Chap 7

V. Chan, MS, RD

Classification & definitions of Vitamins

Essential, noncaloric, organic Role: help make other body processes occur to digest, absorb, metabolize nutrients, also help build body structures Precursors/ Previtamins: compounds converted into active vitamins
(Ex) Beta Carotene & Vitamin A

2 types of Vitamins

Classification of Vitamins
Fat Soluble
Absorbed into the lymph Travel in the blood with protein carriers Can be stored in the liver or fatty tissues

Water Soluble
Absorbed into the blood stream Travel freely in the blood system Excess excreted in urine

Fat Soluble Vitamins

Sources: fats & oils of foods Absorption: bile Storage: liver & fatty tissues until the body needs them
Body can survive weeks w/o consuming Beware of toxicity
Excesses of Vit A & D from supplements and highly fortified foods

Possible deficiency
Fat malabsorption (Ex: liver disease) Mineral oil (used as a laxative) Extremely low fat diets

Vitamin A
Precursor 3 forms of Vitamin A
Retinol: (active form) stored in specialized liver cells Retinal: (converted from Retinol), function in vision Retinoic Acid: (converted from Retinol) function in growth & embryonic development

Food Sources
Liver, fish oil, fortified foods, eggs, carrots, apricots, pumpkin, sweet potatoes, etc

Vitamin A Role: Protein Synthesis & Cell Differentiation

Synthesize protein through gene regulation
Retinoic acid activate protein production

Cell differentiation allows immature cells cells to mature & perform specific functions
(Ex) Epithelial cells
Epithelial tissues on the outside of the body form the skin Epithelial tissues on the inside of the body form the mucous membranes

Vitamin A Role: Reproduction & Growth

Sperm development in men Normal fetal development in women Growth in children
Remolding Bone Process:
Osteoclasts are cells that destroy bone growth Osteoblasts are cells that build bones Lysosomes are sacs of degradative enzymes that destroy bones

Failure to grow is one of the 1st signs of poor vitamin A intake

Vitamin A Role: Immune Function

Keeps the immune system strong against infections Maintains mucosal surfaces Deficiencies are associated with impaired immunity & increased risk of infections diseases

Vitamin A Role: Vision

Help to maintain the cornea
Hard transparent membrane covering the outside of the eye

Light perception
Conversion of light energy into nerve impulses at the retina

Rhodopsin
Light-sensitive pigment of the retina that contains a protein called opsin

Vitamin A Deficiencies
Infectious Diseases
Impaired immunity correlates with vitamin A deficiency in children.
The goals of worldwide health organizations include vitamin A supplementation

Night Blindness
First detectable sign of vitamin A deficiency Inability to see in dim light or inability to recover sight after a flash of bright light Prolonged deficiency can lead to chronic dry eye (xerosis) & build up of keratin debris in the corners of the eyes (kerantinization) Which can lead to retinal corneal damage and lead to permanent blindness (xerophthalmia)

Vitamin A Deficiencies
Blindness
Xerophthalmia is blindness due to vitamin A deficiency Xerosis is the first stage where the cornea becomes dry and hard Keratomalacia is the softening of the cornea

Keratinization
Epithelial cells secrete a protein called keratinthe hard, inflexible protein of hair and nails Changes in epithelial cells results in keratinization, rough, dry and scaly skin

Vitamin A Toxicity
Can occur with large amounts from fortified foods and/ or supplements Consuming excessive amounts of beta carotene from supplements can also be harmful Bone Defects
Increased activity of osteoclasts causes weakened bones and contributes to osteoporosis and fractures

Vitamin A DRI
Vitamin A recommendations is based on body weight Men need average of 900 micrograms/ day Women need average of 700 micrograms/ day
During lactation, needs will increase Children needs decrease

Regular balanced diet should supply more than adequate amounts

With fruits & vegetables

Beta Carotene
Precursor form of Vitamin A
Type of carotenoid (pigment)

Plant-based foods
Dark leafy greens, orange and yellow fruits/ vegetables

Macular degeneration
Common progressive loss of function in the retina Leads to blindness

Dietary antioxidant
Help to reverse effects on oxidation in tissues

Measuring beta-carotene
Retinol activity equivalents (RAE) 12 micrograms beta carotene= 1 microgram retinol IU (international units)

Too Much Beta Carotene.

