1. NS 220 Unit 5 Seminar Vitamins and Health
Brooke Benton MS, RD, LDN, CDE

2. Overview Vitamin Supplementation
Vitamin deficiency diseases & food fortification
Beneficial vitamins for specific populations
Vitamin toxicities
Multivitamins
Today, we will discuss vitamins with specifics on supplementation, vitamin deficiency diseases & food fortification, beneficial vitamins for specific populations, vitamin toxicities, and multivitamins.
According to the National Institutes of Health, annual sales of supplements to Americans are reported at about $23 billion with a substantial share of that being spent on vitamins and minerals.
Today, the supplementation industry is a big business making and selling many different types of dietary supplements that have vitamins, minerals, fiber, amino acids, herbs, or hormones in them. Supplemental vitamins are common worldwide. They come in the form of pills, capsules, powders, gel tabs, extracts, or liquids. Sometimes you find them added to drinks or energy bars. They might be used to add nutrients to your diet or to prevent health problems. Since you don’t need a prescription from your doctor to buy vitamins some people may be taking megadose levels which may be toxic to the body or some people may be taking vitamins that they don’t really need. Some vitamins may be required to treat certain disease states and vitamin deficiencies.
How many of you take some type of vitamin supplementation? If so, what do you take, if you don’t mind sharing?

3. Position of American Dietetic Assoc.
To promote health and reduce risk of chronic disease, choose variety of foods.
Food provides all vitamins you need.
Fortified foods and supplements can help some
meet their nutrition needs.
According to the American Dietetic Association, the best nutritional strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. So, you can obtain all the vitamins you need from food. Additional nutrients from fortified foods and/or supplements can help some people meet their nutritional needs as specified by the DRI’s (Dietary Reference Intakes).

4. What are vitamins?
Essential organic substances needed daily in very small amounts to perform a specific function
Essential for growth and health - an absence or deficiency of vitamins creates specific disorders
Interact with other vitamins and/or nutrients to enhance absorption
Can function as coenzymes
Help release energy from biological reactions during metabolism but they do not provide energy
Vitamins are essential organic substances needed daily in very small amounts to perform a specific function in the body.
Vitamins are essential for growth and health. An absence or deficiency of vitamins creates specific disorders – we will be talking about some of these later today
In the digestive process, vitamins interact with other vitamins and/or nutrients to enhance absorption.
Vitamins can function as coenzymes; that is, they can work with enzymes to speed body chemical reactions. They are used up in the reactions, whereas the enzymes
remain unchanged.
Vitamins help release energy from biological reactions during metabolism. They do not provide energy.
Vitamins are not a structural part of the body.

5. Vitamin Types Water-Soluble Fat-Soluble Vitamin C B Vitamins:
Folate
B12
Thiamin
Riboflavin
Niacin
Biotin
Pantothentic Acid
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Vitamins are classified into groups with regard to their solubility in either fat or water

6. Water Soluble Vitamins
Water soluble vitamins are lost into cooking water
To prevent this lose:
Use only a small amount of cooking water
Use leftover cooking water to make sauces
Minimize cutting food into pieces
Use the shortest cooking times and with the lid when possible to shorten cooking time

7. Water Soluble Vitamins
The body does not store excess water soluble vitamins
Excess are excreted in urine
Supplementation does not provide extra benefits if the person is consuming an adequate amount – excess will be excreted
Vitamins deficiencies usually appear only a few weeks later
Vitamins need to be consumed daily

8. Fat Soluble Vitamins Not affected by cooking and preparation in water
Can be destroyed by high cooking heat, sun drying, forms of dehydration
Oxidations that accompanies rancidity in fat

9. Fat Soluble Vitamins
Excess fat soluble vitamins are stored in body fat and organs, especially the liver
Can delay deficiency for several months
Need to supplement every other day instead of daily
Not immune to large doses – megadoses are toxic to the body

