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See all Premium member Presentation Transcript The Vitamins: The Vitamins Classifying Vitamins: Classifying Vitamins Fat Soluble Vitamins A D E KWater Soluble Vitamins: Water Soluble Vitamins Vitamin C B Vitamins: Thiamin -- Biotin Riboflavin -- Pantothenic acid Niacin B6 Folate (folic acid) B12 Water Soluble Vitamins: 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 Vitamins: 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 urineWater Soluble Vitamins: 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 intakeWater Soluble Vitamins: 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 bloodFat Soluble Vitamins: 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 Vitamins: 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 enrichedThe Vitamins: 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 Thiamin: 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 Deficiency: 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 musclesThiamin Deficiency: 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 Thiamin: Thiamin Toxicity None known Excess thiamin is excreted and not storedRiboflavin: Riboflavin Functions: Needed for the metabolism of carbohydrates, fats, and proteins Places a role in Kreb’s cycle Part of FAD Riboflavin: 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)Riboflavin: 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 Riboflavin: Riboflavin Populations at Risk for Deficiency alcoholics any one with a marginal diet Poor, elderly, eating disorders, drug addicts… Toxicity None reported Excess excretedNiacin: Niacin Functions Plays an essential role in energy metabolism Part of NAD Needed by every cell of the body Niacin: 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 Niacin: 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 Niacin: 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 Niacin: 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 cholesterolNiacin: 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 damageFolic 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 pregnancyFolate: 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 drinkFolate: 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 B12Folate: Folate Recommended intake: 400 micrograms/day Folate: 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 Folate: 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 341Folate: 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 defectsFolate: Folate Toxicity No known symptoms May mask a vitamin B12 deficiency B12 deficiency is VERY seriousVitamin B12: 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 B12: Vitamin B12 Functions: Needed to activate folate Therefore, needed for DNA and new cell (RBC) synthesis Helps maintain myelin sheath around nerve cellsVitamin B12: 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 B12: Vitamin B12 Deficiency: Pernicious anemia (VERY SERIOUS) Megaloblastic anemia Nerve damage creeping paralysis Smooth sore tongue FatigueVitamin B12: Vitamin B12 Pernicious anemia frequently goes undiagnosed Pernicious anemia can be masked by high intakes of folate Vitamin B12: Vitamin B12 Gastric by-pass patients and vegans are at elevated risk Takes several years to develop Toxicity: None reportedB6: 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 B6: 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 fruitsB6: B6 Deficiency: (rare) Anemia Weakness and fatigue Depression, confusion Abnormal brain waves, convulsions Greasy dermatitis B6: 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 B6: 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, restlessnessB6: B6 B6 does not help with: Carpal tunnel syndrome PMS Supplementation above the UL is NOT recommendedBiotin: Biotin Functions: Need for energy metabolism Need to make glycogen Plays a role in fatty acid and amino acid synthesis Biotin: 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 processingBiotin: Biotin Deficiency: RARE Skin rash Hair loss Depression Hallucinations Numbness in legs/armsBiotin: Biotin Deficiency can be induced by eating LARGE quantities of raw egg whites 2 dozen daily for ~2 months! Prevents biotin absorption Toxicity: none reportedPantothenic 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 Acid: Pantothenic Acid Recommended intake: 5 mg/day (AI) Food Sources: Widespread in foodsPantothenic Acid: Pantothenic Acid Deficiency: Rare Fatigue GI distress Insomnia, depression Apathy, irritable Increased sensitivity to insulinPantothenic Acid: Pantothenic Acid Toxicity: none knownVitamin 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 productionVitamin C: Vitamin C Functions: Need for thyroxine production Regulates body temperature and metabolic rate Enhances iron absorption Need to make hemoglobinVitamin C: 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/dayVitamin C: Vitamin C Food sources*: Citrus fruits Strawberries, melon Vegetables Tomatoes, dark green leafy vegetables, potatoes, broccoli… *Heat and oxygen sensitiveVitamin C: 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 C: 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 C: Vitamin C Toxicity Symptoms: Diarrhea Cramps, nausea Headaches, insomnia May interfere with lab tests and meds Increased risk kidney stones Over-absorption of ironFat Soluble Vitamins: Fat Soluble Vitamins A D E KVitamin 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 A: 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 A: 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 A: 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-caroteneVitamin A: Vitamin A Food Sources Vitamin A: All animal sources In fatty portion of the food Dairy products Eggs Meat, liver Fortified skim milk and margarineBeta-Carotene: 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 A: 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 A: Vitamin A Deficiency: Keratinization dry, cracked skin Reduced secretions GI tract Bladder Lungs Above symptoms increase risk of infection Vitamin A: Vitamin A Deficiency: Anemia Slow bone growth Painful joints Cracked, cracked teeth Delayed sexual maturity For others see pages 374Vitamin A: Vitamin A Toxicity: Teratogenic “monster producing” GI distress, weight loss Bone issues Joint pain Stunted bone growth and moreVitamin A: Vitamin A Toxicity: Headaches, pressure inside skull Blurred vision Fatigue, muscle weakness Skin rashes Dry, cracked, bleeding lips Dry, brittle hair Vitamin A: 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 D: Vitamin D Functions: Bone mineralization Works with other nutrients Vitamins A, C. K Several mineralsVitamin D: 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 mineralizationVitamin D: Vitamin D Other Functions: Acts as a hormone Not fully understood Many target organs: Brain and CNS Muscle Reproductive cells…Vitamin D: Vitamin D Recommended intake: Depends upon sun exposure and skin color 5-10 micrograms/day (AI) UL: 50 mcg/dayVitamin D: Vitamin D Food sources*: Fortified milk and margarine Butter Egg yolks Liver Fatty fish and fish oils * animal sourcesVitamin D: Vitamin D Deficiency: Bone abnormalities Kids rickets Adults osteomalciaVitamin D: 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 VegansVitamin D: 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 bioactivityVitamin E: Vitamin E Functions: Antioxidant Component of animal cell membranes Protects unsaturated fatty acids in cell membranes Other roles are not clearly defined, but likely existVitamin E: 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 E: Vitamin E Food sources*: Vegetable oils Nuts and seeds Whole grains Green leafy vegetables Liver Wheat germ Egg yolks *easily destroyed by heat and oxygenVitamin E: 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 absorptionVitamin E: 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 E: Vitamin E Vitamin E may help with: Leg cramps Intermittent claudication Fibrocystic breasts disease “lumpy” breastsVitamin E: 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 visionVITAMIN K: VITAMIN K Functions: Need for synthesis of blood clotting proteins Plays a role in regulation of calcium levelsVitamin K: Vitamin K Recommended intake: 90-120 mcg/day Sources: Made by GI tract bacteria Dark green leafy vegetables, cabbage family Liver Milk Vitamin K: Vitamin K Deficiency: rare Symptoms: Bleeding, hemorrhaging Bone weakness Populations at risk Babies After long-term antibiotic treatment CF Vitamin K: 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 You do not have the permission to view this presentation. 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