Advanced 2-Exam 3

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Homocysteine: 1. stimulates the growth of smooth muscle cells in arteries
2. is an amino acid
3. can be methylated to methionine
Ceruloplasmin functions to oxidize iron so iron can be transported in the blood. True or False: True
What enhances the absorption of non-heme iron?: poultry protein, fish protein, ascorbic acid
Pantothenic acid is: 1. involved in E metabolism
2. a component of CoA
3. involved in acyl transfer
What will tend to lower inorganic iron absorption when the coffee and iron foods are consumed together?: coffee (caffeinated and decaf)
Red blood cell breakage can be used as an assessment measure for which nutrient?: tocotrienols/tocopherols=antioxidants (vitamin E)
Dietary sources for B12 include:: 1. nutritional yeast
2. tempeh
3. cheese
1 mcg of food folate=: 1 DFE
food folate is known as: polyglutamate
1 mcg of folic acid=: 2 DFE
folic acid is known as: monoglutamate
food sources of folate inclulde:: 1. nutritional yeast
2. liver
3. green vegetables
4. legumes
5. whole grain
What must happen to pteroylpolyglutamates prior to absorption?: first must be hydrolyzed by a conjugase (zinc dependent)
When taken on an empty stomach folic acid is absorbed how much better than food folates?: twice as good
Food folate is readily lost in?: vegetable cooking and drying. canned foods seldom have folate added back
What converts the monoglutamate form to N5-methyl THF?: the intestinal cell
Where is folate absorbed so that it can be taken into cells in the N5-methyl THF form?: in the blood
In cells, what form of folate is needed in order to function as a coenzyme?: polyglutamate
What must happen for polyglutamates to be active?: the methyly group must be removed...this requires vitamin B12
How is folate excretion?: Mainly through bile! There is an enterohepatic circulation for folate.
Side effect of deficiency:: increased risk for heart disease due to an elevation of blood homocysteine
Deficiency may be seen in:: malignancy, malabsorption, alcoholism, pregnancy/lactation, oral contraceptive use, anti-convulsive drug use, the elderly, B12 deficiency
Folate toxicity: may mask B12 deficiency
What could folate supplements do to epileptics?: May induce seizures
Determination of folate nutritional status:: 1. Red cell or serum folate and serum B12 (red cell elvels are more accurate)
2.B12 is necessary to activate folate, folate deficiency will usually occur in B12 deficiency. A folate deficiency will be shown biochemically by excretion of N-formiminoglutamate (FIGLU) in the urine
3. testing for thymidylate synethetase activity in lymphocytes or bone marrow cells can be done to determine deficiency
4. related to B12 def-methylmalonate builds up in urine
5. Schilling Test-used for B12 absorption and IF presence
6. Elevated levels of homocysteine in blood possible folate, B12, or B6 problems
What helped angioplasty patients lower their homocysteine levels which made them 32% less likely to have a "major adverse event"?: three B-vitamins
What has been proven to be as effective as NSAIDs in reducing pain and improving fuctional limitation in patients with osteoarthritis w/o the adverse effects often associated w/ NSAID therapies?: SAMe
Which one is a phytoestrogen? lignin, lignan, ligand, lutein: lignan
Ceruloplasmin functions to reduce inorganic iron so iron can be transported in the blood on transferrin. True or False?: False-oxidizes
The excretion of iron in the urine of which metabolite is a measure of nutritional status for folacin?: N-formiminoglutamate
A load test for which amino acid is used in determining the biochemical assessment for folacin or B12?: histidine
200 mcg of supplemental folic acid is enough to supply the body with the DFE RDA. True or False?: True
Food folacin is absorbed into the gut cell as well as supplemental folacin. True or False?: FALSE
If one takes a high enough folic acid supplement, a certain percentage of this does not need vitamin B12 for activation. True or False?: True
