Vitamin B12 Deficiency ROBERT C
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Methylmalonic Methylmalonic Aciduria
12/27/2008 METHYLMALONIC ACIDURIA Marc E. Tischler, PhD; University of Arizona METHYLMALONIC ACIDURIA •methylmalonyl-coenzyme A (methylmalonyl-CoA) is formed during the breakdown of some amino acids (i.e., isoleucine, valine, methionine, threonine) and fatty acids that contain an odd number of carbons (small fraction of total) (Figure 1) •methylmalonyl-CoA is further metabolized: o methylmalonyl-CoA mutase produces succinyl-CoA and requires a modified form of vitamin B12 (adenosyl-B12) o succinyl-CoA enters the citric acid cycle whose function is primarily to produce usable energy in the cell • deficiency of methylmalonyl-CoA mutase prevents the metabolism of methylmalonyl- CoA leading to excessive formation of methylmalonic acid o excessive methylmalonic acid is excreted in the urine causing methylmalonic aciduria o potentially life-threatening because it creates an acidic condition (acidosis) •treatment: o restricting intake of the 4 amino acids o neutralizing the acidosis o providing vitamin B12 to potentially boost the activity of methylmalonyl-CoA mutase 1 12/27/2008 NORMAL DISEASE Methionine, Isoleucine, Methionine, Isoleucine, Valine, Threonine, Valine, Threonine, Odd-chain fatty acids Odd-chain fatty acids Many various enzymes Propionyl-CoA Propionyl-CoA Propypionyl-CoA carboxylase Methylmalonyl-CoA Methylmalonyl-CoA Methylmalonyl- +adenosyl-B12 CoA mutase Succinyl-CoA Succinyl-CoAX Enzyme names for Citric Methylmalonic acid Usable indicated arrow Acid acidosis Cycle energy Figure 1. Metabolism of 4 amino acids and odd-chain fatty acids all proceed via methylmalonyl-CoA. Methylmalonyl- CoA is metabolized to succinyl-CoA that enters the citric acid cycle, which produces usable energy for the cell. In methylmalonic aciduria, methylmalonyl-CoA mutase is deficient (X) so that methylmalonyl-CoA accumulates. -
Recent Insights Into the Role of Vitamin B12 and Vitamin D Upon Cardiovascular Mortality: a Systematic Review
Acta Scientific Pharmaceutical Sciences (ISSN: 2581-5423) Volume 2 Issue 12 December 2018 Review Article Recent Insights into the Role of Vitamin B12 and Vitamin D upon Cardiovascular Mortality: A Systematic Review Raja Chakraverty1 and Pranabesh Chakraborty2* 1Assistant Professor, Bengal School of Technology (A College of Pharmacy), Sugandha, Hooghly, West Bengal, India 2Director (Academic), Bengal School of Technology (A College of Pharmacy),Sugandha, Hooghly, West Bengal, India *Corresponding Author: Pranabesh Chakraborty, Director (Academic), Bengal School of Technology (A College of Pharmacy), Sugandha, Hooghly, West Bengal, India. Received: October 17, 2018; Published: November 22, 2018 Abstract since the pathogenesis of several chronic diseases have been attributed to low concentrations of this vitamin. The present study Vitamin B12 and Vitamin D insufficiency has been observed worldwide at all stages of life. It is a major public health problem, throws light on the causal association of Vitamin B12 to cardiovascular disorders. Several evidences suggested that vitamin D has an effect in cardiovascular diseases thereby reducing the risk. It may happen in case of gene regulation and gene expression the vitamin D receptors in various cells helps in regulation of blood pressure (through renin-angiotensin system), and henceforth modulating the cell growth and proliferation which includes vascular smooth muscle cells and cardiomyocytes functioning. The present review article is based on identifying correct mechanisms and relationships between Vitamin D and such diseases that could be important in future understanding in patient and healthcare policies. There is some reported literature about the causative association between disease (CAD). Numerous retrospective and prospective studies have revealed a consistent, independent relationship of mild hyper- Vitamin B12 deficiency and homocysteinemia, or its role in the development of atherosclerosis and other groups of Coronary artery homocysteinemia with cardiovascular disease and all-cause mortality. -
Polymorphisms in Folic Acid Metabolism Genes Do Not Associate with Cancer Cachexia in Japanese Gastrointestinal Patients
