absorption, tissue distribution, and excretion of vitamin C are tightly regulated by tissue-specific active transporters SVCT-1 and SCVT-2. Ascorbic acid is absorbed into the enterocyte by SVCT-1 and enters the bloodstream via SVCT-2. Other tissues take up ascorbic acid via SVCT-1 and/or SCVT-2. Vitamin C is excreted in the urine at intakes greater than 400 mg/day. Vitamin C is most concentrated in the brain, eyes, and adrenal gland.[rx]
Vitamin A (Retinol) – Vitamin A is ingested both in the form of retinol and provitamin A carotenoids. In the small intestine, retinol and provitamin A carotenoids enter the mucosal cell after combining with bile to form a micelle. Retinol binds to cellular retinol-binding protein (CRBP) II within the intestinal mucosal cells to form a retinol-CRBP II complex. Then, lecithin retinol aminotransferase esterifies CRBP II retinol with a fatty acid to form CRBP-retinyl palmitate. The retinol esters will be incorporated with other lipids and apoproteins to form a chylomicron. The chylomicron will leave the intestinal cell and enter the lymph system and eventually enter the blood. β-carotene, a provitamin A carotenoid, is converted to retinoic acid inside the intestinal cells and is able to directly enter the bloodstream where it attaches to albumin to be transported to the liver.[rx][rx]
Vitamin D (Cholecalciferol) – Vitamin D is obtained mainly through UV-B-induced production in the skin. A minor amount of vitamin D is obtained through dietary intake. In the skin, vitamin D3, or cholecalciferol, is synthesized when 7-dehydrocholesterol is exposed to UV-B light from the sun. Vitamin D3 is transferred to the liver to be further metabolized. Through dietary intake, vitamin D3 is absorbed in the small intestine via incorporation into a micelle to enter the intestinal cells and incorporate into chylomicrons to leave the intestinal cells to enter the lymph system and eventually enter circulation the thoracic duct. In the liver, vitamin D3 enters a hepatocyte and is hydroxylated into 25-OH vitamin D3, which is catalyzed by the enzyme 25-hydroxylase. Then, 25-OH vitamin D3 bind to vitamin D-binding protein, or DBP, to leave the hepatocytes and be transported to the kidney for an additional hydroxylation reaction. In the kidney, 25-OH vitamin D3 is hydroxylated to 1,25-(OH)2 vitamin D3, which is catalyzed by the enzyme 1-hydroxylase. 1,25-(OH)2 vitamin D3 is also known as calcitriol, which is considered the active form of vitamin D. 1,25-(OH)2 vitamin D3 bound to DBP is released to the bone, immune cells, and liver cells.[rx][rx]
Vitamin E (Tocopherol) – Through dietary intake, vitamin E is absorbed in the small intestine via incorporation into a micelle to enter the intestinal cells and incorporate into a chylomicron to leave the intestinal cells and enter the lymph system and eventually enter circulation the thoracic duct. Vitamin E is transported in remnant chylomicrons to the liver, where it is taken up by a hepatocyte. In the hepatocyte, α-tocopherol transfer protein incorporates α-tocopherols into very low-density lipoproteins, or VLDLs, to transport to peripheral tissues. In circulation, lipoprotein lipase (LPL) catalyzes the conversion of VLDL to LDL to HDL. The cellular uptake of α-tocopherol takes place with the uptake of lipoproteins via receptor-mediated endocytosis. Most α-tocopherol is stored in adipose tissue. The remaining tocopherols and tocotrienols are excreted with bile in feces.[rx]
Vitamin K (Phylloquinone; Menaquinone) – Through dietary intake, vitamin K1 and K2 are absorbed in the small intestine via incorporation into a micelle to enter the intestinal cells and incorporation into a chylomicron to leave the intestinal cells and enter the lymph system and eventually enter circulation at the thoracic duct. Vitamin K1 and K2 are transported in remnant chylomicrons to the liver where it is taken up by a hepatocyte. In the hepatocyte, vitamin K1 and K2 are incorporated into very low-density lipoproteins, or VLDLs, to transport to peripheral tissues. In circulation, lipoprotein lipase (LPL) catalyzes the conversion of VLDL to LDL to HDL. The cellular uptake of vitamin K1 and K2 takes place with the uptake of lipoproteins via receptor-mediated endocytosis. Vitamin K is stored predominantly in the liver in the form of menaquinone and is excreted in the urine and feces.[rx]
Calcium – The intestine, kidney, bone, and parathyroid gland work together to tightly regulate calcium balance in the body. The majority of calcium is absorbed in the small intestine via paracellular diffusion. The remainder of calcium is absorbed transcellular through the calcium channel TRPV6 when luminal calcium levels are low. Calcium is transported in the bloodstream in three forms: 48% ionized as free Ca2+, 46% bound to the protein albumin, and 7% complexed with citrate, phosphate, or sulfate. In low blood calcium concentration conditions, the parathyroid gland is stimulated to release parathyroid hormone (PTH). PTH then stimulates the kidneys to increase calcium reabsorption in the proximal convoluted tubule. PTH also stimulates the kidneys to convert 25-OH D3 into 1,25(OH)2 D3, or calcitriol. The increased calcitriol and PTH in the blood travel to the bone and stimulate the resorption of calcium and phosphorus from the bone. Calcitriol also stimulates the small intestine to increase calcium absorption. As a result, blood calcium is increased. In high blood calcium conditions, the thyroid gland releases the hormone calcitonin, preventing calcium mobilization from the bone, thus reducing blood calcium levels. 99% of the calcium in the body is found in the bones and teeth, while the remainder is found in soft tissues and plasma both intracellularly and extracellularly. Most calcium is reabsorbed in the kidney, but the remainder is excreted in urine and feces.[rx][rx]
Magnesium – Magnesium is absorbed in the small intestine through paracellular diffusion and transcellular active transport via TRPM6 and TRMP7. At normal magnesium intakes, 30% of intestinal magnesium absorption occurs via transcellular transport. When magnesium intakes are lower, more magnesium is absorbed via transcellular transport. When magnesium intakes are higher, more magnesium is absorbed through paracellular diffusion. Magnesium is transported in the blood as free Mg2+(60%), protein-bound (30%), and complexed to citrate, phosphate, or sulfate (10%). The kidneys control magnesium homeostasis. About 70% of serum magnesium is available for glomerular filtration, and 96% of the filtered magnesium is reabsorbed in the kidneys through several mechanisms in the proximal tubule, ascending limb, and distal tubule. The remaining magnesium is excreted in the urine. 99% of magnesium in the body is stored intracellularly in bone, muscle, and soft tissues, while 1% of magnesium in the body is found in extracellular fluid.[rx][rx][rx][rx]
Phosphorus – The phosphorus is absorbed in the small intestine into the enterocyte via two processes: active transport by the apical Na+ phosphate transporter NaPi-IIb and paracellular diffusion. Phosphorous leaves the enterocyte to enter the bloodstream via facilitated diffusion. The kidney plays a role in phosphorus homeostasis through the reabsorption of inorganic phosphate from the glomerular filtrate in the proximal convoluted tubule. Approximately 75 to 85% of phosphorus is reabsorbed per day, and the remainder is excreted in the urine. Phosphorus homeostasis can also be regulated secondary to that of calcium with resorption from the bone due to high PTH and calcitriol levels. Throughout the body, phosphorus is distributed 85% in the skeleton, 0.4% in the teeth, 14% in the soft tissue, 0.3% in the blood, and 0.3% in the extravascular fluid.[rx][rx][rx][rx]
Sodium – Sodium is absorbed in the small intestine across the brush border membrane of the enterocyte via sodium-glucose cotransporter 1 (SGLT1). SGLT 1 is an active transporter that absorbs 2 sodium ions and 1 glucose across the brush border membrane of the enterocyte. Sodium is then transported out of the enterocyte into the bloodstream across the basolateral membrane via the sodium-potassium pump, or ATPase. The sodium-potassium pump uses ATP to transport 3 sodium ions out of the enterocyte and 2 potassium ions into the enterocyte. Sodium and water balance are closely linked and maintained by the kidneys. Half of the sodium in the body is found in extracellular fluid, while around 10% is found in intracellular fluid. The remaining 40% of sodium is found in the skeleton. Small losses of sodium can occur through urine, feces, and sweat.[rx][rx]
Potassium – Most of the dietary potassium is absorbed in the small intestine via passive transport. The kidney maintains potassium homeostasis. About 90% of the potassium consumed is excreted in the urine, with the remaining small amount excreted in stool and sweat. Most of the potassium content in the body is found in the intracellular space of the skeletal muscle.[rx][rx]
Chloride – Chloride absorption occurs in the lumen of the small intestine via three distinct mechanisms: paracellularly through passive transport, the coupling of Na+/H+ and Cl−/HCO3− exchangers, and HCO3−-dependent Cl− absorption. Chloride is principally found in extracellular fluid. The kidneys regulate chloride concentration. Around 99% of chloride is reabsorbed in the proximal tubule of the kidneys both paracellularly and transcellular via the Cl−/HCO3− exchanger. The remainder of chloride can be excreted in urine, feces, or sweat.[rx]
Iron – Iron consumed from food can be present in two forms: heme and nonheme iron. 90% of dietary iron consists of nonheme iron, which is far less bioavailable than heme iron. Iron is absorbed in the small intestine in the duodenum. Given nonheme iron is often present in the form of ferric iron, it must be reduced to the ferrous form prior to enterocyte uptake with the ferric reductase enzyme DCYTB. The apical surface of the enterocyte contains divalent metal transporter 1 (DMT1), which transports ferrous iron into the enterocyte. On the basolateral membrane of the enterocyte, ferroportin releases ferrous iron to hephaestin, which oxidizes ferrous iron to ferric iron so it can bind to the transporting protein transferrin in portal circulation. Ferroportin is the main regulatory point of entry for iron in the body. Iron is stored in the liver bound to ferritin, where it can be sequestered to bone marrow for erythropoiesis or red blood cell formation. Macrophages in the reticuloendothelial system of the liver, spleen, and bone marrow can ingest old red blood cells to recycle iron to be stored in the liver. There is no specific excretory system for iron. Iron loss can only occur secondary to the exfoliation of epithelial cells in the skin and gastrointestinal tract in addition to red blood cell loss from the gastrointestinal tract.[rx][rx][rx][rx]
Zinc – Zinc is absorbed in the small intestine via carrier-mediated transport, with ZIP4 taking zinc up into the intestinal cell and ZNT1 releasing it into the bloodstream. Zinc is bound to albumin in circulation. Zinc transporters are pervasive throughout tissues in the body and play a role in maintaining zinc homeostasis. Zinc is excreted in feces.[rx]
Copper – Copper absorption mainly occurs in the small intestine. Copper is taken up by enterocytes with copper transporter 1 (CTR1), which is a copper importer located at the apical membrane of intestinal cells and most tissues. Copper is exported from the enterocytes into the blood by the exporter ATP7A. In portal circulation, most of the copper is bound to the transporter protein ceruloplasmin. Copper is taken up by the liver when copper-bound ceruloplasmin binds to ceruloplasmin receptors. In the hepatocytes, protein metallochaperones serve to assign and transport copper to specific pathways throughout the body. Copper is exported from the hepatocyte via the exporter ATP7B. Excess copper is secreted in the bile, which gets excreted in the feces.[rx][rx]
Iodine – Iodine can be ingested in many chemical forms. Iodide is rapidly and almost completely absorbed in the stomach and small intestine. Iodate, which is used in iodized salt, is reduced in the gut and then absorbed as iodide. In circulation, iodine is taken up mainly by the thyroid gland and kidney. Iodine uptake by the thyroid depends on iodine intake, whereas uptake by the kidney remains fairly constant. Iodine is excreted in the urine. Most of the body’s iodine is stored in the thyroid to be used in thyroid hormone synthesis.[rx]
Selenium – The mechanism of selenium absorption is not well known. Selenium absorption occurs in the small intestine via mechanisms dependant upon the form of selenium. The absorption of inorganic selenate occurs through active transport with a sodium pump. The absorption of inorganic selenite occurs via passive diffusion. Organic selenomethionine and selenocysteine are absorbed via an active transport mechanism similar to that of neutral amino acids like methionine. Selenium is absorbed into the portal bloodstream from the enterocyte and is transported to the liver in multiple forms. Selenite is taken up by erythrocytes and reduced by glutathione reductase to selenide, which is transported in the plasma bound to albumin. Selenium can also be transported in the form of selenoprotein P. Sometimes, selenium may bind to LDL and VLDL. Selenium is stored in tissues in the form of selenomethionine with variable densities in the liver, muscle, kidney, plasma, and other organs. Selenium excretion via urine in the form of methylselenol.[rx]
Molecular
Carbohydrates
Carbohydrates are organic molecules made up of carbon, hydrogen, and oxygen. Carbohydrates are classified based on their chemistry: individual monomer characteristics, degree of polymerization, and type of linkages (α or β). Given this classification, carbohydrates subdivide into three main groups: sugars (degree of polymerization = 1 to 2), oligosaccharides (degree of polymerization = 3 to 10), and polysaccharides (degree of polymerization more than 10). Sugars include monosaccharides and disaccharides. The most common monosaccharides are glucose, fructose, and galactose. The most common disaccharides are sucrose, lactose, and maltose. Examples of oligosaccharides include maltodextrins, raffinose, and polydextrose. Polysaccharides include starches and non-starch polysaccharides. Starches include digestible amylose due to its alpha-linked monosaccharides. Non-starch polysaccharides include non-digestible cellulose due to their β-linked monosaccharides.[rx]
Proteins
Proteins are polymers of amino acids. Amino acids are organic molecules composed of carbon, hydrogen, oxygen, and nitrogen. The general structure of an amino acid consists of a central carbon surrounded by hydrogen, an amino group, a carboxylic acid group, and a side chain “R.” Each amino acid has a unique side chain. Nine essential amino acids must come from dietary sources: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. The body can make eleven non-essential amino acids from precursors: alanine, arginine, asparagine, aspartate, cysteine, glutamate, glutamine, glycine, proline, serine, and tyrosine. There are four structure levels in a protein: primary, secondary, tertiary, and quaternary. The primary structure of a protein is a chain of amino acids connected by peptide bonds; this determines the subsequent structures and biological functions of the protein. The secondary structure of a protein consists of hydrogen bonding within amino acid chains that create either an α-helix or β-sheet conformation. The tertiary structure of a protein derives from attractions between α-helices and β-sheets of a polypeptide resulting in a three-dimensional arrangement of a protein. The quaternary structure of an amino acid consists of a spatial arrangement of multiple polypeptides in a protein.[rx]
Lipids
Lipids are organic molecules that share the common property of being hydrophobic. Dietary lipids are often in the forms of triglycerides, phospholipids, cholesterol, and fatty acids. Fatty acids are classified as saturated or containing no carbon-carbon double bonds, or unsaturated, or containing at least one carbon-carbon double bond. Saturated fatty acids have higher melting points than unsaturated fatty acids, making them solid at room temperature, unlike liquid unsaturated fatty acids. Triglycerides are composed of one 3-carbon glycerol backbone and three fatty acids. Phospholipids contain a phosphate head connected to a glycerol molecule, connected to two fatty acids. Cholesterol is a sterol that is composed of a hydrocarbon ring structure.[rx]
Vitamin B1 (Thiamin) – Thiamin consists of pyrimidine and thiazole rings that are linked by a methylene bridge. Thiamin exists in a variety of phosphorylated forms. Its main form is thiamin pyrophosphate or TPP.[rx]
Vitamin B2 (Riboflavin) – The basic chemical structure of riboflavin consists of a flavin group formed by the tricyclic heterocyclic isoalloxazine and a ribitol sugar group. The main coenzyme forms of riboflavin are flavin mononucleotide or FMN and flavin adenine dinucleotide, or FAD.[rx]
Vitamin B3 (Niacin) – Niacin refers to nicotinamide, nicotinic acid, and other derivatives. The basic chemical structure of nicotinic acid consists of a pyridine ring with a substituted carboxylic acid group. The chemical structure of nicotinamide consists of a pyridine ring with a substituted amide group. The main coenzyme forms of niacin are nicotinamide adenine dinucleotide or NAD and nicotinamide adenine dinucleotide phosphate or NADP.[rx]
Vitamin B5 (Pantothenic Acid) – Pantothenic acid is a water-soluble vitamin synthesized from the condensation reaction of pantoic acid and β-alanine in only plants and bacteria. Pantothenic acid serves to transfer and carry acyl groups.[rx]
Vitamin B6 (Pyridoxine) – Vitamin B6 is a generic term for six related compounds: pyridoxal (PL), pyridoxamine (PM, pyridoxine (PN), and their respective 5’-phosphatase forms (PLP, PMP, and PNP). The major forms of vitamin B6 in animal tissues are PLP and PMP.[rx]
Vitamin B7 (Biotin) – Biotin’s chemical structure consists of a heterobicyclic ring of radio and thiophene with a valeric acid side chain.[rx]
Vitamin B9 (Folate) – Folate is the generic term for the different forms of vitamin B9 that function in single-carbon transfers. The most oxidized and stable form of folate called folic acid is in vitamin supplements. It consists of a p-aminobenzoic acid molecule bound to a pteridine ring on one side and a glutamic acid molecule on the other side. Naturally occurring folates found in food, called food folate, are pteroylpolyglutamates, which contain between one and six additional glutamate molecules connected by a peptide linkage to glutamate’s γ-carboxyl.[rx]