10. Vitamin Deficiencies Vitamin A: may result in xerophthalmia
Vitamin D: rickets and osteomalacia
Vitamin K: deficiency in newborns; made in intestines by good bacteria
Vitamin C: scurvy; delayed wound healing; decrease in iron absorption; capillary bleeding
Thiamin: beriberi; heavy alcohol consumption can lead to poor absorption of thiamin
These are some of the vitamin deficiency diseases.
Vitamin A deficiency may result in xerophthalmia (final question).
Vitamin D deficiency= Rickets and Osteomalacia
Vitamin K deficiency= newborns are born deficient in vitamin K so a shot of vitamin K is given at birth; vit K is synthesized in the intestines by good bacteria and at birth newborns have not yet produced the good bacteria and vit K, so supplement is required (final questions).
Vitamin C: scurvy; delayed wound healing; decrease in iron absorption; capillary bleeding (final question).
Thiamin: beriberi; heavy alcohol consumption can lead to poor absorption of thiamin
Vitamin deficiency diseases such as scurvy (deficiency of vitamin C) and rickets (vitamin D deficiency) and many others are all linked to health conditions, but these diseases have mostly been eradicated with the fortification of many food items. Now, the focus of vitamins has shifted from nutrient deficiency diseases to chronic disease prevention.

11. Dietary Guidelines Nutrients consumed should come primarily from food.
Beneficial Vitamins for Specific Populations:
Which populations??
According to the Dietary Guidelines, there are Beneficial Vitamins for Specific Populations: certain vitamins that may benefit certain populations of people.
The Dietary Guidelines promote health and reducing the risk of chronic diseases through diet and exercise.
So, according to the Dietary Guidelines for Americans, nutrients consumed should come primarily from foods since foods contain not only the vitamins and minerals that are often found in supplements, but also hundreds of naturally occurring substances, including carotenoids and flavonoids that may protect against chronic health conditions.
There are specific instances when supplements may be useful.
What type of instances would a vitamin supplement be useful?
Supplements may be useful when they fill a specific identified nutrient gap that cannot or is not otherwise being met by the individual’s food intake. Supplements are not a substitute for a healthy diet. Let’s review a few vitamins that may be beneficial for specific populations of people.

12. Women and Folic Acid Necessary for all women of
childbearing age and women who are pregnant.
Reduces the risk of neural tube defects and Spina Bifida.
Food fortification & food sources (green leafy vegetables)
RDA: 400 mcg (adults/women childbearing age); mcg (pregnancy)
Folate is the natural form of the vitamin and folic acid is the synthetic form that is found in supplements and added to fortified foods.
One of the functions of folate is that it helps produce and maintain new cells, so this is especially important during periods of rapid cell growth such as during pregnancy and infancy.
Do you know why folic acid is so important for women of childbearing age as well as pregnant women?
Folic acid is one of the necessary vitamins for all women of child bearing age and women who are pregnant since folic acid reduces the risk of the neural tube defects and spina bifida. This is when the neural tube doesn’t close all the way & results in an incompletely formed spinal cord. Now, the incidence of spina bifida can be decreased up to 70 percent when daily folic acid supplements are taken prior to conception.
To help reduce the incidence of neural tube defects, the FDA in 1998 required the addition of folic acid to breads, cereals, flours, pastas, rice, and other grain products. These products have become an important source of folic acid in the US and most people are consuming the recommended amounts of folate because of this.
RDA: For women who are of child bearing age who may or could become pregnant, a daily intake of 400 μg/day of synthetic folic acid (from fortified foods or supplements in addition to food forms of folate from a varied diet) is recommended. Pregnant women should consume a higher amount of 600 μg/day of synthetic folic acid (from fortified foods or supplements) in addition to food forms of folate from a varied diet.
CDC Podcast:

