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The Vitamins. Classifying Vitamins. Fat Soluble Vitamins A D E K. Water Soluble Vitamins. Vitamin C B Vitamins: Thiamin -- Biotin Riboflavin -- Pantothenic acid Niacin B 6 Folate (folic acid) B 12. Water Soluble Vitamins. Digestion, Absorption, and Transport

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classifying vitamins
Classifying Vitamins
  • Fat Soluble Vitamins
    • A
    • D
    • E
    • K
water soluble vitamins
Water Soluble Vitamins
  • Vitamin C
  • B Vitamins:
    • Thiamin -- Biotin
    • Riboflavin -- Pantothenic acid
    • Niacin
    • B6
    • Folate (folic acid)
    • B12
water soluble vitamins1
Water Soluble Vitamins
  • Digestion, Absorption, and Transport
    • No chemical digestion needed
    • Absorbed in the SI into the capillaries
      • Vitamin B12 must bind with a protein called the intrinsic factor (IF) in the stomach for absorption to occur in the SI
    • No carriers required for transport in the blood
water soluble vitamins2
Water Soluble Vitamins
  • Storage and excretion
    • Travel freely in the blood
    • Cells take up water soluble vitamins as needed
      • Limited storage beyond tissue saturation
    • Excess excreted in the urine
water soluble vitamins3
Water Soluble Vitamins
  • Deficiency is more common than toxicity for the water soluble vitamins
    • Why??
    • Any toxicity is likely to be due to overuse of vitamin supplements, not food intake
water soluble vitamins4
Water Soluble Vitamins
  • Other interesting information:
    • Many are destroyed by light, heat, or exposure to oxygen
    • Best to cook whole in a minimum amount of water
      • Why??
    • Frozen vegetables are often higher in vitamin content than grocery store “fresh” veggies
      • Why??
fat soluble vitamins
Fat Soluble Vitamins
  • Digestion, Absorption, and Transport
    • Bile needed to emulsify fat soluble vitamins
    • Form chylomicrons (along with long chain fatty acids and monoglycerides)
    • Chylomicrons are absorbed into the lacteals
    • Travel through lymph system  blood  liver
    • Many require protein carriers to be transported in the blood
fat soluble vitamins1
Fat Soluble Vitamins
  • Storage
    • Stored in liver and fatty tissue
    • Unlimited stores possible
  • Greater risk of toxicity than deficiency for fat soluble vitamins
    • Why??
fat soluble vitamins2
Fat Soluble Vitamins
  • Other interesting facts:
    • Found in the fatty parts of food
    • Removed with the fat when low-fat products are made
      • Many low-fat foods are supplemented with these vitamins to make up for this
        • E.g. milk is vitamin A and D enriched
the vitamins1
The Vitamins
  • For each vitamin we will consider:
    • Functions
    • Dietary needs and food sources
    • Deficiency
    • Toxicity
thiamin
Thiamin

History

Functions:

  • Needed for energy metabolism
    • E.g. -- required for conversion of pyruvate to acetyl CoA
  • Needed for nerve and muscle function
thiamin1
Thiamin