Vitamin B12 (Cobalamin) – Cobalamin, or vitamin B12, is a generic term for a group of cobalt-containing compounds with a corrin ring attached to 5,6-dimethylbenzimidazole, a sugar ribose, and a phosphate. The two cobalamins that are active in human metabolism as coenzymes are methylcobalamin and 5-deoxyadenosylcobalamin.[rx]
Vitamin C (Ascorbic Acid) – Vitamin C, or ascorbic acid, chemically is a simple carbohydrate with an ene-diol structure that makes it an essential water-soluble electron donor. The main form of vitamin C found in foods is its reduced form – ascorbic acid. Ascorbate is the main circulating form of vitamin C in the body.[rx]
Vitamin A (Retinol) – Vitamin A is a generic descriptor for compounds that exhibit the biological activity of retinol and provitamin A carotenoids. Retinol is an unsaturated 20-carbon cyclic alcohol. Provitamin A carotenoids exhibit a 40-carbon basal structure with cyclic end groups and a conjugated system of double bonds.[rx][rx]
Vitamin D (Cholecalciferol) – Vitamin D3, or cholecalciferol, had a chemical structure that contains three steroid rings and an eight-carbon side chain. The structure derives from cholesterol.[rx]
Vitamin E (Tocopherol) – The term vitamin E encompasses eight lipophilic compounds that include four tocopherols and four tocotrienols, each of which has a designation as α-, β-, γ-, and δ-. Each of these compounds contains a chromanol ring and a lipophilic tail. Tocotrienols differ from tocopherols with their unsaturated side chains. α-tocopherol is the only form of vitamin E that is known to reverse deficiency symptoms.[rx]
Vitamin K (Phylloquinone; Menaquinone) – Vitamin K occurs naturally in two main forms: K1, or phylloquinone, and K2, or menaquinone, which has many different forms. Also, vitamin K occurs in the synthetic form of vitamin K3, or menadione, which contains only the 2-methyl-1, a 4-naphthoquinone nucleus common to all forms of vitamin K. The natural forms differ by the number of isoprenoid units in their isoprenoid side chains.[rx]
Calcium – Calcium is an alkaline earth metal cation found in the form of Ca2+. Calcium is a critical divalent cation in intracellular and extracellular fluid.[rx]
Magnesium – Magnesium is an alkaline earth metal cation found in the form of Mg2+. Magnesium is the second most abundant intracellular cation in the body.[rx]
Phosphorus – Phosphorous is a multivalent nonmetal that occurs in both inorganic and organic forms throughout the body. The organic forms of phosphorus include phospholipids and various phosphate esters. The inorganic forms of phosphorus include phosphate ions, protein-bound phosphate, and calcium, sodium, or magnesium-bound phosphate. Most phosphorus exists in the form of an inorganic free phosphate ion (PO42- or PO43-).[rx]
Sodium – Sodium is an alkali metal cation found in the form of Na+. Sodium is the major extracellular cation in the body.[rx][rx]
Potassium – Potassium is an alkali metal cation found in the form of K+. Potassium is the major intracellular cation in the body.[rx]
Chloride – Chloride is a nonmetal anion found in the form of Cl-. Chloride is the body’s principal anion making up 70% of the body’s total anion content and serves as the most important extracellular anion in the body.[rx]
Iron – Iron is a transition metal element. Iron exists in two main oxidation states: Fe2+ and Fe3+. The more bioavailable form of iron is its reduced form ferrous iron, or Fe2+, due to its solubility. The less bioavailable form of iron is its oxidized form ferric iron, or Fe3+, due to its lack of solubility. Heme iron is contained in the protoporphyrin ring of hemoglobin, myoglobin, and cytochromes and is highly bioavailable. Nonheme iron can be found in molecules like iron-sulfur enzymes and ferritin and is less bioavailable.[rx][rx][rx]
Zinc – Zinc is a metal that exists in the form of Zn2+. With the 2+ charge, zinc is a strong electron acceptor in biological systems.[rx]
Copper – Copper is a transition metal that exists in the forms of Cu+ and Cu2+. Cu+ is the cuprous reduced form of copper. Cu2+ is the cupric oxidized form of copper. Copper is absorbed into cells in its reduced form but is ingested and travels through the bloodstream in its oxidized form.[rx][rx]
Iodine – Iodine is a nonmetal element identified by its distinct violet vapor. Iodine is consumed and absorbed in its reduced form of iodide (I-). Iodine is also consumable in its oxidized form of iodate (IO3-), as well as when it is organically bound to thyroxine (T4) and triiodothyronine (T3).[rx]
Selenium – Selenium is present in nature in both organic and inorganic forms. The main organic forms of selenium are selenomethionine and selenocysteine. The inorganic forms of selenium are selenite (SeO32-), selenide (Se2−), selenate (SeO42-), and selenium element (Se).[rx]
Function
Macronutrients – Carbohydrates, Proteins, Lipids
Macronutrients mainly function to supply energy. Carbohydrates function as the main source of cellular energy from the human diet and are particularly essential to supply energy to the glucose-dependent brain and nervous system. Fiber plays a role in lowering cholesterol by binding to bile and promoting gut health. Proteins function less favorably as a source of energy because they play crucial roles in regulating body processes and contributing majorly to cell and body structure. Proteins particularly function as hormones, enzymes, transporters, and antibodies. Lipids function as a source of stored energy, contribute to cell function and structure and protects body organs. Water acts as a solvent for chemical reactions, a medium for nutrient transport, and a thermoregulator.[rx]
Vitamin B1 (Thiamin) – The coenzyme form of thiamin, or TPP, is involved in the following types of metabolic reactions: decarboxylation of α-keto acids and transmetalation. These occur in carbohydrate and branched-chain amino acids metabolism.[rx]
Vitamin B2 (Riboflavin) – Riboflavin functions as a component of the metabolically essential coenzymes FMN and FAD. FMN and FAD can serve as intermediates in electron transfer in redox reactions. As coenzymes, FAD and FMN are often bound to enzymes that are oxidases and dehydrogenases.[rx]
Vitamin B3 (Niacin) – Niacin functions as a component of the metabolically essential coenzymes NAD and NADP. These coenzymes act as hydride ion acceptors or donors in biological redox reactions. They also serve as coenzymes for dehydrogenases.[rx]
Vitamin B5 (Pantothenic Acid) – Pantothenic acid functions as a supporter of the synthesis and maintenance of coenzyme A, a cofactor and acyl group carrier for other enzymes, and an acyl protein carrier in the fatty acid synthase complex.[rx]
Vitamin B6 (Pyridoxine) – Vitamin B6, in the form of PLP, is a coenzyme for over 100 enzymes involved in amino acid metabolism. PLP is a coenzyme for aminotransferases, decarboxylases, racemases, and dehydratases. PLP is a coenzyme in the first step of heme biosynthesis and the transsulfuration of homocysteine to cysteine.[rx]
Vitamin B7 (Biotin) – Biotin functions in metabolism as a coenzyme for transferring single-carbon units in the form of carbon dioxide for the following carboxylases: pyruvate carboxylase, propionyl-CoA carboxylase, acetyl-CoA carboxylase, and β-methylcrotonyl-CoA carboxylase. These enzymes play roles in gluconeogenesis, citric acid cycle, fatty acid synthesis, and leucine degradation.[rx]
Vitamin B9 (Folate) – Folate functions in nucleic and amino acid metabolism as a coenzyme in single-carbon transfers. Folate functions as a coenzyme in nucleic acid metabolism in the processes of DNA synthesis in purine and pyrimidine nucleotide biosynthesis. Folate functions as a coenzyme in amino acid metabolism in amino acid interconversions, including the conversion of homocysteine to methionine, which serves as the major source of methionine for the formation of the major methylating agent S-adenosyl-methionine.[9]
Vitamin B12 (Cobalamin) – Cobalamin functions as a coenzyme for two enzymes in human metabolism: methionine synthase and L-methylmalonyl-CoA mutase. Vitamin B12, in the form of methylcobalamin, is required as a coenzyme to methionine synthase for the methyl transfer reaction from methyltetrahydrofolate to homocysteine resulting in the formation of methionine and tetrahydrofolate. Vitamin B12, in the form of adenosylcobalamin, is required as a coenzyme to L-methylmalonyl-CoA mutase in the isomerization reaction that results in the conversion of L-methylmalonyl-CoA to succinyl-CoA.[rx]
Vitamin C (Ascorbic Acid) – Vitamin C, in the form of ascorbate, has both enzymatic and nonenzymatic functions in the body. Ascorbate functions as a coenzyme as a reducing agent in the synthesis reactions of collagen, carnitine, neurotransmitters, and tyrosine. Ascorbate functions nonenzymatically as a powerful water-soluble antioxidant with the ability to reduce free radicals and reactive oxygen species. Ascorbate notably reduces glutathione radicals produced by the electron transport chain.[rx]
Vitamin A (Retinol) – Vitamin A functions metabolically in vision, cellular differentiation, gene expression, growth, immune system, and reproduction. In the form of 11-cis-retinal, Vitamin A is the chromophore group of rhodopsin found in the rod cells of the retina and is essential for night vision. In the form of retinoic acid, Vitamin A is required for the differentiation of certain cells like keratinocytes to epidermal cells and squamous epithelial keratinizing cells to mucous-secreting cells. Vitamin A can regulate gene expression by acting as transcription factors when bound to RAR and RXR. Vitamin A protects against xerophthalmia by maintaining normal growth of the conjunctival membranes of the eye. Vitamin A plays roles in processes involved in innate and adaptive immunity, including cell differentiation and hematopoiesis. Vitamin A plays a vital role in spermatogenesis in reproduction.[rx][rx][rx][rx][rx]
Vitamin D (Cholecalciferol) – Vitamin D, in its active form 1,25-(OH)2 vitamin D3, can function as a hormone by binding to receptors on target tissues to activate a signal transduction pathway and a regulator of gene expression by binding to a nuclear receptor to affect transcription. One of the most important functions of 1,25-(OH)2 vitamin D3 is to work with parathyroid hormone to maintain blood calcium homeostasis. 1,25-(OH)2 vitamin D3 functions to increase the absorption of calcium in the small intestine and reabsorption of calcium in the kidneys in response to low blood calcium. It also works with parathyroid hormone to stimulate the resorption of calcium from the bone to increase blood calcium levels. 1,25-(OH)2 vitamin D3 can also bind to various nuclear vitamin D receptors, or VDRs, in the bones, intestines, kidneys, and skin to stimulate the transcription of genes. This process is key to osteoclast maturation.[rx]
Vitamin E (Tocopherol) – Vitamin E is best known to function as a chain-breaking antioxidant that neutralizes the lipid peroxyl radicals during lipid peroxidation to prevent cyclic propagation of lipid peroxidation. This process is key in protecting the polyunsaturated fatty acids within the phospholipids of plasma membranes and plasma lipoproteins.[rx]
Vitamin K (Phylloquinone; Menaquinone) – Vitamin K mainly functions in the synthesis of several blood coagulation factors. It also plays a role in bone mineralization. Vitamin K performs these functions by enabling the carboxylation of glutamic acid residues in proteins to form γ-glutamic carboxyl (Gla) residues. Gla residues enable proteins to bind with calcium and interact with other proteins, which is necessary for blood coagulation and bone mineralization.[rx]
Calcium – 99% of the calcium in the body is in bone and teeth as a structural component. The remaining calcium in the body is found in intracellular and extracellular spaces and plays key roles in innervation, muscle contraction, blood coagulation, hormone secretion, and intracellular adhesion.[rx]
Magnesium – Magnesium is an important intracellular cation for numerous functions throughout the body. Magnesium plays a key role in metabolic reactions such as energy storage, glucose metabolism, and nucleic acid and protein synthesis. Magnesium also functions in oxidative reactions, immune function, and bone development. Magnesium plays a role in stabilizing excitable membranes by maintaining electrolyte balance and homeostasis of calcium, sodium, and potassium. Magnesium acts as a calcium channel antagonist and plays a role in vasodilation.[rx]
Phosphorus – Phosphorus has various structural and metabolic functions throughout the body. Structurally, phosphorus functions to form the structure of bone and teeth along with calcium, the phosphate backbone of DNA and RNA, and the phospholipid bilayer of cell membranes. Metabolically, phosphorus functions to create and store energy in phosphate bonds of ATP, regulate acid/base balance in the blood as a buffer, regulate gene transcription, regulate enzyme activity, and enable signal transduction of numerous regulatory pathways.[rx]
Sodium – As an extracellular cation, sodium functions to regulate blood volume, blood pressure, osmotic equilibrium, and pH. Sodium and potassium ions function together to create an action potential maintained by ion pumps that allow for neurotransmission, muscle contraction, and heart function. Sodium also plays a critical role in the transport of nutrients across the plasma membrane.[rx][rx]
Potassium – Potassium is critical for normal cellular function. Sodium and potassium ions function together to create an action potential maintained by Na+-K+ ATPase, allowing for neurotransmission, muscle contraction, and heart function. Potassium also works alongside sodium to maintain intracellular and extracellular osmotic pressure.[rx][rx]
Chloride – As the most important extracellular anion in the body, chloride functions to maintain fluid balance, acid-base balance, electrolyte balance, electrical neutrality, and muscle function throughout the body. Chloride works with sodium to maintain fluid balance. Chloride also works with bicarbonate to maintain acid-base balance.[rx][rx]
Iron – Iron’s functions are essential for oxygen transport and cell proliferation—iron functions as the core of heme proteins like myoglobin, hemoglobin, and cytochromes. Myoglobin and hemoglobin are essential for oxygen storage and transport, while cytochromes are essential for electron transport chain reactions in energy metabolism. Iron is also critical in its nonheme form in iron-sulfur enzymes like succinate dehydrogenase and NADH dehydrogenase in oxidative metabolism.[rx][rx]
Zinc – Zinc functions structurally as a component of proteins and catalytically as a component of >300 enzymes in the body. Zinc’s functions are pervasive throughout the body and crucial to growth, immunity, cognitive function, and bone health.[rx]
Copper – Copper functions as a critical cofactor to a group of cellular transporters called cuproenzymes. Copper is essential for the proper function of human organs and metabolic processes such as hemoglobin synthesis, neurotransmitter synthesis, iron oxidation, cellular respiration, antioxidant peptide amidation, pigment formation, and connective tissue formation.[rx][rx]
Iodine – The primary function of iodine is its role in the synthesis of thyroid hormones thyroxine (T4) and triiodothyronine (T3). At the apical surface of the thyrocyte, iodide is oxidized by the enzymes thyroperoxidase (TPO) and hydrogen peroxide to attach it to tyrosyl residues on thyroglobulin to produce the precursors of thyroid hormones: monoiodotyrosine (MIT) and diiodotyrosine (DIT). TPO then catalyzes the formation of a diether bridge between the phenyl groups of iodotyrosine to create thyroid hormones. The linkage of two DITs produces T4, while the linkage of MIT and DIT produces T3. T3 and T4 are almost structurally identical, but T3 has one less iodine than T4. Thyroid hormones function to regulate fetal cell growth, postnatal growth, and basal metabolic rate.[rx]
Selenium – Selenium functions as an essential component of selenoproteins that play major roles in dense against oxidation, thyroid hormone formation, DNA synthesis, reproduction, and fertility. The functions of most selenoproteins are unknown, but the known functions involve participation in antioxidant and anabolic processes. A family of antioxidant enzymes named glutathione peroxidases is dependent upon selenium to function to neutralize hydrogen peroxide and organic hyperoxides in both intracellular and extracellular compartments. Deiodinases are a group of three selenoenzymes responsible for converting T4 to T3 in thyroid hormone activation. Selenoprotein-P is the most abundant selenoprotein found in plasma and plays a major role in the transport and homeostasis of selenium in tissues.[rx]
Testing
Carbohydrates
Measuring the amount of glucose in plasma is one of the most important ways to screen for and manage diabetes. To clinically test and monitor blood glucose, blood is drawn from a vein, usually when the patient has fasted for at least 8 hours. The level of glucose is measured in milligrams of glucose per deciliter plasma. A healthy fasting blood glucose level is less than or equal to 99 mg/dL. Someone who has an increased risk for diabetes, or prediabetes, falls in the range of fasting blood glucose of 100 to 125 mg/dL. If a patient has a fasting blood glucose of 126 mg/dL or greater on two separate occasions, they can receive a diagnosis of diabetes.[rx][rx]
Proteins
Nitrogen balance is the gold standard for testing the protein status of the body. Nitrogen balance can serve as a marker of adequate nutrition and physiological stress. Nitrogen balance is equal to the grams of nitrogen consumed minus the grams of nitrogen excreted. The grams of nitrogen consumed is calculated by the grams of protein consumed divided by 6.25 grams of protein per 1 gram of nitrogen. The grams of nitrogen excreted is calculated by extrapolating losses with grams of nitrogen in urinary urea plus 4 grams, which accounts for losses in feces, sweat, skin, and wounds. Under normal conditions, an individual should be at nitrogen equilibrium, or nitrogen balance equals zero. Critically ill patients often have negative nitrogen, so the goal with them is to increase the protein intake to achieve a positive nitrogen balance for healing.[rx]
Lipids