ORIGINAL PAPER Nagoya J. Med. Sci. 80. 529–539, 2018 doi:10.18999/nagjms.80.4.529 Polymorphisms in folic acid metabolism genes do not associate with cancer cachexia in Japanese gastrointestinal patients Takuto Morishita1, Asahi Hishida1, Yoshinaga Okugawa2,3,6, Yuuki Morimoto2, Yumiko Shirai4, Kyoko Okamoto5, Sachiko Momokita6, Aki Ogawa5, Koji Tanaka2,7, Ryutaro Nishikawa2, Yuji Toiyama7, Yasuhiro Inoue7, Hiroyuki Sakurai8, Hisashi Urata2, Motoyoshi Tanaka3, and Chikao Miki2,7 1Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan 2Departments of Surgery, Iga City General Hospital, Iga, Japan 3Departments of Medical Oncology, Iga City General Hospital, Iga, Japan 4Departments of Nutrition, Iga City General Hospital, Iga, Japan 5Departments of Nursing, Iga City General Hospital, Iga, Japan 6Departments of Biochemical Laboratory, Iga City General Hospital, Iga, Japan 7Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan 8Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan. ABSTRACT We used clinical data from Iga General Hospital to examine the association between polymorphisms in MTR (methionine synthase) A2756G (rs1805087), MTRR (methionine synthase reductase) His595Tyr (rs10380), MTHFR (methylenetetrahydrofolate reductase) C677T (rs1801133), MTHFR A1298C (rs1801131) and SHMT (serine hydroxymethyltransferase) C1420T (rs1979277), which are genes involved in folate metabolism, and the risk of weight loss in patients with gastrointestinal cancers, with the aim of establishing personalized palliative care for each patient based on genetic information. The data from 59 patients (37 males and 22 females) with gastrointestinal cancers who visited the outpatient clinic for cancer chemotherapy and palliative care at Iga General Hospital from December 2011 to August 2015 were analyzed. -
Dispensing of Vitamin Products by Retail Pharmacies in South Africa: Implications for Dietitians
South African Journal of Clinical Nutrition 2016; 29(4):133–138 http://dx.doi.org/10.1080/16070658.2016.1219468 SAJCN ISSN 1607-0658 EISSN 2221-1268 Open Access article distributed under the terms of the © 2016 The Author(s) Creative Commons License [CC BY-NC 3.0] http://creativecommons.org/licenses/by-nc/3.0 RESEARCH Dispensing of vitamin products by retail pharmacies in South Africa: Implications for dietitians Ilse Trutera* and Liana Steenkampb a Department of Pharmacy, Drug Utilisation Research Unit (DURU), Nelson Mandela Metropolitan University, Port Elizabeth, South Africa b HIV & AIDS Research Unit, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa *Corresponding author, email: [email protected] Objective: The objective of this study was to analyse the dispensing patterns of vitamins (Anatomical Therapeutic Chemical (ATC) group A11) over a one-year period in a group of community pharmacies in South Africa. Design and setting: A retrospective drug utilisation study was conducted on community pharmacy electronic dispensing records in South Africa recorded in 2013. Outcome measures: All products for ATC subgroup A11 were extracted and analysed. Results: A total of 164 233 vitamin products were dispensed to 84 805 patients (62.64% female patients). Males received on average 2.09 (SD = 2.63) vitamin products per year, compared to 1.84 (SD = 2.13) products for females. Ergocalciferol (A11CC01) was the most often dispensed (37.48% of all vitamin products), followed by plain Vitamin B-complex products (A11EA00) accounting for 32.77%. Ergocalciferol (vitamin D2) is only available on prescription (50 000 IU tablets or 50 000 IU/ml oily drops) in South Africa. -
L-Carnitine, Mecobalamin and Folic Acid Tablets) TRINERVE-LC
