VITAMINS

Dr. Rene Manalo

VITAMINS

Are heterogenous organic molecules essential in small quantities for

healthy nutrition in man
They used to be termed vitamines because they thought these were
derived from amino acids. The e was dropped when they found out
that they dont contain amino acids.

The main difference in addition to its solubility in fats, is the

tendency to accumulate as opposed to water soluble vitamins
which are easily excreted out.
There is some degree of overtoxicity with fat soluble vitamins,
no overdosage for water-soluble.
Your body will take what it is needed and what is not needed is
excreted and it results to yellow urine

FAT SOLUBLE vs. WATER-SOLUBLE

FAT SOLUBLE VITAMINS
fat soluble vitamins are A,D,E,K
WATER SOLUBLE VITAMINS
Vitamins C, D, and your B complexes.
VITAMIN A

Generic name for compounds that exhibit biological properties of

Retinol
Retinol comes mainly in the form of carotene which is a
provitamin, an inactive vitamin in stored form, and there is
beta-carotene, the main active form.
CAROTENE (PROVITAMIN A)- purified plant source
BETA CAROTENE- most active
- yellow & green fruits & vegetables
In foods where you find cholesterol, you find vitamin A.
the only consolation in cholesterol is there is vitamin A from it. Most
vitamins from fat and water soluble are derived from the same
sources.
beta-carotene is the chief type of carotene used in vitamin A.

MAJOR DIETARY SOURCES: liver, butter, cheese, whole milk, egg yolk &
fish

VITAMIN A structure


the structural formula for retinol is something associated to the structure of
prostaglandins, so retinol is the primary alcohol type of vitamin A.

VITAMIN A

FUNCTIONS:

Plays an essential role in the functions of the retina. (thats why

the main manifestation in its deficiency is the problems related
to the vision, especially in dim light- NIGHT BLINDNESS)
Growth & differentiation of epithelial tissues - mucous
Bone, reproduction & embryonic development.

FORMS:
Retinal aldehyde form, functional vitamin in vision and maintenance of the
retina
Retinol alcohol form, responsible for actions in reproductive processes
Retinoic acid active form associated with growth, differentiation and
transformation
Retinoic acid is also an agent that you can use for dermatologic reasons,
maybe because if you want to have a complexion of a movie star, you can
eliminate wrinkles by application of retinoic acid continuously for two years,
because it tends to preserve and optimize the basal epithelium.
RETINOL

Its adequate supply is responsible for the functional and structural

integrity of epithelial cells

Plays a major role in the induction and control of epithelial

differentiation in mucus-secreting or keratinizing tissues

Basal epithelial cells are stimulated to produce mucus

In excess, leads to production of thick layer of mucin, inhibition of

keratinization and display of goblet cells

Absence leads to disappearance of goblet mucous cells, atrophy of

epithelium, and proliferation of basal cells, drying and keratinizing effects
--- Stratified, Keratinizing Epithelium
THE VISUAL CYCLE
More potent function of vitamin A is in vision
RHODOPSIN
BATHORHODOPSIN
LUMIRHODOPSIN

METARHODOPSIN I
METARHODOPSIN II
II- CIS RETINAL

ALL-TRANS-RETINAL + OPSIN

II- CIS RETINOL

ALL TRANS-RETINOL

the aldehyde form of vitamin A which is participating in vision, especially night