To test the amount of lipids in the body, a sample of blood is taken via venipuncture in tubes and analyzed for serum or plasma total cholesterol, triglycerides, and lipoproteins. Cholesterol levels remain fairly constant so that sampling is possible at any time. In contrast to cholesterol levels, triglyceride levels fluctuate throughout the day, so blood collection should occur after a 12-hour fasting period because, at that point, chylomicrons should have cleared from the circulation. To separate and quantify lipoproteins from the plasma sample, ultracentrifugation, precipitation, and electrophoresis are performed. High vs. low plasma lipid levels are determined based on the bell-shaped distribution of the general population. Cholesterol levels are determined based on the risk for coronary atherosclerosis. Cholesterol levels below 200 mg/dl are considered desirable, levels from 200 to 239 mg/dl are considered borderline high cholesterol, and levels of 240 mg/dl or greater are considered high cholesterol.[rx]
Vitamin B1 (Thiamin) – Thiamin status is measurable via urinary thiamin excretion, erythrocyte thiamin, and erythrocyte transketolase activity. Erythrocyte transketolase activity is considered the gold standard functional test of thiamin status.[rx]
Vitamin B2 (Riboflavin) – Riboflavin status is measured via erythrocyte glutathione reductase activity, erythrocyte flavin, and urinary flavin. Erythrocyte glutathione reductase activity is the most common method to determine riboflavin status.[rx]
Vitamin B3 (Niacin) – Niacin status can be measured using urinary 1-methyl nicotinamide excretion, plasma concentrations of 2-pyridone, erythrocyte pyridine nucleotides, and transfer of adenosine diphosphate ribose as a functional measurement. Urinary 1-methyl nicotinamide is the most reliable and sensitive measure of niacin status.[rx]
Vitamin B5 (Pantothenic Acid) – Pantothenic acid status can be measured using urinary pantothenic acid excretion and whole blood pantothenic acid concentration.[rx]
Vitamin B6 (Pyridoxine) – Vitamin B6 status assessment is best with plasma PLP. A plasma PLP of <20 nmol/L indicates a vitamin B6 deficiency.[rx]
Vitamin B7 (Biotin) – Biotin status is measurable with urinary biotin and 3-hydroxyisovalerate excretion. Decreased urinary excretion of biotin along with increased urinary excretion of 3-hydroxyisovalerate indicates biotin deficiency.[rx]
Vitamin B9 (Folate) – The primary test used to measure folate status is erythrocyte folate. Given folate is taken up by developing erythrocytes in the bone marrow, erythrocyte folate concentration is an ideal indicator of long-term folate status. Plasma homocysteine can also be useful as an indicator of folate status given in inadequate quantities of folate; not as much homocysteine can undergo conversion to methionine. Serum folate can also be tested as an indicator of dietary folate intake but is limited and should be used in conjunction with additional folate status indicators.[rx]
Vitamin B12 (Cobalamin) – The primary test to measure vitamin B12 status is serum vitamin B12, reflecting both intake and stores. The lower limit of serum vitamin B12 for adults is 170 to 250 pg/mL. Serum methylmalonic acid concentration is another specific and functional indicator of vitamin B12 status because serum methylmalonic acid concentrations become elevated during vitamin B12 deficiency. Serum total homocysteine concentration is a functional but non-specific indicator of vitamin B12 status due to elevation during vitamin B12 deficiency.[rx]
Vitamin C (Ascorbic Acid – Vitamin C status testing is via plasma vitamin C and leukocyte vitamin C. Plasma vitamin C concentration is sensitive to a recent diet, while leukocyte vitamin C reflects tissue stores. A plasma vitamin C concentration of less than 0.2 mg/dL is considered deficient.[rx][rx]
Vitamin A (Retinol) – The gold standard for testing vitamin A status is through a liver biopsy because the liver is vitamin A’s major storage organ. However, this measure is not very feasible in humans. Retinol status is testable with plasma retinol concentration, but it only indicates low status if there is a severe deficiency. Vitamin A status may also be tested with a relative dose-response test, which measures the magnitude of increased RBP following supplementation.[rx]
Vitamin D (Cholecalciferol) – Vitamin D status is tested by using serum 25-hydroxyvitamin D concentrations. A serum 25-hydroxyvitamin D concentration that is less than 20 ng/mL represents a vitamin D deficiency and a need for supplementation.[rx]
Vitamin E (Tocopherol) – Vitamin E status is difficult to test because serum concentrations of vitamin E are largely age-dependent and are influenced by blood lipids. In the general population, α-tocopherol plasma levels can range from 19.9 micromoles/L to 34.2 micromoles. More research needs to be done to adjust specific requirements to an individual’s bioavailability.[rx]
Vitamin K (Phylloquinone; Menaquinone) – Vitamin K status is difficult to assess due to its being lipophilic and not very abundant. However, functional tests such as prothrombin time or Gla protein measurement can be useful to assess vitamin K status indirectly.[rx]
Calcium – Calcium status is difficult to assess in individuals because there is no reliable indicator that can establish a relationship between calcium and a particular disease state. Total body calcium is not useful to assess calcium intake because the body regulates calcium in a very tight range and will adapt to conserve it. Bone-mass measurements may indicate long-term calcium status by assessing changes in bone density.[rx]
Magnesium – Magnesium status can be tested with serum magnesium. Serum magnesium is maintained at a tight range of 1.7 to 2.6 mg/dL. A serum value of under 1.7 mg indicates a magnesium deficiency. A serum value of over 2.6 mg/dL indicates magnesium toxicity.[rx][rx]
Phosphorus – Serum phosphorus is the most common way to assess phosphorus status. Serum phosphorus is maintained in a relatively narrow range of 2.5 to 4.5 mg/dL. Although serum phosphorus does not reflect the full body stores, serum phosphorus is crucial for various cellular processes in the body. Serum phosphorus below or above the normal range can indicate a deficiency and toxicity, respectively.[rx]
Sodium – Sodium balance is tested via plasma sodium concentration. A plasma sodium concentration greater than 150 mmol/L indicates sodium toxicity or hypernatremia. A plasma sodium concentration of less than 136 mmol/L indicates sodium deficiency or hyponatremia.[rx][rx]
Potassium – Potassium balance is tested via serum potassium. The body maintains normal serum potassium levels in a narrow range of 3.5 to 5.5 mmol/L. Potassium toxicity, or hyperkalemia, occurs at serum potassium concentrations greater than 5.5 mmol/L. Potassium deficiency, or hypokalemia, occurs at concentrations less than 3.5 mmol/L.[rx]
Chloride – Since chloride serves as an important diagnostic indicator for various diseases, it can be tested for in serum, sweat, urine, and feces. Serum and urine chloride concentrations are used in the diagnosis of acid-base and osmolar disorders and used in formulas like the anion gap, strong anion gap, strong ion difference, and chloride/sodium ratio. Sweat chloride concentration is used in the diagnosis of cystic fibrosis when it is above 60 mmol/L.[rx]
Iron – Iron is tested via serum-based indicators of iron status, such as hemoglobin, plasma ferritin, and plasma transferrin saturation. Hemoglobin is routinely measured to indicate anemia but is not specific for iron. Plasma ferritin is the gold standard of iron status because it is the most specific indicator of iron stores. A plasma ferritin concentration of less than 20 ng/L indicates iron deficiency. High plasma ferritin values can indicate iron overload. Transferrin saturation indicates the ratio of iron to transferrin to reflect transport iron. Transferrin saturation is low-cost but shows a pronounced diurnal variation.[rx]
Zinc – Zinc status testing is via serum zinc. A concentration of zinc below the lower value of the reference range of 10 to 18 micromol/L is considered a deficiency.[rx]
Copper – Copper status evaluation is via serum copper or serum ceruloplasmin. A concentration of serum copper below the lower value of the reference range of 12 to 20 micromol/L is considered a deficiency.[rx][rx][rx]
Iodine – Iodine status can be assessed with four different methods: urinary iodine concentration, goiter rate, serum TSH, and serum Tg. Urinary iodine, serum Tg, and goiter rate are complementary tests given urinary iodine are sensitive to recent iodine intake in a matter of days, serum Tg shows an intermediate response in a matter of weeks or months, and goiter rate changes reflect iodine nutrition in a matter of months or years. TSH can be used to assess iodine status reflecting on the level of circulating thyroid hormone but is a relatively insensitive indicator of iodine status in adults. However, TSH is a sensitive indicator of iodine status in newborns.[rx]
Selenium – Selenium status is tested via serum selenium. A concentration of selenium below the lower value of the reference range of 0.75 to 1.85 micromol/L is considered a deficiency.[rx]
Clinical Significance
Carbohydrates
Diabetes refers to a group of metabolic diseases of disordered glucose metabolism. Diabetes is characterized by hyperglycemia, or high blood sugar, and premature vascular disease. Symptoms of diabetes-related hyperglycemia include polydipsia, polyuria, weight loss, polyphagia, and blurred vision. Acute and life-threatening complications of uncontrolled diabetes include hyperglycemia with diabetic ketoacidosis or nonketotic hyperosmolar syndrome. Long-term complications of uncontrolled diabetes include macrovascular and microvascular complications that lead to loss of vision, renal failure, neuropathy, and cardiovascular disease. There are three types of diabetes: type 1, type 2, and gestational. Type 1 diabetes occurs in 5 to 10% of cases and is characterized by absolute insulin deficiency and pancreatic beta-cell destruction. Insulin is a hormone produced by pancreatic beta cells that stimulate sugar uptake in the blood by cells. Insulin therapy is required to treat type 1 diabetes. Type 2 diabetes occurs in 90 to 95% of cases and is characterized by insulin resistance and impaired beta-cell function. In some individuals with type 2 diabetes, blood glucose control can be managed with lifestyle changes like diet, weight reduction, and exercise, and/or oral glucose-lowering medications. However, some individuals may need insulin therapy. Gestational diabetes occurs in 9% of pregnant women during the second or third trimester of pregnancy. Glucose tolerance usually returns to normal after delivery, but this increases the risk for type 2 diabetes later in life.[rx]
Proteins
Protein-energy malnutrition is a problem for children in developing and developed countries around the world and contributes to acute and chronic childhood illness. In cases of extreme protein-energy malnutrition, marasmus and kwashiorkor are the two main clinical syndromes seen. Marasmus is more common and is characterized by muscle wasting and depletion of subcutaneous fat stores without edema as a result of deprivation of calories and nutrients. In addition, there is poor growth, little disease resistance, slowed metabolism, and impaired brain development. This usually occurs in children under the age of 5 due to their increased caloric requirements. Kwashiorkor is characterized by normal weight with edema, poor growth, low blood albumin, little disease resistance, and apathy resulting from a diet with an adequate caloric intake but inadequate protein. This commonly occurs in older infants or toddlers who are displaced from breastfeeding due to the birth of a younger sibling and have to wean rapidly but are unable to increase protein intake enough.[rx]
Lipids
Lipids in abnormal concentrations attract clinical attention. Abnormal lipid levels can occur due to abnormalities in the synthesis, degradation, and transport of lipoprotein particles. Hyperlipidemia is defined as elevated levels of lipids or lipoproteins in the blood. Hyperlipidemia is very clinically relevant due to its association with an increased risk of atherosclerotic cardiovascular disease. Other clinical manifestations of hyperlipidemia include ischemic vascular disease, acute pancreatitis, and visible accumulations of lipid deposits. Increased plasma lipid levels can be related to genetic disorders, dietary factors, certain drugs, and as a secondary symptom of certain diseases.[rx]
Vitamin B1 (Thiamin)
Thiamin deficiency is historically known as a disease called beriberi. Currently, in developed nations, thiamin deficiency mainly occurs with chronic alcoholism and is called Wernicke-Korsakoff syndrome. Symptoms of thiamin deficiency are nonspecific and include anorexia, weight loss, apathy, short-term memory issues, confusion, irritability, muscular weakness, and enlargement of the heart.[rx]
Vitamin B2 (Riboflavin)
The symptoms of riboflavin deficiency include sore throat, angular stomatitis, glossitis, dermatitis, and weakness. It is rare but can occur with diseases such as cancer, diabetes, cardiac disease, and alcoholism.[rx]
Vitamin B3 (Niacin)
The classic clinical manifestation of severe niacin deficiency is a disease called pellagra. Pellagra is characterized by a symmetrical, pigmented rash that develops in sunlight exposed areas, GI symptoms such as vomiting, constipation, diarrhea, a bright red tongue, and neurological problems such as depression and fatigue, apathy, headache, and loss of memory. Pellagra was common in the United States and Europe in areas where corn was a dietary staple in the early twentieth century. Pellagra has disappeared from developed countries except for cases of chronic alcoholism. It persists in parts of India, China, and Africa.[rx]
Vitamin B5 (Pantothenic Acid)
Pantothenic acid deficiencies are extremely rare but have been shown in individuals fed diets devoid of pantothenic acid. Symptoms of deficiency include irritability, fatigue, apathy, sleep disturbances, GI complaints, numbness, paresthesias, muscle cramps, and hypoglycemia with increased insulin sensitivity.[rx]
Vitamin B6 (Pyridoxine)
Vitamin B6 deficiency is rare in healthy individuals. Symptoms of vitamin B6 deficiency include seborrheic dermatitis, microcytic anemia, convulsions, and confusion. Microcytic anemia occurs due to PLP’s role as a cofactor in the first step in heme biosynthesis.[rx]
Vitamin B7 (Biotin)
Biotin deficiency is rare but can occur in specific scenarios. Biotin deficiency can occur in people who ingest raw eggs due to the protein avidin, which inhibits biotin absorption. It can also occur in people with genetic defects in the enzyme biotinidase. Symptoms of biotin deficiency include thinning of hair, loss of hair color, dermatitis, depression, lethargy, and hallucinations.[rx]
Vitamin B9 (Folate)
Folate deficiency results in impaired synthesis of DNA and RNA, which can manifest clinically megaloblastic anemia and developmental disorders in utero. Megaloblastic or macrocytic anemia occurs when red blood cell development is halted in the early erythroblast stage due to a lack of folate, allowing DNA synthesis to continue and erythroblasts to divide and mature. Early erythroblasts are large and do not contain much hemoglobin. Inadequate maternal folate status during pregnancy can result in neural tube defects such as spina bifida and anencephaly. Neural tube defect risk reduction has been achieved with daily supplementation of 400 mcg of folate in women of childbearing age. In addition, there is some evidence that might suggest folate reduces the risk of cardiovascular disease, certain cancers, and psychiatric disorders.[rx]
Vitamin B12 (Cobalamin)
The major cause of clinical effects of vitamin B12 deficiency is pernicious anemia, which is caused by a lack of functional intrinsic factor in the stomach due to autoimmune destruction of gastric parietal cells. Malabsorption of food-bound vitamin B12 can also occur due to non-autoimmune atrophic gastritis, which causes loss of stomach acid and mainly affects the elderly. The hematological effects of vitamin B12 deficiency are clinically indistinguishable from those of folate deficiency causing macrocytic, or megaloblastic, anemia. Vitamin B12 deficiency can also result in impaired neurological function and increased neural tube defect risk.[rx]
Vitamin C (Ascorbic Acid)
Vitamin C deficiency is clinically and historically known as scurvy. Vitamin C deficiency is currently rare and only seen in malnourished populations with chronic conditions, poor diet, malabsorption, or substance dependency. Symptoms of vitamin C deficiency include gingival inflammation, fatigue, petechiae, bruising, and joint pain.[rx][rx]
Vitamin A (Retinol)
Vitamin A deficiency affects 20-40 million children worldwide in regions with low-fat, plant-based diets and protein-calorie malnutrition. Vitamin A deficiency more commonly causes death than blindness in children in high-risk regions due to its role in the immune system. Vitamin A deficiency can also cause an increased risk of respiratory and diarrheal infections, decreased growth rate, slow bone development, and decreased survival from a serious illness.[rx]
Vitamin D (Cholecalciferol)
Vitamin D deficiency can lead to rickets and osteomalacia due to its critical role in bone and mineral metabolism. Rickets occurs in infants and children as a result of the failure of the bone to mineralize. The symptoms of rickets include growth retardation and bowing of the long bones of the legs. Osteomalacia occurs in adults; as a result, inadequate amounts of calcium and phosphate causing demineralization of the bone. Vitamin D may have extraskeletal effects and play a role in cardiovascular diseases, autoimmune diseases, neurological diseases, cancer, asthma, and pregnancy complications.[rx]
Vitamin E (Tocopherol)
Vitamin E deficiency is very rare but can occur in certain individuals. Symptoms of vitamin E deficiency include oxidative damage of tissues, membrane damage of cells, neurological abnormalities such as peripheral neuropathy, muscular, functional abnormalities like ataxia, and hemolytic anemia. Vitamin E deficiency most commonly occurs in premature babies of very low birthweight, people with fat-malabsorption disorders like Crohn’s disease and cystic fibrosis, and those who have a rare neurodegenerative disease called ataxia with vitamin E deficiency (AVED) that is caused by mutations in the gene for αβ-tocopherol transfer protein.[rx]
Vitamin K (Phylloquinone; Menaquinone)
