Nutrient Deficiencies- Know How To Combat!

Vitamin D

Vit. D is a fat soluble vitamin and its synthesized in the body

1 billion people worldwide have Vit D deficiency or insufficiency

96.7% Asian-Indian patients have Vitamin D deficiency and are fragile hip fracture (J Assoc Physicians India. 2010 Sep;58:539-42)

Function Of Vitamin DCalcium absorption in the intestines and is

required for the efficient utilization of dietary calcium.

Involved in cellular growth, differentiation and apoptosis.

Simulates insulin secretion.

Modulates the immune system.

Reduces inflammation.

Muscle development

Diagnostic Test

Measurement of 25(OH) vitamin D serum levels best reflects the vitamin D status of an individual.

Normal : >30 ng/ml (>75 nmol/L)

Insufficiency : 20-30 ng/ml (50-75 nmol/L)

Deficiency : <20 ng/ml (<50 nmol/L)

Symptoms

Usually asymptomatic until severe

Musculoskeletal pain

Fractures

Weakness

Causes

Decreased sun exposure/sunscreen ◦ SPF 15 decreases vitamin D3 synthesis by

99%

Decreased intake of foods rich in vitamin D

Impaired absorption due to air pollution

Chronic kidney disease

Vit. D Deficiency Leads To….

Rickets in ChildrenOsteoporosis ObesityDiabetesCancer risk Cardiovascular disease (including MI)

Recommended Dietary Allowance

Age Male FemalePregnan

cyLactatio

n

0–12 months*

400 IU(10 mcg)

400 IU(10

mcg)

   

1–13 years

600 IU(15 mcg)

600 IU(15

mcg)

   

14–18 years

600 IU(15 mcg)

600 IU(15

mcg)

600 IU(15 mcg)

600 IU(15 mcg)

19–50 years

600 IU(15 mcg)

600 IU(15

mcg)

600 IU(15 mcg)

600 IU(15 mcg)

51–70 years

600 IU(15 mcg)

600 IU(15

mcg)

   

>70 years

800 IU(20 mcg)

800 IU(20

mcg)

   

Sources

Regular supplementation of atleast 2000 IU/day of vit. D supplementation to maintain normal vit. D levels.

JAPI • november 2011 • voL. 59

Toxicity

Chronic ingestion of 50 to 100 times normal physiologic requirement of Vit D (> 40,000 IU/day) ie. 25 OH levels of >150 ng/ml can leads to

◦ Renal calculi◦ Hypercalcemia◦ Renal insufficiency◦ Fatigue and weakness

JAPI • november 2011 • voL. 59

Vitamin B12

Vitamin B12 is a water-soluble vitamin

Vitamin b12 is one of the most important vitamin required for growth and division of cells.

It is responsible in other important body functions.

Recommendation: Man,women-1.0 μg Children(1-18) – 0.2-1.0 μg Lactating mothers- 1.5 μg

Diagnostic Test

Normal : 200-900 pg/mL

Deficiency : <20o pg/mL

Toxicity : >900 pg/mL

Symptoms

Weakness, tiredness or light-headedness  Pale skinSore tongueEasy bruising or bleeding gumsStomach upset

In sever case: Tingling or numbness in fingers and toes Difficulty walking Mood changes or depression Memory loss, disorientation, and dementia

CausesPerenicious anemia and atrophic gastritis

Surgery of the stomach or small intestine

Crohn's disease, celiac disease, bacterial growth, or a parasite

Excessive alcohol consumption.

Graves' disease 

Long-term use of acid-reducing drugs

Vegetarian

Vit. B12 Deficiency Leads To….

Hyperhomocysteinemia

Cognitive function

Depression

Diabetic neuropathy

Fatigue, Joint pain (elbow)

Sickle cell disease

Recommended DietaryAllowance

ge Male FemalePregnancy

Lactation

0–6 months*

0.4 mcg 0.4 mcg    

7–12 months*

0.5 mcg 0.5 mcg    

1–3 years

0.9 mcg 0.9 mcg    

4–8 years

1.2 mcg 1.2 mcg    

9–13 years

1.8 mcg 1.8 mcg    

14+ years

2.4 mcg 2.4 mcg 2.6 mcg 2.8 mcg

SourcesFatty fishes like cod,

salmon, tuna, sardines, liver, beef,

chicken and eggs.

Milk and milk products.

Fortified fruit juices and cereals

How much will meet the requirement??Sheep liver provides

91.9μg of Vitamin B12 whereas goat liver provides 90.4 μg

100ml of cow’s and buffalo’s milk gives 0.14 μg of B12

The raw yellow part of hen eggs has got most of the vitamin B12. It provides 1.8 μg of B12 / 100gm

Mackerel is the best amongst all, providing 19μg per 100gm of b12

CalciumMost important mineral for Bone and teeth

health

Calcium helps in normal muscle contraction, blood clotting, contraction of heart muscles

Expert groups say the number of osteoporosis patients at approximately 26 million (2003 figures) with the numbers projected to increase to 36 million by 2013

Ref: http://www.outlookindia.com 2004

Ref:Osteoporosis Society of India (2003) Action Plan Osteoporosis: Consensus statement of an expert group. New Delhi

RequirementsDaily requirement:Normal man&women400mgChildren(13-18yrs)- 600mg It increases in pregnancy, adolescent age

Dairy Products It is world wide known that all dairy products

are high in calcium.

Milk, curds, cheese, etc.Having low fat dairy products will be more beneficial for overall health.

Cheese is the highest source of calcium which gives 1376mg/100gm.

Having a cheese cube in 2 weeks is accepted.

Ragi Amongst all Cereals Ragi is

the richest source of Calcium

It provides about 344mg of calcium every 100gms

Having Ragi 2-3 times a weeks considered beneficial

Nuts And OilseedsSesame seeds provide most calcium when

roasted or dried. One tea spoon of sesame gives almost 88 mg of calcium

Almonds provide around 230mg /100gm and also rich source of Omega3 acids

SoyabeanSoy products are naturally high in calcium, it

also contains boron and magnesium which are Important for bone health

Soy contains isoflavones which inhibit the breakdown of bones

Thus, soybean is beneficial in post menopausal women for their bone health

Soy milk, Tofu are good in calcium

One needs to check for soy allergy

FishEnjoy having Fishes like Salmon not only for

their high calcium content but also for heart healthy Omega3 fatty acids.

Having Fish 2 times a week shows wonders. Remember method of cooking is important. Try grilled, steamed instead of fried.

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