13. Special Groups & Vitamin D
Fat-soluble; obtain from food and sun
Sun source activated in liver & kidney
Deficiency diseases: Rickets & Osteomalacia
Food sources: fortified milk most reliable source
High risk of deficiency:
Breastfed infants
Older adults
Limited sun exposure
Individuals with dark skin
A fat-soluble vitamin that is naturally present in only a few foods, is added to some foods, and can be produced in the body from exposure to the sun.
Adequate vitamin D status is important for optimal calcium absorption, and it can reduce the risk for bone loss leading to osteoporosis. Both calcium and vitamin D in combination help to prevent rickets (final question) in kids and osteomalacia (soft bones resulting in bone pain and muscle weakness) in adults. (Rickets:
Which food sources contain vitamin D?
Food sources: very few foods naturally contain vitamin D…fish (salmon, tuna, mackerel; cod liver oil). Fortified foods consist of milk (100 IU/cup; fortified to prevent rickets), cereals, some orange juice, yogurts, and margarines.
The sun source of vitamin D is produced by sun exposure to the skin that is then converted to the active form of vitamin D in the body. Season, geographic latitude, time of day, cloud coverage, smog, and sunscreen >SPF of 8 are all factors that affect vitamin D synthesis. A latitude north of Boston is insufficient for vitamin D synthesis from November through February. Cloud coverage reduces UV energy by 50% and shale reduces it by 60%. Exposure to sunshine through a window does not produce vitamin D.
Optimal amount of sun exposure is 5-30 mins b/t 10 am – 3 pm at least 2x/week w/o sunscreen…this amount can lead to sufficient vitamin D production.
What do you think some of the limitations may be to obtaining adequate vitamin D intake and production from the sun?
Obtaining sufficient vitamin D from food sources can be difficult as well as adequate sun exposure (less in winter months vs. summer in some climates).
What groups of people might be at risk or insufficient vitamin D?
Breastfed infants: breastmilk alone does not provide adequate vitamin D (supplement with 400 IU per day).
Older Adults (ages 50 and over) are at risk because as people get older their skin cannot synthesize vitamin D as efficiently so housebound individuals and nursing home residents are at risk and they also get limited sun exposure as well.
Jail; daycare
People living in northern climates
Individuals with dark skin because the pigment reduces the skin’s ability to produce vitamin D from the sun
Milk allergy/lactose intolerance
Fat malabsorption: fat-soluble vitamins require dietary fat in the gut for absorption; fat malabsorption conditions include Crohn’s disease, cystic fibrosis, celiac disease, surgical removal of part of the stomach or intestines, and some forms of liver disease.
Obesity: does not affect the skin’s capacity to synthesize vitamin D, but the greater amount of fat sequesters more of the vitamin and alter it’s release into the circulation.
For individuals within the high risk groups, substantially higher daily intakes of vitamin D, up to 1,000 International Units (IU) of vitamin D per day has been recommended to reach and maintain serum vitamin D values. Three cups of vitamin D fortified milk (7.5 μg or 300 IU), 1 cup of vitamin D fortified orange juice (2.5 μg or 100 IU), and 15 μg (600 IU) of supplemental vitamin D would provide 25 μg (1,000 IU) of vitamin D daily.
AI: current levels are 200 IU (birth to 50 yo + pregnancy/lactation); 400 IU (adults yo); 600 IU (71+ yo).
Recent increase recommendation by American Academy of Pediatrics (2008) for infants/children/adolescents to 400 IU per day.
A lot of researchers think the recommended levels for vitamin D are too low due to recent research results and an increased incidence of vitamin D deficiency, so these levels are currently being reviewed by the IOM. Look for new recommended levels in the next year or two.
Toxicities are more likely to occur from high intakes of supplements; excessive sun exposure does not result in toxicity because the sustained heat on the skin is thought to degrade it.

14. People >50 & Vitamin B12 Most adults meeting recommended amounts
Deficiency most likely to occur as a result of an inability to absorb B12 from food.
B12 needs stomach acid & Intrinsic Factor to be absorbed; less gastric secretions over age 50, so decrease in absorption.
Recommend for >50 years old to eat fortified B12 foods or take supplement.
Natural source B12 only in animal foods.
Most children and adults are consuming the recommended amounts of vitamin B12, however a deficiency is most likely to occur as a result of an inability to absorb B12 from food.
HCL in stomach releases B12 in foods during digestion. Once released, B12 combines with intrinsic factor (secreted by gastric cells) and is then absorbed in the GI tract.
There is a substantial proportion (~30%) of individuals over age 50 that have decreased gastric acid secretions, so they are unable to absorb vitamin B12 from food (naturally occurring). They are, however able to absorb the synthetic form of B12 that is added to fortified foods and vitamins.
Thus, all individuals over the age of 50 should be encouraged to meet their Recommended Dietary Allowance (RDA) (2.4 μg/day) for vitamin B12 by eating foods fortified with vitamin B12 such as fortified cereals, or by taking vitamin B12 in the form of a supplement.
Only natural source of B12 comes from animal foods…who might be at risk of B12 defic?

