WATER SOLUBLE VITAMINS - Medico Tutorials

06/16/10 www.similima.com - dr shalini g unnithan 1

WATER SOLUBLE VITAMINS

Presented by:Dr Shalini G UnnithanI MD(Rep)GHMCT

VITAMINS• “VITAMIN” means “vital for life”• VITA + AMINE

• VITAMINS are *Micronutrients which are necessary for everyday healthy functioning

of the body • VITAMINS cannot be synthesised in the body. So

they have to supplied thru’ diet 06/16/10 www.similima.com - dr shalini g

unnithan 2

* Nutrients required in very small amounts - mg or µg

VITAMINS - Two main categories

• B • C

• A• D • E• K


Fat solubleWater soluble

Water soluble

• Cannot be stored in body - regular supply needed

• Excess is excreted in urine - no danger of toxic levels

• Unstable to heat and light, leach into cooking liquids


Fat Soluble

• Can be stored in body - regular supply not needed

• Can accumulate to toxic levels if large amounts ingested

• Fairly stable at normal cooking temperatures

WATER SOLUBLE VITAMINS

Vitamins B and Co Structure

o Functions

o Properties & RDA o Sources

o Co - enzymes

o Effects of deficiency

06/16/10 5www.similima.com - dr shalini g unnithan

Overview of Water soluble Vitamins

• Dissolve in water • Subject to cooking losses• Generally readily excreted• 50-90% of B vitamins are absorbed• Marginal deficiency more common• Function as a coenzyme• In energy metabolism


B-vitamins• Do not give people energy,

like energy yielding nutrients, but help to burn this fuel

• This class contain 8 B vitamins, each work as coenzyme

• Must be present in every cell continuously for the proper cell function


Coenzyme: a small molecule that works with an enzyme to promote theenzymes activity


Vitamin B Complex• Thiamin (B1)• Riboflavin (B2)• Niacin (B3)• Pantothenic Acid(B5)• Pyridoxine (B6)• Biotin (B7)• Folic Acid (B9)• Cyanocobalamine (B12)


Co enzymes:Catalysts in Biochemical pathways

Absorption, Transport, Metabolism of Vitamins

• Absorbed in the SI into the capillaries by a carrier-mediated system

• Vit B12 must bind with Intrinsic Factor in stomach to get absorbed in SI

• Transported by RBC in the blood• No carriers required• B2 – protein carrier

• Excess quickly excreted in the urine


http://cdn.most-expensive.net/wp-content/uploads/2009/01/expensive-tuna-fish.jpg

http://upload.wikimedia.org/wikipedia/commons/3/36/Riboflavin.svg

Absorption


B1

Most of B, Vit C

VitC, B1, B2, B6, B12

Biotin

IF + B12

Release B2


Vitamin B1

THIAMINE

( Aneurine)

Structure• Pyramidine ring ---- -CH2 ----- Thiazole

ring


C12H17N4OS Active form - TPP

Vitamin B1 - ThiamineFunctions• Essential for

release of energy from carbohydrates

• As coenzyme ( TPP )


Vitamin B1 - ThiamineProperties• Destroyed by high

temperatures, alkalies• Stable in crystalline

form• Lost by milling flour,

leaching into cooking liquids and in thawing frozen food


RDA

1.5mg per day Requirement increases with energy expenditure

Vitamin B1 - Thiamine

SourcesOuter layer of grain & germWhole grainsWheatgermPulses , Nuts, SeedsTuna Broccoli Thiaminase found in raw fish

Not in butter & veg oils ( not fat soluble)


http://en.wikipedia.org/wiki/File:Riboflavin_solution.jpg


The 1929 Nobel Prize in Physiology or Medicine

Christiaan Eijkman




"White rice can be poisonous!“ Conclusion of Christiaan Eijkman (1896)

Coenzyme: Thiamin Pyrophosphate (TPP)

• Coenzyme in decarboxylation of pyruvic acid -> acetyl coA in metabolism of carbohydrate

• Kreb’s cycle


• Decreasedo dehydrogenation ->

accumulation of pyruvate & lactate -> vasodilatation &

î CO -> fluid leakage -> oedema

o acetyl coA & ATP formation -> decreased acetyl choline & CNS activity

o Cells cannot utilize glucose -> affects CNS

BeriberiRisk groups• Poor• Alcoholics• Infection • Hard physical labor• Diet with highly

processed food• Thiamine def moms


Beri = I can’t Oriental beriberiWet beriberiEdemaenlarged heart SHOSHIN heart failurePISTOL SHOT sound over femoral artery

