fn- clinical nutrition
TRANSCRIPT
MACRO & MICRO NUTRIENTS TOXICITY
Submitted to: Submitted By:
Dr. B. G. PATEL NEETU GOUDA
PROFESSOR 04-HOMMA-01289-2014
FOOD & NUTRITION DEPARTMENT. Msc. (2nd yr)
CONTENTS:
DEFINITIONS
TOLERABLE UPPER INTAKE LEVEL OF MACRO AND
MICRO NUTRIENTS
MACRONUTRIENTS AND TOXICITY
MICRONUTRIENTS TOXICITY
MINERAL TOXICITY
CONCLUSION2
DEFINITIONS:• Nutrients: A substance that provides nourishment essential for
growth and the maintenance of life.
• TOXICITY: The degree to which a substance (a toxin or poison)can harm humans or animals.
• Acute toxicity involves harmful effects in an organismthrough a single or short-term exposure.
• Sub chronic toxicity is the ability of a toxic substance to causeeffects for more than one year but less than the lifetime of theexposed organism.
• Chronic toxicity is the ability of a substance or mixture ofsubstances to cause harmful effects over an extended period,usually upon repeated or continuous exposure, sometimes lastingfor the entire life of the exposed organism.
• NUTRIENTS TOXICITY: When there is increased amount of anynutrients in the body then its required value, its leads to toxicity inthe body.
3
TOLERABLE UPPER INTAKE LEVEL:
• In 1997 the U.S. Institute of Medicine established a
reference value called the Tolerable Upper Intake Level
(UL). The maximum level of daily nutrient intakes that
is unlikely to pose health risks to almost all of the
individuals in the group for whom they designed.
Consumption of a nutrient in amounts higher than the
UL could be harmful.
4
Substance Amount (males) Amount (females)
Water 3.7 L/day 2.7 L/day
Carbohydrates 130 g/day 130 g/day
Protein 56 g/day 46 g/day
Fiber 38 g/day 25 g/day
Fat 20–35% of calories
Source: https://en.wikipedia.org/wiki/Dietary_Reference_Intake5
MACRONUTRIENTS AND ITS TOXICITY
• There are three macronutrients required by humans:
carbohydrates (sugar), lipids (fats), and proteins. Each of
these macronutrients provides energy in the form of
calories. For example:
• In carbohydrates, there are 4 calories per gram
• In proteins, there are 4 calories per gram
• And in lipids, there are 9 calories per gram
6
BODY COMPOSITION
7
CARBOHYDRATES
• Carbohydrates are primarily found in starchy foods, like grain and
potatoes, as well as fruits, milk, and yogurt.
• Carbohydrates can be simple or complex, which refers to their
chemical structure. Simple carbohydrates taste very sweet (like fruit
sugar), while complex carbohydrates taste savory (like starch in
potatoes).
• Fiber is an indigestible form of carbohydrate.
• Humans need carbohydrates in the largest amounts i.e. 45-65% daily
value for CHO consumption is 300 g/day. Carbohydrates are
incredibly important to the diet.
• Minimum amount of carbohydrate required to avoid ketosis is
considered to be about 50 g/day
8
HARMFUL EFFECTS DUE TO EXCESS CONSUMPTION OF CARBS
Type 2 Diabetes
Type 2 diabetes has been linked to
the overconsumption of refined
carbohydrates, which include white
breads, pasta and many packaged
snack foods. These types of carbs
digest quickly and cause a rush of
glucose into the blood. This
increases the body's need for
insulin and it's theorized that this
higher demand wears out the
insulin-producing cells of the
pancreas leading to the onset of the
disease. 9
Cont…..
Dental Caries
• Dental caries are cavities formedby the destruction of the hardtissues of the teeth.
• They occur when bacteria onyour teeth metabolizecarbohydrates. This leaves behindan acid, slowly destroying thehard enamel covering andunderlying structures of the tooth.Dental carries are commonlyassociated with theoverconsumption of refined carbsand added sugar because theseare the easiest carbs for thebacteria to break down into acids. 10
Cont….