If one has a normal nutritional status for vitamin B12, but is folacin deficient, the enzyme thymidylate synthetase activity will be normal. True or False?: FALSE
From a nutritional standpoint, one can still have neuropathy in a patient without macrocytic anemia. True or False?: True
Does nicotonic acid or nicotinamide have the ability to improve blood lipids in large doses?: nicotonic acid
What can nicotinamide help in?: vitamin function
How is nicotinic acid immediate release taken?: in divided doses
Is nicotonic acid in the immediate release or the sustained release preferred?: immediate release
How is nicotinic acid sustained release taken?: in a tablet packed in gel, slowly breaks down in intestine
Nicotinic acid toxicity causes:: 1. flushing
2. worsens glucose tolerance (diabetes)
3. gout
4. ulcers
5. worsens blood homocysteine
6. liver/muscle damage
How much of nicotinic acid requires monitoring when taken in the immediate release form?: 500mg or more
How much of nicotinic acid requires monitoring when taken in the sustained release form?: 250mg or more
SAM-e is used for what?: adequate functioning in the CNS, hepatoprotective, antioxidant, and antidepressant, improves cognition in Alzheimer's disease, and protects against CAD
What two deficiencies decrease levels of SAM-e?: folate and B12
What two neurotransmitters does SAM-e increase?: dopamine and serotonin
How is SAM-e similar to NSAIDs?: It has antiinflammatory and analgesic effects with fewer side effects.
Why might SAM-e help in osteoporosis?: It is thought to protect cartilage and to assist in the repair of cartilage.
How is the assessment of nutritional status for thiamin done?: 1. blood levels
2. RBC transketolase activation in vitro
What percentage of transketolase if activated by TDP is considered a deficient level?: greater than 25%
How is riboflavin (B2) used for Vitamin B6?: it converts it to PLP
How is the assessment of nutritional status for riboflavin done?: 1. glutathione reductase activation in vitro
How is the assessment of nutritional status for niacin done?: 1. urinary measurement of N-methlynicotinamide (mg) per gram of creatinine after feeding 50 mg niacinamide
What is adequate urinary measurement for niacin?: greater than 1.6 mg
What are niacins functions?: 1. electron/hydrogen transfer reactions (oxidation and reduction rxns)
2. f.a. synthesis
What dose of niacin should be consumed for immediate release forms?: 1-4 grams/day in four equal doses
What dose of niacin should be consumed for sustained release forms?: one-half the dose once a day
Why is the before bed niacin dose important?: Because lipolysis is enhanced over night and niacin functions by reducing lipolysis.
Why shouldn't you use NADH supplements?: they are too highly priced for what they actually do
What is one difference between niacin and nicotinamide?: nicotinamide lacks any lipid-lowering effect and functions only as a vitamin
Niacin inhibits lipolysis so,: it reduces the availability of free fatty acids for hepatic TG synthesis
Niacin does what to HDL and VLDL: increases HDL and decreases VLDL
Niacin increases HDL by what percentage, which is a greater effect than any other currently available lipid-lowering drugs?: 15-40%
Do not increase niacin by more than what per day?: 1.5-2.0 grams
What three forms of B6 are converted to PLP?: pyridoxine, pyridoxal, pyridoxamine
what is the main supplemental form for vitamin B6?: pyridoxine HCl
What is the main blood form of vitamin B6?: pyridoxal phosphate or PLP
What is important for pyridoxine and pyridoxamine conversions?: riboflavin
Main coenzyme form of B6?: PLP
Fuctions of B6?: 1. a.a. interconversions (transamination)
2. urea formation
3 a.a. deamination
4. tryptophan converted to serotonin (decarboxylation)
5. histidine converted to histamine (decarboxylation)
6. tyrosine conversion to dopamine (decarboxylation)
7. synthesis of heme
8. conversion of tryptophan to niacin
9. conversion of methionine to cysteine (transsulfhydration, desulfhydration)
10. lysine conversion to carnitine
What is vitamin B6 excreted as mainly?: pyridoxic acid
What is the DRI for vitamin B6?: For adult men and women aged 19-50 years the RDA is 1.3 mg.

