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The Vitamins. Introduction  Vitamins were discovered at the beginning of the twentieth century.  Vitamin: An essential, noncaloric, organic nutrient.

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Presentation on theme: "The Vitamins. Introduction  Vitamins were discovered at the beginning of the twentieth century.  Vitamin: An essential, noncaloric, organic nutrient."— Presentation transcript:

1 The Vitamins

2 Introduction  Vitamins were discovered at the beginning of the twentieth century.  Vitamin: An essential, noncaloric, organic nutrient needed in tiny amounts in the diet.  The only disease a vitamin can cure is the one caused by a deficiency of that vitamin.

3 Water Soluble Vitamins  Vitamin C  B Vitamins: Thiamin-- Biotin Thiamin-- Biotin Riboflavin-- Pantothenic acid Riboflavin-- Pantothenic acid Niacin Niacin B 6 B 6 Folate (folic acid) Folate (folic acid) B 12 B 12

4 Water Soluble Vitamins  Digestion, Absorption, and Transport No chemical digestion needed No chemical digestion needed Absorbed in the SI into the capillaries Absorbed in the SI into the capillaries Vitamin B 12 must bind with a protein called the intrinsic factor (IF) in the stomach for absorption to occur in the SIVitamin B 12 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 No carriers required for transport in the blood

5 Water Soluble Vitamins  Storage and excretion Travel freely in the blood Travel freely in the blood Cells take up water soluble vitamins as needed Cells take up water soluble vitamins as needed Limited storage beyond tissue saturationLimited storage beyond tissue saturation Excess excreted in the urine Excess excreted in the urine

6 Water Soluble Vitamins  Deficiency is more common than toxicity for the water soluble vitamins Any toxicity is likely to be due to overuse of vitamin supplements, not food intake Any toxicity is likely to be due to overuse of vitamin supplements, not food intake

7 Water Soluble Vitamins  Other interesting information: Many are destroyed by light, heat, or exposure to oxygen Many are destroyed by light, heat, or exposure to oxygen Best to cook whole in a minimum amount of water Best to cook whole in a minimum amount of water Frozen vegetables are often higher in vitamin content than grocery store “fresh” veggies Frozen vegetables are often higher in vitamin content than grocery store “fresh” veggies

8 Classifying Vitamins  Fat Soluble Vitamins A D E K

9 The Fat-Soluble Vitamins  A, D, E, K Found in fats and oils of foods Found in fats and oils of foods Require bile for absorption Require bile for absorption Stored in liver and fatty tissues until needed Stored in liver and fatty tissues until needed Not needed in the diet daily Not needed in the diet daily Can reach toxic levels if too much is consumed Can reach toxic levels if too much is consumed Deficiencies can occur when people eat diets that are extraordinarily low in fat Deficiencies can occur when people eat diets that are extraordinarily low in fat

10 Fat Soluble Vitamins  Digestion, Absorption, and Transport Bile needed to emulsify fat soluble vitamins Bile needed to emulsify fat soluble vitamins Form chylomicrons (along with long chain fatty acids and monoglycerides) Form chylomicrons (along with long chain fatty acids and monoglycerides) Chylomicrons are absorbed into the lacteals Chylomicrons are absorbed into the lacteals Travel through lymph system  blood  liver Travel through lymph system  blood  liver Many require protein carriers to be transported in the blood Many require protein carriers to be transported in the blood

11 Fat Soluble Vitamins  Other interesting facts: Found in the fatty parts of food Found in the fatty parts of food Removed with the fat when low-fat products are made Removed with the fat when low-fat products are made Many low-fat foods are supplemented with these vitamins to make up for thisMany low-fat foods are supplemented with these vitamins to make up for this E.g. milk is vitamin A and D enriched E.g. milk is vitamin A and D enriched

12 The Vitamins  For each vitamin we will consider: Functions Functions Dietary needs and food sources Dietary needs and food sources Deficiency Deficiency Toxicity Toxicity

13  Thiamin, riboflavin, niacin, pantothenic acid, and biotin – participate in the release of energy from the energy nutrients  Folate and vitamin B 12 help cells multiply  Vitamin B 6 helps the body use amino acids to synthesize proteins The B- Vitamins: An Introduction

14 B Vitamin Deficiencies  In a B vitamin deficiency, every cell is affected. Symptoms include Symptoms include NauseaNausea Severe exhaustionSevere exhaustion IrritabilityIrritability DepressionDepression ForgetfulnessForgetfulness Loss of appetite and weightLoss of appetite and weight Impairment of immune responseImpairment of immune response Abnormal heart action Skin problems Swollen red tongue Teary, red eyes Pain in muscles