Vitamin K deficiency is uncommon in healthy adults but may be seen in those with gastrointestinal malabsorptive disorders. However, newborns are at high risk for vitamin K deficiency. Newborns are at risk given milk is low in vitamin K, their stores are low since vitamin K does not pass the placenta, and their intestines are not yet populated with vitamin K synthesizing bacteria. Infants born in the United States and Canada routinely receive 0.5 to 1 mg of intramuscular phylloquinone within 6 hours of birth to prevent vitamin K deficiency bleeding, or VKDB. VKDB can affect infants up to 3 to 4 months of age and cause intracranial hemorrhage, central nervous system damage, and liver damage.[rx]
Calcium
Hypocalcemia, or calcium deficiency, can result from inadequate calcium intake, poor calcium absorption, or excessive calcium losses. Poor calcium absorption can occur due to inadequate vitamin D status. Excessive calcium losses can occur due to a lack of PTH. Symptoms of hypocalcemia can include muscle spasms, cramps, paresthesia, tetany, and seizures. Long-term hypocalcemia can impact bone health and result in reduced bone mass and osteoporosis. Hypercalcemia can occur due to increased bone resorption, increased intestinal absorption, and decreased renal excretion of calcium. Syndromes that increase PTH production can result in excessive calcium reabsorption and calcitriol production in the kidney. Excess PTH and calcitriol production can result in increased bone resorption. Excess calcitriol also can increase intestinal absorption. Symptoms of hypercalcemia include fatigue, confusion, polydipsia, frequent urination, upset stomach, bone pain, muscle weakness, and cardiac arrhythmia.[rx][rx][rx]
Magnesium
Magnesium deficiency, or hypomagnesemia, can occur due to chronic inadequate magnesium intake, chronic diarrhea, magnesium malabsorption, alcoholism, and medications like diuretics, antacids, proton pump inhibitors, and aminoglycoside antibiotics. Symptoms of hypomagnesemia are nonspecific and include muscle weakness, cramps, spasms, and tremors. Magnesium toxicity, or hypermagnesemia, can occur with supplemental magnesium, especially in intestinal or renal disease. Symptoms of hypermagnesemia include diarrhea, nausea, vomiting, headaches, lethargy, and flushing. At very high serum concentrations of magnesium, cardiac and electrocardiogram changes can occur, as well as coma, respiratory depression, and cardiac arrest.[rx][rx]
Phosphorus
Phosphorus deficiency, or hypophosphatemia, is relatively rare in healthy individuals. However, hypophosphatemia can occur due to conditions that cause a shift of phosphorous from extracellular fluid to intracellular fluid, decreased intestinal absorption of phosphorus, or increased renal excretion of phosphorus. Hypophosphatemia may also occur in individuals with rare genetic disorders that decrease renal reabsorption and increase phosphorus excretion. Hypophosphatemia can appear asymptomatic until serum levels reach <1.5 mg/dL, where symptoms of anorexia, confusion, seizures, and paralysis can present. Respiratory depression can occur at serum levels <1 mg/dL. Treatment of hypophosphatemia includes oral or intravenous supplementation, depending on the severity of deficiency. Phosphorus toxicity, or hyperphosphatemia, can occur in those with chronic kidney disease due to decreased phosphorus excretion. Hyperphosphatemia is associated with increased death from cardiovascular disease due to vascular calcification in individuals with and without chronic kidney disease. Hyperphosphatemia is treated first by dietary restriction of phosphate, protein restriction, and dialysis if the latter fails. Hyperphosphatemia can also be treated with oral phosphate binders that block dietary phosphorus absorption.[rx][rx]
Sodium
Given the pervasiveness of sodium in various foods, sodium deficiency is highly unlikely in healthy individuals. Sodium deficiency, or hyponatremia, can only occur in pathological conditions such as adrenal insufficiency, kidney disease that results in excessive sodium losses, excessive burns, diabetic ketoacidosis, and additional conditions that cause excessive sodium losses such as vomiting, diarrhea, prolonged sweating, and excessive diuretic use. Symptoms of hyponatremia include hypovalemia, lethargy, confusion, and weakness. Sodium toxicity, or hypernatremia, can occur with dehydration, hyperaldosteronemia, and renal failure. Symptoms of hypernatremia include hypervolemia, hypertension, convulsions, or coma. Even under normal conditions, continuous excessive intake of sodium can result in hypertension in certain individuals.[rx][rx]
Potassium
Potassium is considered to be a shortfall nutrient in the American diet according to the 2010 Dietary Guidelines for American’s Advisory Committee because most Americans are unable to consume the AI of 4,700 mg/day. There is moderate evidence of an association between blood pressure reduction and potassium intake in adults, which influences cardiovascular disease risk. Hypokalemia usually occurs due to inadequate potassium intake and/or excessive potassium losses. Hypokalemia can clinically manifest in symptoms such as muscle weakness, smooth muscle dysfunction, cardiac complications, and glucose intolerance. Hyperkalemia usually occurs due to impaired renal excretion. Hyperkalemia will manifest in excitatory tissues and present symptoms such as neuromuscular symptoms such as paresthesias and fasciculations, cardiac arrest, and impaired renal function.[rx][rx]
Chloride
Hypochloremia, or chloride deficiency, is related to clinical situations that cause excessive chloride losses due to gastrointestinal or renal conditions such as vomiting and renal failure. When serum chloride levels fall, bicarbonate reabsorption increases proportionately, resulting in metabolic alkalosis. Symptoms of hypochloremia are concurrent with those of metabolic alkalosis and include confusion, apathy, cardiac arrhythmias, and neuromuscular irritability. Hyperchloremia, or chloride toxicity, is related to clinical situations that cause excessive gastrointestinal or renal bicarbonate losses, such as severe diarrhea and medications that promote bicarbonate excretion. When serum bicarbonate levels fall, chloride reabsorption increases proportionately, resulting in metabolic acidosis.[rx]
Iron
The World Health Organization (WHO) indicates iron deficiency to be the most common form of malnutrition globally, affecting 25% of the global population. Iron deficiency is highly prevalent in both developing and developed countries. Iron deficiency is most commonly caused by inadequate dietary iron intake, inadequate iron utilization due to diseases, impaired iron absorption, or excess iron loss. Iron deficiency can often be avoided and reversed with iron supplementation and/or reducing iron losses. Untreated iron deficiency can result in microcytic anemia, poor cognitive performance, impaired immune function, impaired growth in children, poor pregnancy outcomes, and reduced endurance capacity. On the other hand, iron overload can be caused by a disease called hereditary hemochromatosis due to a C282Y mutation in the HFE gene. Hereditary hemochromatosis can be treated with iron removal therapy.[rx][rx][rx]
Zinc
Zinc deficiency can present clinically with symptoms such as dermatitis, alopecia, decreased appetite, frequent diarrhea, frequent upper respiratory infection, stunted growth in children, and hypogonadism. Zinc deficiency can occur due to diarrheal illness, kidney failure, and genetic diseases acrodermatitis enteropathica (AE). AE is a fatal disease of zinc malabsorption due to a mutation in the ZIP4 gene, which encodes the major intestinal zinc uptake protein. AE is treated with lifelong zinc supplementation of 100 mg/kg per day. Zinc toxicity is rare due to the tight regulation of zinc concentrations in the body. However, long-term zinc supplementation above the tolerable upper intake level of 40 mg/day can decrease copper absorption and cause copper deficiency. This occurs because zinc induced the formation of the intestinal cell protein metallothionein, which binds to metals and prevents their absorption by trapping them in the intestinal cell. Metallothionein has a stronger affinity for copper than zinc, thus trapping copper in the intestinal cell and halting absorption.[rx]
Copper
Copper deficiency generally manifests in systems such as bone marrow hematopoiesis, optic nerve function, and the nervous system. Copper deficiency causes symptoms such as fatigue and weakness. Copper deficiency can occur due to excessive zinc supplementation and the genetic disorder of copper malabsorption called Menkes disease. Menkes disease is caused by a mutation in the ATP7A gene, which causes copper to accumulate in the enterocyte, making it unable to reach the blood or any other organ system. Another genetic disease of copper metabolism is Wilson disease, which is a genetic disease of accumulation of copper mainly in the liver and the brain due to a mutation in the ATP7B gene responsible for the ATP7B exporter.[rx][rx]
Iodine
Iodine deficiency will cause a compensatory response of the thyroid gland. When iodine intake falls below approximately 100 mcg/day, the pituitary increases secretion of TSH, which increases plasma iodine clearance by the thyroid. Thus, plasma iodine levels decrease, and thyroid hormone synthesis decreases, resulting in hypothyroidism. The increase in TSH also increases the thyroid cell number and cell size resulting in an enlarged thyroid gland or goiter. The goiter can be treated with iodine supplementation, gradually reducing the size or a thyroidectomy. If left untreated, the goiter may cause tracheal and esophageal pressure. Thyroid deficiency during pregnancy can lead to neurological cretinism in the offspring.[rx]
Selenium
Selenium deficiency has been known to appear in humans after severe and prolonged cases of selenium deprivation. Selenium deficiency is known as Keshan disease and occurs in areas where selenium content in the soil is low, like China. Symptoms of Keshan disease include cardiomyopathy, peripheral myopathy, decreased muscle tone and function, hair thinning, opacification of nails, and anemia.[rx]
Hemp Seeds or industrial hemp is a variety of the Cannabis sativa plant species that is grown specifically for industrial use. It can be used to make a wide range of products. Along with bamboo, hemp is one of the fastest-growing plants[rx] on Earth. It was also one of the first plants to be spun into usable fiber 50,000 years ago.[rx] It can be refined into a variety of commercial items, including paper, rope, textiles, clothing, biodegradable plastics, paint, insulation, biofuel, food, and animal feed.[rx][rx]
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Many people consider hemp seeds to be a superfood. The seeds have a rich nutritional profile and provide a range of health benefits.
Although hemp seeds come from the Cannabis sativa plant, they do not produce a mind-altering effect.
These small, brown seeds are rich in protein, fiber, and healthful fatty acids, including omega-3s and omega-6s. They have antioxidant effects and may reduce symptoms of numerous ailments, improving the health of the heart, skin, and joints.
Nutritional benefits of hemp seeds
These seeds are full of nutritious compounds, including:
1. Protein
Hemp seeds contain almost as much protein as soybeans. In every 30 grams (g) of seeds, or about 3 tablespoons, there are 9.46 g of protein.
These seeds are a complete source of protein, meaning that they provide all nine essential amino acids.
Amino acids are the building blocks for all proteins. The body cannot produce nine of these acids, so a person must absorb them through the diet.
Relatively few plant-based foods are complete sources of protein, making hemp seeds a valuable addition to a vegetarian or vegan diet.
Hemp seeds are especially rich in an amino acid called arginine, which has benefits for heart health.
2. Unsaturated fats
The health benefits of polyunsaturated fats, especially omega-3 fatty acids are becoming increasingly well known.
Hemp seeds are a great source of essential fatty acids, such as alpha-linolenic acid (ALA), which is an omega-3.
The body cannot produce essential fatty acids, and the body must absorb them from the diet. They are crucial for long-term health. The ratio of omega-3s to omega-6s is also important.
In general, people tend to eat too many omega-6s and too few omega-3s, but adding hemp seeds to the diet may help to promote a balance.
According to results of a 2015 animal study, incorporating hemp seeds and hemp seed oil to hens’ diet led to eggs with increased levels of omega-3s in the yolks and a more healthful omega-3 to omega-6 ratio.
Also, hemp seeds are low in saturated fats and contain no trans fats.
3. Fiber
Much of the fiber in a hemp seed lies in its outer hull or shell. If possible, purchase hemp seeds with the hulls intact. However, even without the shells, hemp seeds are a good source of fiber, with three tablespoons containing approximately 1.2 g of fiber.
Hemp seeds contain an impressive array of vitamins and minerals and are especially rich in:
vitamin E
magnesium
phosphorous
potassium
They are also a good source of iron, zinc, and B vitamins, including:
niacin
riboflavin
thiamine
vitamin B-6
folate
Health benefits of hemp seeds
Alongside the nutritional benefits, some research suggests that hemp seeds have a wide range of positive health effects. They may:
5. Protect the brain
A study published in the journal Food Chemistry found that hemp seed extract has antioxidant effects in lab tests. These effects may result from the seeds’ cannabidiol (CBD) content.
Results of a review from 2018 suggest that CBD and other compounds in the seeds may have neuroprotective, anti-inflammatory, effects and may also help to regulate the immune system.
The review suggests that, because of these potential properties, CBD may help with neurological conditions, including:
Parkinson’s disease
Alzheimer’s disease
multiple sclerosis
neuropathic pain
childhood seizure disorders
6. Boost heart health
The medical community believes that omega-3 fatty acids improve the health of the heart and reduce the risk of issues such as arrhythmias and heart disease. Hemp seeds contain high levels of omega-3s and a healthful ratio of omega-3to omega-6 fatty acids. The seeds also contain high levels of arginine, an amino acid that turns into nitric oxide. Nitric oxide is essential for artery and vein dilation, and it helps keep blood vessel walls smooth and elastic. Lowering blood pressure, eating a healthful diet, and participating in varied forms of exercise may help to decrease the risk of heart failure.
7. Reduce inflammation
The amount of omega-3s in hemp seeds and the seeds’ healthful omega-3 to omega-6 ratio can together help to reduce inflammation. In addition, hemp seeds are a rich source of gamma-linolenic acid (GLA), a polyunsaturated fatty acid which may also have anti-inflammatory effects. Some studies on animals suggest that GLA can act as a potent anti-inflammatory. However, recent studies in humans suggest that the acid is not always effective.
A review in The European Journal of Pharmacology states that humans process GLA in a very complicated way, which may explain why the studies in humans produce more varied results than those on animals. When looking at these studies, it is important to note that researchers usually use high concentrations of hemp seed extracts and that eating the seeds may produce less dramatic effects.
Atopic dermatitis (AD) and acne can both result from chronic inflammation. The anti-inflammatory compounds in hemp seeds may help.
Among other possible dietary causes, acne may be linked to a deficiency in omega-3s. The high omega-3 content in hemp seeds may help to manage and reduce acne symptoms.
A 2018 review explored the effects of dietary changes on skin diseases. While the authors found evidence that eating more omega-3s may improve symptoms of acne, determining the extent of the effects will require more research.
The authors also note that prebiotics and plant fibers may help to manage symptoms of AD. Hemp seeds are a rich source of plant fiber.
9. Relieve rheumatoid arthritis
Rheumatoid arthritis is an autoimmune condition. It causes the immune system to attack its own tissues, which leads to inflammation in the joints.
In 2014, research conducted in human cells suggested that hemp seed oil could have anti-rheumatic effects.
However, a 2018 review found a lack of conclusive evidence to suggest that cannabinoids could effectively treat rheumatic diseases. The authors noted that more research is needed.
The nutritional profile of hemp seeds
Hemp seeds contain plenty of protein, healthful fatty acids, and fiber.
Hemp seeds are also a healthful source of vitamin E and minerals, such as calcium, iron, magnesium, potassium, and zinc.
How to add hemp seeds to the diet
When considering the results of studies, it is important to note that researchers often use hemp seed extract rather than whole hemp seeds.
People can purchase shelled, ground, or split seeds. To remove the seeds’ hard outer shells at home, a person can use a mortar and pestle or a food processor.
Whole seeds act as a bulking agent, and they also add fiber to the diet, which can aid digestion.
Try incorporating hemp seeds into the diet by:
sprinkling whole or ground seeds on cereal or yogurt
adding the seeds to smoothies
baking with hemp seeds and others rich in omega-3s
making hemp milk at home using whole seeds
sprinkling hemp seeds, along with other seeds or nuts, on a salad
People can find hemp seeds in some supermarkets, health food stores, and online.
Online stores also offer other hemp products, such as hemp milk, which may be fortified with extra nutrients, and hemp protein powder, which is a plant-based alternative to whey protein powder.
Although hemp seeds come from the cannabis plant, they ideally contain no tetrahydrocannabinol (THC), which is the active ingredient in cannabis.
Hemp seeds will not produce a mind-altering effect.
However, athletes and others who undergo drug testing should be aware that consuming hemp products can, in some cases, lead to failed urine tests. The level of THC in any hemp-based product depends on the suppliers and the manufacturing process.
In Canada, the production of hemp seeds is tightly regulated to prevent cross-contamination of THC from the cannabis plant.
A legal principle in the U.S. prohibits people from growing hemp seeds with THC concentrations higher than 0.3 percent. The U.S. government also strictly regulates the importation of hemp seeds and hemp-based products.