Dry beriberi

Weakness,nerve degeneration, irritabilitypoor limbs coordination, loss of nerve transmission


Infantile Beriberi• Form of wet type• Breast fed babies of

thiamine deficient mom• a/c onset

Restless & crying

o Anorexiao Oedema -> larynx -> aphoniao Tachycardiao Tachypnoea -> death

06/16/10 www.similima.com - dr shalini g unnithan

24

Wernicke’s Encephalopathy• Mid brain, hypothalamus, walls of III ventricle• Haemorrhagic polyencephalitis• c/c alcoholics consuming other food in little amt• Triad- encephalopathy ophthalmoplegia ataxiaIf untreated – Korsakoff’s psychosis coma death


Diagnosis

• Plasma pyruvic acid level î

• Transketolase activity in RBC with / without adding TPP


Interesting facts• It is thought that thiamin can be useful

for motion sickness in air and sea travel, and that this vitamin also repels insects when excreted through the skin.

• In autism management • Thiamin should be taken with the B

group vitamins and manganese.



Vitamin B2

RIBOFLAVIN

Structure• Heterocyclin, isoallaxozine------alc-

ribitol• Flavus = yellow


http://www.google.co.in/imgres?imgurl=http://www.dicts.info/img/ud/yoghurt.jpg&imgrefurl=http://www.dicts.info/picture-dictionary.php%3Fw%3Dyoghurt&usg=__6okokxnM1ZLOVSuZ7AEC2cq8va0=&h=599&w=685&sz=55&hl=en&start=27&itbs=1&tbnid=8Lf00gRldYJ0gM:&tbnh=122&tbnw=139&prev=/images%3Fq%3Dyoghurt%26start%3D18%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D18%26tbs%3Disch:1

http://padmanjali.com/milk.jpg

Vitamin B2 -RiboflavinFunctions• Metabolism of

carbohydrates, proteins and fats

• Precursor for the co enzyme FAD & FMN

• Convert B6 & Folate to active form


Vitamin B2 -RiboflavinProperties• Water soluble• Unstable at high

temperatures• Destroyed by alkalies• Sensitive to uv radiation

(sunlight)• Stored in paper, opaque

plastic containers


RDA

1.5 - 1.8 mg per day 2-2.5 in pregnancy

lactation

child

Vitamin B2 -RiboflavinSourcesMilk & milk productsEggsGerminating seedsOffalLiverOysterYeast extracts


http://upload.wikimedia.org/wikipedia/commons/6/69/Pantothenic_acid_structure.svg

Risk groups• Rare– Low milk/dairy

intake– Elderly – Alcoholics– Long term

phenobarbital use


ARiboflavinosis

oOral –chelosis angular stomatitis glossitis

oOccular – vascularisatn

oSkin - dermatitis oNasolabial seborrhoea

oAnemia – normocytic

Occulo orogenital syn • Occurs within 2

months • Lesions in eyes,

genital, oral mucosa


ARiboflavinosis



Vitamin B3

NIACIN

(Nicotinic Acid/ Nicotinamide)

Structure

• Pyridine – 3 – carboxylic acid• P-P Vitamin


C5H4NCO2H.

Vitamin B3 -Niacin (Nicotinic acid)

Functions• Metabolism of

glucose, proteins

• Mild Vasodilator “niacin flush”



Properties• Water soluble• Stable to heat• Fairly stable to

acids/alkalis• 80 -90% loss in milling• Body can make it from

protein. • The amino acid

tryptophan can be converted to niacin in the body.


*RDA

15 - 20mg per day

*Related to protein intake


SourcesLiver Brewer’s Yeast BranWheatgerm TomatoMilk Maize & Potato-bound form->treated

with lime( alkali)

Instant Coffee 1 cup -> 1 mg niacin


Pellagra • Risk factors• Maize as staple diet• Alcoholism• Malabsorption• Hartnup disease

• Pella=skin, agra=rough• Dermatitis – exposed to

sun, friction areas CASAL’S NECKLACE Pellagra sini pellagra• GIT s/s – loss of app V, D,

Stomatitis, soreness of tongue

• Mental – depressionanxiety


Pellagra

3Do Diarrhoeao Dermatitiso Dementia

Generalised malabsorptionMacrocytic anemiaEncephalopathy




Vitamin B5

Pantothinic acid

(Filtrate factor)

Structure • Pantothen = everywhere• Chick pellagra factor• Peptide derevative• amide between D-pantoate and beta-

alanine


Vitamin B5 - Pantothenic acidFunctions

Acetylation reaction in cells

Commonly named as coenzyme A

Metabolism of AASynthesis of FA & cholesterolFormation of steroids


Vitamin B5 – Pantothenic acidProperties• Water soluble• Heat resistant• Viscous oil


