The Vitamins. Introduction Vitamins were discovered at the beginning of the twentieth century. Vitamin: An essential, noncaloric, organic nutrient

The VitaminsThe Vitamins

IntroductionIntroduction Vitamins were discovered at the beginning Vitamins were discovered at the beginning

of the twentieth century.of the twentieth century. VitaminVitamin: An essential, noncaloric, organic : An essential, noncaloric, organic

nutrient needed in tiny amounts in the diet.nutrient needed in tiny amounts in the diet.

A vitamin can cure a A vitamin can cure a deficiencydeficiency of that of that vitaminvitamin

Classifying VitaminsClassifying Vitamins

Fat Soluble VitaminsFat Soluble Vitamins AA DD EE KK

Water Soluble VitaminsWater Soluble Vitamins

Vitamin CVitamin C B Vitamins:B Vitamins:

ThiaminThiamin -- Biotin-- Biotin RiboflavinRiboflavin -- Pantothenic acid-- Pantothenic acid NiacinNiacin BB66

Folate (folic acid)Folate (folic acid) BB1212


Digestion, Absorption, and TransportDigestion, Absorption, and Transport No chemical digestion neededNo chemical digestion needed Absorbed in the SI into the capillariesAbsorbed in the SI into the capillaries

• Vitamin BVitamin B12 12 must bind with a protein called the must bind with a protein called the intrinsic factor (IF) in the stomach for absorption to intrinsic factor (IF) in the stomach for absorption to occur in the SI occur in the SI

No carriers required for transport in the bloodNo carriers required for transport in the blood


Storage and excretionStorage and excretion Travel freely in the bloodTravel freely in the blood Cells take up water soluble vitamins as Cells take up water soluble vitamins as

neededneeded• Limited storage beyond tissue saturationLimited storage beyond tissue saturation

Excess excreted in the urineExcess excreted in the urine


Deficiency is more common than toxicity Deficiency is more common than toxicity for the water soluble vitaminsfor the water soluble vitamins Any toxicity is likely to be due to overuse of Any toxicity is likely to be due to overuse of

vitamin supplements, not food intakevitamin supplements, not food intake


Other interesting information:Other interesting information: Many are destroyed by light, heat, or Many are destroyed by light, heat, or

exposure to oxygenexposure to oxygen Best to cook whole in a minimum amount of Best to cook whole in a minimum amount of

waterwater Frozen vegetables are often higher in vitamin Frozen vegetables are often higher in vitamin

content than grocery store “fresh” veggiescontent than grocery store “fresh” veggies•

The Fat-Soluble VitaminsThe Fat-Soluble Vitamins A, D, E, KA, D, E, K

Found in fats and oils of foodsFound in fats and oils of foods Require bile for absorptionRequire bile for absorption Stored in liver and fatty tissues until neededStored in liver and fatty tissues until needed Not needed in the diet dailyNot needed in the diet daily Can reach toxic levels if too much is consumedCan reach toxic levels if too much is consumed Deficiencies can occur when people eat diets Deficiencies can occur when people eat diets

that are extraordinarily low in fatthat are extraordinarily low in fat

Fat Soluble VitaminsFat Soluble Vitamins

Digestion, Absorption, and TransportDigestion, Absorption, and Transport Bile needed to emulsify fat soluble vitaminsBile needed to emulsify fat soluble vitamins Form chylomicrons (along with long chain Form chylomicrons (along with long chain

fatty acids and monoglycerides)fatty acids and monoglycerides) Chylomicrons are absorbed into the lactealsChylomicrons are absorbed into the lacteals Travel through lymph system Travel through lymph system blood blood liver liver Many require protein carriers to be Many require protein carriers to be

transported in the bloodtransported in the blood


Other interesting facts:Other interesting facts: Found in the fatty parts of foodFound in the fatty parts of food Removed with the fat when low-fat products Removed with the fat when low-fat products

are madeare made• Many low-fat foods are supplemented with these Many low-fat foods are supplemented with these

vitamins to make up for thisvitamins to make up for this E.g. milk is vitamin A and D enrichedE.g. milk is vitamin A and D enriched

Other interesting vitamin cooking/storing facts – page 293Other interesting vitamin cooking/storing facts – page 293

The VitaminsThe Vitamins

For each vitamin we will consider:For each vitamin we will consider: FunctionsFunctions Dietary needs and food sourcesDietary needs and food sources DeficiencyDeficiency ToxicityToxicity

Thiamin, riboflavin, niacin, pantothenic acid, Thiamin, riboflavin, niacin, pantothenic acid, and biotin – participate in the release of and biotin – participate in the release of energy from the energy nutrientsenergy from the energy nutrients

Folate and vitamin BFolate and vitamin B1212 help cells multiply help cells multiply

Vitamin BVitamin B66 helps the body use amino acids helps the body use amino acids to synthesize proteinsto synthesize proteins

The B- Vitamins: An IntroductionThe B- Vitamins: An Introduction

B Vitamin DeficienciesB Vitamin Deficiencies

In a B vitamin deficiency, every cell is affected.In a B vitamin deficiency, every cell is affected. Symptoms includeSymptoms include

