Appendix:
FACTORS CONTRIBUTING TO NUTRITIONAL DEFICIENCIES
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| 1. General Factors Involved in Vitamin and Mineral Deficiencies |
Basic Process Primary Suspect DisordersDecreased Congenital biliary Laxatives absorption atresia Mineral oil Cystic fibrosis Regional ileitis Dysentery Ulcerative colitis Intestinal cancer Decreased Anorexia Mouth/neck trauma intake Coma Oral/denture problems Dysphagia Starvation Increased Alcoholism Polyuria (eg, diabetes) loss Dialysis Sweating (chronic) Diarrhea (chronic) Tobacco Hemorrhage Vomiting (chronic) Increased Cancer Liver disease utilization Cardiac disease Pregnancy Diabetes Pulmonary disease Hyperthyroidism Pyrexia Kidney disease Alcohol use
| 2. Agents Contributing to Vitamin, Mineral, and Other Nutrient Deficiency Symptoms |
(1) depressing the central appetite center,
(2) decreasing normal blood levels (eg, excessive excretion),
(3) interfering with the nutrient's storage or metabolism,
(4) developing a chemical antagonism (eg, inactivate),
(5) increasing the action of ingested antivitamins or antiminerals, or
(6) destroying intestinal bacteria necessary to synthesize the nutrient.
See Tables A.2, A.3, and A.4.
Table A.2. Agents Contributing to Vitamin Deficiency Symptoms
Vitamin
Deficiency Antivitamin Factors
A Alcohol Iron (excessive)
Aluminum-containing antacids Kanamycin
Calcium carbonate Magnesium-containing antacids
Cholestyramine (Questran) Mineral oil
Coffee Neomycin
Colestipol HCL (Colestid) Paromomycin
Cortisone Vitamin D deficiency
B Complex Alcohol Sleeping pills
Coffee Stress (abnormal)
Diuretics Sugar (excessive)
Infections Sulfa drugs
B-1 Oral contraceptives
Thiamine Alcohol Pyrexia
Antacids Stress (abnormal)
Clams (raw) Sugar (excessive)
Coffee Tobacco
Cyclophosphamide (Cytoxan) Trauma/surgery (severe)
Diuretic drugs
B-2 Alcohol Phenothiazines
Riboflavin Antibiotics Sugar (excessive)
Chlorpromazine HCL Tobacco
Coffee Tranquilizers
Diuretic drugs
B-6 Alcohol Isoniazide (INH, Nydrazid)
Pyridoxine Coffee Oral contraceptives
Cortisone Para-aminosalicylic acid
Cycloserine (Seromycin) Penicillamine (Cuprimine)
Diuretic drugs Radiation
Ethionamide Tetracyclines
Hydralazine HCL (Apresoline) Tobacco
B-12 Alcohol Methotrexate
Cobalamin Barbituates Methotrexate (Folex, Mexate)
Chloramphenicol Neomycin
Cholestyramine Oral contraceptives
Coffee Para-aminosalicylic acid
Colchicine Paromomycin
Diuretic drugs Potassium chloride
Kanamycin Tetracyclines
Laxatives Tobacco
B-15 Alcohol Diuretic drugs
Pangamic Coffee
acid
Biotin Alcohol Diuretic drugs
Antibiotics Egg white (raw)
Coffee
Choline Alcohol Diuretics
Coffee Sugar (excessive)
Folic Alcohol Neomycin
acid Antacids Nitrofurantoin
Anticonvulsants Oral contraceptives
Aspirin Paromomycin
Chlordiazepoxide HCL Phenobarbitol
Cholestyramine (Questran) Phyenytoin sodium (Dilantin)
Coffee Pyrimethamine
Colestipol HCL (Colestid) Salicylates
Diazepam (Valium) Stress (abnormal)
Diuretic drugs Sulfasalazine
Indomethacin Tobacco
Kanamycin Triamterene (Dyrenium)
Lorazepam (Ativan) Trimethroprim
Methotrexate (Folex, Mexate)
Inositol Alcohol Diuretic drugs
Coffee Tea
Niacin Alcohol Isoniazid
(Nicotinic Antibiotics Rifampin-isoniazid
acid) Coffee Starches (excessive)
Corn Sugar (excessive)
Diuretic drugs
Pantothenic Alcohol Diuretic drugs