Recommended Intake

  • 1.1-1.2 mg/day

Food Sources

  • Found in small amounts in many foods
  • Easily destroyed by heat (cooking)
  • Lost in cooking water
  • Good sources include
    • Pork products, soy, legumes, vegetables, whole grains, watermelon….(pg 327)
thiamin deficiency
Thiamin Deficiency
  • Prolonged deficiency leads to beriberi
    • Results in damage to nervous system and muscles (to include the heart)
thiamin deficiency1
Thiamin Deficiency
  • Symptoms Beriberi:
      • Dry form- muscle wasting, poor coordination Muscle weakness
      • Legs heavy, hard to walk, calf pain
      • Apathy, confusion, memory loss
      • Anorexia and weight loss
      • Wet form has additional symptoms of:
        • edema, irregular heart beat, enlarged heart
slide16
In alcoholics thiamin deficiency results in Wernicke-Korsakoff syndrome.
    • Symtpoms
      • Mental confusion
      • Staggering
      • Rapid eye movements or paralysis of the eye muscles
thiamin deficiency2
Thiamin Deficiency
  • Populations at risk:
    • Alcoholics
      • See in alcoholics who obtain the majority of their calories from alcohol
      • Alcohol inhibits thiamin absorption and hastens its excretion
    • Cultures that eat primarily refined grains (and little else)
    • Thiamin deficient moms  infant deaths
slide18
The City of New York
  • DEPARTMENT OF HEALTH AND MENTAL HYGIENE
  • Michael R. Bloomberg Thomas R. Frieden, m.d., m.p.h.
  • Mayor Commissioner
  • _______________________________________________________________
  • nyc.gov/health
  • 2003 Health Alert # 39:
  • A cluster of infantile thiamine (vitamin B1) deficiency (beri-beri) has been reported in Israel among infants fed a vitamin B1-deficient kosher soy-based formula distributed by Remedia. It is possible that this product may be imported into New York City and there may be children in the Orthodox Jewish community who have consumed it.
  • The New York City Department of Health and Mental Hygiene (NYCDOHMH) asks that providers report immediately any suspect case of thiamine deficiency among infants who have been fed this product to:
  • The New York City Poison Control Center at:
  • 1-212-764-7667 (212-POISONS) or 1-800-222-1222.
  • Please distribute to Pediatric staff in the Departments of Cardiology, Critical Care, Emergency Medicine, Family Medicine, General Pediatrics, Outpatient Pediatrics, Neonatology, Neurology, and Infectious Disease
thiamin2
Thiamin
  • Toxicity
    • None known
    • Excess thiamin is excreted and not stored
riboflavin
Riboflavin

Functions:

  • Needed for the metabolism of carbohydrates, fats, and proteins
    • Places a role in Kreb’s cycle
    • Part of FAD
riboflavin1
Riboflavin

Recommended Intake:

  • 1.1 – 1.3 mg/day

Food Sources:

  • Destroyed by ultraviolet light (sun light)
  • Good sources include:
    • Milk and milk products
    • Liver
    • Whole grain breads and cereals, oatmeal
    • Clams and squid!
    • Mushrooms (page 329)
riboflavin2
Riboflavin

Deficiency Symptoms

  • Eyes are inflamed and sensitive to light
  • Cheliosis (cracks at the corners of the mouth)
  • Sore throat
  • Inflammation of the tongue and mouth – painful
  • Inflamed skin, with lesions covered with greasy scales
  • Anemia
riboflavin3
Riboflavin

Populations at Risk for Deficiency

  • alcoholics
  • any one with a marginal diet
    • Poor, elderly, eating disorders, drug addicts…

Toxicity

  • None reported
  • Excess excreted
niacin
Niacin

Functions

  • Plays an essential role in energy metabolism
    • Part of NAD
    • Needed by every cell of the body
niacin1
Niacin

Recommended Intake:

  • 14 – 16 mg/day of niacin or of NE
  • NE = Niacin Equivalents
    • Niacin can be made from the essential amino acid tryptophan
    • It takes 60 mg of tryptophan to make 1 mg of niacin
    • Therefore, 1 NE is 60 mg of tryptophan
niacin2
Niacin

Food Sources:

  • Sources of complete protein
    • Dairy, meats, poultry, fish,…
  • Peanut butter
  • Tomato paste
  • Mushrooms
  • (page 332)
niacin deficiency
Niacin Deficiency

Niacin deficiency disease is called pellagra

Symptoms, 4 D’s:

  • Dermatitis with sun exposure (pg 330)
  • Diarrhea, vomiting
  • Dementia
  • Death

Other symptoms:

  • Inflamed, swollen, red, smooth tongue
  • Loss of appetite
niacin3
Niacin
  • Pellegra - Other interesting information
    • Originally believed to be caused by infection
    • Common up to early 1900’s in US and Europe
      • Many in mental hospitals in south had niacin deficiency, not mental illness
        • Incidence declined in US after WW II when mandatory enrichment of grains began
    • Still common in Africa and Asia
      • Poor bioavailability form corn unless it’s soaked in lime juice
niacin4
Niacin