vision, the aldehyde form in its 11-cis configuration combines with the protein opsin
to form what is known as the visual purple, that's rhodopsin. 11-cis-retinal is the
preferred configuration for the visual purple. 11-cis retinal plus the protein opsin
gives the visual purple known as rhodopsin. Rhodopsin once subjected to light
becomes very unstable, there is the tendency of opsin to immediately dissociate
upon introduction of a photon of light. Light destabilizes rhodopsin and you have
first bathorodopsin that is already in the form that tends to dissociate 11-cis-retinal
from opsin. Bathorodopsin dissociates to lumirhodopsin, lumirhodopsinn to
metarhodopsin I and then metarhodopsin II. These steps in the destabilization of
rhodopsin stimulate a protein known as transducin which sensitizes the optic nerve.
It is the protein transducin that is stimulated by this cascade of destablizing effect
of bathorhodopsin to stimulate transducin which in turn stimulates the optic nerve.
And it is at this point that vision becomes possible.
So, metarhodopsin eventually dissociates into 11-trans retinal + opsin, and you will
see here the different reactions leading to the eventual derivation of cis-retinal. Ang
importante pa rin is to derive 11-cis-retinal for it to be conjugated with opsin,
because if you don't get the 11-cis retinal configuration, then it is very impossible
for you to join it with the opsin of the protein. It is in this form that you should get
back rhodopsin. So rhodopsin is the visual purple, upon introduction of light, it is the
destabilized. In the cascade of events, rhodopsin eventually is broken to 11-cisretinal thereby the stimulation of transducin which bring about vision
SIGNS & SYMPTOMS OF VITAMIN A DEFICIENCY

EYES- Nyctalopia & Keratomalacia (dessication, ulceration and xerosis

of the cornea and conjunctiva)
nyctalopia or night blindness, difficulty of vision in dim light
keratomalacia refers to the drying effect and ulceration of the
cornea and the conjunctiva

BRONCHORESP.- decreased mucus function, keratinization, increased

incidence of resp infections
There is decreased mucus function so you expect them to have
dry hacking cough, not a productive cough, opposite effect,
decreased respiration due to increased mucus production

SKIN- keratinization and drying of epidermis

GENITOURINARY- urinary calculi

formation of stones mainly because of the crystallization of urine
that is retained in the urinary system and

SWEAT GLAND- atrophy, keratinizing squamous-cell metaplasia

There is atrophy and keratinization of the mucous membranes.

HYPERVITAMINOSIS A

Drying of skin, skin desquamation, erythematous dermatitis, fissures

of lips,

pain & tenderness of bony prominences, headaches (peculiar

presentation in hypervitaminosis)
VITAMIN K
Since this agent participates in coagulation, they used Koagulation in German
and vitamin c is discovered earlier than vit k
Vitamin K is the active agent for activation of several factors
required for coagulation, not for synthesis but activation. This
agent, II, VII, IX, X are already present in the system, in the liver.
The only difference is that they need to be activated, and the
function of vitamin K is to activate these four coagulation factors.
The factors are activated by this residue, gamma carboxyglutamic
acid. The function of vitamin K is to cause the incorporation of II, VII,
IX, X for it to be possible to affix the gamma carboxyglutamic acid.
The addition of this gamma, you have now the activation of II, VII, IX, X.
*hydroxylation
II prothrombin
VII - proconvertin
IX - Christmas/PTC
X - Stuart - bridge between extrinsic and intrinsic pathway.
Dietary principle essential for normal biosynthesis of several factors required
for clotting of blood

an essential cofactor for a microsomal enzyme system for the

activation of the Vit. K-dependent factors by incorporation of GAMMACARBOXYGLUTAMIC ACID residues

Dam gave the name Vitamin K (Koagulation vitamin)

FORMS: IMPORTANT!!!

VITAMIN K1- PHYTONADIONE (Phylloquinone)

Found in plants ( in the chloroplast)
Only natural vitamin K available for therapeutic use

VITAMIN K2- MENAQUINONE

Synthesized by gram-positive bacteria

VITAMINE K3- MENADIONE

As active on a molar basis as phytonadione
synthetically derived
In clinics, it is vitamin K3 and K1 that is widely utilized because they are easy to
control.
COAGULANTS

use in some patients wherein there are problems with clotting

Sometimes we use intravenous and parenteral preparation like
heparin synthesized by the mast cells of the liver and heparin is
an anticoagulant normally reversed by protamine sulfate.
There is also an anticoagulant wherein the patient is shifted in
tablet form and we call this Warfarin. warfarin is an