OBESITY
Taking in more than the recommendedamount of carbohydrates also meanstaking in more calories. Extra caloriesthat are not burned are stored in thebody as fat. This may lead to obesity.
CVD
Excess carbohydrate intake also causevascular diseases like CVD as excessglucose which are stored in the liver asglycogen are overloaded so it isdistributed in the blood vessels whichare mostly high triglycerides and verylow density lipoproteins and reducedHDL which directly linked with CVD. 11
Too Much Fiber: Side Effects
• Abdominal bloating and excessive gas (flatulence) may be caused
by soluble fiber.
• Gastroesophageal reflux disease (GERD) may be worsened by
consuming foods high in fructo-oligosaccharides (wheat, onions,
leeks).
• Loose stools or diarrhea may be caused by cellulose supplements.
• A clump of undigested food–a bezoars–in the stomach or intestine
may, rarely, develop in people who eat large amounts of oranges,
persimmons, berries, figs, apples, coconuts, green beans, sauerkraut,
Brussel’s sprouts, potatoes with peels or sunflower seeds with shells.
• Allergic reactions, including anaphylactic reactions, after taking
chitin or chitosan (in people allergic to shellfish), psyllium husk,
insulin or other fiber are possible.12
13
REVIEWS
Carbohydrates India has the second largest
diabetic population in the
world which is projected to rise
to 109 million by 2035. An
estimated 65 million affected
people consume high amount
of carbohydrates, according to
a recent study .In the diabetes
group, the mean percentage of
total energy intake from
carbohydrates was 64.1 per
cent, which is much higher
than the upper limit of 60 per
cent as recommended by the.
According to the International
Diabetes Federation in
collaboration with National
Institute of Nutrition ,
November 19,2014.
14
Carbohydrates
( Simple sugar)
A cross-sectional study carried out
among 420 workers (210 in soft-drinks
factory and 210 in other factories), in
the age group of 20-45 years of Udupi
district, Karnataka, India. The caries
experience was higher in workers
working in soft-drinks factory and this
study also showed that specific caries
index can be used as a valid index for
assessing dental caries experience.
Kumar S, Acharya S,
Vasthare R, Singh SK,
Gupta A, Debnath N.
;Dental caries
experience in high risk
soft drinks factory
workers of South
India: A comparative
study. Indian J Dent
Res 2014;25:174-7
15
PROTEIN
• Proteins are substances consisting of up to 20 different
building blocks, the so-called amino acids
• 10% - 35% of calories in the human diet come from
protein.
• There are 500 known amino acids, 21 of which are needed
by humans. Of the 21 necessary for life, nine are
considered essential since they cannot be produced by the
body and must be eaten. Proteins that contain all nine
essential amino acids are considered 'high quality' proteins.
These high quality proteins tend to come from animal
sources. Proteins that do not contain all nine essential
amino acids are considered 'low quality' proteins, and tend
to come from plant sources.16
PROTEIN RICH FOODS
17
HARMFUL EFFECTS DUE TO EXCESS CONSUMPTION OF PROTEIN
Weight Gain
• .If you take in too much protein, you
may gain weight. If you take in 100
grams of protein, your body can only
use 50 grams of it, your body will store
the extra 200 calories' worth of protein
as fat.
High Cholesterol
• High-protein foods, particularly from
animal sources, contain an abundance
of cholesterol, which contributes to the
development of hardened arteries that
can lead to serious medical conditions,
such as heart attack and stroke. 18
Cont….
Reduced Liver and Brain Function
• An excessive protein intake can be
harmful to your liver, brain and
nervous system. When you eat
protein, your body produces
ammonia, a toxin that your liver
makes harmless. Eating too much
protein over a long period of time
can cause your liver to become
overworked, allowing ammonia and
other toxic substances to build up in
your bloodstream. This can lead to
hepatic encephalopathy. 19
Excess protein is responsible for reactions in the
body:Your blood will turn acidic: When blood
becomes very acidic, the body must correct
itself by making your blood more basic.
