10-1 Chapter 10 Nutrients for Energy Metabolism IF NOTHING ELSE, MY STUDENTS SHOULD LEARN 1. The structures and functions of vitamins differ from the energy yielding nutrients. Vitamins are much smaller in size and do not yield energy. They assist the enzymes that release energy. 2. The water soluble vitamins are needed in frequent, small amounts. The fat soluble vitamins are important in growth and maintenance of the body. 3. Vitamin deficiencies and toxicities present problems. Toxicities are possible, especially when supplements are used. 4. That there are eight different B vitamins, which carry out different functions related to the support of energy metabolism. LEARNING OBJECTIVES Students should be able to: LO 10.1: List the fat soluble and water soluble vitamins, and describe how solubility affects the absorption, transport, and excretion of each type. [Remember/Understand] LO 10.2: Outline the minerals present in the human body, and which ones appear in greater amounts. [Remember/Understand] LO 10.3: Discuss the roles of B vitamins in body tissues, and explain in a general way how the B vitamins assist with energy metabolism. [Understand/Apply] LO 10.4: Outline the individual B vitamins, their effects in the body, and problems associated with under /overconsumption that may lead to deficiency or toxicity conditions. [Understand/Remember] LO 10.5: Suggest foods that can help to ensure adequate B vitamin intake without providing too many calories. [Understand/Apply] LO 10.6: List the different vitamin like compounds (i.e., choline, inositol, and carnitine) and their effects on the body. [Understand/Apply]
10-2 LO 10.7: Outline the role of sulphur, iodine, manganese, and chromium in energy metabolism, problems associated with deficiency/toxicity, and food sources of these minerals. [Understand/Remember] LO 10.8: Discuss the arguments for and against the use of vitamin supplements. [Understand/Apply] W H Y I S T H IS C H A P T E R I M P O RTAN T T O S C I EN T ISTS A ND H E A LT H C A R E P R A C T I T I O N E R S? Of special interest to... symbol key: = Health Care Practitioners 2 = Science Majors As this chapter presents an overview of vitamins and their functions, the health care practitioner will be interested in this basic information so that their patients can be better educated on the myths and truths regarding vitamin supplementation. With respect to vitamin bioavailability (i.e., the extent to which ingested vitamins are absorbed by the body out of the digestive tract), scientists have analyzed various food sources and published the bioavailability of the contained vitamins in tables for convenient reference. There is some research to support the finding that vitamin B supplementation (folate, vitamin B6, and vitamin B12) lowers circulating levels of homocysteine and reduces the risk of heart disease. However, more research is needed to confirm this benefit of Vitamin B supplementation. Health care practitioners should be aware of the problems associated with vitamin B deficiencies or toxicities. Problems such as beriberi, ariboflavinosis, pellagra, and neural tube defects in the developing fetus are known to result from various B vitamin deficiencies. Although the B vitamins are water soluble and carry small risk of toxicity, taking excessive amounts of niacin, folate, and vitamin B6 can lead to the development of various symptoms. The use of various non vitamin supplements (i.e., choline, inositol, and carnitine) by people to gain added health benefits should be done so with knowledge of their benefits and risks. The health care practitioner is in a position to appropriately advise patients regarding the use of such products.
10-3 WHY SHOULD STUDENTS CARE? The B vitamins facilitate the work of every cell. Some help generate energy; others help make protein and new cells. B vitamins work everywhere in the body tissue to metabolize carbohydrate, fat, and protein. Historically, famous B vitamin deficiency diseases are beriberi (thiamin), pellagra (niacin), and pernicious anemia (vitamin B12). Pellagra can be prevented by adequate protein because the amino acid tryptophan can be converted to niacin in the body. A high intake of folate can mask the blood symptom of vitamin B12 deficiency but will not prevent the associated nerve damage. Vitamin B6 is important in amino acid metabolism and can be toxic in excess. Biotin and pantothenic acid are important to the body and are abundant in food. Many people erroneously think that taking vitamin supplements will allow them to skip meals and not pay sufficient attention to their dietary habits. Students should be aware of the different classes of vitamins (i.e., fat soluble vs. water soluble) and how the body handles these two groups of vitamins with respect to supplementation. Important chemicals to support energy metabolism pathways include non vitamin compounds (i.e., choline, inositol, and carnitine). Students should be aware of common food sources for these compounds. Students should understand that by practising the basic principles of healthy eating (i.e., adequate diet and variety), they will increase their likelihood of obtaining an adequate source of B vitamins through their food and will have to rely less on supplements to obtain these important metabolic compounds. W H AT A R E C O M M O N S T U D E N T MISCONCEPTIONS/STUMBLING BLOCKS? 1. Students often erroneously think that processed foods have the same nutrient value as fresh foods. 2. Students have the misconception that taking vitamins is just as good or even better than eating regular, balanced meals. 3. There is a common misconception that taking lots of vitamins is good for you. Students often do not realize that the fat soluble vitamins are stored in the body and can potentially build up to toxic levels if fat soluble vitamins are taken in excess. With respect to the water soluble B vitamins, toxicity problems are possible with niacin, folate, and vitamin B6.