Takeaway
Hemp seeds have a rich nutrition profile. They contain high levels of antioxidants, fatty acids, minerals, and vitamins.
The shells add fiber to the diet, and grinding the seeds helps the body to absorb more of the other nutrients.
Some research has suggested links between hemp seeds and health benefits, but these studies tend to use extracts with high concentrations.
While there are potential health benefits to consuming hemp seeds, avoid eating excessive amounts. There is evidence that some seeds contain levels of THC that exceed the legal limit.
The most healthful choice is to eat a varied diet that contains a wide range of nutrients.
Horny Goat Weed/Epimedium species (aka horny goat weed) have been utilized for the treatment of erectile dysfunction in Traditional Chinese Medicine for many years. Icariin (ICA) is the active moiety of Epimedium species.
Icariin is a member of the class of flavonols that is kaempferol which is substituted at position 8 by a 3-methyl but-2-en-1-yl group and in which the hydroxy groups at positions 3, 4′, and 7 have been converted to the corresponding 6-deoxy-alpha-L-mannopyranoside, methyl ether, and beta-D-glucopyranoside, respectively. A phosphodiesterase-5 inhibitor, it is obtained from several species of plants in the genus Epimedium and is thought to be the main active ingredient of the Chinese herbal medicine Herba Epimedii (yinyanghuo). It has a role as a bone density conservation agent, a phytoestrogen, an EC 3.1.4.35 (3′,5′-cyclic-GMP phosphodiesterase) inhibitor, and an antioxidant. It is a glycosyloxyflavone and a member of flavonols.
Another Name of Horny Goat Weed
OTHER NAME(S): Barrenwort, Épimède, Épimède à Grandes Fleurs, Épimède du Japon, Epimedium, Epimedium acuminatum, Epimedium brevicornum, Epimedium grandiflorum, Epimedium Grandiflorum Radix, Epimedium koreanum, Epimedium macranthum, Epimedium pubescens, Epimedium sagittatum, Epimedium violaceum, Epimedium wushanese, Herba Epimedii, Herbe Cornée de Chèvre, Hierba de Cabra en Celo, Japanese Epimedium, Xian Ling Pi, Yin Yang Huo.
Mechanism of Action
Horny Goat Weed has a high affinity to human alpha-2 adrenoceptors, moderate affinity to alpha-1 adrenoceptors, and low affinity to some of the serotonin and dopamine receptors in the central and peripheral nervous systems [rx]. Alpha-2 adrenoceptors mediate erection-inhibiting impulses in the central nervous system. Yohimbine is generally believed to enhance central sexual impulse by blocking the alpha-2 adrenoceptors in the locus coeruleus in the brain [rx]. In the periphery, yohimbine has been suggested to inhibit alpha-1 and alpha-2 adrenoceptors as well as enhancing the release of nitric oxide (NO) from cavernosal endothelial cells [rx, rx]. In conclusion, the mechanism of action of yohimbine in enhancing sexual function is currently unclear.
Although you can have ED at any age, it becomes more common as men age. In the United States, approximately 12 percent of men younger than 60, 22 percent of men aged 60 to 69, and 30 percent of men 70 or older have ED, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Indications ofHorny Goat Weed
Horny Goat Weed is an herbal supplement that can be used for erectile dysfunction, sexual dysfunction (male or female) and menopausal symptoms. Although more research is need with regard to its efficacy, horny goat weed can also be used for weak back and knees, joint pain, osteoarthritis, mental and physical fatigue, memory loss, high blood pressure, heart disease, bronchitis, liver disease, HIV/AIDS, polio, chronic leucopenia, viral infections of the heart, bone loss after menopause, weak bones (osteoporosis), and as a tonic.
Weak and brittle bones (osteoporosis) – Taking a specific extract of horny goat weed for 24 months in combination with calcium supplements decreases bone loss of the spine and hip in women who have passed menopause better than taking calcium alone. Chemicals in the extract act somewhat like the hormone estrogen.
Health problems after menopause – Taking horny goat weed water extract for 6 months can decrease cholesterol and increase estrogen levels in postmenopausal women.
Bronchitis.
Ejaculation problems.
Erectile dysfunction (ED).
Fatigue.
Heart disease.
High blood pressure.
HIV/AIDS.
Joint pain.
Liver disease.
Memory loss.
Sexual problems.
Other conditions.
Natural Supplement for men and women – Horny Goat Weed is a plant that contains high levels of Icariin. This natural herb is a type of flavonoid that may help boost energy, performance, and stamina.
Infused with pure and potent enhancers – Our formula is the perfect synergy of Horny Goat Weed extracts and other herbal energy boosters like Maca, Tongkat Ali, Panax Ginseng, L-Arginine, and Saw Palmetto.
Promotes healthy circulation – Our supplement may support holistic health. A healthy flow and relaxed muscles contribute to intensified sensations and mental alertness.
A study published in the Journal of Sexual MedicineTrusted Source investigated its effects on rats. Researchers found that rats treated with purified extract of horny goat weed showed improved erectile function. Another study found that icariin is effective in inhibiting human PDE5, the substance that blocks erections, in test tubes. It also determined that sildenafil (Viagra) is 80 times more potent than icariin.
Dosages of Horny Goat Weed
2 caps (1,000 mg, may vary with manufacturer) orally per day
3-4 caps orally 90 minutes before sexual activity
May also be taken as a tea
Preventing osteoporosis: a specific phytoestrogen extract of epimedium containing 60 mg icariin, 15 mg daidzein, and 3 mg genistein, along with 300 mg of elemental calcium orally per day
Dosage Considerations – Should be Given as Follows
Adults receiving dialysis or other immunocompromising conditions
Recombivax HB (40 mcg/mL): 40 mcg intramuscularly at 0, 1, and 6 months, OR
Engerix-B (20 mcg/mL): 40 mcg intramuscularly at 0, 1, and 6 months
Estrogens – Horny goat weed might have some of the same effects as estrogen and might increase blood levels of estrogen in some women. Taking horny goat weed with estrogen might increase the effects and side effects of estrogen. Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.
Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) – Some medications are changed and broken down by the liver. Horny goat weed might decrease how quickly the liver breaks down some medications. Taking horny goat weed along with some medications that are changed by the liver might increase the effects and side effects of some medications. Before taking horny goat weed, talk to your healthcare provider if you take any medications that are changed by the liver. Some of these medications that are changed by the liver include caffeine, clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline (Slo-bid, Theo-Dur, others), zileuton (Zyflo), Zolmitriptan (Zomig), and others.
Medications changed by the liver (Cytochrome P450 2B6 (CYP2B6) substrates) – Some medications are changed and broken down by the liver. Horny goat weed might decrease how quickly the liver breaks down some medications. Taking horny goat weed along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking horny goat weed, talk to your healthcare provider if you take any medications that are changed by the liver. Some medications that are changed by the liver include bupropion (Wellbutrin), cyclophosphamide (Cytoxan), dexamethasone (Decadron), efavirenz (Sustiva), ketamine (Ketalar), methadone (Dolophine), nevirapine (Viramune), orphenadrine (Norflex), phenobarbital, sertraline (Zoloft), tamoxifen (Nolvadex), valproic acid (Depakote), and numerous others.
Medications for high blood pressure (Antihypertensive drugs) – Horny goat weed might lower blood pressure. Taking horny goat weed along with medications for high blood pressure might cause your blood pressure to go too low. Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others.
Medications that can cause an irregular heartbeat (QT interval-prolonging drugs) – Horny goat weed might increase your heart rate. Taking horny goat weed along with medications that can cause an irregular heartbeat might cause serious side effects including an irregular heartbeat. Some medications that can cause an irregular heartbeat include amiodarone (Cordarone), disopyramide (Norpace), dofetilide (Tikosyn), ibutilide (Covert), procainamide (Pronestyl), quinidine, sotalol (Betapace), thioridazine (Mellaril), and many others.
Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) – Horny goat weed might slow blood clotting. Taking horny goat weed along with medications that also slow clotting might increase the chances of bruising and bleeding. Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.
Are there interactions with herbs and supplements?
Herbs and supplements that might lower blood pressure – Horny goat weed might lower blood pressure. Taking it along with other herbs and supplements that could decrease blood pressure might increase the risk of blood pressure dropping too low. Some of these herbs and supplements include Andrographis, casein peptides, cat’s claw, coenzyme Q-10, fish oil, L-arginine, lycium, stinging nettle, theanine, and others.
Herbs and supplements that might slow blood clotting – Horny goat weed might slow blood clotting. Taking horny goat weed along with other herbs and supplements that also slow clotting might increase the chances of bruising and bleeding. These herbs include angelica, clove, danshen, garlic, ginger, ginkgo, quassia, red clover, turmeric, willow, and others.
Pregnancy Category of Horny Goat Weed
Pregnancy and breast-feeding – Horny goat weed is POSSIBLY UNSAFE when taken by mouth during pregnancy. There is a concern that it might harm the developing fetus. Avoid using it. Not enough it knew about the safety of using horny goat weed during breast-feeding. Stay on the safe side and avoid using.
Bleeding disorders – Horny goat weed might slow blood clotting. This might increase the risk of bleeding. In theory, taking horny goat weed might make bleeding disorders worse.
Hormone-sensitive cancers and conditions – Horny goat weed acts like estrogen and can increase estrogen levels in some women. Horny goat weed might make estrogen-sensitive conditions, such as breast and uterine cancer, worse.
Low blood pressure – Horny goat weed might lower blood pressure. In people who already have low blood pressure, using horny goat weed might drop blood pressure too low and increase the risk of fainting.
Surgery – Horny goat weed might slow blood clotting. This might increase the risk of bleeding during surgery. Stop taking horny goat weed at least 2 weeks before surgery.
Top 10 Best Prenatal Vitamins/Prenatal vitamins or supplements are intended to prevent any health problems and help provide the basic or significant nutrients your baby needs to be healthy. These nutrients include Vitamins B and C, Folate, Zinc, Calcium, and Magnesium. Most of them are water solvent, which means you will urinate then when they are too much. Don’t worry, here is a review for you on how to choose the best prenatal vitamins.
Top 10 Best Prenatal Vitamins
10. Smarty Pants
SmartyPants prenatal supplements are very essential. The gummies are produced without dangerous ingredients like artificial colors and flavors. It doesn’t have any side effects. The taste of this vitamin is so good and the texture differs from others. It is very soft.
Prenatal Formula with new premium ingredients, all in one delicious serving: Beta Carotene, Vitamin B6, Vitamin K2 & Choline (Packaging May Vary).
18 essential nutrients: folate (methylfolate) for fetal development, vitamin D3 for immunity, vitamin B12 to support energy metabolism, omega-3 EPA/DHA (from fish oil), vitamin K for bones.*
Gummy multivitamin for prenatal women also with iodine to support the fetal nervous system and normal brain development during pregnancy.*
New serving size! For adult women, take four (4) gummies daily with or without food.
Non-GMO. Free of milk, eggs, peanuts, tree nut allergens, fish allergens, shellfish, soy, gluten and wheat. No synthetic colors or artificial sweeteners/flavors. 3RD PARTY LAB TESTED. No refrigeration required
Reason To Buy This
Beta Carotene, Vitamins B2, K6, and Choline
It contains 1 mg of Folate to assist women in getting the Folic Acid they need.
Contains Zinc, Sodium, and Riboflavin, Thiamin and Biotin
It has Omega-3 fish oil
Contains Vitamin D and Iodine
Free of Lactose, Gluten, and Sugar.
9. Honest Prenatal Vitamins
This supplement doesn’t contain much calcium; only 150 mg. But it contains lots of Vitamin D. It is taken only once in a day. If you want to take this vitamin, you can decide to take on an empty stomach. It has also been proven to be potent, pure, and of good quality.
Daily supplement that helps support brain + eye health during and after pregnancy
Product Note: Exposure to heat or sunlight may lead to melting/damage of product. Hence customers are expected to be available during the product delivery
Enriching formula made from premium Norwegian fish oil
NSF Certified; Doctor + Dietitian reviewed; Ingredients not genetically engineered
Convenient + easy to take; Not tested on animals + no animal by-products
Made in the USA with US and imported materials; Packaging may vary; *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose treat cure or prevent any disease
Reason To Buy This
Iron, Vitamin D, and Folic Acid
contains Spirulina and Vitamin B6, Organic Ginger, Choline and Methylfolate
8. MegaFood Baby And Me
This supplement is quite low in vitamins, mostly Vitamin C, Vitamin K, and Calcium. It also has no Choline and Omega 3. However, it can be taken at any time and on an empty stomach. The MegaFood Baby and Me vitamins are produced from selected herbs, yeast and nutrients. It greatly helps in the development of your baby.
Daily prenatal multivitamin with 23 key nutrients plus real food like broccoli, carrots, and oranges to support optimal nutrition for mom and baby
Doctor-formulated for optimal nutrient absorption - Includes methylated forms of folate and B12, plus 300mg Choline to support baby’s brain and spinal cord development
Choline is critical for lifelong memory and cognition, supports baby's brain development and a healthy nervous system, and is necessary for the normal function of all cells
Can take any time a day, even on an empty stomach. 2 tablets per serving
Non-GMO, Vegetarian; Tested for over 125 chemical substances; Made without 9 allergens: milk, eggs, peanuts, tree nuts, soy, wheat, fish, shellfish, and sesame; Gluten-Free
Reason To Buy This
It has 800 mcg of Folate
Contains Vitamins A, B1, B2, B3, B6, E, and B12
It has Potassium, Organic Ginger Root, and Biotin
7. Garden Of Life Vitamin Code Raw Prenatal
The Vitamin Code Raw Prenatal multivitamin is specially prepared to meet the special demand of women before, during and after pregnancy.
It is manufactured with over 20 vegetables and fruits grown organically and it comes with the addition of vitamins, substance, and blended nutrients.
UNLOCK THE CODE: Our Raw Prenatal whole food multi is designed for mom and her developing baby; Our formula supports neural tube development with over 100 percent daily value of folate and 27mg of stomach-friendly iron for blood and reproductive health
WHOLESOME NUTRIENTS: Our prenatal is a comprehensive multi-nutrient formula, specifically formulated to support pre-conception, pregnancy and lactation; It also has over 20 fruits and veggies, supporting antioxidants, vitamins and even nutrient cofactors
RULE OF THUMB: Raw fruits and vegetables are packed with nutrients, while cooked fruits and veggies have had most, if not all, of the nutrients cooked out of them; Vitamin Code RAW’s rule of thumb is 115 degrees Fahrenheit and under—just like raw foods
LIVE PROBIOTICS AND DIGESTIVE ENZYMES: Vitamin Code Raw Prenatal also provides a prenatal digestive blend with hardy strains like L. rhamnosus and digestive enzymes like Lipase and Protease to help support overall digestion and immunity for mom and baby
UNTREATED, UNADULTERED, AND UNCOOKED: Vitamin Code Raw Prenatal is clean, meaning no synthetic binders, fillers, artificial flavors, sweeteners, colors, or additives and is Non-GMO Project Verified and certified Gluten Free
Reason To Buy This
Probiotic resistant for mother and child
It contains 800mcg Folate
This supplement has 1,400 IU (Vitamin D3)
It is gluten-free
6. Thorne Basic Prenatal
The Thorne Basic Prenatal vitamin is highly concentrated with vitamin D and has a good combination of calcium malate and citrate. You have to take three capsules every day to get all the essential nutrients it contains.
It was produced to help mother and child in good development from the time the mother conceives until the nursing stage. Unlike other supplements that are derived from coatings and additives, this multivitamin is different. It contains 90 capsules.
For Mom and Baby: Pre-conception, pregnancy, and nursing are critical times to ensure a mother's health and nutritional support are being optimized. Thorne’s Basic Prenatal provides folate, choline, and 18 other nutrients that support health without the unnecessary additives in mainstream prenatals
Active Folate: Folate is provided for brain and spinal cord development.* Basic Prenatal includes 5-MTHF, the bioactive form of folate for optimal absorption; especially indicated for women who don't get sufficient folate because of their genetic makeup*
Gentle and Effective: Contains well-absorbed nutrients that are gentle on the stomach. Vitamins C, B6, and K have been shown to benefit “morning sickness”*
Plus Choline: Contains 110 mg of choline per serving, an important nutrient for fetal brain and neurological development*
Trusted: Thorne is trusted by 45,000 health professionals and 100+ pro teams and U.S. Olympic teams. Thorne is the only supplement manufacturer to collaborate with Mayo Clinic on wellness research and content. Our products are manufactured in Summerville, South Carolina
Reason To Buy This
It has Vitamins A, B, C, D, and, E
K zinc, Boron and Biotin
Contains Copper, Calcium, and Chromium
Iodine, Selenium, and Folate
Made from Manganese, Molybdenum, and Magnesium
5. Rainbow Light Prenatal One
The concentration of zinc in this vitamin helps to boost the immune health of mother and child. It is clinically proven to contain vitamins D, B2, and B5 to help the mother and child.
The folic acid in this vitamin will aid the brain and spine in proper development. It also helps to ease any discomfort that pregnancy brings.
