VitaminsMinerals Supplements WHAT DO YOU TAKE

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Vitamins-Minerals Supplements WHAT DO YOU TAKE?

• John Pan, MD

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Should You Take?

• NIH Consensus Conference
• No evidence of benefit
• Most panel members take supplements

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What for

• Causes of all disease/dysfunction
• Free radical
• Inflamation
• Antioxidant
• Anti-inflammatory

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How do you choose

• Dosing BID
• Dissolution
• USP XXIV, gel-caps
• Absorption
• Amino acid Chelation, Nano technology
• Formulation
• Ingredient source natural
• Vit-E mixed
• Updated
• Vitamin, mineral, antioxidant, anti-inflammatory

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WHAT

• Vitamins
• Minerals
• Antioxidants
• Anti-inflammatory

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Vitamins

• Essential nutrients
• scurvy-Vit-C rickets-Vit-D pellegra-Vit-B3
• Normal metabolic function
• Krebs cycle B1,2,3,5,6 Biotin
• Homocysteine B6,12 Folic Acid
• Water soluble/Fat soluble
• Vit-C B vitamins - Vit-A, D, E K
• RDA/RDI Recommended Daily Allowance/Reference
  Daily Intake
• Disease prevention community-gender/age based
  healthy population
• Biochemical individuality, genetic heritage,
  health

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Vitamin E

• Organic source
• Tocopherols
• Alpha, beta, gamma
• Tocotrienols
• Alpha, beta, gamma
• Mixed

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Vitamin D

• Vit-D3 (skin-UVB) 25(OH)D (liver) 1,25(OH)2D
  (kidney)
• Mechanism of Action
• VDR Vit-D Receptor
• VDREs - Vit-D Response Elements modulate gene
  transcription
• Function
• Calcium balance Cell differentiation Immunity
  Insulin secretion Blood pressure regulation

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Vitamin D

• Risk factors
• Exclusively breast fed infants
• Dark skin
• Aging
• Sunscreen and skin covering clothing
• Fat malabsorption syndromes
• IBS
• Obesity
• Measurement
• 25(OH)D 20-25nmol/l 50nmol/l 80 nmol/l
• Toxicity 100,000 IU?
• Supplement

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Minerals

• Essential for normal physiologic function
• Coenzymes, biochemical reactions, alter
  electrical currents, open transport channels,
  muscle contractions, excretory, hormone immune
  function
• Major Minor-Trace
• 5 gms total, daily requirement100mg calcium,
  phosphorus, magnesium, potassium, sodium,
  chloride
• Absorption
• Amino acid chelate
• Calcium/magnesium 2/1

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Free Radical

• Free radical is a cluster of atoms one of which
  contains an unpaired electron in its outermost
  shell of electrons
• Oxygen, nitrogen sulfur
• Reactive Oxygen Species (ROS)
• Sources
• Ionizing radiation Air pollutants Tobacco
  smoke Alcohol - Fried foods - Stress

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ROS - Formation

• Interaction of ionizing radiation
• Natural bi-product of cellular respiration
• Electrons passing down the respiratory chain
  leak away from the main path and directly reduce
  oxygen molecule to superoxide anion
• Synthesized by enzymes in phagocytic cells
  neutrophils macrophages

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ROS - Types

• Hydrogen peroxide
• Hypochlorite ion
• Hydroxyl radical
• Most reactive
• Most damaging
• Superoxide anion or Singlet Oxygen

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ROS - Damage

• Cell Membrane
• Fatty acid side chain
• Hydroxyl radical removes a hydrogen atom from one
  of the carbon atoms
• A molecule of water, leaving an unpaired electron
• React with oxygen forming a singlet oxygen
• Begin chain reaction until two radical form a
  covalent bond linking the two
• Deformed fatty acid chains damage cell membrane
  function
• Mitochondria directly exposed during cellular
  respiration

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ROS - Damage

• Mitochondrial mutation
• Hydroxyl radical
• Attacks all deoxyribose gt breaks in DNA strand
• Deaminate nucleotide gt Single nucleotide
  plymorphisms SNPs
• Cumulative accelerated degradation of
  mitochondrial fucntion
• Premature aging, cancer, neurodegenrative diseases

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ROS - Benefit

• Hydrogen peroxide necessary in synthesis of
  thyroxine
• Macrophages neutrophils
• Generate singlet oxygen that kills bacteria
• Neutrophils
• Generate hydrochlorite ions antiseptic
• Chemotherapy Radiation