10-4 4. Although remembering the role of each vitamin in the body can be overwhelming to students, a discussion of each one separately, followed by an example of either toxicity or deficiency symptoms is helpful. W H AT C A N I D O I N C L A S S? There are a variety of activities that can be done in class. Listed below are some activities that will help introduce the topic of nutrition, and the students to each other. The B vitamins involvement in metabolism offers an opportunity to review that subject. If you want to incorporate information on alcohol and nutrition not previously covered, understanding of the B vitamins roles in metabolism of the energy yielding nutrients makes it possible to appreciate, more deeply than before, the nutritional impact that alcohol has on the body (see Highlight 7). Classroom Activity 10 1: Chapter Opening Quiz Objective: Introduction to chapter Class size: Any Instructions: As a way of introducing any new chapter, give a quiz to the class. This is a quiz designed to be projected on an overhead projector. For details, please see Chapter 1, Classroom Activity 1 4. Classroom Activity 10 2: Vitamin Discovery Timelines Key concept: Historical progress of nutrition science Class size: Any Instructions: Set the stage for the importance of the vitamins by taking the students back historically to the time before vitamins were discovered. Discuss the events leading up to the discovery of vitamins, including the life saving outcomes. This approach may enhance students appreciation for the miraculous functions of these nutrients. Classroom Activity 10 3: Vitamin Flash Cards Key concept: Functions of vitamins Class size: Any Materials needed: 9 index cards for every 2 students Instructions: Have students make index cards with the name of a vitamin on the front of each card. On the back of each card have them list one important function of that vitamin. Then have them study these flash cards in pairs until they can tell from memory the functions of each vitamin in the body. Classroom Activity 10 4: What Nutrient Am I? Key concept: Characteristics of vitamins Class size: Any Materials needed: Index cards/slips of paper with nutrient names (prepared prior to class time), tape Instructions: Before class, prepare Post its, index cards, or slips of paper by writing one water soluble vitamin on each paper or card. (You may also include other terms that 4
10-5 appear in the chapter.) Tape an index card on the back of each student. The goal of the activity is for students to find out what vitamins are written on their backs. To discover What Nutrient Am I? have students circulate throughout the room asking other students questions about the vitamin or vitamin term written on their backs. They are permitted to ask each student two yes or no type questions. After asking a student two questions, they approach another student and ask two more. For example, one question would be Am I involved in energy metabolism? After each student has discovered what vitamin is on their card, they can tell the class how they figured it out and what questions they asked during the activity. Classroom Activity 10 5: A Nutrient Interview1 Key concept: Characteristics of vitamins Class size: Any Instructions: To help students learn all the nutrients covered in this chapter, set up The Body Company. Have each student apply for a job as a vitamin by describing (in an interview) what that vitamin can do for The Body Company and which other nutrients it works best with. Classroom Activity 10 6: Nutrient Vocabulary Worksheets2 Key concept: Characteristics of vitamins Class size: Any Instructions: Ask students to write an original sentence using an assigned nutrient term. Then combine all of the students sentences into a worksheet, removing the term used in the sentence, and replacing it with a blank line. At the end of the worksheet list all of the terms used alphabetically. The students have the fun of seeing their writing in print and are much more likely to enjoy the process than they would filling in the blanks of a canned worksheet. Example: Nutrient Vocabulary Worksheet 1. A deficiency of produces diarrhea, dermatitis, and dementia. [Niacin] Classroom Activity 10 7: Nutrient Review Objective: Review Class size: Any Instructions: Have students keep their books and notes open. Start by asking a student to name one nutrient. Then tell the next student to add some bit of information about that vitamin, and so on, until you get four items of information about that nutrient. The next student names another nutrient. Repeat until all of the nutrients covered in this section have been reviewed. Classroom Activity 10 8: Demonstration B Vitamin Supplement Dissolvability Key concept: Choosing a dietary supplement, dissolvability Class size: Any 1 Activity provided by Marie E. Carter, St. Louis Community College at Florissant Valley. 2 Activity provided by Penny Fredell, Yuba College, Marysville, CA.