15. Toxicities
>100% of RDA could be harmful to health for specific vitamins, esp from supplements.
Fat-soluble more risk of toxicity than water- soluble.
Vit. A toxicity more likely from
high dosage vit A supplements.
UL’s established.
Some people might think that if a little is good, a lot must be better. But, that doesn’t necessarily apply to vitamins and minerals. Depending on the supplement, your age, and your health, taking more than 100% DV could be harmful to your health.
So, more is not necessarily better with supplements, especially the fat-soluble vitamins. Fat-soluble vitamins have a higher potential for toxicity due to their capability to accumulate in the body whereas water-soluble vitamins are excreted in the urine if excess amounts are consumed.
Which fat-soluble vitamins are more likely to be toxic?
Vit. A toxicity more likely from high dosage vit A supplements (final question). High storage levels of vitamin A can lead to toxic symptoms which are birth defects, liver abnormalities, reduced bone mineral density that may result in osteoporosis and central nervous system disorders. .
Vitamin D toxicity can lead to high blood calcium levels and even kidney damage.
UL’s are established for some vits/mins that should not be exceeded per day.
There is more of a risk if someone is supplementing with vitamins and consuming a high amount of fortified foods. For example, a supplement of vitamin A intake of 100% DV (Daily Value) means the supplement is giving you the full amount of vitamin A you need each day. This is in addition to what you are getting from your food.

16. Multivitamins
NIH Consensus and State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention (2006) with results indicating:
There is not strong evidence for beneficial health- related effects of supplements.
There is insufficient evidence to recommend either for or against the use of multivitamin/mineral supplements by the American public to prevent chronic disease.
NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and
Chronic Disease Prevention. Ann Intern Med. 2006;145:364–371.
Use of multivitamins/minerals has grown rapidly over the past several decades, and dietary supplements are now used by more than half of the adult population in the United States.
What are your reasons for taking MVM supplements? POLL: Do you take a multivitamin/mineral supplement?
Despite the widespread use of MVMs, we still have insufficient knowledge about the actual amount of total nutrients that Americans consume from diet and supplements. This is at least in part due to the fortification of foods with these nutrients, which adds to the effects of MVMs or single-vitamin or single-mineral supplements.
With such widespread use of MVM, increasing public and medical confusion over apparently contradictory results from studies… Office of Dietary Supplements and the Office of Medical Applications of Research of the National Institutes of Health convened a State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention, (May 15-17, 2006) in Bethesda, Maryland. The goal of the conference was to assess the evidence available on MVM use and outcomes for chronic disease prevention in the generally healthy population of adults and to make recommendations for future research.
Most of the studies they examined did not provide strong evidence for beneficial health-related effects of supplements taken singly, in pairs, or in combinations of three or more.
Within some studies or subgroups of the study populations, there is encouraging evidence of health benefits, such as increased bone mineral density and decreased fractures in postmenopausal women who use calcium and vitamin D supplements. However, several other studies also provide disturbing evidence of risk, such as increased lung cancer risk with β-carotene use among smokers.
The concensus concluded that the present evidence is insufficient to recommend either for or against the use of MVMs by the American public to prevent chronic disease.
There may be some cases where specific vitamins or even a MVI may be warranted. The may be in cases of:
Health conditions such as malabsorption syndromes, celiac disease
Unbalanced diet such as typically in the cases of chronic alcoholics and possibly older adults
Pregnant or breastfeeding
Anorexia Nervosa or very low calorie intake
Historically, fortification of foods has led to the remediation of vitamin and mineral deficits, but the cumulative effects of supplementation and fortification have also raised safety concerns about exceeding upper levels. Thus, there is a national need to improve the methods of obtaining accurate and current data on the public’s total intake of these nutrients in foods and dietary supplements.

