Choline & Inositol

DESCRIPTION:
The substances choline and inositol are sometimes loosely classified as "B
complex factors" but they are not in fact true vitamins because they can be made
in the body.

STABILITY

Choline and inositol are stable.

FUNCTIONS:
Cell Structure:
Choline and inositol are components of various phospholipids - structural
components within cell walls.
Lipotrophic Action:
They are also both strong lipotrophic factors, helping to prevent fat infiltration of
the liver.
Nerve Impulses:
Choline is part of the neurotransmitter (brain chemical) acetylcholine, which is
vital to nerve impulse transmission.
 

REQUIREMENTS

There are no established RDA values for choline and inositol.

Recommendations for both are 1g daily in supplement form.
 

SUPPLEMENTAL USES

Choline and inositol may be used in supplement form to help emulsify dietary
fats; people with fatty liver or atherosclerotic plaques may also benefit from
supplementation.
Choline may be beneficial in patients with diseases related to impaired
cholinergic transmission (ie, Alzheimer’s disease, memory impairment and
ataxia) (1).

SAFETY

No toxic dose has been reported with inositol. Choline is also very safe, but at
high levels it may cause a fishy smell through the Skin and on the breath.
 

INTERACTIONS AND CONTRA-INDICATIONS

There are no reported drug interactions or contra-indications for choline or
inositol.
FOOD SOURCES - Choline
Food (mg/100g)
Liver, dessicated 2170
Heart, beef 1720
Brewer’s yeast 300
Nuts 220
Pulses 120
Citrus fruits 85
Bread, wholemeal 80
Bananas 44
FOOD SOURCES - Inositol
Food (mg/100g)
Heart, beef 1600
Liver, dessicated 1100
Citrus fruits 210
Nuts 180
Pulses 160
Bananas 120
Bread, wholemeal 100
Brewer’s yeast 50

REFERENCES:
1. "Handbook of Dietary Supplements", Pamela Mason, Blackwell Science, 1995.

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D (Vitamin D)

DESCRIPTION:
Vitamin D is technically a hormone as it is formed in one place but carries out its
action in another. The vitamin is made in the skin by the action of sunlight on
cholesterol.
Vitamin D is measured in µg or i.u. with the conversion factor being: 40i.u. = 1µg

STABILITY
Vitamin D is stable to normal cooking procedures.
FUNCTIONS

Vitamin D is converted in the body to an important Calcium - controlling hormone

(1,25-dihydroxycholecalciferol) and all its functions are related to this hormone’s
effects.
The principle action of vitamin D hormone is to increase the level of Calcium in
the blood by promoting the absorption of Calcium and Phosphorus from the
intestine and promoting the release of these minerals by bone. To maintain the
body’s physiological ratio of Calcium to Phosphorus vitamin D hormone also
increases the excretion of Phosphorus - but not Calcium - from the kidney.
 

DEFICIENCY

Rickets:
Deficiency of vitamin D during childhood leads to the development of rickets.
Rickets may show itself as early as two months of age, when "craniotabes"
(areas of softening on the skull) are noted. Production of the first teeth may be
delayed and the posture affected. Rickets also produces enlargement at the end
of long bones, resulting in characteristic bowing of the legs when the child starts
to walk.
Osteomalacia:
In adults, vitamin D deficiency leads to osteomalacia. The disease is essentially
the same as rickets, but the symptoms are slightly different because the bones
are not still developing. In osteomalacia, there is thinning and weakening of the
bone and spontaneous fractures may occur.
Osteoporosis and Hip Fracture:
Incidence of Osteoporosis (brittle bones) and hip fracture may be increased in
postmenopausal women who have an inadequate vitamin D supply.

REQUIREMENTS

Upper safe level for daily supplementation = 10µg

Recommended Daily Allowance = 5µg

SUPPLEMENTAL USES

There are certain categories of people who are theoretically much more likely to
be at risk of vitamin D deficiency and who may therefore need to supplement with
this nutrient. These include:
 
o Vegetarians and especially vegans (1). (Vitamin D is found mostly in
animal and dairy products).
o Asian women and children who may not eat many vitamin D containing
foods and who choose to cover up their skin (2).
o Lactating women whose breast-milk can be low in vitamin D especially
during the winter (3).
 o The housebound elderly with a tendency to eat poorly (4).

SAFETY

There are some reports of hypercalcaemia (high blood Calcium levels) occurring
in infants at an intake of 50µg (2000i.u.) vitamin D a day. In adults, symptoms of
vitamin D toxicity have been reported at daily intakes of 625µg (25000i.u.).
However, there is also some early evidence that vitamin D at lower levels
(around 1000 µg) may have adverse effects unrelated to hypercalcaemia.