anticoagulant is normally inhibited by vitamin K, that's why if we

give the patient warfarin or coumadin, we should have vitamin
K at hand always. Coumadin/Warfarin blocks Vitamin K
dependent factors.
How do you check coagulation factors? Bleeding or clotting
time? What? It's clotting time. You check clotting time to
check the integrity of the coagulation cascade, bleeding
time for platelet function. If the bleeding time is prolonged,
there is a problem in the number of platelets/function. If your
clotting time is prolonged, in the coagulation cascade, whether
intrinsic/extrinsic or both. Now, when you are using a particular
drug which is warfarin, this blocks the vitamin K dependent
factors, that's why the antidote of Warfarin is vitamin K. Warfarin
is a medication that you sometimes use at home for the use of
poisoning from some visitors. ( RATS)
Warfarin stands for winscosin alumni research foundation
In patient who is bleeding or with liver disease the coagulation
system is at fold.
Vitamin K is important factor to see especially its range because
the liver has difficulty in synthesizing the vitamin k dependent
coagulation factor.

MAJOR DIETARY SOURCES: green leafy vegetables, cabbage, liver

Present in hog liver fat, alfalfa, chloroplasts of plant leaves and in

many vegetable

If you are using Coumadin or warfarin you are advise to avoid eating
vegetables which are high in Vitamin k.
VITAMIN K structure

FUNCTION: (not?)HEPATIC BIOSYNTHESIS but for HEPATIC ACTIVATION

(main function) OF:
Factor II- PROTHROMBIN
Factor VII- PROCONVERTIN
Factor IX- PTC, CHRISTMAS FACTOR
Factor X- STUART

SYMPTOMS OF DEFICIENCY:

Increased tendency to bleed

Ecchymoses

Epistaxis

Hematuria
Gastrointestinal bleed
Post-operative hemorrhage
Intracranial Hemorrhage
Hemoptysis (uncommon)
Intracranial hemorrhage and hemoptysis are the threatened
symptoms.

VITAMIN E

Alpha-tocopherol, similar with the chemistry and function of coenzyme

Q10

Antisterility Vitamin in lower vertebrae not for humans

MAJOR DIETARY SOURCES:

Wheat germ, nuts, legumes, green leafy vegetables, veg,oils

VITAMIN E structure

The only difference in structure with the coenzyme q10 is that the coenzyme q10
has isoprenoid tail but both are similar in antioxidant function.
FUNCTIONS:

Antioxidant
Prevents oxidation of essential cellular constituents i.e. ubiquinone
(Coenzyme Q)

Prevents the formation of toxic oxidation products

Has striking structural similarity to Coenzyme Q

Antisterility vitamin in lower vertebrae

Little evidence of nutritional significance in man

If you want to reduce the effect of cholesterol which is high, vit e is a good
agent to use. It was studied before that youre cholesterol level will not settle
down unless your vit e has highly concentration.
Intake of LDL which becomes foam cells will only happen when LDL is
oxidized, so when youre vit e is high ( taking 400 units of vit.e/ day) you are
protective in atherosclerosis becauase LDL will not be oxidized. Vitamin E
prevents oxidation, protects from toxic oxidation products

*Intestinal absorption of Vitamin A is enhanced by Vitamin E

Prostaglandin synthesis causes free radicals formation which

are unstable atoms

Stealing process to stabilize itself thus robbing the stable ones that
causes tissue destruction.

SYMPTOMS OF DEFICIENCY (in lower vertebrae and in animals)

NERVOUS SYSTEM- axonal degeneration (implicated in Alzheimers)

REPRODUCTIVE SYSTEM- degeneration of germinal epithelium

MUSCULAR SYSTEM- muscular dystrophy ( possible in man because

this is the theory in ERBS DUCHENNE MUSCULAR DYSTROPHY )

HEMATOPOIETIC SYSTEM- disturbed hematopoiesis

VITAMIN D

Cholecalciferol
Great significance in man
Considered as hormone and is already preformed in the body
Plays a major role in the precise control of the concentration of calcium
ion in plasma
Synthesized in the skin by the stimulating effect of ultraviolet
radiations then transported by blood to distant sites in the body, where it is
activated to affect target tissues.\