• NauseaNausea

• Severe exhaustionSevere exhaustion

• IrritabilityIrritability

• DepressionDepression

• ForgetfulnessForgetfulness

• Loss of appetite and weightLoss of appetite and weight

• Impairment of immune responseImpairment of immune response

• Abnormal heart actionAbnormal heart action

• Skin problemsSkin problems

• Swollen red tongueSwollen red tongue

• Teary, red eyesTeary, red eyes

• Pain in musclesPain in muscles

ThiaminThiamin

HistoryHistory

Functions:Functions:1.1. Needed for energy metabolismNeeded for energy metabolism

• E.g. -- required for conversion of pyruvate to E.g. -- required for conversion of pyruvate to acetyl CoAacetyl CoA

2.2. Needed for nerve and muscle functionNeeded for nerve and muscle function

ThiaminThiamin

Recommended IntakeRecommended Intake 1.1-1.2 mg/day1.1-1.2 mg/day

Food SourcesFood Sources Found in small amounts in many foodsFound in small amounts in many foods Easily destroyed by heat (cooking)Easily destroyed by heat (cooking) Lost in cooking waterLost in cooking water Good sources includeGood sources include

• Pork products, soy, legumes, vegetables, whole Pork products, soy, legumes, vegetables, whole grains, watermelon…. Page 311grains, watermelon…. Page 311

Thiamin DeficiencyThiamin Deficiency

Prolonged deficiency leads to Prolonged deficiency leads to beriberiberiberi Results in damage to nervous system and Results in damage to nervous system and

muscles (to include the heart) muscles (to include the heart)


Symptoms Beriberi:Symptoms Beriberi:1.1. Dry formDry form- muscle wasting, poor coordination - muscle wasting, poor coordination

Muscle weaknessMuscle weakness

2.2. Legs heavy, hard to walk, calf painLegs heavy, hard to walk, calf pain

3.3. Apathy, confusion, memory lossApathy, confusion, memory loss

4.4. Anorexia and weight lossAnorexia and weight loss

5.5. Wet formWet form has additional symptoms of: has additional symptoms of:– edema, irregular heart beat, enlarged heartedema, irregular heart beat, enlarged heart



Populations at risk:Populations at risk: Alcoholics Alcoholics

• Often obtain the majority of their calories from Often obtain the majority of their calories from alcohol alcohol

• Alcohol inhibits thiamin absorption and hastens its Alcohol inhibits thiamin absorption and hastens its excretionexcretion

Cultures that eat primarily refined grains (e.g. Cultures that eat primarily refined grains (e.g. white rice) and little elsewhite rice) and little else

Thiamin deficient moms Thiamin deficient moms infant deaths from infant deaths from deficiencydeficiency

In alcoholics thiamin deficiency results in In alcoholics thiamin deficiency results in Wernicke-Korsakoff syndrome.Wernicke-Korsakoff syndrome.

Even if someone who drinks alcohol heavily follows a well-Even if someone who drinks alcohol heavily follows a well-balanced diet, most of the thiamine is not absorbed.balanced diet, most of the thiamine is not absorbed.

SymtpomsSymtpoms• Mental confusionMental confusion• StaggeringStaggering• Rapid eye movements or paralysis of the eye Rapid eye movements or paralysis of the eye

musclesmuscles

The City of New YorkThe City of New York DEPARTMENT OF HEALTH AND MENTAL HYGIENEDEPARTMENT OF HEALTH AND MENTAL HYGIENE Michael R. BloombergMichael R. Bloomberg Thomas R. Frieden, m.d., m.p.h.Thomas R. Frieden, m.d., m.p.h. MayorMayor CommissionerCommissioner

______________________________________________________________________________________________________________________________ nyc.gov/healthnyc.gov/health 2003 Health Alert # 39: 2003 Health Alert # 39: A cluster of infantile thiamine (vitamin B1) deficiency (beri-beri) A cluster of infantile thiamine (vitamin B1) deficiency (beri-beri)

has been reported in Israel among infants fed a vitamin B1-has been reported in Israel among infants fed a vitamin B1-deficient kosher soy-based formula distributed by Remedia. It is deficient kosher soy-based formula distributed by Remedia. It is possible that this product may be imported into New York City and possible that this product may be imported into New York City and there may be children in the Orthodox Jewish community who there may be children in the Orthodox Jewish community who have consumed it.have consumed it.