A rough amount per gram of dietary protein is 0.016mg.
Vitamin B6 deficiency can be found in?: rare but in elderly and in those who consume too much alcohol. certain drugs like anticonvulsants may induce deficiency.
Symptoms of B6 deficiency?: general but could include hypochromic microcytic anemia.

B6 is necessary for heme production
Toxicity of B6: High intakes will cause sensory neuropathy.

The lowest observed adverse effect level is 500mg/day.

UL=1000mg/day
B6 assessment measures include:: 1. xanthurenic acid excretion in the urine following a tryptophan load.

2. plasma PLP levels

3. urinary B6 and urinary pyridoxic acid excretion
How many mg of tryptophan will make how many mg of nicotinamide: 60mg of tryptophan=1mg nicotinamide
What are some harmful chemicals that are put in food through food purchasing and production practices?: polycyclic aromatic hydrocarbons, heterocyclic amines, acrylamide
Food purchasing and production practices can reduce risk for?: heart disease (AGEs increase C-reactive protein), kidney disease, diabetes, human aging
In general, fatty foods form more what than carbohydrate foods?: AGEs
How can you cut down on AGEs from fatty foods?: 1. Reduce purchasing of high fat foods and processed foods
2. Use lean cuts and trim visible fat from foods
3. Consume more skinned poultry particularly white meat
4. Consume more fish
Moisture in cooking greatly reduces the production of?: harmful chemicals
What cooking techniques increase levels of AGEs?: dry cooking techniques like broiling, baking at too high temp, grilling, and frying
(ROASTING can bo OK but keep temps low)
What cooking technique produces little browning and fewer toxic chemicals?: microwave cooking
What can one do to meats to cut down on AGEs if they want to stir-fry?: pre-cook meats by moist cooking methods
A supplementation of how much pyridoxamine (a form of B6) appears to work well with no serious adverse side effects?: 300mg/day
UL=100mg/day
LOABL=500mg/day
If one takes a high enough folic acid supplement, a certain percentage of this supplement can be absorbed into the blood without gut methylation. True or False?: True
A folic acid molecule chemically tagged with a cancer fighting drug may be effective in treating what type of cancer?: FAST GROWING (they have additional folate receptors)
Transketolase is activated by what hexose shunt enzyme?: TDP or TPP (thiamin diphosphate)
Large doses of nicotinic acid may do what to LDL cholesterol?: LOWER
Large doses of nicotinic acid may do what to blood homocysteine?: ELEVATE
Large doses of nicotinic acid may do what to the enzyme adenylate cyclase?: INHIBIT
Nicotinic acid, a form of vitamin B3, at high doses can do what with blood sugar in diabetics?: worsen
In using high dose niacin for blood lipid control, what form is effective?: ACID FORM
What formulation of nicotinic acid is more apt to cause hepatotoxicity unless a proper dose is used?: SLOW RELEASE (must take 1/2 dose of immediate release)
An enzyme is significantly activated in vitro, therefore the patient from whom the enzyme was taken, is in what nutritional status?: poor
The main coenzyme in metabolism for vitamin B6 is?: PLP
The supplement SAMe can be used in patients taking MAOI drugs in order to improve overall drug therapy. True or False?: FALSE
The supplement SAMe cannot be used as potential therapy for those with what two disorders?: Parkinson's disease and bipolar disorder
SAMe, according to some research, can safely be used for treatment of what?: certain depressive disorders and osteoarthritis
Glutathion reductase activation can be used for estimating the nutritional status for what vitamin?: B2, riboflavin
The detection of methylmalonic acid in the urine is indicative of poor nutritional status for what vitamin?: vitamin B12