*RDA

6 – 10 mg per day

* No clear data

Vitamin B5 - ( Pantothenic acid)SourcesAnimal tissuesLiverKidneysSpleenHeartAdrenalsEgg yolk Milk


Risk groups

• Poor pts in South India


Burning foot syndromeGrierson-Gopalan syndrome

Grey hairAdrenocortical insuffNeuromuscular failure

Commercial uses• Topical application

for burns• Treatment of acne reducing oil content of face

• Also in paralytic ileus

• Exploited in shampoo industries



Vitamin B6

Pyridoxine

( adermin )

Structure • 3 comp – pyridoxal

pyridoxol pyridoxine pyridoxamine

pyridoxal PO4


Origin of name

• PYRIDine hydrOXyl & vitamIN

• AntiDERMatitis vitamIN


Vitamin B6 -PyridoxineFunctions• Protein

metabolism• Involved in

formation hormones and structural proteins


Vitamin B6 -PyridoxineProperties• Water soluble• Reasonably heat stable• Sensitive to high

temperatures, oxygen, milling and processing


RDA

2mg per day

Increase with high proteindiet

Vitamin B6 -PyridoxineSources

Yeast extractsBananaEgg yolkFishMeat, milkWhole grains, cabbage

Intestinal bacteria


Deficiency • Rare deficiency, usually in infants• Dermatitis• Anaemia – hypochromic microcytic• Cheilitis, conjunctivitis • Seizures, irritability in infants - fed on artificial milk

powder• Familial pyridoxine- responsive anemia• Xanthuric aciduria + mental retardation

• Anti TB drugs -> peripheral neuritis06/16/10 www.similima.com - dr shalini g

unnithan 57

Can prevent…..

o N & V during pregnancy & Radiation sickness

o Local application in seborrhoeic dermatitis

o Kidney stone & homocystinurea



Vitamin B12

CyanoCobalamin

Structure • 2 comp – cyanide group

cobaltCobalt containing porphyrin


Vitamin B12 - (Cyano) CobalaminFunctions

• DNA synthesis• Nervous system -

maintains myelin sheath around nerves

• Helps treat pernicious anaemia


Vitamin B12 - (Cyano) CobalaminProperties• Water soluble• Heat stable up to 100°C• Affected by strong

acids/alkalis• Affected by light


RDA

3-4 µg per day

Vitamin B12 - (Cyano) CobalaminSourcesMeat, OffalFishCheese , eggs

Liver storage


No B12 in plant foods – vegans, vegetarians risk of deficiency

Risk groups

• Lack of intake• Absence of intrinsic

factor• Gastrectomy• Fish tapeworm• Diseases of ileum• Congenital vit malabs• Excess demand


oCongenital B12 defeciency in childhood

oPernicious anemia – def of IF

Deficiency • Haematological o Megaloblastic anaemiao Megaloblastic bone marrowo RBC survival time – 60 days

• Neurologicalo Sub a/c combined degeneration ( demyelination)o Degen of lat & post columns of spinal cordo Peripheral neuropathyo Glove & stocking impairement of superficial sensationo Occational mental changes06/16/10 www.similima.com - dr shalini g

unnithan 65

Diagnosis • Schilling test• Distinguishes deficiency

caused by pernicious anemia with that caused by malabsorption



Vitamin B9

Folic Acid

(Pteroylglutamic Acid)

Structure • Folium = leaf• Lactobacillus casei factor• Mono/ Poly glutamates• Pteridyl grop & glutamic acid +

paraamino benzoic acid


Vitamin B9 -Folic AcidFunctions• Development of brain,

spinal cord and skeleton in foetus

• Reduces risk of neural tube defects e.g. spina bifida

• May play role preventing heart attacks, strokes and cancer


Vitamin B9 -Folic AcidProperties• Water soluble• Unaffected by acids• Sensitive to light and oxidation


RDA300 µg per day

More during pregnancy

Vitamin B9 -Folic AcidSourcesFortified cerealsDark green leafy

vegetablesCitrus fruitsShell fishMeat Liver


Vitamin B 9 -Folic AcidRisk groupsPoor Alcoholism PregnancyInfancyLeukemia Prox SI diseases – coeliac

diseases


Deficiency• Fatigue in mild cases• Megaloblastic anemia• Infertility – severe

cases• Tropical sprue • Neural tube defects

Important to take folic acid prior to conception and vital during first 3 months pregnancy



Neural tube defects

Folic acid antagonistsantifols

• Folic acid-vit B12 antagonism Folic acid supplements can correct the anemia

associated with vitamin B12 deficiency. Unfortunately, folic acid will not correct changes in the nervous system that result from vitamin B12 deficiency. Permanent nerve damage could theoretically occur if vitamin B12 deficiency is not treated

• Provides fuel to malignant cells of leukemia, myeloma, hodgkin’s disease



Vitamin B7 (H)

Biotin

Named after….