HIGH POTENCY PRENATAL MULTIVITAMIN: Nourish mom’s health and baby’s development through conception, pregnancy, and breastfeeding with folate, calcium and iron, while promoting energy with a potent B vitamin complex
SUPPORTS IMMUNE HEALTH: This women’s multivitamin helps support immune health as a high-potency source of zinc, and supports red blood cell health*
CLINICALLY PROVEN ABSORPTION*: Rainbow Light Prenatal One Multivitamin delivers clinically proven absorption of Vitamins D, B2, B5, folate, calcium, iron and zinc
SUPERFOODS BLEND WITH PROBIOTICS: This daily vitamin is formulated with blends derived from fruits and vegetables, and contains probiotic digestive enzymes*
NON-GMO AND VEGETARIAN: This Non-GMO Project Verified, vegetarian prenatal supplement is made with no colors, flavors or sweeteners
Reason To Buy This
Microcrystalline Cellulose
Silica, Iron and Zinc
Stearic Acid and Magnesium Stearate
4. TheraNatal Complete Prenatal Vitamin
If you are a pregnant woman that wants a complete prenatal vitamin, then you should go for the TheraNatal vitamin. All you need in a day is a soft gel and two tablets during pregnancy.
It is free from unnatural color, gluten-free and hygienically produced in the United States.
ONLY THE BEST FOR YOUR BABY: you only want the best for your baby. TheraNatal Complete is our most comprehensive prenatal supplement formulated with methylated folate, DHA, vitamin D, choline, and more to ensure you meet all your nutrient needs in support of a healthy fetal development during pregnancy.* Take two tablets and one softgel per day.
MOST COMPREHENSIVE - TheraNatal Complete provides all you need, including methylated folate, choline, DHA, iron, iodine, vitamin D3, and vitamin B6.
ALL YOU NEED - The pink multivitamin and mineral tablet contains essential nutrients for pregnancy. The white tablet provides additional vitamin D3, vitamin B6 for nausea reduction, and choline for healthy brain.* The softgel provides 300 mg of DHA and 60 mg of EPA to support a healthy fetal development during pregnancy and your baby's brain development.*
QUALITY YOU CAN TRUST - Made in the USA. Independently tested and certified by NSF International & IFOS, in a cGMP compliant facility. TheraNatal Complete is free from artificial dyes, certified gluten-free, and dairy-free. Gelatin softgels are made from certified BSE-free bovine gelatin.
Note: because TheraNatal products use only natural coatings, some of the nutrients may become visible, giving the tablets a speckled appearance. This is normal and does not compromise the effectiveness or safety of the product in any way.
Reason To Buy This
It contains Vitamins A, B6, B12, C, D3, E and K
Composed of Thiamin, Riboflavin, and Niacin
Contains folate, Biotin, Calcium, Iron, Iodine and more
3. Mama Bird Prenatal Vitamin
This is a pretty big tablet, making it a little difficult to swallow. It is free of iron and iodine.
It is ideal for pre and postnatal (during pregnancy and breasting feeding) stages. You need just two tablets in a day and the good thing is, you can decide when to take them.
BRAIN-BOOSTING, SCIENCE-BACKED NUTRITION: Designed to beautifully nourish you during your postnatal time. Supports healthy immunity and neuro-development for babies during breastfeeding. Promotes energy production, and improves memory & brain processing speed due to active methylated vitamins. Our unique postnatal vitamin formula of probiotics, digestive enzymes, and superfoods is designed to support you and your baby’s growing needs.
THE BEST INGREDIENTS MAKE THE BEST VITAMINS: Mama Bird Postnatal Multivitamin contains the active methylated forms found naturally in our bodies: methylfolate (vitamin B9), methylcobalamin (B12), and pyridoxal-5-phosphate (B6). This is important if you have the MTHFR gene variant. Cleared by a third-party ISO/IEC 17025 lab to support the active ingredient concentration, heavy metals concentrations, and purity.
LIVE BEAUTIFULLY THROUGH SMART NUTRITION: Our easy to swallow postnatal vitamins for breastfeeding moms are formulated by our founder - a neurologist and mother to help nourish you and your baby for vibrant health. Easy to swallow, ultra-gentle caplet. One (1) serving a day is convenient and easy to remember.
GIVE THEM THE VERY BEST FROM THE VERY START: Mama Bird Postnatal Multivitamin is free of soy, yeast, fish/shellfish, sugar, preservatives, artificial colors and flavors, nuts, GMOs, gluten, and dairy/lactose. Natural whole food-based. Proudly made in the U.S.A. This product is vegan. Color may vary, as this is a natural product. We do not use single-use plastic outer seals in an effort to eliminate plastic waste.
FOLLOW OUR BRAND STORE: Complete your Best Nest supplement routine with our other vitamins and supplements! Mama Bird Postnatal Multi+ pairs well with Mama Bird Mineral Complex and Mama Bird Probiotics for vibrant brain health. Visit our Brand Store to see everything Best Nest has to offer.
Reason To Buy This
It has a great number of Vitamins A, B1, C, D, and E
Concentrated with Zinc, Thiamin, Riboflavin, Niacin, and Pyridoxine
The high amount of Biotin, and Folate
2. Nature Made Prenatal + DHA 200 Mg
This multivitamin contains important minerals and vitamins that help pregnant women every day. Swallowing these pills is with ease and it contains all 8 B vitamins.
One good thing about Nature Made multivitamins is that it has a high concentration of DHA, which helps to improve the brain of your baby.
Reason To Buy This
No Starch or Yeast
Has Vitamins A, C, D, and E
Produced with DHA, iron, and calcium
Gluten-free and no unnatural colors
1. One- A- Day Prenatal Vitamin
We picked One-A-Day as our number one because it is packed with important nutrients like Omega-3 DHA, Folic Acid, Iron, Vitamin D, and Calcium. This supplement can be used before, during and after childbirth. It is low in fructose.
A complete prenatal multivitamin that provides nutritional support for women before, during, and after pregnancy
Product Note: Exposure to heat or sunlight may lead to melting/damage of product. Hence customers are expected to be available during the product delivery
With key nutrients, like folic acid, DHA, iron and calcium all in one single soft gel
Provides 100% of the daily value of folic acid; Gluten free
One-A-Day is the most popular among all prenatal brands. It has also been verified by an independent lab, which makes it very reliable. Prenatal vitamins are very good for women during pregnancy and after. It helps to keep mother and child health. So, from the above list, pick the one that suits your needs or recommended by your doctor in some special cases.
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Venosmine/Diosmin is a disaccharide derivative that consists of diosmetin substituted by a 6-O-(alpha-L-rhamnopyranosyl)-beta-D-glucopyranosyl moiety at position 7 via a glycosidic linkage. It has a role as an antioxidant and an anti-inflammatory agent. It is a glycosyloxyflavone, a rutinoside, a disaccharide derivative, a monomethoxyflavone, and a dihydroxyflavanone. It derives from a diosmetin.
Diosmin is a semisynthetic drug indicated for the treatment of venous disease. Diosmin is a flavone that can be found in the plant Teucrium gnaphalodes. Diosmin is available as prescription medicine in several European countries and is available as a nutritional supplement in the United States and the rest of Europe. It should be noted that clinical studies have been inconclusive and no articles have been published pertaining to its use in the treatment of vascular disease. When used in rats, diosmin has been effective at mitigating hyperglycemia, and may also have antineutrino degenerative properties.
Another Name
Barosmin
Buchu Resin
Daflon
Diosmin
Resin, Buchu
Venosmine
Diosmin
Diosmina
Diosmine
Diosminum
Mechanism of Action of Diosmin
Ligand-activated transcriptional activator. Binds to the XRE promoter region of genes it activates. Activates the expression of multiple phases I and II xenobiotic chemical metabolizing enzyme gene. Diosmin is a semisynthetic drug indicated for the treatment of venous disease. Diosmin is a flavone that can be found in the plant Teucrium gnaphalodes. Diosmin is available as prescription medicine in several European countries and is available as a nutritional supplement in the United States and the rest of Europe. It should be noted that clinical studies have been inconclusive and no articles have been published pertaining to its use in the treatment of vascular disease. When used in rats, diosmin has been effective at mitigating hyperglycemia, and may also have antineutrino degenerative properties.
Indications of Diosmin
Venous Insufficiency –general or unspecified but usually of the legs; coordinate IM with the specific vein (IM) or organ /blood supply (IM) if pertinent cope NoteImpaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
Hemorrhoidal; hemorrhoidal disease; hemorrhoids – Swollen veins in the lower part of the RECTUM or ANUS. Hemorrhoids can be inside the anus (internal), under the skin around the anus (external), or protruding from inside to outside of the anus. People with hemorrhoids may or may not exhibit symptoms that include bleeding, itching, and pain.\
Edema –general prefer specifics; coordinate IM with organ/diseases term (IM); egg-white edema: coordinate IM with OVALBUMIN (NIM if indexed at all); EPH (Edema, Proteinuria, Hypertension) gestosis, EPH & do not index under EDEMA unless it is particularly discussedScope NoteAbnormal fluid accumulation in TISSUES or body cavities. Most cases of edema are present under the SKIN in SUBCUTANEOUS TISSUE.
Diosmin is a dietary supplement – used to aid the treatment of hemorrhoids and venous diseases, i.e., chronic venous insufficiency including spider and varicose veins, leg swelling (edema), stasis dermatitis and venous ulcers. The mechanism of action of Diosmin and other phlebotomists is undefined, and clinical evidence of benefit is limited. Diosmin is not recommended for treating the rectal mucosa, skin irritations, or wounds, and should not be used to treat dermatitis, eczema, or urticaria. Diosmin is not recommended for use in children or women during pregnancy.[rx]
Chronic venous insufficiency
Diabetes
Hemorrhoids
High blood pressure
Lymphedema (swelling of the arms)
Premenstrual syndrome
Ulcerative colitis
Varicose veins
Contraindications of Diosmin
The gel formulation is contraindicated for application to mucosa, dermal irritations, or wounds, and it should not be used to treat dermatitis, eczema, or urticaria. Diosmin is not recommended for use in children.
Dosage of Diosmin
For venous insufficiency, the dosage is 2 tablets daily. For acute hemorrhoidal attack, the dosage is 6 tablets daily for 4 days, followed by 4 tablets daily over the next 3 days.[rx] For chronic venous disease, the dosage is 2 tablets a day for at least 2 months.[rx]
BY MOUTH
For the treatment of internal hemorrhoids – 1350 mg of diosmin plus 150 mg of hesperidin twice daily for 4 days followed by 900 mg of diosmin and 100 mg of hesperidin twice daily for 3 days. Some researchers also try 600 mg of diosmin three times daily for 4 days, followed by 300 mg twice daily for 10 days, in combination with 11 grams of psyllium daily. However, this lower diosmin dose does not seem to be as effective.
For prevention of relapse internal hemorrhoids – 450 mg of diosmin plus 50 mg of hesperidin twice daily for 3 months of therapy.
For the treatment of leg wounds due to blood flow problems (venous stasis ulcers) – the combination of 900 mg of diosmin and 100 mg of hesperidin daily has been used for up to 2 months.
Side Effects of Venosmine
Diosmin is safe for most people when used short-term for up to 6 months. It can cause some side effects such as stomach and abdominal pain, diarrhea, dizziness, headache, skin redness and hives, muscle pain, blood problems, and altered heart rate.
In some 10% of users, diosmin causes mild gastrointestinal disorders or skin irritations (hives, itching), stomach pain, nausea, heart arrhythmias, or anemia.[rx] Preliminary research indicates no evidence of toxicity.[rx] The US Food and Drug Administration (FDA) concluded in 2001 that there was inadequate evidence on which to base an expectation of safety. As of 2013, the FDA did not revise this position.[rx]
Drug Interactions of Venosmine
We currently have no information about DIOSMIN Interactions.
Pregnancy Category of Venosmine
Pregnancy and breast-feeding
Not enough is known about the use of diosmin during pregnancy and breast-feeding. Stay on the safe side and avoid use.
Bleeding disorders
Diosmin might make bleeding disorders worse. If you have a bleeding disorder, don’t use diosmin.
Rhubarb is a cultivated plant in the genus Rheum in the family Polygonaceae. It is a herbaceous perennial growing from short, thick rhizomes. Historically, different plants have been called rhubarb in English and used for two distinct purposes. The roots of some species were first used in medicine. Later, the fleshy, edible stalks (petioles) of other species and hybrids (culinary rhubarb) were cooked and used for food. The large, triangular leaves contain high levels of oxalic acid, making them inedible. The small flowers are grouped in large compound leafy greenish-white to rose-red inflorescences.
Rhubarb is grown primarily for its fleshy leafstalks, technically known as petioles. The use of rhubarb stalks as food is a relatively recent innovation. This usage was first recorded in 18th to 19th-century England after affordable sugar became more widely available.
Commonly, it is stewed with sugar or used in pies and desserts, but it can also be put into savory dishes or pickled. Rhubarb can be dehydrated and infused with fruit juice. In the United States, it is usually infused with strawberry juice to mimic their popular strawberry rhubarb pie.
Food
The species Rheum Ribes has been eaten in the Islamic world since the 10th century.
In Northern Europe and North America, the stalks are commonly cut into pieces and stewed with added sugar until soft. The resulting compote, sometimes thickened with corn starch, can then be used in pies, tarts and crumbles. Alternatively, greater quantities of sugar can be added with pectin to make jams. The most popular accompanying spice to use is ginger, although cinnamon and nutmeg are also popular additions.
In the United Kingdom, as well as being used in the typical pies, tarts and crumbles, rhubarb compote is also combined with whipped cream and/or custard to make respectively rhubarb fool and rhubarb and custard.
In the United States, the common usage of rhubarb in pies has led to it being nicknamed ‘pie plant’, by which it is referred to in many 19th century US cookbooks. Rhubarb in the US is also often paired with strawberries to make a strawberry-rhubarb pie, though some rhubarb purists jokingly consider this “a rather unhappy marriage.
In former days, a common and affordable sweet for children in parts of the United Kingdom and Sweden was a tender stick of rhubarb, dipped in sugar. It is still eaten this way in western Finland, Norway, Canada, Iceland, Lithuania, the Faroe Islands and Sweden, and also some other parts of the world.
Rhubarb can also be used to make alcoholic drinks, such as fruit wines or Finnish Rhubarb sima (mead). It is also used to make Kompot. Being a bit sour, it is very refreshing and can be drunk cold, especially during the summer.
Traditional Chinese medicine
In traditional Chinese medicine, rhubarb roots of a number of species have been thought of as a laxative for several millennia. Rhubarb also appears in medieval Arabic and European prescriptions. It was one of the first Chinese medicines to be imported to the West from China.
Health Benefit Of Estriol/Estriol is a metabolite of estrone metabolized via 16alpha-hydroxy estrone through the enzyme 16alpha-hydroxysteroid dehydrogenase or to 2- or 4-hydroxy estrone (catechol estrogens) by the action of catechol-O-methyltransferase. The latter metabolites can be formed in the brain and may compete with receptors for catecholamines. Metabolites are conjugated with sulfate or glucuronide before excretion by the kidney. During pregnancy, estriol constitutes 60-70% of the total estrogens, increasing to 300-500-fold in relation to non-pregnant women. The late-term human fetus produces relatively large amounts of 16 alpha-hydroxy DHEA, which serves the mother as a precursor of estriol. It has been shown that 90% of the precursors for the formation of estriol are of fetal origin. If abnormal maternal serum screening results, specifically low levels of unconjugated estriol in the second trimester are detected, a diagnosis of Smith-Lemli-Opitz syndrome (SLOS), or RSH is suspected. SLOS is an autosomal recessive disorder caused by mutations of the gene encoding 7-dehydrocholesterol reductase
Estriol (E3), also spelled oestriol, is a steroid, a weak estrogen, and a minor female sex hormone. It is one of three major endogenous estrogens, the others being estradiol and estrone. Levels of estriol in women who are not pregnant are almost undetectable. However, during pregnancy, estriol is synthesized in very high quantities by the placenta and is the most produced estrogen in the body by far, although circulating levels of estriol are similar to those of other estrogens due to a relatively high rate of metabolism and excretion.[rx][rx] Relative to estradiol, both estriol and estrone have far weaker activity as estrogens.[rx]
Mechanism of Action of Estriol
Estriol levels can be measured to give an indication of the general health of the fetus. DHEA-S is produced by the adrenal cortex of the fetus. This is converted to estriol by the placenta. If levels of “unconjugated estriol” are abnormally low in a pregnant woman, this may indicate a problem with the development of the child. The drug interacts with a target cell receptor. When the estrogen receptor has bound its ligand it can enter the nucleus of the target cell, and regulate gene transcription which leads to the formation of messenger RNA. The mRNA interacts with ribosomes to produce specific proteins that express the effect of estriol upon the target cell. Estrogens increase the hepatic synthesis of sex hormone-binding globulin (SHBG), thyroid-binding globulin (TBG), and other serum proteins and suppress follicle-stimulating hormone (FSH) from the anterior pituitary.