The most basic available element in your
body is calcium. Your bones will release
calcium into your blood, which will then
bond to the acidic byproducts of the protein,
turning your blood back to a neutral level.
You could develop kidney stones: Protein
toxicity with proteinuria can result in those
with preexisting , kidney disease or those
who have lost kidney function due to age.
Azotemia :It is an elevation of blood urea
nitrogen (reference range, 8-20 mg/dl) and
serum creatinine (normal value, 0.7-1.4
mg/dl) levels. 20
FATS:
• The basic units of fats are fatty acids and glycerol. There are over
forty different types of fatty acids. Fatty acids can be divided into
three groups:
1. Saturated fatty acids
2. Monounsaturated fatty acids
3. Polyunsaturated fatty acids
• Fatty acids serve several important functions in our body. Fats,
like carbohydrates, provide us with energy, and they are essential
for absorption of vitamins A, D, E, and K.
21
TYPES OF FATTY FOODS:
22
HARMFUL EFFECTS DUE TO EXCESS CONSUMPTION OF FATS
Atherosclerosis
• Eating foods rich in fats increases
your risk of developing
atherosclerosis, which is a condition
that causes the walls of the arteries to
thicken. This constricts the flow of
blood to the tissues, increasing the
risk of heart attack or stroke.
Increased Cancer Risk
• Excessive consumption of dietary fats
from dairy products and red meat
increases the risk of pancreatic cancer23
Cont…..
Risk of Obesity
• Obesity occurs when you consume morecalories than you need. Excessive intake ofboth fats and carbohydrates hastensobesity.
Brain Injury
• Eating foods high in saturated fats maydamage your hypothalamus -- which is thearea of your brain that regulates energybalance.
Constipation
• Diets that are high in fat can affect yourdigestive organs, including the stomachand colon.If your diet is high in saturatedfat to the detriment of your fiber intake,you may become constipated frequently 24
REVIEWS
Fat A study found that the
presence of “bad”
cholesterol or low-
density lipoprotein in the
blood contributed to the
development of
atherosclerosis. Low
density lipoprotein is a
compound made up of
protein and lipid
molecules.
A study published in
August 2002 in the
“Journal of Clinical
Epidemiology”
25
Fats The study involved tracking
the dietary intake of over
500,000 participants
between 1995 and 1996.
Researchers found that men
and women who ate foods
rich in total fats --
specifically animal fats --
had a higher incidence of
pancreatic cancer than
those with low fat
consumption. However
they also noted that further
studies are needed to
determine whether meat, or
lifestyle and dietary
preferences associated with
meat consumption, is the
real culprit.
(According to a study
published in June
2009 in the “Journal
of the National
Cancer Institute.” )
26
Fats A study led by
researchers at
McMaster University
has found that that
trans fats are
associated with greater
risk of death and
coronary heart disease,
but saturated fats are
not associated with an
increased risk of death,
heart disease, stroke,
or Type 2 diabetes.
McMaster University.
"Trans fats, but not
saturated fats like
butter, linked to greater
risk of early death and
heart disease."Science
Daily, 11 August 2015.