Toxicity

  • Tolerable Upper Intake Level (UL) = 35 mg/day
  • High doses of niacin are commonly used to treat high cholesterol
    • 1500 -3000 mg/day recommended for treating high cholesterol
niacin5
Niacin

Toxicity Symptoms

  • Niacin flush
  • Excessive sweating
  • Tingling
  • GI distress
  • Frequent need to urinate
    • May mask prostrate cancer symptoms in men
  • Blurred vision, headaches
  • Liver damage
folic acid folate
Folic Acid = Folate

Functions:

  • Needed for DNA synthesis
    • Need to make all new cells
    • E.g. Need to make new RBC
  • Reduces incidence of neural tube defects
    • Defects occur in first weeks of pregnancy
folate
Folate
  • Plays a role in protein synthesis
  • Breaks down the amino acid homocysteine
    • High levels of homocysteine increases risk of blood clot formation
  • May reduce risk some cancers
    • Pancreatic cancer in men who smoke
    • Breast cancer in women who drink
folate1
Folate
  • Absorption and Activation
    • Folate in foods must be acted upon by an intestinal enzyme for it to be absorbed and transported to cells
    • Folate in cells needs to be activated by vitamin B12
      • Process also activates the B12
folate2
Folate
  • Recommended intake:
    • 400 micrograms/day
folate3
Folate
  • Factors impacting needs
    • Pregnancy -600 mcg/day
    • Aspirin, antacids, smoking, oral contraceptives reduce absorption
    • Some cancer drugs reduce absorption
    • GI tract damage reduces absorption
      • Occurs with alcoholism, anorexia
      • Poor absorption, leads to even more damage to GI tract
folate4
Folate
  • Food Sources
    • Cooking destroys up to 50% of folate
    • Oxygen destroys folate
    • Good sources include:
      • Green leafy vegetables
      • Legumes
      • Fortified cereals and Seeds
      • Liver
      • Orange juice (ok, but not great source) pg 341
folate5
Folate

Folate Deficiency

  • Impairs cell division and protein synthesis
  • Symptoms:
      • Megaloblastic anemia
        • Fewer red blood cells (RBC) made
        • RBC larger than normal
        • RBC do not carry oxygen as well
folate deficiency
Folate Deficiency
  • Confusion, irritability, weakness, fatigue
    • Related to the anemia
  • GI tract deterioration
  • Elevated homocysteine levels
  • Smooth red tongue
  • Increased risk neural tube defects
folate6
Folate
  • Toxicity
    • No known symptoms
    • May mask a vitamin B12 deficiency
      • B12 deficiency is VERY serious
vitamin b 12
Vitamin B12
  • Dorothy Crowfoot Hodgkin
    • Awarded the Nobel prize in chemistry for deducing the structure of vitamin B12
      • Took her eight years
    • Headline in the London paper announcing this read

“Nobel Prize for British Wife”

vitamin b 121
Vitamin B12

Functions:

  • Needed to activate folate
    • Therefore, needed for DNA and new cell (RBC) synthesis
  • Helps maintain myelin sheath around nerve cells
vitamin b 122
Vitamin B12

Recommended intake:

  • 2.4 microgams per day

Food Sources*:

  • ONLY found naturally in animal products
    • Meat, poultry, fish, eggs, dairy, liver….
  • Fortified grains

*Easily destroyed by microwave cooking

vitamin b 123
Vitamin B12

Deficiency:

  • Pernicious anemia (VERY SERIOUS)
    • Megaloblastic anemia
    • Nerve damage  creeping paralysis
    • Smooth sore tongue
    • Fatigue
vitamin b 124
Vitamin B12
  • Pernicious anemia frequently goes undiagnosed
  • Pernicious anemia can be masked by high intakes of folate
vitamin b 125
Vitamin B12
  • Gastric by-pass patients and vegans are at elevated risk
    • Takes several years to develop
  • Toxicity:
    • None reported
slide46
B6

Functions:

  • Need for protein and fatty acid metabolism
  • Need for amino acid metabolism
    • E.g. For converting tryptophan to other niacin
    • need to make serotonin form tryptophan
  • Helps make RBC
  • Other functions under study
slide47
B6

Recommended Intake:

  • 1.3 mg/day
  • UL: 100 mg/day

Food sources: destroyed by heat

  • Meat, fish, poultry
  • Legumes
  • Seeds and nuts
  • Liver
  • Non-citrus fruits
slide48
B6

Deficiency: (rare)

  • Anemia  Weakness and fatigue
  • Depression, confusion
  • Abnormal brain waves, convulsions
  • Greasy dermatitis
slide49
B6

Increased risk of deficiency:

  • Alcoholics
    • Alcohol contributes to increased B6 breakdown and excretion
  • Oral contraceptives may increase risk of B6

deficiency

Drug INH inactivates B6

INH used to treat tuberculosis

slide50
B6

Toxicity: Serious

  • Stored in muscle cells, toxicity seen with supplements
  • Symptoms:
    • Irreversible nerve damage  numbness in hands and feet  Difficult to walk
    • Convulsions
    • Insomnia, restlessness
slide51
B6
  • B6 does not help with:
    • Carpal tunnel syndrome
    • PMS
    • Supplementation above the UL is NOT recommended
biotin
Biotin

Functions:

  • Need for energy metabolism
  • Need to make glycogen
  • Plays a role in fatty acid and amino acid synthesis
biotin1
Biotin

Recommended Intake:

  • 30 micrograms/day (AI)

Food Sources*:

  • Widespread in foods: liver, egg yolk, legumes, fish, mushrooms, whole grains…
  • Some produced by GI tract bacteria

*easily destroyed by processing

biotin2
Biotin

Deficiency:

  • RARE
    • Skin rash
    • Hair loss
    • Depression
    • Hallucinations
    • Numbness in legs/arms
biotin3
Biotin
  • Deficiency can be induced by eating LARGE quantities of raw egg whites
    • 2 dozen daily for ~2 months!
    • Prevents biotin absorption
  • Toxicity: none reported
pantothenic acid
Pantothenic Acid

Functions:

  • Need for energy metabolism
    • Part of acetyl CoA
  • Plays a role in the synthesis of many substances:
    • Lipids
    • Hormones
    • Neurotransmitters
    • Hemoglobin
pantothenic acid1
Pantothenic Acid

Recommended intake:

  • 5 mg/day (AI)

Food Sources:

  • Widespread in foods
pantothenic acid2
Pantothenic Acid

Deficiency: Rare

  • Fatigue
  • GI distress
  • Insomnia, depression
  • Apathy, irritable
  • Increased sensitivity to insulin
pantothenic acid3
Pantothenic Acid
  • Toxicity: none known
vitamin c
Vitamin C

Functions:

  • Collagen synthesis
    • Part of scar tissue
    • Strengthens blood vessels
    • Provides matrix for bone growth
  • Antioxidant
  • Need for healthy immune system
  • Need for thyroxine production
vitamin c1
Vitamin C

Functions:

  • Need for thyroxine production
    • Regulates body temperature and metabolic rate
  • Enhances iron absorption
  • Need to make hemoglobin
vitamin c2
Vitamin C

Recommended intake:

  • Men: 90 mg/day
  • Women: 75 mg/day
  • Smokers: an extra 35 mg/day
    • More free radicals that need to be “neutralized”
  • UL: 2000 mg/day
vitamin c3
Vitamin C

Food sources*:

  • Citrus fruits
  • Strawberries, melon
  • Vegetables
    • Tomatoes, dark green leafy vegetables, potatoes, broccoli…

*Heat and oxygen sensitive

vitamin c4
Vitamin C

Deficiency:  Scurvy

  • Poor wound healing - Increased infection
  • Weakness
  • Bleeding gums
  • Loose teeth
  • Broken blood vessels
  • Loss of appetite
  • Joint pain and fragile bones
  • Anemia
vitamin c5
Vitamin C

Populations at increased risk:

  • Alcoholics
  • Elderly
  • Babies and toddlers fed only milk/cereals
  • Smokers
  • After illness or stress
    • Fever and stress deplete vitamin C stores
vitamin c6
Vitamin C

Toxicity Symptoms:

  • Diarrhea
  • Cramps, nausea
  • Headaches, insomnia
  • May interfere with lab tests and meds
  • Increased risk kidney stones
  • Over-absorption of iron
vitamin a
Vitamin A

Chemical nature:

  • Active forms of vitamin A
    • Retinol
    • Retinoic acid
    • Retinal
  • Precursor form
    • Beta-carotene
    • Converted to active vitamin A as needed
vitamin a1
Vitamin A

Functions:

  • Need for night vision
    • See handout
  • Need for protein synthesis
  • Plays a role in cell differentiation
    • Need to build healthy epithelial and mucous tissue
    • Need to maintain healthy cornea
vitamin a2
Vitamin A

Functions:

  • Plays a role in reproductive health
    • Sperm production
    • Fetal development
    • Sexual maturation
  • Need for bone growth
beta carotene
Beta-Carotene

Functions beta-carotene;

  • Can be converted to active vitamin A as needed
  • Antioxidant
vitamin a3
Vitamin A

Recommended intake:

  • 700-900 RAE micrograms/day
  • RAE = retinol activity equivalents
    • Older unit is IU = International Units
    • See page 360 for conversions between these units
  • UL 3000 RAE
    • UL refers to active vitamin A only, not beta-carotene
vitamin a4
Vitamin A

Food Sources Vitamin A:

  • All animal sources
    • In fatty portion of the food
    • Dairy products
    • Eggs
    • Meat, liver
    • Fortified skim milk and margarine
beta carotene1
Beta-Carotene

Food Sources:

  • All plant sources
  • Yellow/orange/red fruits and vegetables
    • Carrots, apricots, cantaloupe, mangos, pumpkin, sweet potato, winter squash, peppers……
  • Dark green leafy vegetables
    • Spinach, kale, broccoli, beet greens (but not the beet!)
vitamin a5
Vitamin A

Deficiency:

  • Night blindness
  • Blindness
    • Leading cause of blindness worldwide
    • ~ ½ million children go blind each year due to a vitamin A deficiency
vitamin a6
Vitamin A

Deficiency:

  • Keratinization  dry, cracked skin
  • Reduced secretions
    • GI tract
    • Bladder
    • Lungs
  • Above symptoms increase risk of infection
vitamin a7
Vitamin A

Deficiency:

  • Anemia
  • Slow bone growth
  • Painful joints
  • Cracked, cracked teeth
  • Delayed sexual maturity

For others see pages 374

vitamin a8
Vitamin A

Toxicity:

  • Teratogenic
    • “monster producing”
  • GI distress, weight loss
  • Bone issues
    • Joint pain
    • Stunted bone growth and more
vitamin a9
Vitamin A

Toxicity:

  • Headaches, pressure inside skull
  • Blurred vision
  • Fatigue, muscle weakness
  • Skin rashes
  • Dry, cracked, bleeding lips
  • Dry, brittle hair
vitamin a10
Vitamin A
  • Vitamin A toxicity can be fatal
    • Polar bear liver story
  • Symptoms go away quickly if diet changes
  • Toxicity is never from beta-carotene sources
    • Beta-carotene toxicity…..
vitamin d
Vitamin D

Chemical nature:

  • Vitamin D is a sterol
  • Body can make from cholesterol
    • Requires sunlight exposure
  • Synthesis of vitamin D
    • See page 376
vitamin d1
Vitamin D

Functions:

  • Bone mineralization
    • Works with other nutrients
      • Vitamins A, C. K
      • Several minerals
vitamin d2
Vitamin D

Functions:

  • Regulates calcium and phosphorus levels
    • Stimulates Ca and P absorption in SI
    • Regulates movement of Ca and P in/out of bones
    • Stimulates kidneys to retain Ca and P
    • All of the above are related to bone mineralization
vitamin d3
Vitamin D