acid Coffee Tetracyclines
Para- Alcohol Diuretics
aminoben- Coffee Sulfa drugs
zoic acid
C Antibiotics Oral contraceptives
Ascorbic Aspirin Pyrexia
acid Barbituates Stress (abnormal)
Cortisone Sulfasalazine
Diuretic drugs Tea
Indomethacin Tobacco
D Antacids Kanamycin
Anticonvulsants Lorazepam (Ativan)
Barbituates Mineral oil
Chlordiazepoxide HCL Neomycin
Cholestyramine (Questran) Paromomycin
Colestipol HCL (Colestid) Phenobarbital
Diazepam (Valium) Phyenytoin sodium (Dilantin)
Diuretic drugs Primidone (Mysoline)
Glutethimide (Doriden) Rifampin (Rifadin)
Isoniazid
E Chlorine Oral contraceptives
Tocopherol Iron Rancid fats and oils
Mineral oil
F
Unsaturated Radiation
fatty acids
K Antibiotics (prolonged) Mineral oil
Menadione Aspirin Neomycin
Barbituates Para-aminosalicylic acid
Chlordiazepoxide HCL Paromomycin
Cholestyramine (Questran) Phenobarbitol
Colestipol HCL (Colestid) Phyenytoin sodium (Dilantin)
Coumarin Primidone
Diazepam (Valium) Radiation
Indandione derivatives Rancid fats and oils
Kanamycin Tetracyclines
Lorazepam (Ativan)
P Antibiotics Oral contraceptives
Bioflav- Aspirin Prolonged fever
onoids Barbituates Stress (abnormal)
Cortisone Tobacco
Diuretic drugs
Table A.3. Agents Contributing to Mineral Deficiency Symptoms
Mineral
Deficiency Antimineral Factors
Calcium Actinomycin D Mithramycin
Amikacin Neomycin
Barbituates Paromomycin
Capreomycin Phyenytoin
Cholortetracycline Plicamycin (Mithracin)
Dactinomycin (Cosmegen) Stress (abnormal)
Furosemide (Lasix) Tetracycline
Gentamycin Thiazides
Kanamycin Tobramycin
Lack of exercise Viomycin
Copper Ethanbutol Zinc (large intake)
Penicillamine
Iodine Thiazides
Iron Aspirin Paromomycin
Chloramphenicol Phosphorus (excessive)
Coffee Prednisone
Glucocorticoids Sulfasalazine
Indomethacin Tea
Kanamycin Tetracyclines
Neomycin Zinc (excessive)
Magnesium Cortisone
Manganese Calcium (excessive) Thiazides
Phosphorus (excessive)
Phosphorus Alcohol Gentamycin
Aluminum Iron (excessive)
Amikacin Magnesium (excessive)
Amphotericin Sugar (excessive)
Calcium-containing antacids Tobramycin
Capreomycin Viomycin
Potassium Alcohol Neomycin
Amikacin Para-aminosalicylic acid
Amphotericin Paromomycin
Coffee Salt (excessive)
Cortisone Stress (abnormal)
Diuretic drugs Sugar (excessive)
Furosemide (Lasix) Thiazides
Gentamycin Tobramycin
Kanamycin Viomycin
Laxatives
Sodium Aluminum-containing antacids Magnesium-containing antacids
Chlorine deficiency Neomycin
Ethacrynic acid Paromomycin
Kanamycin Potassium deficiency
Zinc Alcohol Phosphorus deficiency
Calcium (excessive) Tetracyclines
Cortisone Thiazides
Table A.4. Agents Contributing to Miscellaneous Nutrient Deficiencies
Miscellaneous
Nutrients Antinutrient Factors
Amino acids Kanamycin Paromomycin
Neomycin Trimethroprim
Carotene Methotrexate (Folex, Mexate)
Cholesterol Methotrexate (Folex, Mexate)
Lipids Cyclophosphamide (Cytoxan) Neomycin
Kanamycin Paromomycin
Methotrexate (Folex, Mexate)
Sugars Ampicillin Lincomycin
(glucose, Chloramphenicol Methotrexate (Folex, Mexate)
lactose, Clofibrate Neomycin
xylose) Digitalis Para-aminosalicylic acid
Kanamycin Paromomycin
Some adverse nondrug factors include abnormal stress, aluminum cookware, diuretic beverages (eg, coffee, ethanol, tea), excessive sugar/starch intake, lack of exercise, laxatives, prolonged fever, radiation, tobacco, and severe surgery or trauma.