Present in our body (skin) as 7 DEHYDROCHOLESTEROL upon exposure to

uv radiation it is converted vit D3 ( cholecalciferol in the blood) then
transported to the liver for the initial hydroxylation process. Cholecalciferol
is hydroxylated to 25 dihydrocholecalciferol (calcifediol) in the liver.
Then transported to liver where it undergoes second hydroxylation process.
In renal mitochondria with the participation of molecular oxygen and
NADPH it is hydroxylated to 1, 25 dihydrocholecalciferol (calcitriol).
MAJOR DIETARY SOURCES: Cod-liver oil, eggs, dairy products, fortified milk and
margarine

Functions to promote growth and mineralization of bones, Increases

absorption of calcium and phosphorous in small intestines

DEFICIENCY: Rickets (children)

Osteomalacia (adults)
VITAMIN D structure

Carbon 18 and 19 broken from Cyclopenthano perhydro penanthrene ring

(ISRAEL!!!).Cholesterol is not entirely bad, it should not be in excess.
FUNCTION:

Positive regulator in calcium and phosphate homeostasis

Facilitates absorption of Ca & PO4 in the small intestine

Enhance their mobilization from the bone

Decrease their excretion by the kidneys

***the bottom line is tries to maintain the serum calcium level at normal level
CALCIUM DEFICIENCY- muscle cramps, when you have decrease calcium, muscle is
hyperpolarized and easy to cause muscle contraction because calcium is the
relaxing factor so there is no relaxation what,you have is heightened tetanic
contraction which you feel as muscle cramps.
TREATMENT: take calcium tablet for 3 to 5 days
LATE SIGNS OF HYPOCALCEMIA
Chvostek sign- try to tap the facial nerve and you can have tetanic
contractions in ipsilateral side of the face
Trosseau sign- you stimulate this when you get the blood pressure cuff and
put it midway in the pulse pressure and you have carpal spasm
Main d accocheur- you have carpal spasm without any trigger it can be
elicited by letting your patient hyperventilate. (Also known as HYSTERIA)
You can see this sign in parathyroid problems.
VITAMINS & VITAMIN-LIKE NUTRIENTS
WATER-SOLUBLE VITAMINS
THIAMINE (B1)
Precursor of co-enzyme THIAMINE PYROPHOSPHATE ( krebs cycle)
Helps the body to convert food into energy and aids in the function
in the heart, brain and nervous system.

DEFICIENCY: BERI-BERI- a form of cardiovascular disease that

is manifested as anasarca, hypotension, pronounce

vasodilatation that is massive because you lose the integrity

of the vessels when you have this disease.
Sometimes termed as WET BERI BERI because of the
CONGESTIVE HEART FAILURE

RIBOFLAVIN (B2)
Precursor of FMN & FAD ( respiratory chain and krebs cycle)

DEFICIENCY: may lead to growth retardation

NICOTINIC ACID/ NIACIN (B3)

Precursor of NAD( glycolysis), NADP (HMP shunt)
Only agent pharmacologically available that can lower down your
both cholesterol and triglycerides at the same time but its side effect
is pruritus and burning sensation in the entire body.
To escape with the side effect take aspirin 30mins before getting
nicotinic acid.
If triglycerides are high, this is the risk factor for acute hemorrhagic
pancreatitis. ( BANGUNGOT- the only Filipino termed included in
HARRISONS book. :- )
Start treating triglycerides when it exceed to 200mg/dl, when it is
400mg/dl it is in danger zone
Statins HmG CoA reductase inhibitors
The number one treatment for increased triglycerides is increase
activity
Fibrates are the pharmacological treatment for increase triglycerides.