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Antioxidants - Endogenous

• Endogenous
• Super Oxide Desmutase SOD
• Converts 2 superoxide anion and 2 hydrogen
  molecules to 1 Oxygen and 1 hydrogen peroxide
• Glutathione peroxidase
• Converts 2 GSH 1 hydrogen peroxide to 1 GSSG
  2 water
• Catalase
• Converts 2 hydrogen peroxides into 2 molecules of
  water and 1 oxygen

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Antioxidants - Exogenous

• Vitamin-A Retinol 900mcg/700mcg
• Quench singlet oxygen
• Toxicity Liver Teratogenic
• Preformed (animal) Carotenoids (veg)
• Vitamin-C Ascorbate
• Electron donor gt ascorbyl radical
• Oral dose plasma concentration sigmoidal
• Saturated at 400mg/day entire absorbed dose
  excreted above 500mg/day
• Vitamin-E Tocopherols Tocotrienols
• Alpha, beta, gama delta
• Peroxyl radical scavenger
• Lipid domain of the body cell membrane - LDL

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Antioxidants - Exogenous

• Zinc
• Protects membranes against oxidative damage
• Forms Cu/Zn-SOD
• Copper
• Cu/Zn-SOD ceruloplasmin
• Manganese
• Scavenge hydroxyl and superoxide radicals
• MnSOD principle mitochondrial oxidant defense
• Selenium
• Glutathione peroxidase

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Antioxidants - Exogenous

• Flavonoids
• Proanthcyanidins
• Quercitin
• Citrus bioflavenoids Rutin
• Green tea polyphenols
• EGCG

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Antioxidants - Exogenous

• Carotenoids
• Beta-carotene alpha-carotene
• Lycopene
• Zeaxathin
• Lutein

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Antioxidant - Exogenous

• Co Q-10
• Protect against lipid peroxidation in cell
  membrane
• Inhibits oxidation of LDL-cholesterol
• Alpha Lipoic Acid
• Scavenge all ROS

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Biomarkers Antioxidant Nutrients

• Carotenoids Beta-carotene
• Dietary-reliablel Plasma-HPLC - Tissues Fat
  Skin
• Vitamin-E alpha tocopherol
• Dietary-supplement Plasma-HPLC Tissue
  adipose
• Vitamin-C
• Dietary-multivariable Plasma-HPLC
• Selenium
• Dietary-soil dependent Plasma-AAS Toe nail

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Biomarkers Oxidative Stress

• Lipid Oxidation
• Thiobarbiturate acid-reactive substance TBARS
• Breath hydrocarbons Pentane Ethane
• LDL resistance to oxidation
• DNA Oxidation
• 8-OHdG HPLC ELISA - Lymphocyte

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Biomarker Oxidative Stress

• Protein Oxidation
• Protein carbonyls colorimetric ELISA
• Neurodegenerative diseases
• Overall capacity
• Oxygen radical absorbance capacity ORAC
• Total peroxyl radical-trapping antioxidant
  potential TRAP

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Other Complexities

• Interactions
• Vit-E protects Vit-A, increasing storage
• Vit-C regenerates the tocopheroxyl radical and
  restores Vit-Es antioxidative functions
• Antioxidant to Pro-oxidant
• Beta-carotene in absence of Vit-C E
• Vit-C in presence of iron
• Hydrogen peroxide with ferrous iron

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Essential Fatty Acids

• Balancing Omega-3 Omega-6
• Omega-3 Fatty Acids
• Fish oil
• Flax seed oil
• Omega-6 Fatty Acids
• Animal fats
• Plant borage, sunflower, safflower

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Omega-3

• EPA DHA
• Dose 600 mg
• Fish oil
• Krill oil
• ALA
• Flax seed oil

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Botanicals

• Boswellia serrata
• Boswellic acid 1,200 mg, bid-tid blocks
  lipoxygenase
• Tumeric-Curcumin
• Ginger 500-1,000 mg/day/powder, 5g fresh
• Ashwaganda
• Capsaicin cream 0.25-0.75

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How do you choose

• Dosing BID
• Dissolution
• USP XXIV, gel-caps
• Absorption
• Amino acid Chelation, Nano technology
• Formulation
• Ingredient source natural
• Vit-E mixed
• Updated
• Vitamin, mineral, antioxidant, anti-inflammatory