10-6 Materials needed: Plastic cups and coffee stirrers for each student, large bottle of vinegar Instructions: Instruct students to bring nutrient supplements to the next class. Bring vinegar and clear plastic cups. The purpose of this activity is to demonstrate disintegration characteristics of vitamin/mineral supplements. Supplements that do not disintegrate have little chance of entering the bloodstream. To demonstrate how well or how poorly different vitamin/mineral supplements dissolve in the stomach, conduct an experiment by filling several clear plastic cups with vinegar (to mimic the ph of the stomach). Place one supplement in each cup and every 5 minutes stir or swirl the contents. Leave supplements in the cups for approximately 15 30 minutes. Observe what happens. See if there are differences between time released supplements and others. Discuss the many implications. This activity can be used as a vehicle for discussing many issues related to supplementation, including appropriate and inappropriate reasons for taking supplements and guidelines for supplement selection. Worksheet 10 3 can be used in conjunction with this activity to provide an avenue for evaluating supplements. Classroom Activity 10 9: Vitamin/Mineral Supplement Evaluation Key concept: Choosing a dietary supplement Class size: Any Materials needed: 1 copy of Worksheet 10 3 for each student Instructions: Distribute Worksheet 10 3 (Vitamin/Mineral Supplement Evaluation Form). Instruct students to select a nutrient supplement and evaluate the supplement using the form. Issues that will be covered include cost, completeness, percent of RDA/AI (low amounts or dangerously high amounts), presence of unnecessary nutrients or ingredients, and advertising terms such as natural, organic, chelated, no sugar, or stress reliever. Have students share their evaluations with the class. Classroom Activity 10 10: Research on Chromium Supplements3 Key concept: Chromium supplementation Class size: Small to medium Instructions: Chromium supplements have been used by both athletes and individuals wishing to lose weight. These individuals believe that chromium s actions with insulin and glucose can be beneficial in weight loss and athletic performance. Have students select one of the two populations of individuals, do a literature review of the topic, and write a short report of the efficacy of chromium as an athletic performance enhancement or weight loss aid. Students can share results with the class. The instructor can either allow the students to choose the population or can assign a population to ensure that there are a balanced number of students studying each group within the class. The students will find sufficient literature on each group of individuals; however, the athlete group data will be a bit more abundant at this point in time than the weight loss data. In this exercise, the students are able to connect the mineral s function or mechanism of action with a potential use, albeit a bit far reaching. 3 Provided by Kathleen Rourke. 6
10-7 Students should study the articles to determine whether the research was well planned and the conclusions reached were appropriate for the methodology of the study (in their opinion and based on where they are in their curriculum with regard to nutrition research). Then have students summarize the overall theme of the findings on the efficacy for the mineral and state whether they believed the research authors drew solid conclusions that consumers could and should believe. Critical Thinking Questions4 These questions will also be posted to the book s website so that students can complete them online and email their answers to you. 1. Outline the differences between macronutrients (carbohydrates, fats, and proteins) and vitamins. 2. The B vitamins are very important in many critical functions of the body, yet many patients perceive B vitamins in a much less critical manner. How would you educate patients about the importance of B vitamins and their critical functions without confusing them? 3. Suppose one of your colleagues came up to you and asked what you were majoring in. You told her that you were majoring in nutrition and dietetics and were really stressed about your upcoming biochemistry test! All of a sudden your friend responded, I thought you said you were majoring in nutrition and dietetics... are you planning on going to med school or something? Why would you need chemistry when you are in a cooking major? How might you best respond to your friend to help her understand how important biochemistry is to the field of nutrition and dietetics? 4. Differentiate between water and fat soluble vitamins and discuss how a diet that is low in fat might impact vitamin absorption. 4 Contributed by Kathleen Rourke.
