Therapeutic Nutrition and Supplements in Practice The best way to get started, is to get started. THERAPEUTIC NUTRITION AND SUPPLEMENTATION IN PRACTICE Instructor: Josh Gitalis, Ba(Hons), CNP, RNCP/ROHP Contact: [email protected] (Put “TNSP” as the subject) Website: www.joshgitalis.com Optional texts (recommended): • Staying Healthy with Nutrition (Elson Haas) • Encyclopedia of Natural Medicine (Michael Murray and Joseph Pizzorno) Certification exam • Final open book exam: passing mark is 80% Table of Contents Pages Elemental Composition of the Body 1 Slope of Health 2 Nutrient Summary Chart 3-4 Risk of Dying 5 Vitamins and Mineral Supplement Ranges and Indications 6-24 Dietary Reference Intakes 25-39 Vitamin D Dosing 40-41 Vitamin D Disease Incidence Prevention 42 Antioxidant Network 43 Pediatric Dosing 44 Essential Fatty Acids 45-50 Glandulars 51-53 Amino Acids 54-57 Enzyme Therapy 58-65 Accessory Nutrients 66-75 Contraindications of Therapeutic Supplements 76-80 Nutrient Depletions Caused By Pharmaceuticals 81 Herbs 82-90 Mushrooms 91-101 Bee Medicine 102-109 Juicing 110-112 Therapeutic Foods 113-123 Therapeutic Superfoods 125-129 References 130 All rights reserved. Neither this document nor any part of it may be reproduced or transmitted in any form or by any means including photocopying without prior written permission of the author. Copyright © 2015 ● Josh Gitalis Ba(H), RNCP/ROHP, CNP ● All Rights Reserved Elemental Composition of The Human Body (70 Kg) Macrominerals Key Function Grams Oxygen Cell and tissue respiration, water 43,000 Carbon Protoplasm 12,000 Hydrogen Water, tissue 6,300 Nitrogen Protein tissue 2,000 Calcium Bone and teeth 1,100 Phosphorus Bone and teeth 750 Potassium Intracellular electrolyte 225 Sulfur Amino acids, hair, and skin 150 Chloride Electrolyte 100 Sodium Extracellular electrolyte 90 Magnesium Metabolic electrolyte 35 Silicon Connective tissue 30 Micorminerals Mg Iron Hemoglobin, oxygen carrier 4,200 Fluoride Bones and teeth 2,600 Zinc Metallo-enzymes 2,400 Strontium Bone integrity 320 Copper Enzyme cofactor 90 Cobalt Vitamin B12 core 20 Vanadium Lipid metabolism 20 Iodine Thyroid hormone 15 Tin Unknown 15 Selenium Enzyme, antioxidant, detoxification 15 Manganese Metallo-enzymes 13 Nickel Unknown 11 Molybdenum Enzyme cofactor 8 Chromium Glucose tolerance factor 6 This chart is adapted from a paper entitled “Essential trace Elements, An Overview”, by Dewitt Hunter and is based on percent body weights and parts per million (ppm) in this text. 1 ppm = 1 mcg. (microgram) per gram, 1000 mcg. = 1 mg. (milligram), 1000 mg = 1 g. (gram) 1 The Slope of Health Life Blood tests normal Heredity Medical (effect) (inherited factors) Physical signs and symptoms of body out of balance - pain, fatigue, headaches, etc. Poor diet + lifestyle OTC drugs to suppress symptoms Vitamin + mineral deficiency Diagnosis of a disease/condition Lifestyle (cause) Artificial food additives Surgery to remove dysfunctional body part or stronger meds to further suppress symptoms Pesticides and chemical exposure Cancer, tumors, and growths Environmental pollution More surgery, chemotherapy, Digestive problems