The New York City Department of Health and Mental Hygiene The New York City Department of Health and Mental Hygiene (NYCDOHMH) asks that providers report immediately any suspect (NYCDOHMH) asks that providers report immediately any suspect case of thiamine deficiency among infants who have been fed this case of thiamine deficiency among infants who have been fed this product to: product to:

The New York City Poison Control Center at:The New York City Poison Control Center at: 1-212-764-7667 (212-POISONS) or 1-800-222-1222.1-212-764-7667 (212-POISONS) or 1-800-222-1222. Please distribute to Pediatric staff in the Departments of Please distribute to Pediatric staff in the Departments of

Cardiology, Critical Care, Emergency Medicine, Family Medicine, Cardiology, Critical Care, Emergency Medicine, Family Medicine, General Pediatrics, Outpatient Pediatrics, Neonatology, Neurology, General Pediatrics, Outpatient Pediatrics, Neonatology, Neurology, and Infectious Diseaseand Infectious Disease

ThiaminThiamin

ToxicityToxicity None knownNone known Excess thiamin is excreted and not storedExcess thiamin is excreted and not stored

RiboflavinRiboflavin

Functions:Functions:1.1. Needed for the metabolism of Needed for the metabolism of

carbohydrates, fats, and proteinscarbohydrates, fats, and proteins• Places a role in Kreb’s cyclePlaces a role in Kreb’s cycle• Part of FADPart of FAD

2.2. This text includes an antioxidant function as This text includes an antioxidant function as well….most do not consider riboflavin an well….most do not consider riboflavin an anti-oxidantanti-oxidant


Recommended Intake:Recommended Intake: 1.1 – 1.3 mg/day1.1 – 1.3 mg/day

Food Sources:Food Sources: Destroyed by ultraviolet light (sun light)Destroyed by ultraviolet light (sun light) Good sources include (page 313)Good sources include (page 313)

• Whole grain breads and cereals, oatmealWhole grain breads and cereals, oatmeal• LiverLiver• Milk and milk productsMilk and milk products• Clams and squid!Clams and squid!• MushroomsMushrooms


Deficiency Symptoms Deficiency Symptoms 1.1. Eyes are inflamed and sensitive to lightEyes are inflamed and sensitive to light

2.2. Cheliosis Cheliosis (cracks at the corners of the mouth)(cracks at the corners of the mouth)

3.3. Sore throatSore throat

4.4. Inflammation of the tongue and mouth – Inflammation of the tongue and mouth – painfulpainful

5.5. Inflamed skin, with lesions covered with Inflamed skin, with lesions covered with greasy scalesgreasy scales

6.6. AnemiaAnemia page 312page 312

RiboflavinRiboflavinPopulations at Risk for DeficiencyPopulations at Risk for Deficiency

alcoholicsalcoholics any one with a marginal dietany one with a marginal diet

• Poor, elderly, eating disorders, drug addicts…Poor, elderly, eating disorders, drug addicts…

ToxicityToxicity None reportedNone reported Excess excretedExcess excreted

NiacinNiacin

FunctionsFunctions1.1. Plays an essential role in energy metabolismPlays an essential role in energy metabolism

• Part of NADPart of NAD• Needed by every cell of the bodyNeeded by every cell of the body

NiacinNiacin

Recommended Intake:Recommended Intake: 14 – 16 mg/day of niacin or of NE14 – 16 mg/day of niacin or of NE NE = Niacin EquivalentsNE = Niacin Equivalents

• Niacin can be made from the essential amino acid Niacin can be made from the essential amino acid tryptophantryptophan

• It takes 60 mg of tryptophan to make 1 mg of It takes 60 mg of tryptophan to make 1 mg of niacinniacin

• Therefore, 1 NE is 60 mg of tryptophan Therefore, 1 NE is 60 mg of tryptophan

NiacinNiacin

Food Sources (page 315):Food Sources (page 315): Sources of complete proteinSources of complete protein

• Dairy, meats, poultry, fish,…Dairy, meats, poultry, fish,… Peanut butterPeanut butter Tomato pasteTomato paste MushroomsMushrooms

Niacin DeficiencyNiacin Deficiency

Niacin deficiency disease is called Niacin deficiency disease is called pellagrapellagraSymptoms, 4 D’s:Symptoms, 4 D’s:

1.1. Dermatitis especially with sun exposure Dermatitis especially with sun exposure

2.2. Diarrhea, vomitingDiarrhea, vomiting

3.3. DementiaDementia

4.4. DeathDeath

Other symptoms:Other symptoms:1.1. Inflamed, swollen, red, smooth tongueInflamed, swollen, red, smooth tongue

2.2. Loss of appetiteLoss of appetite

3.3. Page 314Page 314

Pellagra symptoms: 4 “D’s”Pellagra symptoms: 4 “D’s” DiarrheaDiarrhea DermatitisDermatitis DementiaDementia DeathDeath

NiacinNiacin

NiacinNiacin

Pellegra - Other interesting informationPellegra - Other interesting information Originally believed to be caused by infectionOriginally believed to be caused by infection Common up to early 1900’s in US and EuropeCommon up to early 1900’s in US and Europe

• Many in mental hospitals in south had niacin Many in mental hospitals in south had niacin deficiency, not mental illnessdeficiency, not mental illness

Incidence declined in US after WW II when mandatory Incidence declined in US after WW II when mandatory enrichment of grains beganenrichment of grains began