10-8 W H A T O T H E R R E S O U R C E S A R E AVA I L A B L E? You can look up information about vitamin facts, content in different food, as well as any health condition that you are interested in learning more about. Consult the following websites to get reliable information on the following: Find out more about prenatal guidelines for folic acid supplementation at http://www.hc sc.gc.ca/fn an/pubs/nutrition/folate eng.php Visit the National Council on Health Fraud to learn more about which claims about a vitamin are the truth or are actually a fraud: http://www.ncahf.org. The nutrient value of some common foods are published online by health Canada: http://www.hc sc.gc.ca/fn an/nutrition/fiche nutri data/nutrient_value valeurs_nutritives eng.php A searchable version of the Canadian Nutrient File (CNF) which contains more than 5000 foods is available electronically at http://www.hc sc.gc.ca/fn an/nutrition/fiche nutri data/cnf_aboutus aproposdenous_fcen eng.php. ANSWER KEY FOR ALL I N S T R U C T O R S M A N UA L AC T I V I T I E S Critical Thinking Questions5 These questions will also be posted to the book s website so that students can complete them online and e mail their answers to you. 1. Answer: There are many to discuss: Structure: Vitamins are individual units, as opposed to macronutrients, which can be broken down further into individual units that provide energy. Vitamins do not provide energy per se but are involved in metabolic pathways that provide energy. Vitamins are utilized for metabolic pathways and several other functions and they are available readily. Function: Vitamins do not yield any energy but do help in metabolic pathways that yield energy. Many of the B vitamins assist enzymes in their functions in the metabolic pathways. Amount in Food Content: Vitamins are needed in minimal amounts as opposed to the large amounts of macronutrients required. While the water soluble and fat soluble vitamins are very necessary, as are macronutrients, the absolute amounts are much less. 5 Contributed by Kathleen Rourke. 8
10-9 Bioavailability: While macronutrients are generally stable in foods and relatively easily absorbed and utilized by the body for energy, micronutrients retain many issues that impact their bioavailability. For example, heat and light can destroy many of the B vitamins during food preparation or storage. Precursors: Some of the water soluble vitamins are precursors to reactions or are provitamins. Macronutrients do not have this function. This again gets back to their roles in metabolic pathways. Organic Nature: Macronutrients are of course organic. Vitamins, however, can be destroyed by light and many types of handling that the macronutrients are not susceptible to. While proteins are susceptible to denaturing by high heat, vitamins, particularly water soluble vitamins, are very susceptible to heat, sunlight, and other factors. Whereas macronutrients are normally broken down in the body for use, and hence denaturing of proteins is a normal part of digestion, vitamins must retain their chemical structures as they are absorbed or they cannot perform their functions. Solubility: Water soluble vitamins are hydrophilic. This differs from the lipids, but not from the proteins and carbohydrates. Toxicity: While most water soluble vitamins are not believed to pose a toxicity risk, there is some ability for the body to store these vitamins. The macronutrients (proteins, carbohydrates, and fatty acids), for the most part, are not able to cause toxic effects to the body (protein has limited ability to cause toxic effects). Toxicity, however, is more common with the fat soluble vitamins, which are stored extensively in adipose tissues. 2. Answer: The B vitamins have many different roles in reactions within the metabolic pathways. Thiamin: This water soluble vitamin is a vital part of thiamin pyrophosphate, a coenzyme that is very important for energy metabolism. This vitamin is very heat liable, and a deficiency causes beriberi. Thiamin is available in many foods, including fruits, vegetables, and meats. Riboflavin: This water soluble vitamin also functions as a coenzyme in many reactions in energy metabolism. Riboflavin is also very heat and sun labile and serves many functions in maintenance of the integrity of the membranes of the skin, eyes, and GI tract. Riboflavin is available in several foods including dairy products and meats. Niacin: This is another important vitamin that functions as a coenzyme in many metabolic reactions. Without niacin, many of these reactions could not take place. Niacin deficiency is associated with pellagra, which is seldom seen in developed nations. Tryptophan is a precursor to niacin. Sources include proteins, whole grains, and nuts. Niacin has been prescribed for lowering cholesterol and can be quite effective. However, too much niacin can result in a hot flash like reaction referred to as niacin flush that causes considerable discomfort. Caution should be taken when considering a niacin supplement.