and internal toxicity and/or radiation Personal Health Assessment Suppressive medications Where am I on The Slope of Health? How did I get there? End stage How long will it take for me to climb back? What do you think it takes to get up the slope back to health? Copyright2 © 2013 NUTRIENT SUMMARY CHART Note: All RDA values are for an adult male Nutrient RDA Maintenance Therapeutic Vitamin A 3000 IU/day 2500-5000 IU/day 50,000-100,000 IU/day Beta-carotene 10,000 IU/day 25,000 IU/day 300,000 IU/day >1 year 1000 IU/day <1 yr 1000 IU/ 25 lbs of body Vitamin D 600 IU/day 10,000 IU/day 50,000 IU/week weight/day Adults 5000-10,000 IU/day Vitamin E 22.5 IU 400 IU 400-3200 IU/day Vitamin K 90-120 mcg/day 150-500 mcg/day 150-500 mcg/day Vitamin C 90 mg/day 2-9 g/day 2-75 g/day in divided doses Thiamin 1.2 mg/day 10 mg/day 50 mg - 8 g/day Riboflavin 1.3 mg/day 5-10 mg/day Up to 400 mg/day • Niacinamide 25 mg/kg of body for Diabetes • Flushing Niacin 100 mg increased over 4-6 Niacin 16 mg/day 25-50 mg/day wks to 1.5-3 g daily in divided doses • Inositol Hexaniacinate 500 mg TID for 2 wks then increase to 1000 mg Pyridoxine 1.3 mg/day 10-15 mg/day 50-1000 mg/day Biotin 30 mcg/day 30-100 mcg/day Up to 3000 mcg/day Pantothenic Acid 5 mg 25-100 mg/day 250 mg – 2 g/day Cobalamin 2.4 mcg/day 100 mcg/day Up to 60 mg/day Folic Acid 400 mcg/day 400 mcg/day 5-20 mg/day Choline 425-550 mg/day 425-550 mg/day 350-10,000 mg/day as phosphatidylcholine Inositol None 100-2000 mcg/day 100-2000 mcg/day Calcium 1000 mg/day 1000-1200 mg/day or lower 12 mg/2.2 lbs of body weight/day or to bowel Magnesium 310-420 mg/day 6 mg/2.2 lbs of body weight/day tolerance Potassium None 1.9-5.6 g/day 1.9-5.6 g/day Zinc 8-11 mg/day 15-20 mg/day 30-150 mg/day Boron None 3-9 mg/day 3-9 mg/day Chromium 25-35 mcg/day 200 mcg/day 1000 mcg/day Copper 900 mcg/day 1.5-3 mg/day 1.5-3 mg/day Iodine 150 mcg/day 500 mcg – 100 mg/day 500 mcg – 100 mg/day 60-90 mg/day Iron 8-18 mg/day iron succinate/fumarate Manganese 1.8-2.3 mg/day 2-5 mg/day 5-200 mg/day Molybdenum 45 mcg/day 45-500 mcg/day 45-500 mcg/day Children 1.5 mcg/lb of body Children 1.5 mcg/lb of body weight Selenium 55 mcg/day weight Adults 50-200 mcg/day Adults 50-200 mcg/day Silicon None 2-20 mg/day Up to 120 mg/day Vanadium None 50-100 mcg/day Up to 2.4 mg/day 1-2 tbsp flax oil/day EFAs None 2 g omega-3 fish oil/day 6 g omega-3 fish oil/day 3 Nutrient Therapeutic Nutrient Therapeutic 1 cap/day, increase every 2 days until Adrenal Glycine 4-8 g/day stimulatory effect, then decrease by 1 Liver 2 g/day Proline 2 g/day Pancreas 2 g/day L-Glutamine 5-40 g/day Spleen 1.5 g/day Tyrosine 500 mg – 2 g/day Thymus 800 mg/day Carnitine 1.5-4 g/day in divided doses Pituitary 270 mg/day Taurine 1.5-6 g/day Kidney 3 g/day Bovine Colostrum 1 tsp – 2 tbsp /day Ovary/Uterus 600 mg/day Coenzyme Q10 50-1000 mg/day Heart 600 mg/day Proanthocyanins 150-300 mg/day as GSE or PBE Lung 400 mg/day Quercetin 200-8000 mg/day Green tea Brain 600 mg/day 240-320 mg/day polyphenols Lysine 1000 mg TID (500 mg non-acute) Rutin 1-3 g/day Phenylalanine 1-3 g/day Glucosamine 500 mg TID Tryptophan 1-3 g/day Lipoic Acid 20-600 mg/day R-type