Egg white injury factorAvidin combines with biotin in intestine &

prevents absorption of biotin from intestine


H represents "Haar und Haut” German words for “hair and skin”

Structure • Heterocyclic S containing

monocarboxylic acid


Vitamin B7 (H) - BiotinFunctionsCell growthProduction of fatty acidsMetabolism of fats and aaRole in the TCA CycleHelps to transfer carbon

dioxideMaintains a steady blood

sugar levelStrengthens hair and nails


Vitamin B7 (H) - BiotinProperties• Water soluble


RDA300μg/day

Vitamin B7 (H) - Biotin

Sources


CheeseBeef LiverBrewer’s yeastCauliflowerChocolates Mushrooms Spinach

Risk groups• Persons who

have taken large amt of raw eggs for long time

• Partial gastrectomy

• Alcoholics• Anticonvulsant

drug06/16/10 www.similima.com - dr shalini g

unnithan 82

skin rash

hair loss

Convulsion

neurological disorders

impaired growth in children

Interesting facts• It seems that biotin may affect hair color,

together with PABA, folic acid and pantothenic acid.

• Some research had varying results with biotin supplements in returning hair to its original color.

• This has proved only successful to a limited degree and only when natural vitamins were used, as the synthetic vitamins did not influence the results very much.


Vitamin B Complex & carbohydrates

• B take part in carb metabolism at various stages

• In nature B combined with carbohydrates

• B deficiency leads to impaired carb metabolism

• So administer B complex when glucose given parenterally



Vitamin C

Ascorbic acid

Structure • enolic form of 3-oxo-L-gulofuranolactoneDisease of Sailors


Vitamin C -Ascorbic AcidFunctions

• Prevents scurvy• Acts as

antioxidant, protects HDL cholesterol


Vitamin C -Ascorbic AcidProperties• Water soluble• Destroyed by alkalis, dry or moist

heat and enzymes• Sensitive to Fe, Cu • Sensitive to light and oxygen• Acts as an antioxidant


RDA

30-60 mg per day

Least stable of all vitamins

Vitamin C -Ascorbic Acid

SourcesGuavas(boiled/stewed) blackcurrantsgreen peppers, kiwiCitrus fruitsstrawberriesspinach, cabbageBroccolli

Exception : dried cereals & pulses


Risk Groups

Infantselderly men Alcoholicssmokers

• Prolonged consumption of dry fruits & vegetables

• Defective Hydroxylation of proline to hydroxyproline

• Deficiency of collagen

Permeability of capillaries -> haemorrhage

Defective erythropoesis -> anaemia

Defective collagen form. -> delayed wound healing


Pathology

Scurvy• Weakness & debility• Swollen & spongy gums• Gums – scurvy buds• Hallitosis Cutaneous bleeding in lower thigh -> Perifollicular Bleeding ->

petechial haemorrhage usually in ankle & feet Haem in deep tissues of thighs & legs -> woody leg Heaping of keratin like material -> corkscrew appearance of hair


Rebound scurvyInfantile scurvy ( Barlow’s Disease)

LassitudeAnaemia• Scurvy buds – after

teeth eruption• Frog-legs position• Scorbutic rosary

Immediate halt to excess vitamin C supplements



Perifollicular bleedingCorkscrew appearance


Scorbutic rosary

Bogus Vitamins


Vitamin B 4 Adenine

Vitamin B 10 Identical with Folic acid

Vitamin B 11 „ „ „

Vitamin B 15 Pandemic acid

Vitamin B 13 Orotic acid

Vitamin B 17 Laetrile

Vitamin B 19 Wormser’s secret formula

DO s & DON’T s for nutrition

• Do peel the skin as thinly as possible. • The nutrients are concentrated just below the skin, so peeling

before boiling increases the loss of Vitamin C, Folic Acid and other B vitamins. Better scrape

• Do not cut vegetables into very small cubes as each small part comes in contact with oxygen, destroying vitamins.


DO s & DON’T s for nutrition • Do not soak vegetables in water to

prevent discoloration. • Almost 40 % of the water soluble vitamins and minerals are lost

in the soaking water. If you must soak, use up the soaking water to knead dough, prepare soups & gravies

• Root vegetables should be boiled with skins on and then peeled after boiling. This helps the nutrients to migrate to the center of the vegetables, helping better retention of its nutrients. Do eat with skin on whenever possible.