15 Thiamin HistoryFunctions: 1. Needed for energy metabolism E.g. -- required for conversion of pyruvate to acetyl CoAE.g. -- required for conversion of pyruvate to acetyl CoA 2. Needed for nerve and muscle function

16 Thiamin Recommended Intake mg/day mg/day Food Sources Found in small amounts in many foods Found in small amounts in many foods Easily destroyed by heat (cooking) Easily destroyed by heat (cooking) Lost in cooking water Lost in cooking water Good sources include Good sources include Pork products, soy, legumes, vegetables, whole grains, watermelon…. (page 311)Pork products, soy, legumes, vegetables, whole grains, watermelon…. (page 311)

17 Thiamin Deficiency  Prolonged deficiency leads to beriberi Results in damage to nervous system and muscles (to include the heart) Results in damage to nervous system and muscles (to include the heart)

18 Thiamin Deficiency  Symptoms Beriberi: 1.Dry form- muscle wasting, poor coordination Muscle weakness 2.Legs heavy, hard to walk, calf pain 3.Apathy, confusion, memory loss 4.Anorexia and weight loss 5.Wet form has additional symptoms of: – edema, irregular heart beat, enlarged heart

19 Thiamin Deficiency

20  Populations at risk: Alcoholics Alcoholics See in alcoholics who obtain the majority of their calories from alcoholSee in alcoholics who obtain the majority of their calories from alcohol Alcohol inhibits thiamin absorption and hastens its excretionAlcohol inhibits thiamin absorption and hastens its excretion Cultures that eat primarily refined grains (and little else) Cultures that eat primarily refined grains (and little else) Thiamin deficient moms  infant deaths Thiamin deficient moms  infant deaths

21  In alcoholics thiamin deficiency results in Wernicke-Korsakoff syndrome. Symtpoms Symtpoms Mental confusionMental confusion StaggeringStaggering Rapid eye movements or paralysis of the eye musclesRapid eye movements or paralysis of the eye muscles

22  The City of New York  DEPARTMENT OF HEALTH AND MENTAL HYGIENE  Michael R. BloombergThomas R. Frieden, m.d., m.p.h.  MayorCommissioner  _______________________________________________________________  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:  (212-POISONS) or  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

23 Thiamin  Toxicity None known None known Excess thiamin is excreted and not stored Excess thiamin is excreted and not stored

24 Riboflavin Functions: 1. Needed for the metabolism of carbohydrates, fats, and proteins Places a role in Kreb’s cyclePlaces a role in Kreb’s cycle Part of FADPart of FAD

25 Riboflavin Recommended Intake: 1.1 – 1.3 mg/day 1.1 – 1.3 mg/day Food Sources: Destroyed by ultraviolet light (sun light) Destroyed by ultraviolet light (sun light) Good sources include: Good sources include: Milk and milk productsMilk and milk products LiverLiver Whole grain breads and cereals, oatmealWhole grain breads and cereals, oatmeal Clams and squid!Clams and squid! Mushrooms (page 313)Mushrooms (page 313)

26 Riboflavin Deficiency Symptoms 1. Eyes are inflamed and sensitive to light 2. Cheliosis (cracks at the corners of the mouth) 3. Sore throat 4. Inflammation of the tongue and mouth – painful 5. Inflamed skin, with lesions covered with greasy scales 6. Anemia

27 Riboflavin Deficiency

28 Riboflavin Populations at Risk for Deficiency alcoholics alcoholics any one with a marginal diet any one with a marginal diet Poor, elderly, eating disorders, drug addicts…Poor, elderly, eating disorders, drug addicts…Toxicity None reported None reported Excess excreted Excess excreted

29 Niacin Functions 1. Plays an essential role in energy metabolism Part of NADPart of NAD Needed by every cell of the bodyNeeded by every cell of the body

30 Niacin Recommended Intake: 14 – 16 mg/day of niacin or of NE 14 – 16 mg/day of niacin or of NE NE = Niacin Equivalents NE = Niacin Equivalents Niacin can be made from the essential amino acid tryptophanNiacin can be made from the essential amino acid tryptophan It takes 60 mg of tryptophan to make 1 mg of niacinIt takes 60 mg of tryptophan to make 1 mg of niacin Therefore, 1 NE is 60 mg of tryptophanTherefore, 1 NE is 60 mg of tryptophan