27
Micronutrients AND ITS TOXICITY
• A chemical element or substance required in trace amounts for the normal growth and development of living organisms. The micronutrients include all the vitamins and minerals:
Nutrient EAR RDA/AI UL Unit
Vitamin A 625 900 3000 µg
Vitamin C 75 90 2000 mg
Vitamin D 10 15 100 µg
Source: https://en.wikipedia.org/wiki/Dietary_Reference_Intake28
Nutrient EAR RDA/AI UL Unit
Vitamin K NE 120 ND µg
Vitamin B6 1.1 1.3 100 mg
α-tocopherol
(Vitamin E)12 15 1000 mg
Biotin (B7) NE 30 ND µg
Calcium 800 1000 2500 mg
Chloride NE 2300 3600 mg
Chromium NE 35 ND µg
Choline NE 550 3500 mg
Copper 700 900 10000 µg 29
Nutrient EAR RDA/AI UL Unit
Cyanocobalami
n (B12)2.0 2.4 ND µg
Fluoride NE 4 10 mg
Folate (B9) 320 400 1000 µg
Iodine 95 150 1100 µg
Iron 6 8 45 mg
Magnesium 330 400 350 mg
Manganese NE 2.3 11 mg
Molybdenum 34 45 2000 µg
Niacin (B3) 12 16 35 mg 30
Nutrient EAR RDA/AI UL Unit
Pantothenic acid
(B5)NE 5 ND mg
Phosphorus 580 700 4000 mg
Potassium NE 4700 ND mg
Riboflavin (B2) 1.1 1.3 ND mg
Selenium 45 55 400 µg
Sodium NE 1500 2300 mg
Thiamin (B1) 1.0 1.2 ND mg
Zinc 9.4 11 40 mg 31
Vitamin B complex
Vitamin B1- Thiamine
• Thiamine overdose can cause
restlessness, fluid retention, nausea,
weakness and sweating. In severe cases,
a thiamine overdose can cause dizziness,
difficulty breathing, and tightness in the
chest, swelling of the tongue or face, or
discoloration of the skin.
Vitamin B2- Riboflavin
• Riboflavin supplement will frequently
cause the urine to turn a yellow-orange
color. Severe reactions can cause
difficulty breathing, swelling of the face,
lips, throat or tongue, or hives on the
skin.32
Cont….
Vitamin B3- Niacin
• Niacin will frequently cause
flushing, which may include
burning, sweating, tingling, redness
or chills.In severe cases, taking
niacin can result in persistent
headache, irregular heartbeat,
swelling of the arms or legs, joint
pain, or blurred vision.
Vitamin B5- Pantothenic Acid
• Patients who take pantothenic acid
are very prone to overdose. This
can result in severe diarrhea.33
REVIEWS
Vitamin B3Researchers from The
Children's Hospital of
Philadelphia and The
University of Pennsylvania
reported on two adults and two
adolescents who suffered toxic
side effects from taking large
amounts of niacin, also known
as vitamin B3, in mistaken
attempts to foil urine drug
tests.
Both adult patients suffered
skin irritation, while both
adolescents had potentially
life-threatening reactions,
including liver toxicity and
hypoglycemia (low blood
sugar), as well as nausea,
vomiting and dizziness. One of
the teens also had disrupted
heart rhythms.
Children's Hospital of
Philadelphia."Misusing
Vitamin To Foil Drug Test
May Be Toxic; Plus, It Doesn't
Work."Science Daily, 11 April
2007.
34
Cont….
Vitamin B6- Pyridoxine
• Harmless effects of pyridoxine includestomach pain, drowsiness, tingling, andloss of appetite, nausea, or vomiting.
• In rare cases, this can lead to a numbingsensation in various parts of the body,most notably in the hands and feet, poorcoordination or extreme fatigue
Vitamin B7- Biotin
• There is no indication that biotin is toxic,even when took much is taken. However,in pregnant women it has been shown toshrink the placenta, which could lead toproblems for the fetus, or evenmiscarriage
35
Cont….
Vitamin B9- Folic Acid
• Taking excessive amounts of folic acid
can increase the risk of heart attack,
particularly in those who already suffer
from heart trouble. Overusing folic acid
may also increase your risk of developing
lung or prostate cancer
Vitamin B10- Para benzoic acid
• Hypothyroid, liver disease, jaundice,
nausea, vomiting, increased Vitamin C
requirements ,increased Vitamin B6
requirements, decreased estrogen
breakdown by the liver 36
Cont….