INTERACTIONS AND CONTRA-INDICATIONS

Heart Drugs:
When digotoxin and certain other cardiac glycoside heart drugs are taken in
combination with vitamin D, there is a slight risk of abnormal heart rhythm.
Thiazide Diuretics:
It may also be unwise to take substantial amounts of vitamin D with thiazide
diuretics as there have been some reports of high blood Calcium when these are
taken in combination.
 

FOOD SOURCES

Food (i.u./100g) (µg/100g)

Cod liver oil 8500 212.5
Herring and kipper 896 22.4
Salmon, canned 500 12.5
Milk, evaporated 160 4.0
Eggs 65 1.6
Butter 32 0.8
Liver 32 0.8
Cheese, cheddar 12 0.3
Milk, whole 1.2 0.03
Milk, skimmed 0 0

REFERENCES:
1. Parsons TJ. et al. Reduced bone mass in Dutch adolescents fed a macrobiotic
diet in early life. J Bone Miner Res,12;9:1486-1494, 1997.
2. "Dietary Reference Values for Food, Energy and Nutrients for the United
Kingdom", Dept. of Health, HMSO, 1991.
3. Specker BL, Nutritional concerns of lactating women consuming vegetarian
diets. Am J Clin Nutr, 59;5 suppl:1182S-1186S, 1994.
4. Russell RM. New views on the RDAs for older adults. J AM Diet Assoc,
97;5:515-518, 1997.
 
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E (Vitamin E)

DESCRIPTION:
Vitamin E occurs as eight compounds in nature: alpha, beta, delta and gamma
tocopherol and tocotrienols. On supplement labels vitamin E refers to "d-alpha
tocopherol/tocotrienol." equivalent. The synthetic form of vitamin E is "dl-alpha
tocopherol" and is a less active form. Vitamin E is measured in mg and i.u.
where:
1 mg = 1.49 i.u.

 STABILITY
Commercial food processing reduces the vitamin E content of foods as does
freezing and deep-frying. Solvent extraction of vegetable oils also destroys
vitamin E.
N.B. Acetate and succinate are more stable forms of vitamin E often used in
supplement manufacture.

FUNCTIONS
Vitamin E is a very important antioxidant. Its properties are vital in the
membranes of tissues which have a high concentration of polyunsaturated fats
(PUFAs), such as in the brain, nervous system and lungs.
Vitamin E helps protect PUFAs and other fatty substances such as cholesterol
from oxidation caused by free radicals, the highly reactive by-products of
metabolism which also arise from environmental sources.
As an antioxidant nutrient, vitamin E helps to prevent conversion of nitrites in
smoked, pickled and cured foods to nitrosamines (possible carcinogens) in the
stomach. As an antioxidant, vitamin E works closely with Vitamin C.
Vitamin E has a very powerful antioxidant effect in the body - protecting the lipids
in cell walls particularly. Lipids are particularly susceptible to oxidation by free
radicals (highly reactive by-products of metabolism also arising from
environmental sources).
In its capacity as an antioxidant, vitamin E can act to reduce the oxygen
requirement of muscles and thereby increase exercise capacity. It also helps
healing and is protective against atherosclerosis and thrombosis.
Vitamin E also has an important neurological role and prevents degeneration of
the nerves and muscles.
Vitamin E may also play an important role in stimulating the immune response
(1).

DEFICIENCY

Deficiency of vitamin E does not lead to any specific disease in the short term,
but chronic insufficiency of vitamin E is thought to be a contributory factor in
cancer and heart disease.
In children, fat malabsorption can lead to a deficiency of vitamin E characterised
by abnormal red blood cell development.
 

REQUIREMENTS

Upper safe level for daily supplementation = 800mg (1200i.u.)

Recommended Daily Allowance = 10mg
 

SUPPLEMENTAL USES

Vitamin E supplements are advised in individuals who have fat malabsorption

problems.
To date, these are some of the conditions that vitamin E supplements may help
prevent:
o Heart conditions (2)
o Circulatory disorders(3)
o Fibrocystic breast disease (4)
o Blood platelet aggregation (e.g. in susceptible women on the
contraceptive pill) (5)
o Vitamin E requirement increases when the intake of polyunsaturated fats
(PUFAs) increases.
o Extra vitamin E has benefited smokers. Free radical damage in the lungs
increases the requirement for this vitamin.
Vitamin E may also be used as a nutritional therapy in the following conditions:

o pre-menstrual syndrome(6) (especially with Evening Primrose Oil

o Post-operative wound healing (7)
o Poor circulation (3), varicose veins, etc.
o Alzheimer’s disease (8)

Coronary Heart Disease:

Recent studies indicate that supplementation with 400-800i.u. of vitamin E can
reduce the incidents of non-fatal heart attacks by preventing lipid oxidation,
thereby modifying the size of the coronary atherosclerotic plaque (9).
Parkinson’s Disease:
Studies suggest that high intakes of vitamin E may slow down the progression of
Parkinson’s disease and reduce the severity of other neurological disorders (1).