Toxicity
Can occur when beta carotene cannot be converted to retinol

Vitamin D
AKA Calciferol, Calcitrol, Cholecalciferol (D3), Ergocalciferol (D2) Nonessential, acts like a hormone in the body Bone regulation Sunlight The plant version: ergocalciferol (D2) The animal version: cholecalciferol (D3)

 Once the vitamin enters the body it must become activated

By the liver & kidneys

Vitamin D Role: Bone Growth

Help maintain blood levels of calcium and phosphorus Work in combination with other nutrients and hormones
Vitamin A, vitamin C, vitamin K Parathormone and calcitonin Collagen Calcium, phosphorus, magnesium, and fluoride

More of Vitamin D Roles

Immune System
Regulate immune system & cells May help to prevent cancer

Brain & nervous system development

Vitamin D Deficiency Factors

Contributing factors to deficiencies
Dark skin Breastfeeding without supplementation Lack of sunlight Use of nonfortified milk

Vitamin D Deficiency: Rickets

Children: bowed legs
Inadequate calcification of bones Growth retardation Misshapen bones including bowing of the legs Enlargement of the ends of long bones Deformities of ribs

Adults: Osteomalacia
Bones become soft, flexible, brittle & deformed Easily missed in elderly, often mistaken for arthritis Can further lead to osteoporosis

Vitamin D From The Sun

Ultraviolet (UV) B light rays
Converted into a vitamin D precursor (7dehyrocholesterol) Directly absorbed in the blood

Over the next 2 days, the liver & kidneys convert the precursor to the active form of vitamin D (calcitriol)
Sunlight does not cause Vitamin D toxicity
Sun can break down excess vitamin D made in the skin

Over sun exposure causes premature skin wrinkles & skin cancers SPF over 8 prevents vitamin D synthesis

Vitamin D DRI
Infants, children, adolescent- 400 IU daily
Teens who drink soda instead of milk & live a sedentary lifestyle (indoors) fail to develop bone density needed later in life

Adults 19- 50: 5 micrograms daily Adults 51- 70: 10 micrograms daily Adults over 70: 15 micrograms daily DRI UL: 50 micrograms daily
Or 2,000 on supplement labels

Vitamin D Food Sources

Cod liver oil Salmon Mackerel Sardines Fortified milk, soy milk, butter, margarine Fortified cereals Egg Liver Vegans may need supplementation if they do not get enough sun exposure

Vitamin E (Tocopherol)
4 different tocopherol compounds
alpha-tocopherol is the active form in humans

Deficiencies
Rarely occur in healthy people May occur in those who have fat malabsorption or in premature infants
In premature infants, red blood cells rupture (erythrocyte hemolysis), thus becoming anemic

May occur in those with liver or pancreas disease Symptoms in adults include loss of muscle coordination & reflexes and impaired vision & speech

Toxicities
Rare & least toxic of the fat soluble vitamins

Vitamin E (Tocopherol) Role

Antioxidant
Stops the chain reaction of free radicals
Free radicals can cause inflammation which may lead to cancers, heart disease & other diseases

Protection of polyunsaturated fatty acids and vitamin A Protects the oxidation of LDLs

Vitamin E (Tocopherol)
DRI Vitamin E
Adults: 15 micrograms daily Adults UL: 1000 micrograms daily

Food Sources
Vegetable oils
And products made from them (margarine, salad dressings, etc)

Wheat germ oil

Whole grain products Animal fat have little to none

Leafy green vegetables Liver & eggs Nuts & seeds Easily destroyed by heat & O2

Vitamin K
Unique in that of human needs are from our intestinal bacteria Essential in blood clotting Bone protein synthesis that regulate blood calcium
Can lead to low bone mineral density without Vitamin K

Deficiency can cause uncontrolled bleeding Deficiencies can occur in newborn infants and people taking antibiotics Warfarin is used to thin blood (by preventing blood clots)
Rx for irregular heartbeats, those suffered from heart attacks, those with prosthetic heart values, thrombosis, pulmonary embolism

Vitamin K Deficiencies
Cause hemorrhages (profuse bleeding from ruptured blood vessels) Secondary deficiencies may occur with use of antibiotics Newborn infants receive a single dose of vitamin K at birth because of a sterile intestinal tract
Takes weeks to establish vitamin K producing bacteria

Vitamin K Toxicity
Rare Infants & pregnant women may experience toxicity from over intake of Vitamin K supplements Jaundice
Increase of red blood cells breakdown Bilirubin, byproduct of old red blood cells Jaundice can also occur due to liver damage

Vitamin K DRI
Men: 120 micrograms daily Women: 90 micrograms daily Vitamin K Sources
Bacterial synthesis in the digestive tract Significant Food Sources
Leafy green vegetables & cabbage type vegetables
Kale, spinach

Soybeans Canola oil Liver Fortified foods

Water Soluble Vitamins

Storage: None Toxicities: possible with supplement use Types:
Vitamin C B Vitamins
Thiamin Riboflavin Niacin Folate -B6 -B12 (cyanocobalamin) -Biotin -Pantothenic Acid