Vitamin B12- Cyanocobalamin
• Patients using cyanocobalamin may
experience diarrhea, itching or an
increased risk of blood clots, chest
pain, swelling of the face, tongue, or
lips, swelling of the body, muscle
weakness, fever, chills, bruising or
bleeding.
Choline
• Consuming too much choline can
lead dizziness or lightheadedness in
some cases. Choline overdose can
cause excessive sweating and
salivation as well as a fishy body
odor caused by byproducts of choline
metabolism in your body.37
Vitamin A (Retinol)
• Hypervitaminosis A-This conditionmay be acute or chronic.
• Symptoms vary based on whethertoxicity is acute or chronic; howeverheadaches and rash are common toboth types.
Other potential complications include:
• liver damage
• osteoporosis (a condition causingbones to become brittle, weak, andprone to breaks)
• excessive calcium build-up in thebody
• kidney damage due to excesscalcium 38
REVIEWS
Vitamin AHypervitaminosis A may be
acute or chronic. The acute
form of the condition occurs as
a result of ingesting large
amount of vitamin A over a
short period, such as few hours
or days, whereas the chronic
form results when the
vitamin accumulates in the
body gradually over a long
period. The excess vitamin A
may have been ingested via the
diet, vitamin supplementation
or the use of prescribed
medicines.
Dr Ananya Mandal, MD
http://www.news
medical.net/health/Vitamin-A-
Toxicity.aspx
39
Vitamin- AOsteoporosis is a major cause
of morbidity and mortality
among postmenopausal
women and is the most
common metabolic bone
disorder in the United States.
Furthermore, recent research
has implicated excess vitamin
A as a risk factor for
osteoporosis. Even though
implications suggest that
excess levels of vitamin A
may be a forerunner for
osteoporosis, it is a necessary
vitamin for sustaining a
healthy life.
Carly, James .;
Hypervitaminosis A: An unrecognized
potential risk factor for osteoporosis.
Medicine;
Epidemiology, MAI 49/04, Aug 2011
40
Vitamin C (Ascorbic acid)
Vitamin C toxicity can cause:
• Diarrhea
• Nausea
• Stomach cramps
• Vitamin C toxicity is usually not serious
and is treated by stopping vitamin C
supplements
• For people with a condition called
hemochromatosis, vitamin C toxicity
may be serious. Hemochromatosis
causes the body to store too much iron.
High doses of vitamin C could worsen
iron overload and cause damage to body
tissues.41
Vitamin D
• Vitamin D toxicity, also called
hypervitaminosis D
• The main consequence of vitamin D
toxicity is a buildup of calcium in
your blood (hypercalcemia), which
can cause poor appetite, nausea and
vomiting. Weakness, frequent
urination and kidney problems also
may occur.
• Vitamin D toxicity is usually caused
by megadoses of vitamin D
supplements — not by diet or sun
exposure. 42
REVIEWS
Vitamin D Pregnant women should
avoid taking vitamin D
supplements, new research
suggests. Substitution
appears to raise the risk of
children developing a food
allergy after birth.
A recent study by
Rebsamen and colleagues
found that vitamin D
induced a dose-dependent
increase in vascular smooth
muscle cell migration in rat
aorta, suggesting a possible
mechanism
of vitamin D in
atherosclerosis and vascular
remodeling.
K. Weisse, S. et al.;
Maternal and newborn
vitamin D status and its
impact on food allergy
development in the German
LINA cohort study. Allergy,
2013; 68 (2): 220.
Rebsamen M. C, Sun J.,
Norman AW, Liao JK. 1 ,25-
dihydroxyvitamin D3 induces
vascular smooth muscle cell
migration via activation of
phosphatidylinositol 3-kinase.
Circ Res.
2002;91:17-24.
43
Vitamin E
Vitamin E reduces the blood’s
ability to form clots after a cut or
injury. High doses of vitamin E
from supplements may also cause
serious bleeding in the brain.
This is known as a hemorrhagic
stroke. High doses of vitamin E
may also increase the risk of
death in some adults with serious
health conditions.