3. Disease States Contributing to Specific Nutritional Deficiencies
Any prolonged state of disease increases normal nutritional needs. However, certain disorders have been shown to have a particularly adverse effect on specific deficiencies.
See Table A.5.
Table A.5. Abnormal States Caused by or Contributing to Specific Deficiencies
Disorder Deficiency State
Acne A, B425, D, niacin, potassium
Aging, premature C, calcium, E, pangamic acid
Alcoholism A, B-complex, C, D, iron, magnesium, thiamine, zinc
Allergies A, B4125, C, D, E, F, manganese, pantothenic acid
Anemia B-complex, copper, iron
Arthritis A, B425, B4125, C, calcium, D, E, pantothenic acid, sulfur
Asthma, bronchial A, B4125, F, manganese, P, pangamic acid
Atherosclerosis B465, C, choline, E, folate, inositol, pangamic acid, zinc
Athletes foot A, B42
Baldness, nongenetic B-complex, C, copper, E, F, iodine, zinc
Barbituate toxicosis B-complex
Beriberi Thiamine
Biliary atresia Fat-soluble vitamins, especially E
Biliary cirrhosis Copper
Bleeding gums C, P
Bone loss Calcium
Bronchitis A
Bruising, easy K
Burns E, para-aminobenzoic acid, potassium
Bursitis B412
Cancer (certain forms) A, B-complex, C, protein
Cardiovascular disease A, B-complex, C, E, F, magnesium, potassium
Cataracts B42
Cholesteremia B465, C, choline, E, F, inositol, magnesium, pangamic acid
Colds A, C, P
Colic, infantile Potassium
Colitis Iron
Constipation B415, choline, inositol
Cyanide toxicosis Folic acid
Cystic fibrosis Fat-soluble vitamins, especially E
Cystitis A, B465, C, D, E, pantothenic acid
Dehydration Sodium
Depression Magnesium
Dermatitis Biotin, sulfur
Diabetes A, B415, B425, chromium, manganese, phosphate, potassium
Diarrheal disorders B415, B425, fat-soluble vitamins, folic acid, niacin
Dizziness Choline, P
Dry skin Para-aminobenzoic acid
Dyspnea Pangamic acid
Eczema A, biotin, D, F, P, sulfur
Emphysema Pangamic acid
Epilepsy B412
Eye hemorrhages K
Facial oiliness B46
Fatigue, severe B4125, folic acid, manganese
Febrile illnesses B-complex, C, protein
Gallbladder disorders F
Gallstones K
Goiter Iodine
Graying hair Para-aminobenzoic acid
Growth retardation Phosphorus
Halitosis Niacin
Headaches Choline, pangamic acid
Heat stroke Sodium
Hemochromatosis Iron
Hemorrhoids P
Hemosiderosis Iron
Hepatitis A, C
Herpes B412
Hyperkinesis B-complex
Hyperlipidemia Niacin
Hypertension Choline, niacin, P, potassium
Hyperthyroidism B-complex, iodine, para-aminobenzoic acid, potassium
Hypoglycemia B-complex, C, chromium
Indigestion B415, B425, pantothenic acid
Infertility Para-aminobenzoic acid, zinc
Insect stings C
Insomnia B4125, calcium, choline, niacin, pangamic acid
Kidney disease B-complex, calcium, D, iron, magnesium, potassium, zinc
Kidney stones Magnesium
Leg cramps Biotin, calcium, niacin
Leg ulcers F
Liver disease A, B-complex, copper, D, iron, K, protein, zinc
Malabsorption syndrome Fat-soluble vitamins, potassium
Meniere's syndrome B-complex
Menopause syndrome E
Menstrual syndromes B-complex, calcium, E, iron, K
Mental illness B415, B46
Migraine A, B-complex, E
Miliaria C
Myopathy B46
Myopia E
Nausea B415, B46
Nervousness Calcium, magnesium
Neuropathy B46
Nitrate toxicosis Folic acid
Nitrous oxide toxicosis Folic acid
Noise sensitivity Magnesium
Obesity A, B-complex, C, calcium, E, F, magnesium
Parasitic disease Para-aminobenzoic acid
Pellagra Niacin
Peptic ulcers Magnesium, P