For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only (L-Carnitine, Mecobalamin and Folic acid Tablets) TRINERVE-LC 1. Name of the medicinal product Trinerve-LC Tablets 2. Qualitative and quantitative composition Each film- coated tablets contains L-Carnitine…………………….500 mg Mecobalamin……………….1500 mcg Folic acid IP…………………..1.5mg 3. Pharmaceutical form Film- coated tablets 4. Clinical particulars 4.1 Therapeutic indications Vitamin and micronutrient supplementation in the management of chronic disease. 4.2 Posology and method of administration For oral administration only. One tablet daily or as directed by physician. 4.3 Contraindications Hypersensitivity to any constituent of the product. 4.4 Special warnings and precautions for use L-Carnitine The safety and efficacy of oral L-Carnitine has not been evaluated in patients with renal insufficiency. Chronic administration of high doses of oral L-Carnitine in patients with severely compromised renal function or in ESRD patients on dialysis may result in accumulation of the potentially toxic metabolites, trimethylamine (TMA) and trimethylamine-N-oxide (TMAO), since these metabolites are normally excreted in the urine. Mecobalamin Should be given with caution in patients suffering from folate deficiency. The following warnings and precautions suggested with parent form – vitamin B12 The treatment of vitamin B12 deficiency can unmask the symptoms of polycythemia vera. Megaloblastic anemia is sometimes corrected by treatment with vitamin B12. But this can have very serious side effects. Don’t attempt vitamin B12 therapy without close supervision by healthcare provider. Do not take vitamin B12 if Leber’s disease, a hereditary eye disease. -
Vitamins Minerals Nutrients
vitamins minerals nutrients Vitamin B12 (Cyanocobalamin) Snapshot Monograph Vitamin B12 Nutrient name(s): (Cyanocobalamin) Vitamin B12 Most Frequent Reported Uses: Cyanocobalamin • Homocysteine regulation Methylcobalamin • Neurological health, including Adenosylcobalamin (Cobamamide) diabetic neuropathy, cognitive Hydroxycobalamin (European) function, vascular dementia, stroke prevention • Anemias, including pernicious and megaloblastic • Sulfite sensitivity Cyanocobalamin Introduction: Vitamin B12 was isolated from liver extract in 1948 and reported to control pernicious anemia. Cobalamin is the generic name of vitamin B12 because it contains the heavy metal cobalt, which gives this water-soluble vitamin its red color. Vitamin B12 is an essential growth factor and plays a role in the metabolism of cells, especially those of the gastrointestinal tract, bone marrow, and nervous tissue. Several different cobalamin compounds exhibit vitamin B12 activity. The most stable form is cyanocobalamin, which contains a cyanide group that is well below toxic levels. To become active in the body, cyanocobalamin must be converted to either methylcobalamin or adenosylcobalamin. Adenosylcobalamin is the primary form of vitamin B12 in the liver. © Copyright 2013, Integrative Health Resources, LLC | www.metaboliccode.com A protein in gastric secretions called intrinsic factor binds to vitamin B12 and facilitates its absorption. Without intrinsic factor, only a small percentage of vitamin B12 is absorbed. Once absorbed, relatively large amounts of vitamin B12 can be stored in the liver. The body actually reabsorbs vitamin B12 in the intestines and returns much of it to the liver, allowing for very little to be excreted from the body. However, when there are problems in the intestines, such as the microflora being imbalanced resulting in gastrointestinal inflammation, then vitamin B12 deficiencies can occur. -
Family Practice
THE JOURNAL OF FAMILY PRACTICE Emmanuel Andrès, MD, B12 deficiency: A look beyond Laure Federici, MD, Stéphan Affenberger, MD pernicious anemia Department of Internal Medicine, Diabetes and Metabolic Diseases, Food-B12 malabsorption—not pernicious anemia—is the Hôpitaux Universitaires de Strasbourg, leading cause of B12 malabsorption. It’s also very subtle Strasbourg, France emmanuel.andres @chru-strasbourg.fr Practice recommendations such as its link to Helicobacter pylori • Mild, preclinical B deficiency infection and long-term antacid and bi- Josep Vidal-Alaball, MD 12 Department of General is associated with food-B12 guanide use. It also requires that you Practice, Cardiff University, malabsorption more often than consider not only a patient’s serum B12 United Kingdom with pernicious anemia. (C) ® Dowdenlevels, but his Health homocysteine Media and meth - Noureddine Henoun ylmalonic acid levels, since they are con- Loukili, PhD • The classic treatment for B 12 Department of Hygiene and deficiency—particularly when the sidered more sensitive indicators of co- 6 Fight against Nosocomial cause is not a dietaryCopyright deficiency—isFor personalbalamin deficiency. use Keyingonly in on these Infections, Hôpital Calmette, 100 to 1000 mcg per month of indicators early will ensure prompt treat- CHRU de Lille, Lille, France cyanocobalamin, IM. (B) ment, which typically includes intramus- cular injections of the vitamin, but which Jacques Zimmer, MD, PhD • Oral crystalline cyanocobalamin could revolve around a more convenient Laboratoire is an effective treatment for food- d’Immunogénétique- option: oral B12. Allergologie, Centre de B12 malabsorption, though it’s Recherche Public de la Santé effectiveness in the long term has (CRP-Santé) de Luxembourg, not been demonstrated. -
