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Australian Journal of Pharmacy : November 2006
counselling casebook Associate Professor Louis Roller BPharm, PhD, FPS, FACPP, Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University Dr Jenny Gowan PhD, FPS, FACPP, HMR Facilitator, Northern & North East Valley Divisions of General Practice, Melbourne, Consultant Pharmacist The pharmacist and nutrition Part One: Use and misuse of vitamins This is the first of three articles in the area of nutrition and the pharmacist.The second article to be published in January 2007 will deal with the use and misuse of minerals and the third article to be published in March 2007 will deal with the pharmacist and nutrition advice ITAMIN deficiencies still occur in affluent countries; such as folate, thiamine, vitamin D and vitamin C. Some of these deficiencies are induced by diseases or medications. In developing countries deficiency diseases are more common. Vitamin A deficiency (xerophthalmia), for example, is a major cause of blindness. V Vitamins have caught the popular imagination, and they are also big business. Many people take over-the-counter vitamins without professional advice and a few practitioners prescribe megavitamin therapy. A recent study established that some 52 per cent of the Australian population takes some form of com- plementary medicine, 37 per cent of which were taking vitamins (that is, an overall of 19.2 per cent of the total population were taking vitamins (3.85 million people in Australia).1 Table One lists the approximate average daily requirements of vitamins for Australians. Vitamins in all shapes, forms, combinations and doses are sold through supermarkets, health-food shops and of course, phar- macies. Pharmacists, in carrying out their duty of care as profession- als, must ensure that they have a good understanding about what their customers are taking and any potential problems associated with these agents. Vitamins are organic substances or groups of related sub- stances that are found in some foods, have specific biochemical functions in the human body, are generally not made in the body (or not in sufficient quantity) and are required in very small amounts. Vitamins are divided on the basis of their water or their lipid solubility. The fat-soluble vitamins tend to be stored in fat tissue from which they are slowly removed. These are vitamins A, D, E and K. The water-soluble vitamins are more rapidly removed from the body so a regular intake is needed. These are thiamin (B1), vitamins B2, B6, B12, C, niacin, pantothenic acid, folic acid, biotin).3–6 Fat-soluble vitamins Vitamin A (retinol) plays an important role in night vision and, hence, night blindness (difficulty in seeing in dim light) is the ear- liest symptom of deficiency. Other symptoms include dry, rough skin, loss of appetite, and diarrhoea; resistance to infection is decreased; the eyes may become dry and inflamed. Severe defi- ciency may lead to corneal ulcers and weak bones and teeth. Food sources include liver, fish liver oils, kidney, dairy prod- uct, eggs, eel and fortified margarine. ß-carotene (a precursor of vitamin A) can be found in carrots, red palm oil, dark green leafy Table One: Australian approximate, average daily requirements of vitamins for healthy adults2* Vitamin A Pantothenic acid 5mg Biotin Folate Vitamin B6 Vitamin B12 Choline Vitamin C Vitamin D Vitamin E Vitamin K 0.8mg Thiamin (B1) 1mg Riboflavin (B2) 1.4mg Niacin 14mg# 1.5mg 0.030mg 0.4mg 0.002mg 500mg 45mg 0.010mg** 10mg 0.060mg *There may be increased or decreased requirements for some vitamins and/or minerals in specific groups, for example, babies, pregnant women, breast feeding mothers and older adults. # double dose in pregnancy ** more for growth: no dietary requirement if adequate exposure and absorption from sunlight Note: 1µg of cholecalciferol = 40 international units (IU) of vitamin D activity. 1µg of vitamin A = 33 international units (IU) of vitamin A activity.7 THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 NOVEMBER 2006 ? 67 education AJPCPE CONTINUING PROFESSIONAL EDUCATIO