10-10 Biotin: This B vitamin also plays an important role in carbohydrate metabolism within the TCA cycle. While deficiencies are rare, there are instances where consumption of egg whites can cause a deficiency of biotin. Biotin is found in protein sources such egg yolks, liver, and soybeans. Pantothenic Acid: Another important vitamin in metabolic pathways is pathothenic acid. This vitamin is part of coenzyme A and thus part of the TCA cycle. While the needs for this vitamin are not large, a deficiency can cause many issues in neurologic function. Sources of pantothenic acid are proteins and whole grains. Vitamin B6: This vitamin is very important as a coenzyme that helps metabolize urea. Vitamin B6 also helps convert tryptophan to niacin and functions to activate neurotransmsmitters. This vitamin is very heat liable and can be stored in the muscles, making toxicity a possibility. Sources of vitamin B6 are protein sources as well as potatoes, green vegetables, and fruits. Folate: This vitamin is a coenzyme for some of the most important metabolic functions, particularly with regard to DNA synthesis. Its importance has only been recognized in the last couple of decades. This vitamin helps prevent neural tube defects and (in some individuals) cancer. Sources include fruits and vegetables as well as legumes. VItamin B12: This vitamin and folate are closely intertwined as B12 is required to convert folate to its active form. B12 is important for nervous system function and nerve cell maintenance. The need for B12 is very small and it can be recycled very effectively. Most deficiencies are related to absorption of the vitamin rather than intake. Given that sources of B12 are all animal derived foods, vegans need fortified foods or supplementation of B12. Careful selection of food products, such as fortified soy milk, miso, and yeast can adequately provide enough B12 for an individual on a vegan diet. Finally, it is important to understand the overall role of all the B vitamins within the metabolic pathways. Collectively, they help to ensure that the metabolic pathways function at an optimal level. As noted in Figure 10 16, the many B vitamins perform a multitude of activities as coenzymes, and without them, energy metabolism would not occur. 3. Answer: Students, especially in the undergraduate years, don t always fully comprehend the importance of the role of their biochemistry classes in their studies, and here is where they can really comprehend its true importance. All of the B vitamins are critical in playing a role in energy metabolism, most as coenzymes or cofactors. Without the B vitamins, energy metabolism would halt. Students simply need to explain the following: Thiamin: Thiamin functions as the coenzyme thiamin pyrophosphate in the reaction that converts pyruvate to acetyl CoA. This conversion of a three carbon to a two carbon compound is required for the TCA cycle. Riboflavin: Riboflavin also serves as a coenzyme and functions as an electron donor in FMN and FAD. 10
10-11 Niacin: The same holds true for niacin as NAD and NADP. Nicotinamide is very active in several areas of the metabolic cycles, including glycolysis and amino acid metabolism. Vitamin B6: Vitamin B6 functions as a coenzyme as pyridoxal phosphate in critical reactions in glycolysis and in amino acid metabolism. Folate: Folate or tetrahydrofolate requires B12 to activate it and serves as the coenzyme for one carbon transfers. The result is the generation of the amino acid methionine. Vitamin B12: B12 and folate are intimately involved in a coupled reaction that involves the activation of folate, production of methionine, and synthesis of DNA. Clearly, without B vitamins, energy metabolism as we know it would not exist; therefore, the study of nutrition and dietetics is well beyond cooking food. This is a field for research and education on the role of food in the body for energy production, protein synthesis, tissue repair, growth and development, recovery from illness and injury, and improvement of health, as well as many other areas. The student s friend learned even more than anticipated from her encounter with a nutrition and dietetics student, which of course, always happens! 4. Answer: Water soluble vitamins are vitamins that can be absorbed in an aqueous environment. In general, they are not stored in the body; however, vitamin B6 appears to have some ability to be stored in the muscle. There is little risk that the water soluble vitamins that cannot be stored in the body will reach toxic levels. Because the body does not generally store these vitamins, water soluble vitamins need to be replenished on a regular basis. Excess is excreted by the kidneys into the urine. Fat soluble vitamins require ingestion of fatty acids in order for the vitamin to be absorbed. Therefore, they are absorbed into the lymph before being transferred to the bloodstream. Because of their association with fatty acids, fat soluble vitamins can be stored; as a result, they can reach toxic levels in the body, most particularly vitamin A. To rid the body of excessive stores, the person should consume less so that stores are reduced. An individual who is consuming a low fat diet may not be consuming enough fat to allow for absorption of fat soluble vitamins, though in general, a low fat diet would not preclude their absorption. The amount of fat in the diet can be very little; only two tablespoons of added oil a day is enough to provide for the body s needs. However, if an individual is not consuming added fat and is avoiding all fat in his or her diet, as well as perhaps taking an over the counter medication such as alli, which works to excrete about 30 percent of the fat consumed, it may be conceivable that an individual (such as an anorexic) may need to be worked with nutritionally to aid in fat soluble vitamin absorption. One tactic that can be taken is to rub monounsaturated or polyunsaturated fatty acids into the skin of the patient, which will allow some to be absorbed over a short time. With vitamin supplementation, short term results can be achieved for those patients who do not require immediate hospitalization.