Nutrition 102 – Class 3
Nutrition 102 – Class 3 Angel Woolever, RD, CD 1 Nutrition 102 “Introduction to Human Nutrition” second edition Edited by Michael J. Gibney, Susan A. Lanham-New, Aedin Cassidy, and Hester H. Vorster May be purchased online but is not required for the class. 2 Technical Difficulties Contact: Erin Deichman 574.753.1706 [email protected] 3 Questions You may raise your hand and type your question. All questions will be answered at the end of the webinar to save time. 4 Review from Last Week Vitamins E, K, and C What it is Source Function Requirement Absorption Deficiency Toxicity Non-essential compounds Bioflavonoids: Carnitine, Choline, Inositol, Taurine, and Ubiquinone Phytoceuticals 5 Priorities for Today’s Session B Vitamins What they are Source Function Requirement Absorption Deficiency Toxicity 6 7 What Is Vitamin B1 First B Vitamin to be discovered 8 Vitamin B1 Sources Pork – rich source Potatoes Whole-grain cereals Meat Fish 9 Functions of Vitamin B1 Converts carbohydrates into glucose for energy metabolism Strengthens immune system Improves body’s ability to withstand stressful conditions 10 Thiamine Requirements Groups: RDA (mg/day): Infants 0.4 Children 0.7-1.2 Males 1.5 Females 1 Pregnancy 2 Lactation 2 11 Thiamine Absorption Absorbed in the duodenum and proximal jejunum Alcoholics are especially susceptible to thiamine deficiency Excreted in urine, diuresis, and sweat Little storage of thiamine in the body 12 Barriers to Thiamine Absorption Lost into cooking water Unstable to light Exposure to sunlight Destroyed -
Case Study 54 Year Old Female with DEPRESSION
Case Study 54 year old female with DEPRESSION Patient was initially seen in June of 2008. She had been suffering from depression for the past 5 years. Her psychiatrist had tried various anti-depressant medications, including Zoloft and Lexapro. At the time of her initial consultation, she was taking Prozac which provided mild relief of her depression. In addition to this, she had been taking Prempro for 3 years. Interestingly, her homocysteine levels were 18.2 umol/L. She had been taking a once-a-day multivitamin and a calcium citrate/vitamin D supplement. She was 20 pounds overweight. Her appetite was described as “too good”. She also has had a long history of poor sleep. SpectraCell’s MicroNutrient testing revealed functional deficiencies of folic acid, vitamin b6, vitamin d, selenium and serine. However, the whole family of B vitamins was at the lowest end of normal. Based upon these deficiencies, she was administered the following daily nutritional supplement protocol. 1) B-complex weighted with extra B6 (250 mg). This contained 800 mcg of folic acid 2) 1000 IU of vitamin D3. This was in addition to her calcium/vitamin D supplement which provided 400 IU per day 3) 200 mcg of selenium 4) 100 mg of PHOSPHATIDYLSERINE TID In addition, she was instructed to consume foods high in these nutrients. She was also instructed to receive 15 minutes of direct sunlight each morning. Follow up SpectraCell’s MicroNutrient testing was performed six months later. All deficiencies were resolved except for vitamin D, which was improved but not fully resolved. -
Self-Administering a Vitamin B12 Injection