Vitamin C
As an antioxidant
Defends against free radicals Protects tissues from oxidative stress

As a cofactor in collagen formation

Collagen is used for bones and teeth, scar tissue, and artery walls Works with iron to form hydroxiproline which is needed in collagen formation

As a Cofactor in Other Reactions

Converts tryptophan to neurotransmitters Makes hormones

Vitamin C
Needs increase during body stress
(Ex): infections, burns, smoking

Cure for common cold

Provides some relief of symptoms Deactivates histamine (antihistamine)

Disease prevention is still being researched

As a Cure for the Common Cold

Vitamin C Deficiency
Scurvy
Breakdown of collagen Loss of appetite Bleeding gums & loosen teeth Bone fragility & joint pain Poor wound healing & frequent infections Rough skin & blotchy bruises Anemia

Those at risk:
Smokers Alcoholics Infants who only drink cows milk & receive no vitamin C

Vitamin C Toxicity
Symptoms can include:
Nausea, abdominal cramps, diarrhea, headache, fatigue and insomnia Hot flashes and rashes Interference with medical tests, creating a false positive or a false negative Aggravation of gout symptoms, urinary tract infections, and kidney stones

Vitamin C DRI
Men: 90 mg/ day Women: 75 mg/ day Smokers:+ 35mg/ day Adults UL: 2,000 mg/ day

Vitamin C Food Sources

Citrus fruits, cantaloupe, strawberries, papayas and mangoes Cabbage-type vegetables, dark green vegetables like green peppers and broccoli, lettuce, tomatoes and potatoes Other Relevant Information
Also called ascorbic acid Easily destroyed by heat and oxygen

Vitamin B:
8 types
Function in unison
Coenzymes

Metabolism & cell multiplication

There are deficiencies, toxicities and food sources that are unique for each vitamin

Thiamin (Vitamin B1)

Energy metabolism of all cells Deficiencies
Wernicke-Korsakoff syndrome
Brain damage due to inability to absorb thiamin Common in those with alcohol abuse

Beriberi
Wet beriberi presents with edema, affects cardiovascular system Dry beriberi presents with muscle wasting, affects the nervous system

Thiamin (Vitamin B1)

DRI
Men: 1.2 mg/day Women: 1.1 mg/day

Food Sources
Pork Organ meats Fortified/ enriched food products Whole grains Nuts/ seeds

Easily destroyed by heat

Riboflavin (Vitamin B2)

Energy metabolism of all cells Deficiency symptoms
Inflamed eyelids, sensitivity to light, and reddening of the cornea Sore throat and cracks and redness at the corners of the mouth Painful, smooth and purplish red tongue Skin rashes

Riboflavin (Vitamin B2)

DRI
Men: 1.3 mg/day Women: 1.1 mg/day

Food Sources
Milk products, including yogurt and cheese Enriched/ fortified and whole grains Liver

Destruction of vitamin
UV light Milk Irradiation However, is heat stable (not destroyed by cooking)

Niacin (Vitamin B3)

Involved in the metabolism of glucose, fat & alcohol
Deficiency
Pellagra
Diarrhea Dermatitis
flakey paint Rash occurs in sunlight

Dementia Death

Toxicity
Niacin flush
Physicians may give a large dose of niacin to help improve blood lipids due to CVD When taken in large doses, niacin can dilate the capillaries & may be painful

Niacin (Vitamin B3)

DRI
Precursor: tryptophan (60 mg of tryptophan = 1 mg niacin); therefore niacin intake is measured in niacin equivalents (NE) Men: 16 NE/day Women: 14 NE/day

Food sources
Milk Eggs, meat, poultry and fish Whole-grain & enriched/ fortified breads and cereals Nuts and all protein-containing foods

Resistant to heat

Folate
Involved in the synthesis of DNA and the formation of new cells Require B12 to function properly Deficiencies
Macrocytic anemia Diminished Immunity Abnormal digestive function

Most vulnerable of all the vitamins to interactions with medications

Anticancer drugs Antacids and aspirin

Folate & Birth Defects

Neural tube defects, include spina bifida and anencephaly (baby born w/o a part of brain & skull) Recommended for women of childbearing age eat folate-rich foods and folate-fortified foods and take folate supplements containing 0.4 mg (400 microgram) of folate daily.
Pregnant women should take folate supplements

Folate
Toxicities
Masks vitamin B12 deficiency symptoms

DRI
Adults: 400 micrograms/ day UL: 1,000 micrograms/ day

Food Sources
Beef liver Leafy green vegetables Fortified/ enriched grain products Legumes & seeds

Easily destroyed by heat & O2

Vitamin B12 (Cobalamin)