DO s & DON’T s for nutrition • Certain amount of minerals and vitamins

are lost even during preliminary washing before cooking.

• Washing may remove as much as 40% of the thiamine and nicotinic acid. Thats why it is preferable to wash rice with minimum amount of water.

• Salads should be prepared just before serving and should be served in closed dishes to avoid excessive exposure to air.


DO s & DON’T s for nutrition • Do not throw away the excess water

drained after boiling rice or vegetables. When preparing cottage cheese, the water left over after curdling is called whey. It is extremely rich in good quality proteins and vitamins and should be used up in preparing gravies, kneading dough or simply had as a refreshing drink after

flavoring with lemon juice and salt and pepper.• Do not keep milk open or exposed to

light, as considerable destruction of riboflavin can occur.


DO s & DON’T s for nutrition • Baking soda makes cooking water

alkaline and thus helps retain the color of vegetables as

well as speed up the cooking process, BUT it destroys thiamin and vitamin C.

• Cooked vegetables when exposed to the atmosphere before serving may also result in loss of vitamin C.

• It is preferable to cook vegetables in minimum amount of water keeping the vessel covered and to consume it as soon as possible.

Reheating cooked vegetables further destroys vitamins.06/16/10 www.similima.com - dr shalini g

unnithan 100


homoeopathy

DEWEY W. A. Practical Homeopathic Therapeutics

• Vitamine therapy• As Cartier remarks - "Without these imponderable vitamines

life would be impossible".• It reminds of Hahnemann's "spirit-like force" which he applied

to the action of remedies.

Vitamines are of special interest to the homoeopathic physician. • First, they offer positive evidence of the curative power of

imponderables and infinitesimals • Second, they are analogous practically to the Tissue Remedy Therapy

of Schuessler introduced by Hering and practiced by our physicians all over the world.

• It was pointed out by Schuessler and verified first by Hering and then by the physicians of our school, that the deficiency condition due to a lack of a mineral salt would not necessarily be remedied by giving foods rich in the deficient salt, and that the deficiency disease would continue quite frequently no matter how much was taken into the system in foods.


PSORIC MIASM -- GEORGE LOUKAS• The feature of deficiency regarding body manifests

itself in various ways, such as inadequate nourishment. He eats all the time but the organism cannot assimilate the foods and the result is deficiency.

• Those who mention that deficiency of vitamins and minerals are the cause of various diseases go together with the homeopathic thinking because they focus on the point related to psoric miasm.

• For instance deficiency of vitamin A causes dryness. Dryness is one of the main symptoms of psoric miasm. When Hanhemann wrote about psoric miasm, he was not aware of the existence of vitamin A.


Medicines with vitamins• Aegle marmelos • Embelica officinalis • Thea • Coffea • Vaccinium myrtillus• Daucus carote• Oleum triticum• Oleum jecoris• Angelica sinensis• Taraxacum


• Citricum acidum• Chocolate• Sarothamnus scoparius• Beta vulgaris• Draba verna• Ilex mate• Marrubium vulgare• Rosa canina• Hydrastis• Aesculus

Contd……• Aloes • Bambusa • Capsicum• Coca• Crocus• Rheum palmatum• Sambucus• Thuja• Urtica urens• Vibernum


• Allium sativum• Apium graveolans• Aqua marina• Asparagus• Crataegus• Cucurbita• Fagopyrin• Ginseng• Mangifera• Menyanthus

Contd……• Raphanus• Solanum• Veronica


SCHROYENS F., Synthesis [original English version] [9th Ed.]

Vit b1+b2+b6+b12

REPERTORY


Synthesis GENERALS – BERIBERI GENERALS – PELLAGRA MOUTH bleeding gums scurvy GENERALS SCURVY, scorbutus GENERALS - FOOD and DRINKS - vitamin C

Phatak B – BeriberiP – Pellagra S - Scurvy

REPERTORY

Complete • SKIN – PELLAGRA• GENERALITIES – PELLAGRA• MOUTH - HEMORRHAGE - Gums – scurvy• GENERALITIES - SCURVY, scorbutus


Murphy • GENERALITIES – PELLAGRA• Skin – PELLAGRA• Skin – PELLAGRA• Diseases – SCURVY – scorbutus• Fever – HECTIC fever-scurvy• Mouth – BLEEDING – bleeding,gums - scurvy


THANK YOU

Documents

WATER SOLUBLE VITAMINS - Medico Tutorials