10-12 Long term, with a patient that has avoided any fat, it will be a matter of nutrition education, counselling, and patience to add a small amount of oil to the diet and supplement with fat soluble vitamins. Worksheet Answer Key Worksheet 10 1: Vitamin History in Clinical Research Answers will vary. Worksheet 10 2: Bioavailability Concept Situations Bioavailability Parboiling Minimal Effect on Bioavailability Bioavailability Microwaving Processed foods Fortified foods Medical condition of individual Amount of food eaten Quality of food eaten Nutritional status of individual Food composition of a meal Worksheets 10 3 and 10 4 Answers will vary. Worksheet 10 5: Chapter 10 Crossword Puzzle 1. pellagra 2D. false negative 4. anemia 6. beriberi 8. scurvy 2A. false positive 7. antagonist 9. cheilosis 3. niacin flush 5. glossitis Worksheet 10 6: Water Soluble Vitamin Review (Internet Exercise) 1. b 2. False 3. True 4. a and b 5. False 6. a) Helps with fat synthesis; b) Decreases homocysteine levels; c) Increased incidence of kidney stones can occur with overconsumption, d) Overconsumption can cause irritability; e) Cracks around the mouth can occur in deficiency states 12
10-13 Worksheet 10 7: Beyond the Goiter Belt 1. See http://emedicine.medscape.com/article/120392 overview (prevalence = 655 million internationally). 2. Salt first became iodized in the United States in 1924; see http://www.mortonsalt.com/heritage/heritage_timeline.html. 3. There are 60 micrograms iodine per gram salt, which would equal 60 mg per 1000 g. Per http://www.gourmetsleuth.com/gram_calc.htm, there are 292 g salt in 1 cup, which would mean there are 17.52 mg iodine per cup of salt. 4. Minimal cost per person; see http://jn.nutrition.org/content/135/4/675.full to read about David Marine, the father of iodized salt. 5. Yes, these are known as goitrogens. 6. Yes, pregnant woman are at risk both for deficiency as well as toxicity in terms of fetal development. 7. Thyroid function lab tests: TSH (thyroid stimulating hormone), T3 and T4 levels should be evaluated. 8. Yes. 9. No.
10-14 W O R K S H E E T AC T I V I T I E S Worksheet 10 1: Vitamin History in Clinical Research 1. Perform a web based search in Pub Med or Science Direct for the following: thiamin vitamin history, niacin vitamin history, and ascorbic acid vitamin history. 2. How many articles did you find on each vitamin? 3. Were you able to obtain any of the full articles or just the abstracts as a free source? 4. Now perform the same search using a non scientific search engine such as Google or Ask. 5. How many hits did you find, and what types of information did you obtain? Consider the following questions using a ROUND table approach: In terms of scientific evidence do we have a long history of information with respect to thiamin, niacin, or ascorbic acid? How have the discoveries of these vitamins led to influences in public health practices throughout the world? How has the discovery of vitamins led to an increase in awareness of the need for clinical research? Identify how each vitamin was discovered in terms of clinical research. If that research study were to be performed today, would the researcher be allowed to run the study? Why or Why not? 14
10-15 Worksheet 10 2: Bioavailability Concept For the following situations, indicate whether or not the bioavailability of the nutrient content would be affected related to vitamin content. (Choose all that apply.) Situations Bioavailability Minimal Effect on Bioavailability Bioavailability Parboiling Microwaving Processed foods Fortified foods Medical condition of individual Amount of food eaten Quality of food eaten Nutritional status of individual Food composition of a meal
10-16 Worksheet 10 3: Vitamin/Mineral Supplement Evaluation Complete the supplement evaluation form about a selected supplement. 1. What is the name of the supplement? 2. What is the cost per pill? 3. Is the supplement complete (does it contain all vitamins and minerals with established DRI)? If no, what is missing? 4. Are most vitamins and minerals present at or near 100% of the adult DRI? Exceptions include biotin, calcium, magnesium, and phosphorus, which are rarely found in amounts near 100% of the DRI. List any vitamins or minerals that are present in low amounts or dangerously high amounts. 5. Does the supplement contain unnecessary nutrients or non nutrients? If yes, list them. 6. Is there hype on the label? Does the label use the terms natural, organic, chelated, no sugar, stress reliever, immune formula, etc.? List any terms used. 16