Closely related to folate Involved in the synthesis of new cells, maintains nerve cells, reforms folate coenzymes and helps break down some fatty acids and amino acids Deficiencies
May be masked by folic acid intake Pernicious anemia

Vitamin B12 absorption

Intrinsic factor, compound aid in absorption

Vitamin B12 (Cobalamin)

DRI
Adults: 2.4 micrograms /day

Food Sources
Meat, fish, poultry, and shellfish Milk, cheese and eggs Fortified/ enriched cereals

Easily destroyed by microwave cooking

Vitamin B6 (Pyridoxin)
The coenzyme forms of vitamin B6 are involved in amino and fatty acid metabolism, the conversion of tryptophan to niacin or serotonin and the production of red blood cells Vitamin B6 Deficiency/ Toxicity
Anemia In adults, affects the peripheral nerves, skin, mucous membranes and the circulator system In children, the central nervous system (CNS) is also affected

Vitamin B6 (Pyridoxin)
DRI
Adults 19-50 years: 1.3 mg/day UL: 100 mg/ day

Food Sources
Meats, fish, poultry and liver Legumes and soy products Non-citrus fruits Fortified/ enriched cereals

Easily destroyed by alcohol

Biotin
As part of a coenzyme used in energy metabolism, biotin assists in glycogen synthesis, fat synthesis, and amino acid metabolism Deficiency
Rare Symptoms
Depression, lethargy, and hallucinations Numb or tingling sensation in the arms and legs Red, scaly rash around the eyes, nose and mouth Hair loss

Biotin can be bound with raw egg-white protein (avidin)

Biotin
DRI
AI: Adults: 30 g/day No UL

Food Sources
Widespread in foods Organ meats, egg yolks and fish Soybeans Whole grains Can also be made by intestinal bacteria

Pantothenic Acid
Involved in energy metabolism as a key enzyme Deficiency
Rare Symptoms
Vomiting, nausea, and stomach cramps Insomnia and fatigue Depression, irritability, restlessness, and apathy Hypoglycemia and increased sensitivity to insulin

Pantothenic Acid
DRI
AI Adults: 5 mg/day No UL

Food Sources
Widespread in foods Organ meats Mushrooms, avocados, and broccoli Whole grains

Can be destroyed by freezing, canning, and refining

Non B- Vitamin: Choline

Conditionally essential nutrient, but not a vitamin Involved in the synthesis of acetylcholine (neurotransmitter in the nervous system) and lecithin Important role in fetal development Deficiency/ Toxicity
Deficiencies are rare Deficiency symptom is liver damage Toxicity Symptoms Body odor and sweating Salivation Reduced growth rate Low blood pressure Liver damage

Non B- Vitamin: Choline

DRI
AI Men: 550 mg/day AI Women: 425 mg/day UL: 3,500 mg/day

Food Sources
Milk Liver Eggs Peanuts

Non B- Vitamins: Inositol, Carnitine & Lipoic Acid

Nonvitamins
Not essential nutrients for humans

Inositol is made from glucose and is part of the cell membrane structure Carnitine is made from lysine and transports long-chain fatty acids to be oxidized Alpha Lipoic acid is used in the body to break down carbohydrates and to make energy for the other organs in the body Be wary of supplements

Summary of B Vitamins
The B Vitamins are interdependent. The presence of one may affect the absorption, metabolism and excretion of another A deficiency of one may affect the functioning or deficiency of another A variety of foods from each food group will provide an adequate supply of all the B vitamins

Summary of B Vitamins
B Vitamin Roles
Coenzymes involved directly or indirectly with energy metabolism Facilitate energy-releasing reactions Build new cells to deliver oxygen and nutrients for energy reactions

Summary of B Vitamins
B Vitamin Deficiencies
Deficiencies rarely occur singly except for beriberi and pellagra Can be primary or secondary causes Tongue inflammation and dry, cracked lips are two symptoms common to B vitamin deficiencies

B vitamin toxicities can occur with supplements

Summary of B Vitamins
B Vitamin Food Sources
Grains group provides thiamin, riboflavin, niacin and folate Fruits and vegetables provide folate Meat group provides thiamin, niacin, vitamin B6 and vitamin B12 Milk group provides riboflavin and vitamin B12

Did You Know That

Vitamins can be destroyed by exposure to light, oxidation, cooking, and storage Methods used to minimize nutrient lose
Refrigerate fruits and vegetables Store cut fruits and vegetables in airtight wrappers or closed containers and refrigerate Clean fruits and vegetables before they are cut Use a microwave, steam, or simmer in small amounts of water Save cooking water for other uses Avoid high temperatures and long cooking times