Still common in Africa and AsiaStill common in Africa and Asia• Poor bioavailability form corn unless it’s soaked in Poor bioavailability form corn unless it’s soaked in

lime juicelime juice

NiacinNiacin

ToxicityToxicity Tolerable Upper Intake Level (UL) = 35 Tolerable Upper Intake Level (UL) = 35

mg/daymg/day High doses of niacin are commonly used to High doses of niacin are commonly used to

treat high cholesteroltreat high cholesterol• 1500 -3000 mg/day recommended for treating high 1500 -3000 mg/day recommended for treating high

cholesterolcholesterol

NiacinNiacin

Toxicity SymptomsToxicity Symptoms1.1. Niacin flush Niacin flush 2.2. Excessive sweatingExcessive sweating3.3. TinglingTingling4.4. GI distressGI distress5.5. Frequent need to urinateFrequent need to urinate

• May mask prostrate cancer symptoms in menMay mask prostrate cancer symptoms in men

6.6. Blurred vision, headachesBlurred vision, headaches7.7. Liver damageLiver damage

Folic Acid = FolateFolic Acid = Folate

Functions:Functions:1.1. Needed for DNA synthesisNeeded for DNA synthesis

• Need to make all new cellsNeed to make all new cells• E.g. Need to make new RBCE.g. Need to make new RBC

2.2. Reduces incidence of neural tube defectsReduces incidence of neural tube defects• Defects occur in first weeks of pregnancyDefects occur in first weeks of pregnancy

FolateFolate

3.3. Plays a role in protein synthesisPlays a role in protein synthesis

4.4. Breaks down the amino acid homocysteineBreaks down the amino acid homocysteine– High levels of homocysteine increases risk of High levels of homocysteine increases risk of

blood clot formationblood clot formation

5.5. May reduce risk some cancersMay reduce risk some cancers– Pancreatic cancer in men who smokePancreatic cancer in men who smoke– Breast cancer in women who drinkBreast cancer in women who drink

FolateFolate

Absorption and ActivationAbsorption and Activation Folate in foods must be acted upon by an Folate in foods must be acted upon by an

intestinal enzyme for it to be absorbed and intestinal enzyme for it to be absorbed and transported to cellstransported to cells

Folate in cells needs to be activated by Folate in cells needs to be activated by vitamin Bvitamin B1212• Process also activates the BProcess also activates the B1212

FolateFolate

Recommended intake: 400 mcg/dayRecommended intake: 400 mcg/day Factors impacting needsFactors impacting needs

Pregnancy -600 mcg/dayPregnancy -600 mcg/day Aspirin, antacids, smoking, oral contraceptives Aspirin, antacids, smoking, oral contraceptives

reduce absorptionreduce absorption Some cancer drugs reduce absorptionSome cancer drugs reduce absorption GI tract damage reduces absorptionGI tract damage reduces absorption

• Occurs with alcoholism, anorexiaOccurs with alcoholism, anorexia

• Poor absorption, leads to even more damage to GI Poor absorption, leads to even more damage to GI tracttract

FolateFolate

Food SourcesFood Sources Cooking destroys up to 50% of folateCooking destroys up to 50% of folate Oxygen destroys folateOxygen destroys folate Good sources include (page 323):Good sources include (page 323):

• Green leafy vegetablesGreen leafy vegetables• AsparagusAsparagus• LegumesLegumes• Fortified cereals and SeedsFortified cereals and Seeds• LiverLiver• Orange juice (ok, but not great source)Orange juice (ok, but not great source)

FolateFolate

Folate Deficiency (page 321)Folate Deficiency (page 321) Impairs cell division and protein Impairs cell division and protein

synthesissynthesis Symptoms:Symptoms:

1.1. Megaloblastic anemiaMegaloblastic anemia Fewer red blood cells (RBC) madeFewer red blood cells (RBC) made RBC larger than normalRBC larger than normal RBC do not carry oxygen as wellRBC do not carry oxygen as well

Folate DeficiencyFolate Deficiency2.2. Confusion, irritability, weakness, fatigueConfusion, irritability, weakness, fatigue

• Related to the anemiaRelated to the anemia

3.3. GI tract deteriorationGI tract deterioration

4.4. Elevated homocysteine levelsElevated homocysteine levels

5.5. Smooth red tongueSmooth red tongue

6.6. Increased risk neural tube defectsIncreased risk neural tube defects

FolateFolate

ToxicityToxicity No known symptomsNo known symptoms May mask a vitamin BMay mask a vitamin B12 12 deficiencydeficiency

• BB12 12 deficiency is VERY seriousdeficiency is VERY serious

Vitamin BVitamin B1212

Dorothy Crowfoot HodgkinDorothy Crowfoot Hodgkin Awarded the Nobel prize in chemistry for Awarded the Nobel prize in chemistry for

deducing the structure of vitamin B12 deducing the structure of vitamin B12 • Took her eight years Took her eight years

Headline in the London paper announcing this Headline in the London paper announcing this read read

““Nobel Prize for British Wife”Nobel Prize for British Wife”


Functions:Functions: Needed to activate folateNeeded to activate folate

• Therefore, needed for DNA and new cell (RBC) Therefore, needed for DNA and new cell (RBC) synthesissynthesis

Helps maintain myelin sheath around nerve Helps maintain myelin sheath around nerve cellscells


Recommended intake:Recommended intake: 2.4 microgams per day2.4 microgams per day