Uses Indications of Estriol
Used as a test to determine the general health of an unborn fetus
The treatment of hormone-dependent urinary incontinence due to sphincter mechanism incompetence in ovariohysterectomised bitches.
Estriol is indicated as hormone replacement therapy for the treatment of atrophic vaginitis and kraurosis in post-menopausal women.
Estriol is indicated for the treatment of pruritus vulvae and dyspareunia associated with atrophic vaginal epithelium.
Estriol is used in menopausal hormone therapy to treat menopausal symptoms, such as hot flashes, vulvovaginal atrophy, and dyspareunia (difficult or painful sexual intercourse). The benefits of estriol on bone mineral density and osteoporosis prevention have been inconsistent and are less clear. Estriol has been found to reduce the risk of urinary tract infections and other uEstriolrogenital symptoms.[rx][rx]
Contraindications of Estriol
Allergic (hypersensitive) to any of the ingredients of estriol
Estriol contains cetyl alcohol and stearyl alcohol. This may cause local skin reactions (e.g.contact
dermatitis).
Known hypersensitivity to estriol or any of the excipients.
Known, past or suspected cancer of the breast
Known or suspected estrogen-dependent malignant tumors (eg endometrial cancer)
Undiagnosed genital bleeding
Untreated endometrial hyperplasia
Previous or current venous thromboembolism (deep venous thrombosis, pulmonary embolism)
Known thrombophilic disorders (eg protein C, protein S, or antithrombin deficiency, see section 4.4)
Active or recent arterial thromboembolic disease (eg angina, myocardial infarction)
Acute liver disease, or a history of liver disease as long as liver function tests have failed to return to normal
Porphyria.
In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient.
Dosage of Estriol
Adult menopausal and postmenopausal females
0.5 mg to 2 mg PO once daily. Usual initial dose: 1 or 2 mg PO once daily. Less than 1 mg/day PO may suffice for vaginal/vulvar symptoms only; however, in such patients, consider vaginal therapy alone.
Use the lowest effective dose. The administration should be cyclic (e.g., 3 weeks on and 1 week off). In women with an intact uterus, estrogen may be given cyclically or combined with progestin for at least 10 to 14 days per month to minimize the risk of endometrial hyperplasia.
Menopausal and postmenopausal females
1 patch (delivering 0.025 mg, 0.0375 mg, 0.05 mg, 0.06 mg, 0.075 mg, or 0.1 mg per day) applied and replaced every 7 days. Usual initial dose is 0.0375 mg/day or 0.05 mg/day.
Use the lowest effective dose. A switch between transdermal system types can be done immediately; if on oral therapy, begin 1 week after oral treatment is discontinued or when symptoms reappear.
Topical dosage (topical gel only)
Adult menopausal and postmenopausal females
Initially, apply 1 actuation of the pump (0.87 grams estriol gel containing 0.52 mg of estradiol and delivering 12.5 mcg/day of estradiol systemically) once daily to the upper arm. Adjust based upon the individual patient response. The usual dose range is 1 to 2 pump actuation per day.
Vaginal dosage ( vaginal ring; Femring only)
Adult menopausal and postmenopausal females
Insert 1 vaginal ring (delivering either 50 or 100 mcg per 24 hours) vaginally into the upper third of the vaginal vault; keep in place continuously for 3 months, then remove. If appropriate, insert a new ring. Use the lowest effective dose. While Femring may be used to treat isolated genitourinary symptoms, consider other vaginal products of lower estradiol dosage first.
Administration
The cream can be started any time after the manifestation of atrophic vaginitis or associated symptoms (eg dyspareunia, pruritus). The recommended initial daily dose is one applicator full per day.
A maintenance dose of one applicator full twice a week may be used after restoration of the vaginal mucosa has been achieved.
For initiation and continuation of treatment of postmenopausal symptoms, the lowest effective dose for the shortest duration should be used. Attempts to discontinue medication should be made at three to six-month intervals following a physical examination.
The cream is to be applied to the vagina, using an applicator. The applicator holds 5ml of a cream containing 0.5mg estriol. The filled applicator should be inserted high into the vagina and emptied, preferably in the evening.
Remove the cap from a new tube and use the top of the cap to pierce the metal seal on the tube.
One end of the applicator is fitted with a plunger. Ensure the plunger is fully inserted into the applicator. Screw the other end of the applicator onto the tube. Squeeze the tube, so that the barrel of the applicator fills with cream. Unscrew the applicator and replace the cap on the tube.
Lie down, with knees bent and spread apart. Gently insert the open end of the applicator well into the vagina. Push the plunger firmly but gently as far as it will go to empty the cream into the vagina.
Keeping the plunger pressed down firmly, grip the applicator by the barrel and remove it. There is no relevant indication for use of Gynest in children
Missed Dose
When a dose is inadvertently forgotten, resume dosing when the omission is realized.
Side Effects of Estriol
The Most Common
Breast tenderness may sometimes occur as a side effect of estriol. Local reactions with vaginal estriol such as discomfort (irritation, burning, itching) and discharge may occur.
Nausea, vomiting,
Vaginal bleeding, and reversible feminization.
Breast enlargement,
Headache,
Abdominal tenderness, or persistent upper abdominal pain
Estriol may produce endometrial hyperplasia similarly to estradiol and other estrogens[rx][rx]
However, it appears that typical clinical dosages of vaginal estriol are not associated with an important risk of endometrial proliferation or hyperplasia.[rx][rx]
Increased risk of blood clots,
Cardiovascular disease, and, when combined with most progestogens,
Breast cancer.
Estrogens can cause breast development
Feminization
Infertility
Low testosterone levels,
Sexual dysfunction among others.
More Common
signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
acne
breast pain
darkening of the skin
decreased interest in sexual activity
fatigue
fluid retention
hair loss
irritability
migraine headaches
increased blood pressure
nausea
problems wearing contact lenses
unexpected vaginal bleeding
vomiting
nausea
nervousness
stomach cramps and bloating
Rare
a problem caused by growth of the womb lining outside the womb (fibroids or endometriosis)
any problem with your heart or circulation(including high blood pressure or risk factors for a blood clot.
relatives who have had a blood clot
asthma
diabetes
migraine or severe headaches
epilepsy (fits)
gallstones
liver or kidney problems
a rare problem called ‘systemic lupus
erythematosus’ (SLE)
otosclerosis (a hearing disorder).
Drug Interactions of Estriol Cream
Estriol may interact with following drugs, supplements & may change the efficacy of drugs
Estriol should not be used during pregnancy, as it may be harmful to the developing baby. If you become pregnant while taking this medication, contact your doctor immediately.
Lactation
Taking estriol while breast-feeding may decrease the amount and quality of breast milk. Estriol is also passed through breast milk to your breastfeeding child. Women who are breast-feeding should not take this medication. The safety and effectiveness of this medication have not been established for use by children.
What are the symptoms of pantothenic acid deficiency?/Pantothenic Acid is a water-soluble vitamin ubiquitously found in plants and animal tissues with antioxidant properties. Vitamin B5 is a component of coenzyme A (CoA) and a part of the vitamin B2 complex. Vitamin B5 is a growth factor and is essential for various metabolic functions, including the metabolism of carbohydrates, proteins, and fatty acids. This vitamin is also involved in the synthesis of cholesterol, lipids, neurotransmitters, steroid hormones, and hemoglobin.
Vitamin B5 or Pantothenic acid is a water-soluble vitamin. Pantothenic acid is an essential nutrient. Animals require pantothenic acid in order to synthesize coenzyme-A (CoA), as well as to synthesize and metabolize proteins, carbohydrates, and fats. The anion is called pantothenate. Pantothenic acid is the amide between pantoic acid and β-alanine. Its name derives from the Greek pantothen, meaning from everywhere, and small quantities of pantothenic acid are found in nearly every food, with high amounts in fortified whole-grain cereals, egg yolks, liver, and dried mushrooms. It is commonly found as its alcohol analog, the provitamin panthenol (pantothenol), and calcium pantothenate.
Deficiency Symptoms of Pantothenic Acid / Vitamin B5
Pantothenic acid deficiency has only been observed in individuals who were fed diets virtually devoid of pantothenic acid or who were given a pantothenic acid metabolic antagonist, omega-methyl pantothenic acid. The subjects exhibited various degrees of signs and symptoms, including irritability and restlessness; fatigue; apathy; malaise; sleep disturbances; gastrointestinal complaints such as nausea, vomiting, and abdominal cramps; neurobiological symptoms such as numbness, paresthesias, muscle cramps, and staggering gait; and hypoglycemia and increased sensitivity to insulin.
Intake recommendations for pantothenic acid and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and sex, include:
Recommended Dietary Allowance (RDA) – Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.
Adequate Intake (AI) – Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA.
Estimated Average Requirement (EAR) – Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals.
Tolerable Upper Intake Level (UL) – Maximum daily intake unlikely to cause adverse health effects.
When the FNB evaluated the available data, it found the data insufficient to derive an EAR for pantothenic acid. Consequently, the FNB established AIs for all ages based on usual pantothenic acid intakes in healthy populations.
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Adequate Intakes (AIs) for Pantothenic Acid
Age
Male
Female
Pregnancy
Lactation
Birth to 6 months
1.7 mg
1.7 mg
7–12 months
1.8 mg
1.8 mg
1–3 years
2 mg
2 mg
4–8 years
3 mg
3 mg
9–13 years
4 mg
4 mg
14–18 years
5 mg
5 mg
6 mg
7 mg
19+ years
5 mg
5 mg
6 mg
7 mg
Dietary Reference Intakes for Pantothenic Acid by Life Stage Group (mg/day)
Adequate Intake
Life Stage Group
0-6 mo
1.7
7-12 mo
1.8
1-3 yr
2
4-8 yr
3
9-13 yr
4
14-18 yr
5
19-30 yr
5
31-50 yr
5
51-70 yr
5
> 70 yr
5
Pregnancy
< or = 18 yr
6
19-50 yr
6
Lactation
< or = 18 yr
7
19-50 yr
7
[/stextbox]
Food Source of Pantothenic Acid / Vitamin B5
Several food sources of pantothenic acid are listed bellow
Selected Food Sources of Pantothenic Acid
Food
Milligrams
(mg) per
serving
Percent
DV*
Breakfast cereals, fortified with 100% of the DV
10
100
Beef liver, boiled, 3 ounces
8.3
83
Shitake mushrooms, cooked, ½ cup pieces
2.6
26
Sunflower seeds, ¼ cup
2.4
24
Chicken, breast meat, skinless, roasted, 3 ounces
1.3
13
Tuna, fresh, bluefin, cooked, 3 ounces
1.2
12
Avocados, raw, ½ avocado
1.0
10
Milk, 2% milkfat, 1 cup
0.9
9
Mushrooms, white, stir-fried, ½ cup sliced
0.8
8
Potatoes, russet, flesh, and skin, baked, 1 medium
*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for the values in Table 2 is 10 mg for adults and children age 4 years and older. This value, however, decreases to 5 mg when the updated Nutrition and Supplement Facts labels are implemented. The updated labels must appear on food products and dietary supplements beginning in January 2020, but they can be used now. The FDA does not require food labels to list pantothenic acid content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.
The U.S. Department of Agriculture’s (USDA’s) National Nutrient Database for Standard Reference website lists the nutrient content of many foods and provides a comprehensive list of foods containing pantothenic acid arranged by pantothenic acid content and by food name.
Health Benefit of Pantothenic Acid / Vitamin B5
Pantothenic acid – has been used for a wide range of disorders such as acne, alopecia, allergies, burning feet, asthma, grey hair, dandruff, cholesterol-lowering, improving exercise performance, depression, osteoarthritis, rheumatoid arthritis, multiple sclerosis, stress, shingles, aging and Parkinson’s disease. It has been investigated in clinical trials for arthritis, cholesterol-lowering and exercise performance.[Mason P; Dietary Supplements,
The topical application of pantothenate – is widely used in clinical practice for wound healing.
Pantothenic acid deficiency – Taking pantothenic acid by mouth prevents and treats pantothenic acid deficiency.
Skin reactions from radiation therapy – Applying dexpanthenol, a chemical similar to pantothenic acid, to areas of irritated skin does not seem to help treat skin reactions from radiation therapy.
Some research suggests that taking pantothenic acid in combination with pantethine and thiamine does not improve muscular strength or endurance in well-trained athletes.
There is conflicting evidence regarding the usefulness of pantothenic acid in combination with large doses of other vitamins for the treatment of ADHD.
Early research suggests that taking dexpanthenol, a chemical similar to pantothenic acid, by mouth daily or receiving dexpanthenol shots can help treat constipation.
Early research suggests that using specific eye drops (Siccaprotect) containing dexpanthenol, a chemical similar to pantothenic acid, does not improve most symptoms of dry eyes.
Some evidence suggests that applying gel or drops containing dexpanthenol, a chemical similar to pantothenic acid, reduces some symptoms of eye trauma. However, not all research is consistent.
Early research suggests that pantothenic acid (given as calcium pantothenate) does not reduce symptoms of osteoarthritis.
There is inconsistent evidence on the potential benefits of taking pantothenic acid after surgery. Taking pantothenic acid or dexpanthenol, a chemical similar to pantothenic acid, does not seem to improve bowel function after stomach surgery. However, taking dexpanthenol by mouth might reduce other symptoms after surgery, such as sore throat.
Developing research suggests that pantothenic acid (given as calcium pantothenate) does not reduce the symptoms of arthritis in people with rheumatoid arthritis.
Early research suggests that using a specific spray (Nasicur) that contains dexpanthenol, a chemical similar to pantothenic acid, helps relieve nasal dryness.
Early research suggests that using a nasal spray containing dexpanthenol, a chemical similar to pantothenic acid, after sinus surgery reduces discharge from the nose, but not other symptoms.
Research on the effects of pantothenic acid for preventing skin irritations is not consistent. Some early research suggests that a specific product (Bepanthol Handbalsam) containing dexpanthenol, a chemical similar to pantothenic acid, does not prevent skin irritation when applied to the skin. However, other research suggests that dexpanthenol ointment can prevent skin irritation.
Early research suggests that using a specific ointment (Hepathrombin-50,000-Salbe Adenylchemie) containing dexpanthenol, a chemical similar to pantothenic acid, as well as heparin and allantoin reduces swelling related to ankle sprains.
What Is Vitamin B5 ?/Vitamin B5 is a water-soluble vitamin ubiquitously found in plants and animal tissues with antioxidant properties. Vitamin B5 is a component of coenzyme A (CoA) and a part of the vitamin B2 complex. Vitamin B5 is a growth factor and is essential for various metabolic functions, including the metabolism of carbohydrates, proteins, and fatty acids. This vitamin is also involved in the synthesis of cholesterol, lipids, neurotransmitters, steroid hormones, and hemoglobin.
Vitamin B5 or Pantothenic acid is a water-soluble vitamin. Pantothenic acid is an essential nutrient. Animals require pantothenic acid in order to synthesize coenzyme-A (CoA), as well as to synthesize and metabolize proteins, carbohydrates, and fats. The anion is called pantothenate. Pantothenic acid is the amide between pantoic acid and β-alanine. Its name derives from the Greek pantothen, meaning from everywhere, and small quantities of pantothenic acid are found in nearly every food, with high amounts in fortified whole-grain cereals, egg yolks, liver, and dried mushrooms. It is commonly found as its alcohol analog, the provitamin panthenol (pantothenol), and calcium pantothenate.
Deficiency Symptoms of Vitamin B5
Pantothenic acid deficiency has only been observed in individuals who were fed diets virtually devoid of pantothenic acid or who were given a pantothenic acid metabolic antagonist, omega-methyl pantothenic acid. The subjects exhibited various degrees of signs and symptoms, including irritability and restlessness; fatigue; apathy; malaise; sleep disturbances; gastrointestinal complaints such as nausea, vomiting, and abdominal cramps; neurobiological symptoms such as numbness, paresthesias, muscle cramps, and staggering gait; and hypoglycemia and increased sensitivity to insulin.
Intake recommendations for pantothenic acid and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and sex, include:
Recommended Dietary Allowance (RDA) – Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.
Adequate Intake (AI) – Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA.
Estimated Average Requirement (EAR) – Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals.
Tolerable Upper Intake Level (UL) – Maximum daily intake unlikely to cause adverse health effects.
When the FNB evaluated the available data, it found the data insufficient to derive an EAR for pantothenic acid. Consequently, the FNB established AIs for all ages based on usual pantothenic acid intakes in healthy populations.