Other Functions:

  • Acts as a hormone
    • Not fully understood
    • Many target organs:
      • Brain and CNS
      • Muscle
      • Reproductive cells…
vitamin d4
Vitamin D

Recommended intake:

  • Depends upon sun exposure and skin color
  • 5-10 micrograms/day (AI)
  • UL: 50 mcg/day
vitamin d5
Vitamin D

Food sources*:

  • Fortified milk and margarine
  • Butter
  • Egg yolks
  • Liver
  • Fatty fish and fish oils

* animal sources

vitamin d6
Vitamin D

Deficiency:

  • Bone abnormalities
    • Kids  rickets
    • Adults  osteomalcia
vitamin d7
Vitamin D

Populations at risk for deficiency:

  • Inner-city kids
  • Dark skinned
  • Live in a northern climate
  • Limited sun exposure
  • Elderly
  • Kidney or liver disease
  • Vegans
vitamin d8
Vitamin D

Toxicity:

  • Very toxic
    • Can be lethal
    • Milk story
  • Toxicity is never from sun exposure
vitamin d toxicity
Vitamin D Toxicity
  • Symptoms:
    • Calcium deposits in soft tissue
      • Muscles, lungs, heart
    • Kidney stones
    • Calcium deposits on walls of arteries
    • Joint pain
    • Frequent urination
    • GI distress
vitamin e
Vitamin E

Chemical nature:

  • A type of tocopherol
  • 4 forms
    • Alpha, beta, gamma, delta
    • Alpha-tocopherol is the most active form
    • Other forms have very limited bioactivity
vitamin e1
Vitamin E

Functions:

  • Antioxidant
    • Component of animal cell membranes
    • Protects unsaturated fatty acids in cell membranes
  • Other roles are not clearly defined, but likely exist
vitamin e2
Vitamin E

Recommended intake:

  • 15 mg/day
  • Need more if eat more polyunsaturated fats
  • most students did not meet their vitamin E requirement on the day analyzed
vitamin e3
Vitamin E

Food sources*:

  • Vegetable oils
  • Nuts and seeds
  • Whole grains
  • Green leafy vegetables
  • Liver
  • Wheat germ
  • Egg yolks *easily destroyed by heat and oxygen
vitamin e4
Vitamin E

Deficiency:

  • Rare as most vitamin E is recycled
  • See in premature babies
    • Transferred from mom to baby in last weeks of pregnancy
  • Cystic fibrosis patients
    • Due to poor fat absorption
vitamin e5
Vitamin E
  • Symptoms deficiency:
    • Hemolytic anemia
      • RBC break open
    • Neurological problems with prolonged deficiency
      • Loss of coordination
      • Vision and speech problems
      • Does not prevent/cure MD
vitamin e6
Vitamin E

Vitamin E may help with:

  • Leg cramps
    • Intermittent claudication
  • Fibrocystic breasts disease
    • “lumpy” breasts
vitamin e7
Vitamin E

Toxicity: Rare

  • Supplements recommended by many, but not above the UL = 1000 mg
    • 200 mg supplement probably enough
  • May interfere with blood clotting
    • Stop taking supplements prior to surgery
  • Other symptoms: nausea, fatigue, blurred vision
vitamin k
VITAMIN K

Functions:

  • Need for synthesis of blood clotting proteins
  • Plays a role in regulation of calcium levels
vitamin k1
Vitamin K

Recommended intake:

  • 90-120 mcg/day

Sources:

  • Made by GI tract bacteria
  • Dark green leafy vegetables, cabbage family
  • Liver
  • Milk
vitamin k2
Vitamin K

Deficiency: rare

  • Symptoms:
    • Bleeding, hemorrhaging
    • Bone weakness
  • Populations at risk
    • Babies
    • After long-term antibiotic treatment
    • CF
vitamin k3
Vitamin K

Toxicity: rare

  • Occurs with supplement overuse
    • Take with caution, even if prescribed
  • Symptoms:
    • RBC break open
    • Jaundice
    • Brain damage
    • Interferes with anti-clotting meds