Food Sources*:Food Sources*: ONLY found naturally in animal productsONLY found naturally in animal products

• Meat, poultry, fish, eggs, dairy, liver….Meat, poultry, fish, eggs, dairy, liver…. Fortified grainsFortified grains

**Easily destroyed by microwave cookingEasily destroyed by microwave cooking


Deficiency:Deficiency: Pernicious anemia (VERY SERIOUS)Pernicious anemia (VERY SERIOUS)

• Megaloblastic anemiaMegaloblastic anemia• Nerve damage Nerve damage creeping paralysis creeping paralysis• Smooth sore tongueSmooth sore tongue• FatigueFatigue



Pernicious anemia frequently goes Pernicious anemia frequently goes undiagnosedundiagnosed

Pernicious anemia can be masked by high Pernicious anemia can be masked by high intakes of folateintakes of folate Generally as supplementsGenerally as supplements

B-12 and FolateB-12 and Folate

Presence of immature red blood cells - Presence of immature red blood cells - symptom of symptom of folate or vitamin Bfolate or vitamin B1212

deficiencydeficiency Extra folate corrects this blood condition Extra folate corrects this blood condition

BB1212 deficiency continues deficiency continues

Vitamin BVitamin B1212’s other functions then become ’s other functions then become

compromisedcompromised


Gastric by-pass patients and vegans are Gastric by-pass patients and vegans are at elevated riskat elevated risk Takes several years to developTakes several years to develop

Toxicity:Toxicity: None reportedNone reported

BB66

Functions:Functions: Need for protein and fatty acid metabolismNeed for protein and fatty acid metabolism Need for amino acid metabolismNeed for amino acid metabolism

• E.g. For converting tryptophan to other niacinE.g. For converting tryptophan to other niacin• need to make serotonin form tryptophanneed to make serotonin form tryptophan

Helps make RBCHelps make RBC Other functions under studyOther functions under study

BB66

Recommended Intake:Recommended Intake: 1.3 mg/day1.3 mg/day UL: 100 mg/dayUL: 100 mg/day

Food sources (page 318): Food sources (page 318): destroyed by heatdestroyed by heat

Meat, fish, poultryMeat, fish, poultry LegumesLegumes Seeds and nutsSeeds and nuts LiverLiver Non-citrus fruitsNon-citrus fruits

BB66

Deficiency: (rare)Deficiency: (rare) Anemia Anemia Weakness and fatigue Weakness and fatigue Depression, confusionDepression, confusion Abnormal brain waves, convulsionsAbnormal brain waves, convulsions Greasy dermatitisGreasy dermatitis

BB66

Increased risk of deficiency:Increased risk of deficiency: AlcoholicsAlcoholics

• Alcohol contributes to increased B6 breakdown Alcohol contributes to increased B6 breakdown and excretionand excretion

Oral contraceptives may increase risk of B6Oral contraceptives may increase risk of B6

deficiencydeficiency

Drug INH inactivates B6Drug INH inactivates B6INH used to treat tuberculosisINH used to treat tuberculosis

BB66

Toxicity: SeriousToxicity: Serious Stored in muscle cells, toxicity seen with Stored in muscle cells, toxicity seen with

supplementssupplements Symptoms: Symptoms:

• Irreversible nerve damage Irreversible nerve damage numbness in hands numbness in hands

and feet and feet Difficult to walkDifficult to walk• ConvulsionsConvulsions• Insomnia, restlessnessInsomnia, restlessness

BB66

BB66 does not help with: does not help with: Carpal tunnel syndromeCarpal tunnel syndrome PMSPMS Supplementation above the UL is NOT Supplementation above the UL is NOT

recommendedrecommended

BiotinBiotin

Functions:Functions: Need for energy metabolismNeed for energy metabolism Need to make glycogenNeed to make glycogen Plays a role in fatty acid and amino acid Plays a role in fatty acid and amino acid

synthesissynthesis

BiotinBiotin

Recommended Intake:Recommended Intake: 30 micrograms/day (AI)30 micrograms/day (AI)

Food Sources*:Food Sources*: Widespread in foods: liver, egg yolk, Widespread in foods: liver, egg yolk,

legumes, fish, mushrooms, whole grains…legumes, fish, mushrooms, whole grains… Some produced by GI tract bacteriaSome produced by GI tract bacteria

*easily destroyed by processing*easily destroyed by processing

BiotinBiotin

Deficiency:Deficiency: RARERARE

• Skin rashSkin rash• Hair lossHair loss• DepressionDepression• HallucinationsHallucinations• Numbness in legs/armsNumbness in legs/arms

BiotinBiotin

Deficiency can be induced by eating Deficiency can be induced by eating LARGE quantities of raw egg whitesLARGE quantities of raw egg whites 2 dozen daily for ~2 months!2 dozen daily for ~2 months! Prevents biotin absorptionPrevents biotin absorption