Vitamin E toxicity is not usually
caused by getting too much
vitamin E from food44
REVIEWS
Vitamin E and
Selenium
High-dose supplementation
with both the trace element
selenium and vitamin E
increase the risk of high-
grade prostate cancer. But
importantly, this risk
depends upon a man’s
selenium status before
taking the supplements.
"Men using these
supplements should stop,
period. Neither selenium
nor vitamin E
supplementation confers
any known benefits -- only
risks
Alan R. Kristal et al .Baseline
Selenium Status and Effects of
Selenium and Vitamin E
Supplementation on Prostate
Cancer Risk. .; Journal of the
National Cancer Institute, 10;
February 2014 .
45
Vitamin K
Although allergic reaction is
possible, there is no known
toxicity associated with high
doses (dietary or supplemental)
of the phylloquinone (vitamin
K1) or menaquinone (vitamin
K2) forms of vitamin K. The
same is not true for synthetic
menadione (vitamin K3) and its
derivatives. Menadione can
interfere with the function of
glutathione, one of the body's
natural antioxidants, resulting in
oxidative damage to cell
membranes.46
Minerals:
The minerals that are relevant to human
nutrition are water, sodium, potassium,
chloride, calcium, iron, zinc, iodine, and
selenium.
1. Water: Water intoxication, also known as
dilutional hyponatremia, is a potentially
fatal disturbance in brain functions. Water
intoxication provokes disturbances in
electrolyte balance, resulting in a rapid
decrease in serum sodium concentration
and eventual death.
47
Cont….
2. Sodium: Hypernatremia
is an elevated sodium
level in the blood.
Other potential problems
are:
• High Blood Pressure
• Fluid Retention
• Hypernatremia
48
REVIEWS
Sodium A study by scientists
found that using excess
salt to induce vomiting in
intoxicated persons may
lead to death due to fatal
hypernatremia.
University of Hamburg
published in the
January 2005 issue
of “Legal Medicine”
49
Cont…..
3. Potassium:
• Hyperkalemia- If you take morepotassium than your kidneys caneliminate, the concentration ofpotassium in your blood can elevateto a point where you develop acondition called hyperkalemia.
• Side Effects
• Some people who take potassiumsupplements experience side effects,mostly of a gastrointestinal nature.Abdominal pain, nausea, vomiting,and diarrhea are commonlyreported, but people taking enteric-coated potassium chloride tabletsmay develop intestinal ulcers, aswell. 50
REVIEWS
Potassium Taking more than 18 grams of
potassium per day can cause
this mineral to accumulate, as
can kidney failure or diuretic
use, . People with
hyperkalemia may experience
tingling of their extremities,
weakness or cardiac
arrhythmia, or abnormal heart
rhythm that can be deadly,
according to researchers of
(According to the Linus
Pauling Institute a study
published in a 2006 issue of
"Texas Heart Institute
Journal.“)
51
Cont….
4. Zinc: If you overdose on zinc, you
might notice a number of symptoms
caused by the toxic effects of the
mineral.
• Short-Term Effects
• Consuming too much zinc can cause
digestive upset, including diarrhea and
abdominal pain. Very large doses of
zinc -- 225 milligrams in a single dose
-- can also cause you to vomit. Smaller
doses, as little as 50 milligrams in a
single dose, can cause milder digestive
upset. 52
53
Cont…..
5. Calcium: Hypercalcemia is anelevated calcium (Ca2+) level in theblood. Calcium toxicity is usuallycaused by taking too manysupplements. Calcium toxicity is notusually caused by getting too muchcalcium from food sources. Gettingtoo much calcium can causeconstipation. It might also interferewith the body's ability to absorb ironand zinc.
In adults, too much calcium fromdietary supplements might increasethe risk of kidney stones. Too muchcalcium from food sources does notincrease that risk.
54
Cont….
6. Chloride: A higher-than-normal
level of chloride in blood is
known as hyperchloremia.