Deficiency: leads to PELLAGRA

PANTOTHENIC ACID (B5)

Precursor or Coenzyme A

Deficiency: Dermatitis in chicken

BIOTIN (B7)
Precursor of enzyme BIOCYTIN

Deficiency: Dermatitis in MAN

PYRIDOXINE (B6)
Precursor of Coenzyme PYRIDOXAL PO4

Deficiency: DERMATITIS

FOLIC ACID (B9)

Precursor of Co-enzyme TETRAHYDROFOLIC ACID

Deficiency: ANEMIAS ( megaloblastic anemia)

CYANOCOBALAMIN (B12) ( extrinsic factor )

Precursor of Co-enzyme DEOXYADENOSYL COBALAMIN ( important in
rbc formation )
Absorbed in terminal ileum

Deficiency leads to PERNICIOUS ANEMIA

WATER-SOLUBLE VITAMINS
ASCORBIC ACID (Vitamin C)
Co-substrate in HYDROXYLATION of PROLINE in COLLAGEN
Good agent that protects you from viral infection ( influenza )
Hasten the injury to rapidly resolved
Epistaxis- one way to strengthen the blood vessels is to take ascorbic
acid
Cataracts- the first enzyme that will convert water into sorbitol is
blocked by ascorbic acid
One factor that may protect you from developing cancer.

Deficiency leads to SCURVY

- bleeding in gums lips and nose
because of the loss of integrity in the blood vessels, cataracts

Cell membrane in the cell has phospholipids.

Inosistol and Choline same functions
PGI2 (prostacyclin)
TXA (thromboxane) causes ATP to decrease thus CAMP decrease causing
platelet aggregation
Low dose asoirin for ischemic heart disease
French Triad allergy to aspirin, sinusitis and asthma
NSAIDS block COX, directs pathway to lipooxigenase pathway
Tartrazine FD&C 5 and 6 blocks CO pathway found in food coloring
Fatty acids subjected to beta oxidation to produce ATP
Alpha lipoic acid antioxidant, prevents neuropathies?
The phospholipids are phosphatidylcholine, phosphatidylinositol,
phosphatidylserine and phosphatidylethanolamine
In almost all pathologic and physiologic processs you have oxidation of the
four for the formation of arachidonic acid.

 Phospholipase A2/C
Arachidonic acids will give prostaglandin with 2 subtrates. If It has

prostaglandin with 1 substrate it is linoleic acid.

With 3 substrates- EICOSAPENTHAENOIC ACID- seen in fish oil
The enzyme is phospholipase c
In every peristaltic contraction this happens- phospholipase will remove the

arachidonic in phosphatidyl.
Arachidonic has 2 competing system ( lipooxygenase and cyclooxygenase)
This will lead to formation of radicals.
Leukotriene a, b, e and f are collectively known as SRSA (slow reacting

substances of anaphylaxis) LT DEF

PGA PGB PGC PGD PGD-PGE PGI2 PGF2 ALPHA, TXA2, PGG2, PGH2,PGA2
If you are asthmatic probably you have high levels of pgf2 alpha- causes

bronchospasm/bronchoconstriction treatment is pge

Pgf is also the prostaglandin that causes contraction during parturition.
Pge will produce pain- mefenamic acid to block cyclooxygenase to block

formation of pge
Thre are very strong reciprocal between the pgi and the thromboxane.
Pgi will cause increase in atp, cylic amp,vasodilatation, platelet dispersion.
Thromboxane- not causes atp to increase.
Aspirin is given to inhibit the effect of thromboxane in patient with ischemia
in low dose.
Asthmatic- be sure you are not allergic to aspirin.
Benzane will block cyclooxygenase and the pathway will go to lipooxygenase
pathway which more potent to bronchoconstriction that will lead to
respiratory arrest.
Carnitine will promote the movement of fatty acid to mitochondria then
converted to enery via omega and beta oxidation.

VITAMINS FOR SPIRITUAL BODY

VITAMIN A-ttendance in church service, & offering ourselves to the

LORD.

VITAMIN B-ible study, we need this daily to gain more knowledge

about GOD.

VITAMIN C-hristian service, showing our Love & kindness to everyone

VITAMIN D-aily prayer, dont forget to communicate with GOD.