10-17 Worksheet 10 4: Vitamins in Your Diet A diet that offers a variety of foods from each group, prepared with reasonable care, serves up ample vitamins. The cereal and bread group delivers thiamin, riboflavin, niacin, and folate. The fruit and vegetable groups excel in folate, vitamin C, vitamin A, and vitamin K. The meat and alternatives group serves thiamin, niacin, vitamin B 6, and vitamin B12. The milk and alternatives group stands out for riboflavin, vitamin B12, vitamin A, and vitamin D. Even the oils group with its vegetable oils provides vitamin E. Determine whether these food choices are typical of your diet. Food Choices Frequency per Week Citrus fruits Dark green, leafy vegetables Deep yellow or orange fruits or vegetables Legumes Milk and milk products Vegetable oils Whole or enriched grain products 1. Do you eat dark green, leafy or deep yellow vegetables daily? 2. Do you drink vitamin A and D fortified milk regularly? 3. Do you use vegetable oils when you cook? 4. Do you choose whole or enriched grains, citrus fruits, and legumes often?
10-18 Worksheet 10 5: Chapter 10 Crossword Puzzle 1 4 3 2 6 5 7 8 9 Across Down 2. A test result indicating that a condition is present when in fact it is not 5. A symptom of vitamin B deficiencies; an inflammation of the tongue 7. A competing factor that counteracts the action of another factor 8. The vitamin C deficiency disease 9. A symptom of vitamin B deficiencies; a condition of reddened lips with cracks at the corners 1. The niacin deficiency disease causing dermatitis 2. A test result indicating that a condition is not present when in fact it is present 3. A temporary burning, tingling, and itching sensation that occurs when a person takes a large dose of nicotinic acid; often accompanied by a headache and reddened face, arms, and chest 4. Literally, too little blood ; any condition in which too few red blood cells are present or are immature, or too small, or contain too little hemoglobin 6. The thiamin deficiency disease 18
10-19 Worksheet 10 6: Water Soluble Vitamin Review (Internet Exercise) Go to this website to answer questions 1 6: http://www.ext.colostate.edu/pubs/foodnut/09312.html. 1. Which of the B vitamins is most sensitive to light? a. Folic acid b. Riboflavin c. Panthothenic acid d. Biotin 2. The ingestion of water soluble vitamins does not cause any side effects or adverse reactions due to their solubility. a. True b. False 3. The stability of some water soluble vitamins is affected by alkaline solutions. a. True b. False 4. Which water soluble vitamin helps participate in protein metabolism? Select ALL that apply. a. Pyridoxine b. Folacin c. Biotin 5. Pernicious anemia occurs as a result of thiamin deficiency. a. True b. False 6. Match the vitamin with its corresponding pertinent information. a. Biotin b. Folic acid c. Ascorbic acid d. Niacin e. Riboflavin Cracks around the mouth can occur in deficiency states Decreases homocysteine levels Helps with fat synthesis Overconsumption can cause irritability Increased incidence of kidney stones can occur with overconsumption
10-20 Worksheet 10 7: Beyond the Goiter Belt Research the following questions and be prepared to discuss your findings in a round table discussion format. Iodine 1. What are the prevalence of goiter in the world? incidence and 2. When did salt become iodized in the United States? 3. How much iodine is in iodized salt? 4. How much does it cost in terms of economic values to prepare iodized salt? 5. Can food products such as peaches or strawberries interfere with the ability of the thyroid gland to function normally? 6. Are pregnant women at risk for problems with iodine? 7. What lab tests should be assessed to determine whether or not a person has normal thyroid function? 8. Can goiters develop as a consequence of either iodine deficiency or iodine toxicity? 9. Do individuals living in Canada and the United States need to take iodine supplements other than iodized salt? 20
Handout 10 1: RDA/AI and UL for Vitamins Compared 10-21