Sleep 0.1-3 mg before bed Arginine 500 mg – 4 g/day Melatonin Anticancer up to 50 mg/day 250-750 mg/day with 3x the amount Cysteine of vitamin C Nutrient Maintenance Therapeutic Phosphatidylserine 600 mg/day Probiotics 10-25 billion/day 50 billion - 1 trillion /day • Depression, Osteoarthritis 400 mg 3-4x/day S-Adenosylmethionine • Fibromyalgia 200-400 mg BID Osteoarthritis 200 mg BID (SAM) • Liver disorders 200-400 2-3 x/day • Migraines 200-400 BID Policosanol 20 mg/day Fibre 38 g/day Work up from 1 to 15 g/day (Including dietary fibre) Curcumin 20-600mg of Curcumin, 240mg of Theracurmin Lecithin 10-25 g/day Hydrochloric Acid 700 mg – 5 g /meal HCl 4 Risk of Dying Compared to Being Killed on a Boeing 747 Flight (See separate table for units of risk used) Relative risk 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 11,000 Associated with medical injury in acute hospitals only 10,348 Smoking 6,303 Preventable medical injury - (Acute Hospitals - NZ/AUS/USA adj) 4,085 Preventable medical injury - (Acute Hospitals only Minister's est) 3,268 1,000 of Risk Preventable adverse drug reaction - acute hospitals (NZ adj) 1,716 Less than 1 per Cardiovascular disease 1,290 Very High Level Adverse drug reaction (all) 980 Adverse effects of pharmaceutical drugs - all (USA adj) 756 Lung cancer 492 Motorcycle accidents 471 Cerebrovascular disease 462 Breast cancer 311 Alcohol related (Liver disease + direct) 277 Firearms - total 270 Ultralight aircraft 235 Prostate cancer 233 High Level of Risk 1:1,000 to 1:10,000 Diabetes 183 Horse riding 163 Higher level of risk - safety Suicide 157 Farm work 115 Traffic accidents 97 All Terrain Vehicles 69 Workplace accidents 56 Accidental falls 55 Snowmobiles 54 Accidental Poisoning - Medicines 46 War operations 39 Influenza 24 Air - corporate/private/clubs (Per hour Canada) 23 Suicide - Pharmaceutical drugs 19 1:10,000 - 1:100,000 Food (est - USA/Aus) 19 Moderate Level of Risk Homicide 15 Drowning - accidental (male) 15 Pedestrians 13 School bus accidents 10 Firearms - accidental 9 Air accidents (All Canada - Per flight) 9 Choking on food/other objects 8 Risk (1 fatality per x Units of Exposure to Fire 8 Food - Highly preventable (est - USA/Aus) 8 Water transport 7 Pedal cyclist 6 Avalanche 5 Forces of nature 4 Low Level of Risk Railway (total) 4 1:100,000 to 1:1,000,000 Tuberculosis 3 Sport & recreation 2 Menningitis 1.7 Boeing 747 (#flights- worldwide) 1.0 Acceptable risk for cancer (food additives) 1.0 Railway -- Pedestrian 0.96 Electrocution 0.86 Airbus A300 (#flights - worldwide) 0.68 Commercial airliners (per hour - Canada) 0.57 Air accidents (all passengers - Canada) 0.37 Lightning 0.25 1:1,000,000 - 1:10,000,000 Bee/wasp/hornet sting 0.06 Natural healthcare & therapeutic products 0.014 De Minimus Level of Risk Meteorite 0.000006 Ultra Safe to Very Low Level of Risk Greater than 1:10,000,000 Sources: Extensive search of many Canadian Government, quasi government and NGO websites, documents, databases and research outputs © R Law 2004 5 Vitamin and Mineral Supplement Ranges and Indications Basic supplementation Maintenance in healthy person or base for therapeutic program 1.