SAFETY

Levels over about 800mg vitamin E (d-alpha tocopherol) have occasionally been
associated with such symptoms as fatigue, nausea, mild gastrointestinal
problems, palpitations and transient blood pressure increase. Such symptoms
are reversible.
 

INTERACTIONS AND CONTRA-INDICATIONS

Anti-coagulant Drugs:
Vitamin E supplements should only be taken under medical supervision by
people taking these drugs.
Diabetes and Hypothyroidism:
High levels of vitamin E are best avoided by those suffering from these
conditions.
Selenium:
Vitamin E activity is increased by Selenium and vice versa.
This is known as a synergistic action.
 

FOOD SOURCES

Food (mg/100g)
Wheatgerm oil 178
Safflower oil 97
Sunflower seeds, raw 74
Sunflower oil 73
Almonds 37
Mayonnaise 19
Wheatgerm 17
Margarine, hard 16
Peanut butter 9
Soybean oil 8
Butter 3
Asparagus 2.7
Spinach 2.7
Broccoli 0.7
Bananas 0.3
Strawberries 0.3

REFERENCES:
1. "Human Nutrition and Dietetics", J S Garrow & W P T James, Churchill
Livingstone, 1996.
2. Kwiterovich PO Jr. The effect of dietary fat, Antioxidants, and pro-oxidants on
blood lipids, lipoproteins, and Atherosclerosis. J Am Diet Assoc, 97;7 suppl:S31-
41, 1997.
3. "Martindale The Extra Pharmacopoeia", J Reynolds, The Pharmaceutical
Press, 29th Ed, 1989.
4. London RS et al. Endocrine parameters and alpha-tocopherol therapy of
patients with mammary dysplasia. Caner Res, 41:3811-3813, 1981.
5. Renaud S et al. Influence of vitamin E administration on platelet functions in
hormonal contraceptive users. Contraception, 36:347-358, 1987.
6. London RS et al. Efficacy of alpha-tocopherol in the treatment of the
premenstrual syndrome. J Reprod Med, 32;6:400-404, 1987.
7. Int J Dermatol, 1995,34;7:506-509.
8. Sano et al. A controlled clinical trial of Selegiline, Alpha-tocopherol or both as
treatment for Alzheimer's Disease. New England J Med, 336;17:1216-1222,
1997.
9. Stephens NG et al. Randomised controlled trial of vitamin E in patients with
coronary disease: Cambridge Heart Antioxidant and Study (CHAOS). The
Lancet, 347;9004:781-786, 1996.

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 Folic Acid

DESCRIPTION:
Folic acid was originally found in yeast, where it was recognised to be an "anti-
Anaemia" factor. Folic acid is a member of the B complex and has the chemical
name pteroyl glutamic acid.

STABILITY

Folic acid is unstable to heat, air, water and alkali, and careful cooking methods
must be employed to ensure adequate amounts of this vitamin are retained.

FUNCTIONS
Folic acid is needed for many physiological reactions. More specifically, folic acid
is needed for the synthesis of DNA and therefore for cell division. It is also
involved in the production of the non-essential Amino Acids methionine and
glycine.

DEFICIENCY
Folic acid deficiency causes a megaloblastic Anaemia (see vitamin B12). This is
often also associated with a diminished number of white blood cells (leucopenia).
Rapidly generating tissues are affected by folic acid deficiency and so the
intestinal mucosa may also suffer. In babies and young children, growth may be
affected.
Those who are most at risk from folic acid deficiency are as follows:

o The elderly (who tend to have poorer diets or impaired absorption)

o Those with intestinal malabsorption syndromes (particularly steatorrhoea,
where the stools contain undigested fat)
o Pregnant women (the developing foetus make considerable demands on
the maternal folic acid stores)
o Alcoholics

REQUIREMENTS

Upper safe level for daily supplementation = 400µg

Recommended Daily Allowance = 200µg
 

SUPPLEMENTAL USES
Birth Defects:
Supplements of folic acid (400 µg per day) are highly advisable prior to
conception as well as in the first twelve weeks of Pregnancy, as low folic acid
intake is strongly associated with the birth defect spina bifida (1).
Anaemia:
Folic acid supplements must be used under medical supervision for the treatment
of diagnosed megaloblastic Anaemia, as folic acid can mask a vitamin B12
deficiency (2) (see under vitamin B12 section). Normally, folic acid is only
prescribed after vitamin B12 has already failed to bring a response.
Alcoholics:
Alcoholics may benefit from a supplement of folic acid as they tend to have
depleted levels of this vitamin (3).
Coronary Heart Disease:
Recent research shows that folic acid supplements may offer protection against
heart problems in later life by maintaining low blood homocysteine levels (4).