L-ascorbic acid (vitamin C) is an acid sugar of what?: glucose
Why should one not cook vegetables with added sodium bicarbonate?: It will destroy several vitamins including vitamin C
What is the best supplemental source for vitamin C?: Calcium Ascorbate (ester C)
What are the supplemental sources of vitamin C?: ascorbic acid (dental damage), calcium ascorbate (best), sodium ascorbate (sodium), ascorbyl palmitate (fat)
RDA for vitamin C?: 90mg for adult males
75mg for adult females
What are the functions of vitamin C?: 1. Prevents or cures scurvy (a connective tissue problem)
2. Carnitine synthesis
3. Neurotransmitter formation such as Serotonin
4. Dopamine conversion to norepinephrine
5. folate reduction forming THF
6. increases non-heme iron absorption and iron storage as ferritin
7. Phenylalanine conversion to tyrosine
8. reduces nitrosamine (carcinogen) formation in upper gut
9. neutralizes free radicals and regenerates vitamin E
10. may help control blood pressure
Excretion of vitamin C is cleaved to?: oxalic acid which may increase the risk for kidney stones
Deficiency of vitamin C can cause?: petechial hemorrhage, spongy bleeding gums, ecchymoses (bruising), perifolliculosis
UL for vitamin C is what?: UL=2 g/day
Chronic high doses of vitamin C could lead to calcium oxalate kidney stones in those predisposed to what?: urolithiasis
Excessive ascorbate excretion in the urine or feces can interfere with some lab testing causing?: 1. false-negative tests for fecal and urine occult blood (blood is there but not detected)
2. tests for glucose in the urine can be rendered invalid causing a false positive test (glucose is not there but the test shows it is)
The chewable forms of vit C cause what?: dental erosion
Nutrition assessment for vitamin C?: serum or plasma levels of ascorbic acid are most commonly done
What functional test is done for assessment of vitamin C?: capillary fragility test combined with serum levels
Vitamin C may improve dilation of the small blood vessels that control pressure because of?: arginine which leads to nitric oxide that dilates blood vessels. Vitamin C protects nitric oxide.
What is recommended in order to get 200mg daily of vitamin C?: food!
Tocopherols and tocotrienols all have vitamin E activity. True or False?: FALSE-"most"
Are tocotrienols more unsaturated or saturated?: UNSATURATED
Are tocopherols more unsaturated or saturated?: SATURATED
What are the chiral carbons in tocopherols and tocotrienols?: 2, 4, and 8
RRR of vitamin is in what form?: The "d" form.
Vitamin A alternative names include:: retinol, retinal, retinoic acid (provitamins like carotenoids, particularly beta carotene
Vitamin A function: synthesis of rhodopsin, cell differentiation
Vitamin A deficiency: poor dark adaptation, night blindness, Bitot's spots
Vitamin A RDA: Adult males=900 micrograms
Adult females=700 micrograms
Vitamin D alternative names include:: Ergosterol, 7-dehydrocholesterol, Vitamin D2 (ergocalciferol), Vitamin D3 (cholecalciferol)
Vitamin D function: regulator of bone mineral metabolism, blood calcium homeostasis, and cell differentiation, proliferation, and growth, and decreases cancer risk
Vitamin D deficiency: rickets, osteomalacia
Vitamin D AIs: 5-15 micrograms
Vitamin E alternative names include:: tocopherols and tocotrienols
Vitamin E functions: antioxidant
Vitamin E deficiency: anemia (hemolytic), neuropathy and myopathy
Vitamin E RDA: 15 mg (d-alpha-tocopherol)
Vitamin K alternative names include:: phylloquinones, menaquinones, menadione
Vitamin K functions: activates blood-clotting factors, carboxylates bone and kidney problems (vit K needed to activate osteocalcin which improves bone strength)
Vitamin K deficiency: defective blood clotting
Vitamin K AIs: Adult males=120 micrograms
Adult females=90 micrograms

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