Self-administering a Vitamin B12 injection This is usually given as an intramuscular injection, every 2-3 months. Alternatives to an intramuscular injection are: Oral Vitamin B12 at a dose of at least 1000mcg per day. • Available as tablets or a spray. They can be bought over the counter and available at most health food stores and pharmacies. • Oral Vitamin B12 is not recommended if: - If you have a bowel condition such as inflammatory bowel disease, Coeliac disease, small bowel overgrowth, bile acid malabsorption and short bowel (you will require injections) - You require an initial loading of B12 (soon after diagnosis) It is important to monitor your symptoms if you change to oral B12. If symptoms return, then the oral/sublingual dose can be increased to 2000mcg or you may need to consider starting back on injections. https://www.hollandandbarrett.com/shop/product/betteryou-pure-energy-b12-boost-oral-spray-60099160?skuid=099160 https://www.hollandandbarrett.com/search?query=%20Vitamin%20B12%20Tablets&utm_medium=cpc&utm_source=google&isSearch=true# gclid=EAIaIQobChMIh5nLgOH26AIVxLTtCh0JIA_GEAAYASAAEgJL-fD_BwE&gclsrc=aw.ds Subcutaneous (SC) injection; this is off-licence but still effective. It is considered an easier method of administration. It is how insulin and blood thinning medication are usually self-administered. Equipment needed to self-inject - Prescribed medicine - 1 syringe (2 ml) - 2 needles (1 for drawing up the drug and 1 for administration – you can use the same size needle for both). o For an IM injection; the needle gauge should be 19-25. The needle length is 1- 1 ½ inches (up to 3 inches for larger adults) o For a SC injection; the needle gauge should be 25-27. -
Guidelines on Food Fortification with Micronutrients
GUIDELINES ON FOOD FORTIFICATION FORTIFICATION FOOD ON GUIDELINES Interest in micronutrient malnutrition has increased greatly over the last few MICRONUTRIENTS WITH years. One of the main reasons is the realization that micronutrient malnutrition contributes substantially to the global burden of disease. Furthermore, although micronutrient malnutrition is more frequent and severe in the developing world and among disadvantaged populations, it also represents a public health problem in some industrialized countries. Measures to correct micronutrient deficiencies aim at ensuring consumption of a balanced diet that is adequate in every nutrient. Unfortunately, this is far from being achieved everywhere since it requires universal access to adequate food and appropriate dietary habits. Food fortification has the dual advantage of being able to deliver nutrients to large segments of the population without requiring radical changes in food consumption patterns. Drawing on several recent high quality publications and programme experience on the subject, information on food fortification has been critically analysed and then translated into scientifically sound guidelines for application in the field. The main purpose of these guidelines is to assist countries in the design and implementation of appropriate food fortification programmes. They are intended to be a resource for governments and agencies that are currently implementing or considering food fortification, and a source of information for scientists, technologists and the food industry. The guidelines are written from a nutrition and public health perspective, to provide practical guidance on how food fortification should be implemented, monitored and evaluated. They are primarily intended for nutrition-related public health programme managers, but should also be useful to all those working to control micronutrient malnutrition, including the food industry. -
DRIDIETARY REFERENCE INTAKES Thiamin, Riboflavin, Niacin, Vitamin
Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline http://www.nap.edu/catalog/6015.html DIETARY REFERENCE INTAKES DRI FOR Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients Food and Nutrition Board Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C. Copyright © National Academy of Sciences. All rights reserved. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline http://www.nap.edu/catalog/6015.html NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, N.W. • Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was funded by the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion, Contract No. 282-96-0033, T01; the National Institutes of Health Office of Nutrition Supplements, Contract No. N01-OD-4-2139, T024, the Centers for Disease Control and Prevention, National Center for Chronic Disease Preven- tion and Health Promotion, Division of Nutrition and Physical Activity; Health Canada; the Institute of Medicine; and the Dietary Reference Intakes Corporate Donors’ Fund.