Toxicity: none reportedToxicity: none reported

Pantothenic AcidPantothenic Acid

Functions:Functions: Need for energy metabolismNeed for energy metabolism

• Part of acetyl CoAPart of acetyl CoA Plays a role in the synthesis of many Plays a role in the synthesis of many

substances:substances:• LipidsLipids• HormonesHormones• NeurotransmittersNeurotransmitters• HemoglobinHemoglobin


Recommended intake: Recommended intake: 5 mg/day (AI)5 mg/day (AI)

Food Sources:Food Sources: Widespread in foodsWidespread in foods


Deficiency: RareDeficiency: Rare FatigueFatigue GI distressGI distress Insomnia, depressionInsomnia, depression Apathy, irritableApathy, irritable Increased sensitivity to insulinIncreased sensitivity to insulin

Toxicity: none knownToxicity: none known

Vitamin CVitamin C

Functions:Functions: Collagen synthesisCollagen synthesis

• Part of scar tissuePart of scar tissue• Strengthens blood vesselsStrengthens blood vessels• Provides matrix for bone growthProvides matrix for bone growth

AntioxidantAntioxidant Need for healthy immune systemNeed for healthy immune system Need for thyroxine productionNeed for thyroxine production

Vitamin CVitamin C

Functions:Functions: Need for thyroxine productionNeed for thyroxine production

• Regulates body temperature and metabolic rateRegulates body temperature and metabolic rate Enhances iron absorptionEnhances iron absorption Need to make hemoglobinNeed to make hemoglobin

Vitamin CVitamin C

Recommended intake:Recommended intake: Men: 90 mg/dayMen: 90 mg/day Women: 75 mg/dayWomen: 75 mg/day Smokers: an extra 35 mg/daySmokers: an extra 35 mg/day

• More free radicals that need to be “neutralized”More free radicals that need to be “neutralized”

UL: 2000 mg/dayUL: 2000 mg/day

Vitamin CVitamin C

Food sources* (page 329):Food sources* (page 329): Citrus fruitsCitrus fruits Strawberries, melonStrawberries, melon VegetablesVegetables

• Tomatoes, dark green leafy vegetables, potatoes, Tomatoes, dark green leafy vegetables, potatoes, broccoli…broccoli…

*Heat and oxygen sensitive*Heat and oxygen sensitive

Vitamin CVitamin C

Deficiency: Deficiency: Scurvy Scurvy Poor wound healingPoor wound healing - Increased infection- Increased infection WeaknessWeakness Bleeding gumsBleeding gums Loose teethLoose teeth Broken blood vesselsBroken blood vessels Loss of appetiteLoss of appetite Joint pain and fragile bonesJoint pain and fragile bones AnemiaAnemia

Deficiency SymptomsDeficiency Symptoms

Vitamin CVitamin C

Populations at increased risk:Populations at increased risk: AlcoholicsAlcoholics ElderlyElderly Babies and toddlers fed only milk/cerealsBabies and toddlers fed only milk/cereals SmokersSmokers After illness or stressAfter illness or stress

• Fever and stress deplete vitamin C stores Fever and stress deplete vitamin C stores

Vitamin CVitamin C

Toxicity Symptoms:Toxicity Symptoms: DiarrheaDiarrhea Cramps, nauseaCramps, nausea Headaches, insomniaHeadaches, insomnia May interfere with lab tests and medsMay interfere with lab tests and meds Increased risk kidney stonesIncreased risk kidney stones Over-absorption of ironOver-absorption of iron


AA DD EE KK

Vitamin AVitamin A

Chemical nature:Chemical nature: Active forms of vitamin AActive forms of vitamin A

• RetinolRetinol• Retinoic acidRetinoic acid• RetinalRetinal

Precursor formPrecursor form• Beta-caroteneBeta-carotene• Converted to active vitamin A Converted to active vitamin A as neededas needed

Vitamin A plays a role in Vitamin A plays a role in • Gene expressionGene expression• VisionVision• Maintenance of body linings and skinMaintenance of body linings and skin

Need to build healthy epithelial and mucous tissueNeed to build healthy epithelial and mucous tissue

• Immune defensesImmune defenses• Growth of bones and of the bodyGrowth of bones and of the body• Normal development of cellsNormal development of cells

Plays a role in cell differentiationPlays a role in cell differentiation

• ReproductionReproduction

Vitamin A - FunctionsVitamin A - Functions

Vitamin A plays two roles in eye sight:Vitamin A plays two roles in eye sight: Process of light perception at the retinaProcess of light perception at the retina Maintenance of a healthy corneaMaintenance of a healthy cornea

Beta-CaroteneBeta-Carotene

Functions beta-carotene;Functions beta-carotene; Can be converted to active vitamin A as Can be converted to active vitamin A as

neededneeded AntioxidantAntioxidant

Vitamin AVitamin A

Recommended intake:Recommended intake: 700-900 RAE micrograms/day700-900 RAE micrograms/day RAE = retinol activity equivalentsRAE = retinol activity equivalents

• Older unit is IU = International UnitsOlder unit is IU = International Units UL 3000 RAEUL 3000 RAE

• UL refers to active vitamin A only, not beta-UL refers to active vitamin A only, not beta-carotenecarotene