31 Niacin Food Sources: Sources of complete protein Sources of complete protein Dairy, meats, poultry, fish,…Dairy, meats, poultry, fish,… Peanut butter Peanut butter Tomato paste Tomato paste Mushrooms Mushrooms Page 315 Page 315

32 Niacin Deficiency Niacin deficiency disease is called pellagra Symptoms, 4 D’s: 1.Dermatitis with sun exposure 2.Diarrhea, vomiting 3.Dementia 4.Death Other symptoms: 1.Inflamed, swollen, red, smooth tongue 2.Loss of appetite  Page 314

33  Pellagra symptoms: 4 “D’s” Diarrhea Diarrhea Dermatitis Dermatitis Dementia Dementia Death Death Niacin

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

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

36 Niacin Toxicity Symptoms 1. Niacin flush 2. Excessive sweating 3. Tingling 4. GI distress 5. Frequent need to urinate May mask prostrate cancer symptoms in menMay mask prostrate cancer symptoms in men 6. Blurred vision, headaches 7. Liver damage

37 Folic Acid = Folate Functions: 1. Needed for DNA synthesis Need to make all new cellsNeed to make all new cells E.g. Need to make new RBCE.g. Need to make new RBC 2. Reduces incidence of neural tube defects Defects occur in first weeks of pregnancyDefects occur in first weeks of pregnancy

38 Folate 3. Plays a role in protein synthesis 4. Breaks down the amino acid homocysteine –High levels of homocysteine increases risk of blood clot formation 5. May reduce risk some cancers –Pancreatic cancer in men who smoke –Breast cancer in women who drink

39 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 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 B 12 Folate in cells needs to be activated by vitamin B 12 Process also activates the B 12Process also activates the B 12

40 Folate  Recommended intake: 400 micrograms/day 400 micrograms/day

41 Folate  Factors impacting needs Pregnancy -600 mcg/day Pregnancy -600 mcg/day Aspirin, antacids, smoking, oral contraceptives reduce absorption Aspirin, antacids, smoking, oral contraceptives reduce absorption Some cancer drugs reduce absorption Some cancer drugs reduce absorption GI tract damage reduces absorption GI tract damage reduces absorption Occurs with alcoholism, anorexiaOccurs with alcoholism, anorexia Poor absorption, leads to even more damage to GI tractPoor absorption, leads to even more damage to GI tract

42 Folate  Food Sources Cooking destroys up to 50% of folate Cooking destroys up to 50% of folate Oxygen destroys folate Oxygen destroys folate Good sources include: Good sources include: Green leafy vegetablesGreen leafy vegetables LegumesLegumes Fortified cereals and SeedsFortified cereals and Seeds LiverLiver Orange juice (ok, but not great source) pg 323Orange juice (ok, but not great source) pg 323

43 Folate Folate Deficiency  Impairs cell division and protein synthesis  Symptoms: 1.Megaloblastic anemia Fewer red blood cells (RBC) made Fewer red blood cells (RBC) made RBC larger than normal RBC larger than normal RBC do not carry oxygen as well RBC do not carry oxygen as well

44 Folate Deficiency 2. Confusion, irritability, weakness, fatigue Related to the anemiaRelated to the anemia 3. GI tract deterioration 4. Elevated homocysteine levels 5. Smooth red tongue 6. Increased risk neural tube defects

45 Folate  Toxicity No known symptoms No known symptoms May mask a vitamin B 12 deficiency May mask a vitamin B 12 deficiency B 12 deficiency is VERY seriousB 12 deficiency is VERY serious

46 Vitamin B 12  Dorothy Crowfoot Hodgkin Awarded the Nobel prize in chemistry for deducing the structure of vitamin B12 Awarded the Nobel prize in chemistry for deducing the structure of vitamin B12 Took her eight yearsTook her eight years Headline in the London paper announcing this read Headline in the London paper announcing this read “Nobel Prize for British Wife”

47 Vitamin B 12 Functions: Needed to activate folate Needed to activate folate Therefore, needed for DNA and new cell (RBC) synthesisTherefore, needed for DNA and new cell (RBC) synthesis Helps maintain myelin sheath around nerve cells Helps maintain myelin sheath around nerve cells

48 Vitamin B 12 Recommended intake: 2.4 microgams per day 2.4 microgams per day Food Sources*: ONLY found naturally in animal products ONLY found naturally in animal products Meat, poultry, fish, eggs, dairy, liver….pg 326Meat, poultry, fish, eggs, dairy, liver….pg 326 Fortified grains Fortified grains * Easily destroyed by microwave cooking