SAFETY

The overall risk from folic acid mega-dosing is deemed very slight.

INTERACTIONS AND CONTRA-INDICATIONS

Vitamin B12:
As previously mentioned, folic acid supplements taken by people with developing
vitamin B12 deficiency may obscure a correct diagnosis and delay the
appropriate treatment.
Zinc:
Very high folic acid intakes may also result in disturbed Zinc absorption.
Methotrexate:
Certain drugs used in the treatment of cancer (e.g. methotrexate) are specifically
designed to inhibit folic acid. People being given these drugs should therefore
only take folic acid containing supplements under strict medical supervision.
Anticonvulsant Drugs:
Folic acid should not be taken with anti-convulsant drugs unless directed by a
medical doctor.

FOOD SOURCES

Food (µg/100g)
Brewer’s yeast 2400
Wheatgerm 310
Wheat bran 260
Nuts 110
Pig’s liver 110
Leafy green vegetables 90
Bread, wholemeal 39
Eggs 30
Bread, white 27
Fish, fatty 26
Bananas 22
Potatoes 14

REFERENCES:
1. Butterworth CE Jr and Bendich A. Folic acid and the prevention of birth
defects. Annu Rev Nutr, 16:73-97, 1996.
2. Matthews JH. Cobalamin and folate deficiency in the elderly. Baillieres Clin
Haematol, 8;3:679-697, 1995.
3. Cravo ML et al. Hyperhomocysteinemia in chronic Alcoholism: correlation with
folate, vitamin B12 and vitamin B6 status. Am J Clin Nutr, 63;2:220-224, 1996.
4. Lowering blood homocysteine with folic acid based supplements: meta-analysis of
randomised trials, 316:894-8, 1998.

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K (Vitamin K)

DESCRIPTION:
Vitamin K is necessary for proper bone formation and blood clotting. It is
administered to all new-born infants to prevent the development of deficiencies, a
risk in breast-fed infants. Leafy green vegetables are the best source of vitamin
K. The natural vegetable form of vitamin K is called phylloquinone.
FUNCTIONS
Vitamin K is needed for the proper transport of Calcium in the body. For this
reason, it is essential for proper bone formation and blood clotting. Vitamin K also
enhances the effects of calcium on these functions.
 
DEFICIENCY
Deficiencies in vitamin K can cause uncontrolled bleeding, although the condition
occurs rarely. Individuals with certain malabsorption diseases and breast-fed
babies are at increased risk of vitamin K deficiency.

REQUIREMENTS

65-80 mg daily.
Eating vegetables can be sufficient to obtain the daily requirement.

SUPPLEMENTAL USES

Coeliac Disease:
Vitamin K is a suggested supplement for Coeliac Disease patients who have a
vitamin K deficiency.
Osteoporosis:
Vitamin K can help fight Osteoporosis by enhancing the effects of calcium and
facilitating the building of bone.
Morning sickness:
Vitamin K may be helpful for treating morning sickness. The effect may be
enhanced if combined with Vitamin C (1).
Warfarin:
Medical doctors use vitamin K to treat overdose of the drug warfarin, an
anticoagulant that slows blood clotting. People who are taking warfarin and
require surgery are also given vitamin K to prevent excessive bleeding.

SAFETY

Phylloquinone does not appear to cause any side effects.

INTERACTIONS AND CONTRA-INDICATIONS

The action of some prescription blood thinners may be disrupted by vitamin K.

Only under medical supervision should people taking these drugs use Vitamin K
supplementation.

FOOD SOURCES

Food (mcg/ 100 g)

Turnip greens 650
Beef kidney 100-300
Beef liver 100-300
Broccoli 100-300
Cabbage 100-300
Cauliflower 100-300
Lettuce 100-300
Soybean 100-300
Spinach 100-300
Alfafa 10-100
Bacon 10-100
Bran flake 10-100
Butter 10-100
Cheese 10-100
Egg yolk 10-100
Potato 10-100
Strawberry 10-100
Tomato 10-100
Whole wheat 10-100

REFERENCES:
1. Merkel, R. "The use of menadione bisulfite and ascorbic acid in the treatment
of nausea and vomiting ofpPregnancy." Am J Ob Gyn. 1952, 64, pp. 416-418.

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