Pernicious anemia B4125
Phlebitis E
Premenstrual tension B465, calcium, E, K
Prostate problems Magnesium, zinc
Psoriasis D, F, sulfur
Pulmonary disease B-complex, C
Rheumatic fever P, para-aminobenzoic acid
Rheumatism Calcium, P, pangamic acid
Rheumatoid arthritis F
Scurvy C
Sinusitis C, E
Smoking toxicosis Beta-carotene, C, folic acid
Stress (abnormal) A, B-complex, C, D, E, phosphorus
Subacute encephalopathy Thiamine
Sun sensitivity B465, para-aminobenzoic acid
Tachycardia B41
Tinnitus Choline
Tooth decay C, magnesium, niacin, pantothenic acid, phosphorus
Tremors, finger Calcium
Warts E
Weight loss F
Wilson's disease Copper
Wrinkles E, para-aminobenzoic acid
4. Effects of Some Nutrients on Certain Medications
Just as certain medications and dietary substances have an adverse effect on certain nutritional substances, some nutrients (especially in excessive amounts) have an adverse effect on certain medications a particular patient may be taking. Thus, it is important that such medications be noted during the case history process. Because these nutrients may counteract or inhibit the absorption or utilization of various medications, conditions being treated medically may be exacerbated.
See Table A.6.
Table A.6. Effects of Some Nutrients on Certain Medications
Nutrient Antagonistic to:
C Methyldopa, oral contraceptives (greater than 1000 mg/day)
Calcium Tetracyclines
E Oral coagulants
Folic acid Anticonvulsants, fluorouracil, levodopa, methotrexate
Iron Tetracyclines
K Anticoagulants
Magnesium Tetracyclines
Pyridoxine (B465) Levodopa, penicillamine
Zinc Tetracyclines
5. Symptoms of Hypervitamin Toxicosis
It has been long recognized that excessive amounts of vitamins A and D can lead to toxicosis. In recent years, adverse effects have also been shown to be contributed to megadoses of vitamins C and E.
See Table A.7.
Table A.7. Symptoms of Hypervitamin Toxicosis
Prolonged
Intake
Vitamin Levels Manifestations
A Adults: Anorexia Gastrointestinal dis-
50,000+ IU/d Behavioral changes tress
Infants: Bone pain Hair loss
20,000+ IU/d Cerebral edema Headaches
Depression Malaise
Dry/scaly skin Schizophrenia
Fatigue Spontaneous fractures
C Adults: Decreased beta-carotene Infantile mega-C level
4+ g/d utilization (possible) dependency
Decreased cysteine Intestinal colic
Diarrhea Iron overload (possible)
Hypercalcemia (possible) Low leukocyte activity
Increased cadimium ab- (possible)
sorption Nausea
Increased copper ab- Rectal bleeding
sorption Urinary tract calculi
D Adults: Anorexia Kidney stones
50,000+ IU/d Arrhythmia Muscular hypotonia
Infants: Bradycardia Polydipsia
3,000+ IU/d Constipation Polyuria
Hypercalcemia Vomiting
Kidney calcification
E Adults: Blurred vision (hypo- Low leukocyte activity
2,000+ IU/d vitaminosis A) Myopathy
Diarrhea Nausea
Fatigue (extreme) Pulmonary embolism
Gonadal dysfunction Purpura (hypovitamino-
Gynecomastia sis K)
Hypertension Rash
Intestinal colic Thrombophlebitis
E + Oral Increased serum choles- Increased serum trigly-
contraceptives terol cerides
Niacin Adults: Hypertension Liver damage
5+ g/d
Pyri- Adults: Injury to dorsal roots of spinal cord
doxine 500+ mg/d
Nutritional or ingested environment minerals may also lead to toxicosis.
Toxicity levels have already been established for:
copper (40 mg),
iron (100 mg),
magnesium (30,000 mg),
potassium (1.950—5.850 mg), and
sodium (2,300—6.900 mg/d).