Vitamin AVitamin A

Food Sources Food Sources pre-formed Vitamin Apre-formed Vitamin A:: All animal sourcesAll animal sources

• In fatty portion of the foodIn fatty portion of the food• Dairy productsDairy products• EggsEggs• Meat, liverMeat, liver• Fortified skim milk and margarineFortified skim milk and margarine

• Page 296Page 296

Beta-CaroteneBeta-Carotene

Food Sources Food Sources beta-carotenebeta-carotene:: All plant sourcesAll plant sources Yellow/orange/red fruits and vegetablesYellow/orange/red fruits and vegetables

• Carrots, apricots, cantaloupe, mangos, pumpkin, Carrots, apricots, cantaloupe, mangos, pumpkin, sweet potato, winter squash, peppers……sweet potato, winter squash, peppers……

Dark green leafy vegetablesDark green leafy vegetables• Spinach, kale, broccoli, beet greens (but not the Spinach, kale, broccoli, beet greens (but not the

beet!)beet!)

Vitamin AVitamin A

Deficiency Symptoms – eye sight relatedDeficiency Symptoms – eye sight related Night blindnessNight blindness BlindnessBlindness

• Leading cause of blindness worldwideLeading cause of blindness worldwide• ~ ½ million children go blind each year due to a ~ ½ million children go blind each year due to a

vitamin A deficiencyvitamin A deficiency

EyesightEyesight

Vitamin AVitamin A

Deficiency:Deficiency: Keratinization Keratinization dry, cracked skin dry, cracked skin Reduced secretionsReduced secretions

• GI tractGI tract• BladderBladder• LungsLungs

Above symptoms increase risk of infectionAbove symptoms increase risk of infection

Skin And Body LiningsSkin And Body Linings

The skin in vitamin A deficiencyThe skin in vitamin A deficiency

Vitamin AVitamin A

Deficiency:Deficiency: AnemiaAnemia Slow bone growthSlow bone growth Painful jointsPainful joints Cracked, cracked teethCracked, cracked teeth Delayed sexual maturityDelayed sexual maturity

Vitamin AVitamin A

Toxicity:Toxicity: TeratogenicTeratogenic

• ““monster producing”monster producing” GI distress, weight lossGI distress, weight loss Bone issuesBone issues

• Joint painJoint pain• Stunted bone growth and moreStunted bone growth and more

Vitamin AVitamin A

Toxicity:Toxicity: Headaches, pressure inside skullHeadaches, pressure inside skull Blurred visionBlurred vision Fatigue, muscle weaknessFatigue, muscle weakness Skin rashesSkin rashes Dry, cracked, bleeding lipsDry, cracked, bleeding lips Dry, brittle hairDry, brittle hair

Vitamin AVitamin A Vitamin A toxicity can be fatalVitamin A toxicity can be fatal Symptoms go away quickly if diet changesSymptoms go away quickly if diet changes Toxicity is never from beta-carotene Toxicity is never from beta-carotene

sourcessources Beta-carotene toxicity…..Beta-carotene toxicity…..

Vitamin DVitamin D

Chemical nature:Chemical nature: Vitamin D is a sterolVitamin D is a sterol Body can make from cholesterol – see page Body can make from cholesterol – see page

299299• Requires sunlight exposure, action of skin, liver, Requires sunlight exposure, action of skin, liver,

and kidneyand kidney

Vitamin DVitamin D

Functions:Functions: Bone mineralizationBone mineralization

• Works with other nutrientsWorks with other nutrients Vitamins A, C. KVitamins A, C. K Several mineralsSeveral minerals

Regulates calcium and phosphorus levelsRegulates calcium and phosphorus levels• Stimulates Ca and P absorption in SIStimulates Ca and P absorption in SI• Regulates movement of Ca and P in/out of bonesRegulates movement of Ca and P in/out of bones• Stimulates kidneys to retain Ca and PStimulates kidneys to retain Ca and P

All of the above are related to bone mineralizationAll of the above are related to bone mineralization

Vitamin DVitamin D

Other Functions:Other Functions: Acts as a hormoneActs as a hormone

• Not fully understoodNot fully understood• Many target organs:Many target organs:

Brain and CNSBrain and CNS MuscleMuscle Reproductive cells…Reproductive cells…

Vitamin DVitamin D

Recommended intake:Recommended intake: Depends upon sun exposure and skin colorDepends upon sun exposure and skin color 5-10 micrograms/day (AI)5-10 micrograms/day (AI)

UL: 50 mcg/dayUL: 50 mcg/day

Vitamin DVitamin D

Food sources* (page 301):Food sources* (page 301): Fortified milk and margarineFortified milk and margarine ButterButter Egg yolksEgg yolks LiverLiver Fatty fish and fish oilsFatty fish and fish oils

*natural sources are all animal sources*natural sources are all animal sources

Vitamin DVitamin D

Deficiency:Deficiency: Bone abnormalitiesBone abnormalities

• Kids Kids rickets rickets• Adults Adults osteomalcia osteomalcia

Vitamin DVitamin D

Populations at risk for deficiency:Populations at risk for deficiency: Inner-city kidsInner-city kids Dark skinnedDark skinned Live in a northern climateLive in a northern climate Limited sun exposureLimited sun exposure ElderlyElderly Kidney or liver diseaseKidney or liver disease VegansVegans