17. Questions???

18. Let’s Play Vitamin Trivia!

19. Vitamin Trivia
Which of the following vitamins has a requirement based on the amount of carbohydrate in the diet?
Riboflavin
Thiamin B6
B12
Niacin
Thiamin

20. Vitamin Trivia
Which of the following vitamins may be synthesized from the amino acid tryptophan?
Riboflavin
Thiamin B6
B12
Niacin
Niacin

21. Vitamin Trivia
Which of the following vitamins has a deficiency that causes cracked skin around the mouth, inflamed lips, and a sore tongue?
Riboflavin
Thiamin B6
B12
Niacin
Riboflavin

22. Vitamin Trivia
Which of the following vitamins helps change one amino acid into another?
Riboflavin
Thiamin B6
B12
Niacin B6

23. Vitamin Trivia
Which of the following vitamins is a cobalt containing vitamin needed for red blood cell formation?
Riboflavin
Thiamin B6
B12
Niacin
B12

24. Vitamin Trivia
True or False Synthetic vitamins are nutritionally equivalent to naturally occurring vitamins.
True

25. Vitamin Trivia
True or False Vitamin losses from fruits and vegetables can occur as a result of poor conditions of harvesting and storing.
True

26. Vitamin Trivia
True or False Natural and synthetic vitamins are used by the body the same way.
True

27. Vitamin Trivia
True or False Vitamin K is required for the synthesis of blood- clotting factors.
True

28. Vitamin Trivia
True or False B vitamins serve as co-enzymes in metabolic reactions in the body.
True

29. Vitamin Trivia
True or False There is no RDA/DRI for Vitamin K because it is produced by the body.
True

30. Vitamin Trivia
Is the following phrase true of a Water Soluble or Fat Soluble vitamin? These are excreted in urine.
Water

31. Vitamin Trivia
Is the following phrase true of a Water Soluble or Fat Soluble vitamin? These require regular consumption in the diet because storage in the body is minimal.
Water

32. Vitamin Trivia
Is the following phrase true of a Water Soluble or Fat Soluble vitamin? These have deficiencies that are slow to develop.
Fat

33. Vitamin Trivia
Is the following phrase true of a Water Soluble or Fat Soluble vitamin? These include the vitamin B complex and vitamin C.
Water

34. Vitamin Trivia
Is the following phrase true of a Water Soluble or Fat Soluble vitamin? The include vitamins A, D, E, and K.
Fat

35. Vitamin Trivia
Is the following phrase true of a Water Soluble or Fat Soluble vitamin? These are stored in appreciable amounts in the body.
Fat

36. Vitamin Trivia
Which of the following food preparation methods is most likely to cause large losses of vitamins?
Cooking fruits and vegetables whole and unpared
Dicing fruits and vegetables into small pieced
Cutting fruits and vegetables into medium, chunky pieces
Cutting just before serving time B

37. Vitamin Trivia
When cooking vegetables to conserve vitamins, which is preferred?
Small amounts of water
Large amounts of water
No water
Addition of baking soda A

38. Vitamin Trivia
Which vegetable preparation method tends to conserve the most vitamins?
Boiling
Simmering
Stir-frying
baking C

39. Vitamin Trivia Excessive vitamin intake has:
Not been demonstrated to be beneficial in humans
Been shown to cause toxicity by some vitamins
Been shown to cause increased excretion of the water-soluble vitamins
All of the above D

40. Vitamin Trivia
An important role of the water-soluble vitamins is to serve as:
Enzymes
Hormones
Electrolytes
coenzymes D

41. Vitamin Trivia
Vitamin/mineral supplements are generally recommended for ______ because they are at higher risk for developing deficiencies?
Infants
Pregnant and lactating women
Strict vegetarians
Persons with malabsorption diseases A

42. Vitamin Trivia
One should avoid taking vitamin pills unless especially prescribed by one’s doctor because:
They are too expensive
Fat-soluble vitamins are stored in the body and can build up to toxic levels
Water-soluble vitamins in excess of daily requirements become toxic to the liver
Edema can result from high blood levels of water soluble vitamins B

43. Vitamin Trivia Good food sources of thiamin include all except:
Lean pork, beef, liver
Citrus fruits
Green leafy vegetables
Sunflower and sesame seeds B

44. Reference
Hui, Y.H. & Stanfield, P. (2010). Nutrition and Diet Therapy: Self-Instructional Approaches, 5th edition. Sudbury, Massachusetts: Jones and Bartlett Publishers