• Hyperchloremia may be due to :
• excessively high intake of
sodium chloride (table salt) or
potassium chloride
• reduced urinary excretion in
certain cases of cancer, gastritis,
and kidney disease
• dehydration
• intake of certain drugs 55
Cont….
7. Iodine: Moderate toxicity is typically
marked by elevated levels of thyroid
stimulating hormone, or TSH, in the
bloodstream.
Consumption of more than 1,700
micrograms of iodine per day may cause
goiter, or enlargement of the thyroid
gland.
Acute iodine toxicity may cause
symptoms such as diarrhea, nausea and
vomiting, as well as a burning sensation
in the stomach, throat and mouth. Weak
pulse and coma are also potential
complications of acute toxicity. 56
Cont….
8. Selenium: Neurological Effects
Selenium toxicity negatively
affects your nervous system.
Selenosis also causes peripheral
neuropathy -- damage to the
nerves found throughout your
body. This nerve damage prevents
the nerve endings in your tissues
from communicating properly
with your spinal cord and brain.
57
Cont….
9. Iron: Iron overload is known
as hemochromatosis andusually is caused by a gene thatenhances iron absorption.
Other common symptoms ofiron overload include enlargedliver, skin pigmentation,lethargy, joint diseases, loss ofbody hair, amenorrhea andimpotence.
58
REVIEWS
IronResearchers at Wake Forest
Baptist Medical Center have
found that dietary iron intake,
equivalent to heavy red meat
consumption, suppresses
leptin, a hormone that
regulates appetite.
Iron is the one mineral that
humans can't excrete, so the
more iron that is consumed the
greater the likelihood that
leptin levels will drop,
resulting in increased appetite
and the potential to overeat
which will lead to obesity.
Yan Gao, Zhonggang Li, J.
Scott Gabrielsen, Judith A.
Simcox, Soh-hyun Lee,
Deborah Jones, Bob Cooksey,
Gregory Stoddard, William T.
Cefalu, Donald A. McClain.
Adipocyte iron regulates leptin
and food intake. Journal of
Clinical Investigation, 2015;
10.
59
REFERENCES
https://en.wikipedia.org/wiki/Dietary_Reference_Intake
Kumar S, Acharya S, Vasthare R, Singh SK, Gupta A, Debnath N. ;Dental caries
experience in high risk soft drinks factory workers of South India: A comparative study.
Indian J Dent Res 2014;25:174-7.
Children's Hospital of Philadelphia."Misusing Vitamin To Foil Drug Test May Be
Toxic; Plus, It Doesn't Work."Science Daily, 11 April 2007.
Mandal Ananya, MD, Website:http://www.news medical.net/health/Vitamin-A
Toxicity.aspx.
Carly, James .;Hypervitaminosis A: An unrecognized potential risk factor for
osteoporosis.Medicine Epidemiology, MAI 49/04, Aug 201160
K. Weisse, S. et al.; Maternal and newborn vitamin D status and its impact on
food allergy development in the German LINA cohort study. Allergy, 2013; 68
(2): 220.
Rebsamen M. C, Sun J., Norman AW, Liao JK. 1 ,25-dihydroxyvitamin D3
induces vascular smooth muscle cell migration via activation of
phosphatidylinositol 3-kinase. Circ Res.2002;91:17-24.
Alan R. Kristal et al .Baseline Selenium Status and Effects of Selenium and Vitamin E
Supplementation on Prostate Cancer Risk. .; Journal of the National Cancer Institute,
10; February 2014 .
Pauling Linus, Institute a study published in a 2006 issue of "Texas Heart Institute
Journal.“)61
Yan Gao, Zhonggang Li, J. Scott Gabrielsen, Judith A. Simcox, Soh-hyun Lee, Deborah
Jones, Bob Cooksey, Gregory Stoddard, William T. Cefalu, Donald A. McClain.
Adipocyte iron regulates leptin and food intake. Journal of Clinical Investigation, 2015;
10.
62