Vitamin DVitamin D

Toxicity:Toxicity: Very toxicVery toxic

• Can be lethalCan be lethal• Milk storyMilk story

Toxicity is never from sun exposureToxicity is never from sun exposure

Vitamin D ToxicityVitamin D Toxicity

Symptoms:Symptoms: Calcium deposits in soft tissueCalcium deposits in soft tissue

• Muscles, lungs, heartMuscles, lungs, heart Kidney stonesKidney stones Calcium deposits on walls of arteriesCalcium deposits on walls of arteries Joint painJoint pain Frequent urinationFrequent urination GI distressGI distress

Vitamin EVitamin E

Chemical nature:Chemical nature: A type of tocopherolA type of tocopherol 4 forms4 forms

• Alpha, beta, gamma, deltaAlpha, beta, gamma, delta• Alpha-tocopherol is the most active formAlpha-tocopherol is the most active form• Other forms have very limited bioactivityOther forms have very limited bioactivity

Vitamin EVitamin E

Functions:Functions: AntioxidantAntioxidant

• Component of animal cell membranesComponent of animal cell membranes• Protects unsaturated fatty acids in cell membranesProtects unsaturated fatty acids in cell membranes

Other roles are not clearly defined, but likely Other roles are not clearly defined, but likely existexist

Vitamin EVitamin E

Recommended intake:Recommended intake: 15 mg/day15 mg/day Need more if eat more polyunsaturated fatsNeed more if eat more polyunsaturated fats

most students did not meet their vitamin E most students did not meet their vitamin E requirement on the day analyzedrequirement on the day analyzed

Vitamin EVitamin E

Food sources* (page 303):Food sources* (page 303): Vegetable oilsVegetable oils Nuts and seeds Nuts and seeds Whole grainsWhole grains Green leafy vegetablesGreen leafy vegetables LiverLiver Wheat germWheat germ Egg yolksEgg yolks *easily destroyed by heat and oxygen*easily destroyed by heat and oxygen

Vitamin EVitamin E

Deficiency:Deficiency: Rare as most vitamin E is recycledRare as most vitamin E is recycled See in premature babiesSee in premature babies

• Transferred from mom to baby in last weeks of Transferred from mom to baby in last weeks of pregnancypregnancy

Cystic fibrosis patientsCystic fibrosis patients• Due to poor fat absorptionDue to poor fat absorption

Vitamin EVitamin E

Symptoms deficiency:Symptoms deficiency: Hemolytic anemiaHemolytic anemia

• RBC break openRBC break open Neurological problems with prolonged Neurological problems with prolonged

deficiencydeficiency• Loss of coordinationLoss of coordination• Vision and speech problemsVision and speech problems• Does not prevent/cure MDDoes not prevent/cure MD

Vitamin EVitamin E

Vitamin E may help with:Vitamin E may help with: Leg crampsLeg cramps

• Intermittent claudicationIntermittent claudication Fibrocystic breasts diseaseFibrocystic breasts disease

• ““lumpy” breastslumpy” breasts

Vitamin EVitamin E

Toxicity: RareToxicity: Rare Supplements recommended by many, but not Supplements recommended by many, but not

above the UL = 1000 mgabove the UL = 1000 mg• 200 mg supplement probably enough200 mg supplement probably enough

May interfere with blood clottingMay interfere with blood clotting• Stop taking supplements prior to surgeryStop taking supplements prior to surgery

Other symptoms: nausea, fatigue, blurred Other symptoms: nausea, fatigue, blurred visionvision

VITAMIN KVITAMIN K

Functions:Functions: Need for synthesis of blood clotting proteinsNeed for synthesis of blood clotting proteins Plays a role in regulation of calcium levelsPlays a role in regulation of calcium levels

Vitamin KVitamin K

Recommended intake:Recommended intake: 90-120 mcg/day90-120 mcg/day

Sources:Sources: Made by GI tract bacteriaMade by GI tract bacteria Dark green leafy vegetables, cabbage familyDark green leafy vegetables, cabbage family LiverLiver MilkMilk

Vitamin KVitamin K

Deficiency: rareDeficiency: rare Symptoms: Symptoms:

• Bleeding, hemorrhagingBleeding, hemorrhaging• Bone weaknessBone weakness

Populations at riskPopulations at risk• BabiesBabies• After long-term antibiotic treatmentAfter long-term antibiotic treatment• CF CF

Vitamin KVitamin K

Toxicity: rareToxicity: rare Occurs with supplement overuseOccurs with supplement overuse

• Take with caution, even if prescribedTake with caution, even if prescribed Symptoms:Symptoms:

• RBC break openRBC break open• JaundiceJaundice• Brain damageBrain damage• Interferes with anti-clotting medsInterferes with anti-clotting meds

Documents

The Vitamins. Introduction Vitamins were discovered at the beginning of the twentieth century. Vitamin: An essential, noncaloric, organic nutrient