[stextbox id=’custom’]
Adequate Intakes (AIs) for Pantothenic Acid
Age
Male
Female
Pregnancy
Lactation
Birth to 6 months
1.7 mg
1.7 mg
7–12 months
1.8 mg
1.8 mg
1–3 years
2 mg
2 mg
4–8 years
3 mg
3 mg
9–13 years
4 mg
4 mg
14–18 years
5 mg
5 mg
6 mg
7 mg
19+ years
5 mg
5 mg
6 mg
7 mg
Dietary Reference Intakes for Pantothenic Acid by Life Stage Group (mg/day)
Adequate Intake
Life Stage Group
0-6 mo
1.7
7-12 mo
1.8
1-3 yr
2
4-8 yr
3
9-13 yr
4
14-18 yr
5
19-30 yr
5
31-50 yr
5
51-70 yr
5
> 70 yr
5
Pregnancy
< or = 18 yr
6
19-50 yr
6
Lactation
< or = 18 yr
7
19-50 yr
7
[/stextbox]
Food Source of Vitamin B5
[stextbox id=’info’]
Several food sources of pantothenic acid are listed bellow
Selected Food Sources of Pantothenic Acid
Food
Milligrams
(mg) per
serving
Percent
DV*
Breakfast cereals, fortified with 100% of the DV
10
100
Beef liver, boiled, 3 ounces
8.3
83
Shitake mushrooms, cooked, ½ cup pieces
2.6
26
Sunflower seeds, ¼ cup
2.4
24
Chicken, breast meat, skinless, roasted, 3 ounces
1.3
13
Tuna, fresh, bluefin, cooked, 3 ounces
1.2
12
Avocados, raw, ½ avocado
1.0
10
Milk, 2% milkfat, 1 cup
0.9
9
Mushrooms, white, stir-fried, ½ cup sliced
0.8
8
Potatoes, russet, flesh, and skin, baked, 1 medium
*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for the values in Table 2 is 10 mg for adults and children age 4 years and older. This value, however, decreases to 5 mg when the updated Nutrition and Supplement Facts labels are implemented. The updated labels must appear on food products and dietary supplements beginning in January 2020, but they can be used now. The FDA does not require food labels to list pantothenic acid content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.
The U.S. Department of Agriculture’s (USDA’s) National Nutrient Database for Standard Reference website lists the nutrient content of many foods and provides a comprehensive list of foods containing pantothenic acid arranged by pantothenic acid content and by food name.
[/stextbox]
Health Benefit of Pantothenic Acid / Vitamin B5
Pantothenic acid – has been used for a wide range of disorders such as acne, alopecia, allergies, burning feet, asthma, grey hair, dandruff, cholesterol-lowering, improving exercise performance, depression, osteoarthritis, rheumatoid arthritis, multiple sclerosis, stress, shingles, aging and Parkinson’s disease. It has been investigated in clinical trials for arthritis, cholesterol-lowering and exercise performance.[Mason P; Dietary Supplements,
The topical application of pantothenate – is widely used in clinical practice for wound healing.
Pantothenic acid deficiency – Taking pantothenic acid by mouth prevents and treats pantothenic acid deficiency.
Skin reactions from radiation therapy – Applying dexpanthenol, a chemical similar to pantothenic acid, to areas of irritated skin does not seem to help treat skin reactions from radiation therapy.
Some research suggests that taking pantothenic acid in combination with pantethine and thiamine does not improve muscular strength or endurance in well-trained athletes.
There is conflicting evidence regarding the usefulness of pantothenic acid in combination with large doses of other vitamins for the treatment of ADHD.
Early research suggests that taking dexpanthenol, a chemical similar to pantothenic acid, by mouth daily or receiving dexpanthenol shots can help treat constipation.
Early research suggests that using specific eye drops (Siccaprotect) containing dexpanthenol, a chemical similar to pantothenic acid, does not improve most symptoms of dry eyes.
Some evidence suggests that applying gel or drops containing dexpanthenol, a chemical similar to pantothenic acid, reduces some symptoms of eye trauma. However, not all research is consistent.
Early research suggests that pantothenic acid (given as calcium pantothenate) does not reduce symptoms of osteoarthritis.
There is inconsistent evidence on the potential benefits of taking pantothenic acid after surgery. Taking pantothenic acid or dexpanthenol, a chemical similar to pantothenic acid, does not seem to improve bowel function after stomach surgery. However, taking dexpanthenol by mouth might reduce other symptoms after surgery, such as sore throat.
Developing research suggests that pantothenic acid (given as calcium pantothenate) does not reduce the symptoms of arthritis in people with rheumatoid arthritis.
Early research suggests that using a specific spray (Nasicur) that contains dexpanthenol, a chemical similar to pantothenic acid, helps relieve nasal dryness.
Early research suggests that using a nasal spray containing dexpanthenol, a chemical similar to pantothenic acid, after sinus surgery reduces discharge from the nose, but not other symptoms.
Research on the effects of pantothenic acid for preventing skin irritations is not consistent. Some early research suggests that a specific product (Bepanthol Handbalsam) containing dexpanthenol, a chemical similar to pantothenic acid, does not prevent skin irritation when applied to the skin. However, other research suggests that dexpanthenol ointment can prevent skin irritation.
Early research suggests that using a specific ointment (Hepathrombin-50,000-Salbe Adenylchemie) containing dexpanthenol, a chemical similar to pantothenic acid, as well as heparin and allantoin reduces swelling related to ankle sprains.
Vitamin B5 is a water-soluble vitamin ubiquitously found in plants and animal tissues with antioxidant properties. Vitamin B5 is a component of coenzyme A (CoA) and a part of the vitamin B2 complex. Vitamin B5 is a growth factor and is essential for various metabolic functions, including the metabolism of carbohydrates, proteins, and fatty acids. This vitamin is also involved in the synthesis of cholesterol, lipids, neurotransmitters, steroid hormones, and hemoglobin.
Vitamin B5 or Pantothenic acid is a water-soluble vitamin. Pantothenic acid is an essential nutrient. Animals require pantothenic acid in order to synthesize coenzyme-A (CoA), as well as to synthesize and metabolize proteins, carbohydrates, and fats. The anion is called pantothenate. Pantothenic acid is the amide between pantoic acid and β-alanine. Its name derives from the Greek pantothen, meaning from everywhere, and small quantities of pantothenic acid are found in nearly every food, with high amounts in fortified whole-grain cereals, egg yolks, liver, and dried mushrooms. It is commonly found as its alcohol analog, the provitamin panthenol (pantothenol), and calcium pantothenate.
Deficiency Symptoms of Vitamin B5
Pantothenic acid deficiency has only been observed in individuals who were fed diets virtually devoid of pantothenic acid or who were given a pantothenic acid metabolic antagonist, omega-methyl pantothenic acid. The subjects exhibited various degrees of signs and symptoms, including irritability and restlessness; fatigue; apathy; malaise; sleep disturbances; gastrointestinal complaints such as nausea, vomiting, and abdominal cramps; neurobiological symptoms such as numbness, paresthesias, muscle cramps, and staggering gait; and hypoglycemia and increased sensitivity to insulin.
Intake recommendations for pantothenic acid and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and sex, include:
Recommended Dietary Allowance (RDA) – Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.
Adequate Intake (AI) – Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA.
Estimated Average Requirement (EAR) – Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals.
Tolerable Upper Intake Level (UL) – Maximum daily intake unlikely to cause adverse health effects.
When the FNB evaluated the available data, it found the data insufficient to derive an EAR for pantothenic acid. Consequently, the FNB established AIs for all ages based on usual pantothenic acid intakes in healthy populations.
[stextbox id=’custom’]
Adequate Intakes (AIs) for Pantothenic Acid
Age
Male
Female
Pregnancy
Lactation
Birth to 6 months
1.7 mg
1.7 mg
7–12 months
1.8 mg
1.8 mg
1–3 years
2 mg
2 mg
4–8 years
3 mg
3 mg
9–13 years
4 mg
4 mg
14–18 years
5 mg
5 mg
6 mg
7 mg
19+ years
5 mg
5 mg
6 mg
7 mg
Dietary Reference Intakes for Pantothenic Acid by Life Stage Group (mg/day)
Adequate Intake
Life Stage Group
0-6 mo
1.7
7-12 mo
1.8
1-3 yr
2
4-8 yr
3
9-13 yr
4
14-18 yr
5
19-30 yr
5
31-50 yr
5
51-70 yr
5
> 70 yr
5
Pregnancy
< or = 18 yr
6
19-50 yr
6
Lactation
< or = 18 yr
7
19-50 yr
7
[/stextbox]
Food Source of Vitamin B5
[stextbox id=’info’]
Several food sources of pantothenic acid are listed bellow
Selected Food Sources of Pantothenic Acid
Food
Milligrams
(mg) per
serving
Percent
DV*
Breakfast cereals, fortified with 100% of the DV
10
100
Beef liver, boiled, 3 ounces
8.3
83
Shitake mushrooms, cooked, ½ cup pieces
2.6
26
Sunflower seeds, ¼ cup
2.4
24
Chicken, breast meat, skinless, roasted, 3 ounces
1.3
13
Tuna, fresh, bluefin, cooked, 3 ounces
1.2
12
Avocados, raw, ½ avocado
1.0
10
Milk, 2% milkfat, 1 cup
0.9
9
Mushrooms, white, stir-fried, ½ cup sliced
0.8
8
Potatoes, russet, flesh, and skin, baked, 1 medium
*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for the values in Table 2 is 10 mg for adults and children age 4 years and older. This value, however, decreases to 5 mg when the updated Nutrition and Supplement Facts labels are implemented. The updated labels must appear on food products and dietary supplements beginning in January 2020, but they can be used now. The FDA does not require food labels to list pantothenic acid content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.
The U.S. Department of Agriculture’s (USDA’s) National Nutrient Database for Standard Reference website lists the nutrient content of many foods and provides a comprehensive list of foods containing pantothenic acid arranged by pantothenic acid content and by food name.
[/stextbox]
Health Benefit of Pantothenic Acid / Vitamin B5
Pantothenic acid – has been used for a wide range of disorders such as acne, alopecia, allergies, burning feet, asthma, grey hair, dandruff, cholesterol-lowering, improving exercise performance, depression, osteoarthritis, rheumatoid arthritis, multiple sclerosis, stress, shingles, aging and Parkinson’s disease. It has been investigated in clinical trials for arthritis, cholesterol-lowering and exercise performance.[Mason P; Dietary Supplements,
The topical application of pantothenate – is widely used in clinical practice for wound healing.
Pantothenic acid deficiency – Taking pantothenic acid by mouth prevents and treats pantothenic acid deficiency.
Skin reactions from radiation therapy – Applying dexpanthenol, a chemical similar to pantothenic acid, to areas of irritated skin does not seem to help treat skin reactions from radiation therapy.
Some research suggests that taking pantothenic acid in combination with pantethine and thiamine does not improve muscular strength or endurance in well-trained athletes.
There is conflicting evidence regarding the usefulness of pantothenic acid in combination with large doses of other vitamins for the treatment of ADHD.
Early research suggests that taking dexpanthenol, a chemical similar to pantothenic acid, by mouth daily or receiving dexpanthenol shots can help treat constipation.
Early research suggests that using specific eye drops (Siccaprotect) containing dexpanthenol, a chemical similar to pantothenic acid, does not improve most symptoms of dry eyes.
Some evidence suggests that applying gel or drops containing dexpanthenol, a chemical similar to pantothenic acid, reduces some symptoms of eye trauma. However, not all research is consistent.
Early research suggests that pantothenic acid (given as calcium pantothenate) does not reduce symptoms of osteoarthritis.
There is inconsistent evidence on the potential benefits of taking pantothenic acid after surgery. Taking pantothenic acid or dexpanthenol, a chemical similar to pantothenic acid, does not seem to improve bowel function after stomach surgery. However, taking dexpanthenol by mouth might reduce other symptoms after surgery, such as sore throat.
Developing research suggests that pantothenic acid (given as calcium pantothenate) does not reduce the symptoms of arthritis in people with rheumatoid arthritis.
Early research suggests that using a specific spray (Nasicur) that contains dexpanthenol, a chemical similar to pantothenic acid, helps relieve nasal dryness.
Early research suggests that using a nasal spray containing dexpanthenol, a chemical similar to pantothenic acid, after sinus surgery reduces discharge from the nose, but not other symptoms.
Research on the effects of pantothenic acid for preventing skin irritations is not consistent. Some early research suggests that a specific product (Bepanthol Handbalsam) containing dexpanthenol, a chemical similar to pantothenic acid, does not prevent skin irritation when applied to the skin. However, other research suggests that dexpanthenol ointment can prevent skin irritation.
Early research suggests that using a specific ointment (Hepathrombin-50,000-Salbe Adenylchemie) containing dexpanthenol, a chemical similar to pantothenic acid, as well as heparin and allantoin reduces swelling related to ankle sprains.
Amygdalin is found in almond. Bitter glycoside of the Rosaceae, found especially in kernels of cherries, peaches and apricots. Amygdalin is present in cold-pressed bitter almond oil from the above sources prior to enzymic hydrolysis and steam distillation for food use Amygdalin , C20H27NO11, is a glycoside initially isolated from the seeds of the tree Prunus dulcis, also known as bitter almonds, by Pierre-Jean Robiquet and A. F. Boutron-Charlard in 1803, and subsequently investigated by Liebig and Wohler in 1830, and others. Several other related species in the genus of Prunus, including apricot (Prunus armeniaca) and black cherry (Prunus serotina), also contain amygdalin. It was promoted as a cancer cure by Ernst T. Krebs under the name “Vitamin B17“, but studies have found it to be ineffective. Amygdalin is sometimes confounded with laevomandelonitrile, also called laetrile for short; however, amygdalin and laetrile are different chemical compounds.
Amygdalin is a cyanogenic glucoside isolated from almonds and seeds of other plants of the family Rosaceae. Amygdalin is converted by plant emulsion (a combination of a-glucosidase and a nitrilase) or hydrochloric acid into benzaldehyde, D-glucose, and hydrocyanic acid. (NCI04)
Food Source of Amygdalin
Amygdalin is found in almond. Bitter glycoside of the Rosaceae, found especially in kernels of cherries, peaches and apricots. Amygdalin is present in cold-pressed bitter almond oil from the above sources prior to enzymic hydrolysis and steam distillation for food use Amygdalin , C20H27NO11, is a glycoside initially isolated from the seeds of the tree Prunus dulcis, also known as bitter almonds, by Pierre-Jean Robiquet and A. F. Boutron-Charlard in 1803, and subsequently investigated by Liebig and Wohler in 1830, and others. Several other related species in the genus of Prunus, including apricot (Prunus armeniaca) and black cherry (Prunus serotina), also contain amygdalin. It was promoted as a cancer cure by Ernst T. Krebs under the name “Vitamin B17“, but studies have found it to be ineffective. Amygdalin is sometimes confounded with laevomandelonitrile, also called laetrile for short; however, amygdalin and laetrile are different chemical compounds.
Vitamin B18 (Choline) is a water-soluble nutrient and a new member of the vitamin B family. Since all the numbers of the vitamin B family have been already taken, we, at the Canadian Academy of Sports Nutrition, have named choline as the “vitamin B18” for the first time. Being referred to as a “lipotropic agent”, choline is considered a “conditionally essential” nutrient in that de novo synthesis occurs in the liver.
Functions of Choline Vitamin B18 (Choline)
It is a precursor for acetylcholine, phospholipids, and betaine.
It is required for the metabolism of fat and cholesterol.
It is necessary for the integrity of cell membranes and transmembrane signaling.
It helps with the utilization of fats in the body (lipotropic).
It has an important role in the detoxification system.
It is vital for the myelin sheaths of the nerves and normal function of the liver and gallbladder.
Food Sources and Absorption Vitamin B18 (Choline)
The highest amount of choline is found in phosphatidylcholine (lecithin), which is usually extracted from soybeans. Other food sources are brewer`s yeast, wheat germ, egg yolk, organ meats, flaxseeds, sesame seeds, and peanuts. Small amounts can be found in potatoes, lentils, cauliflowers, and oats. This vitamin is manufactured by the liver as well.
Choline is absorbed well from the small intestine and can easily cross the blood-brain barrier into the spinal fluid and brain wherein it is used to produce the neurotransmitter acetylcholine.
Athletic Benefits of Choline
Heavy exercise and intense training lower the levels of choline in the body. Being claimed as a sport ergogenic aid, choline may demonstrate the following athletic benefits:
It may improve exercise recovery.
It may enhance mental acuity.
It may increase endurance performance.
It may prevent post-exercise muscle damage (rhabdomyolysis).under the section of “Athletic Disorders”.
It may diminish exercise-induced fatigue.
Non-Athletic Benefits of Choline
Choline may be beneficial in the following conditions:
Choline deficiency results in a wide range of health concerns, such as fatty liver, elevated liver enzymes, skeletal muscle damage with elevated levels of creatine phosphokinase, and fatigue. It has been also linked to insomnia, high levels of homocysteine, and heart diseases.
Dosage and Side Effects:
The recommended adequate intakes of choline for men and women are 550 mg per day and 425 mg per day, respectively. The PDI (performance daily intake) of choline for athletes and physically active men and women is 600 – 1200 mg a day. The upper limit for choline has been set at 3500 mg a day.
Choline is available either as 250 mg, 500 mg, and 1000 mg and usually combined with inositol (vitamin B8) or as lecithin at 1200 mg. One pill of lecithin provides about 50 mg of choline.
Larger doses of choline may cause stomach upset, nausea, vomiting, diarrhea, sweating, and fishy body odor (due to breakdown of choline to trimethylamine in the GI tract).
People with fish odor syndrome (trimethylaminuria) should avoid taking choline supplements.