49 Vitamin B 12 Deficiency: Pernicious anemia (VERY SERIOUS) Pernicious anemia (VERY SERIOUS) Megaloblastic anemiaMegaloblastic anemia Nerve damage  creeping paralysisNerve damage  creeping paralysis Smooth sore tongueSmooth sore tongue FatigueFatigue

50 Vitamin B 12

51  Pernicious anemia frequently goes undiagnosed  Pernicious anemia can be masked by high intakes of folate Generally as supplements Generally as supplements

52 B-12 and Folate  Presence of immature red blood cells - symptom of folate or vitamin B 12 deficiency  Extra folate corrects this blood condition B 12 deficiency continues B 12 deficiency continues  Vitamin B 12 ’s other functions then become compromised

53 Vitamin B 12  Gastric by-pass patients and vegans are at elevated risk Takes several years to develop Takes several years to develop Breast fed infants of vegan mom’s are at elevated risk as well Breast fed infants of vegan mom’s are at elevated risk as well  Toxicity: None reported None reported

54 B6B6B6B6 Functions: Need for protein and fatty acid metabolism Need for protein and fatty acid metabolism Need for amino acid metabolism Need for amino acid metabolism E.g. For converting tryptophan to other niacinE.g. For converting tryptophan to other niacin need to make serotonin form tryptophanneed to make serotonin form tryptophan Helps make RBC Helps make RBC Other functions under study Other functions under study May help reduce nausea in 1 st trimesterMay help reduce nausea in 1 st trimester

55 B6B6B6B6 Recommended Intake: 1.3 mg/day 1.3 mg/day UL: 100 mg/day UL: 100 mg/day Food sources: destroyed by heat Meat, fish, poultry – animal sources are better absorbed Meat, fish, poultry – animal sources are better absorbed Liver Liver Legumes Legumes Seeds and nuts Seeds and nuts Non-citrus fruitspg 318 Non-citrus fruitspg 318

56 B6B6B6B6 Deficiency: (rare) Anemia  Weakness and fatigue Anemia  Weakness and fatigue Depression, confusion Depression, confusion Abnormal brain waves, convulsions Abnormal brain waves, convulsions Greasy dermatitis Greasy dermatitis

57 B6B6B6B6 Increased risk of deficiency: Alcoholics Alcoholics Alcohol contributes to increased B6 breakdown and excretionAlcohol contributes to increased B6 breakdown and excretion Oral contraceptives may increase risk of B6 Oral contraceptives may increase risk of B6deficiency Drug INH inactivates B6 INH used to treat tuberculosis

58 B6B6B6B6 Toxicity: Serious Stored in muscle cells, toxicity seen with supplements Stored in muscle cells, toxicity seen with supplements Symptoms: Symptoms: Irreversible nerve damage  numbness in hands and feet  Difficult to walkIrreversible nerve damage  numbness in hands and feet  Difficult to walk ConvulsionsConvulsions Insomnia, restlessnessInsomnia, restlessness

59 B6B6B6B6  B 6 does not help with: Carpal tunnel syndrome Carpal tunnel syndrome PMS PMS Supplementation above the UL is NOT recommended Supplementation above the UL is NOT recommended

60 Biotin Functions: Need for energy metabolism Need for energy metabolism Need to make glycogen Need to make glycogen Plays a role in fatty acid and amino acid synthesis Plays a role in fatty acid and amino acid synthesis

61 Biotin Recommended Intake: 30 micrograms/day (AI) 30 micrograms/day (AI) Food Sources*: Widespread in foods: liver, egg yolk, legumes, fish, mushrooms, whole grains… Widespread in foods: liver, egg yolk, legumes, fish, mushrooms, whole grains… Some produced by GI tract bacteria Some produced by GI tract bacteria *easily destroyed by processing

62 Biotin Deficiency: RARE RARE Skin rashSkin rash Hair lossHair loss DepressionDepression HallucinationsHallucinations Numbness in legs/armsNumbness in legs/arms

63 Biotin  Deficiency can be induced by eating LARGE quantities of raw egg whites 2 dozen daily for ~2 months! 2 dozen daily for ~2 months! Prevents biotin absorption Prevents biotin absorption  Toxicity: none reported

64 Pantothenic Acid Functions: Need for energy metabolism Need for energy metabolism Part of acetyl CoAPart of acetyl CoA Plays a role in the synthesis of many substances: Plays a role in the synthesis of many substances: LipidsLipids HormonesHormones NeurotransmittersNeurotransmitters HemoglobinHemoglobin

65 Pantothenic Acid Recommended intake: 5 mg/day (AI) 5 mg/day (AI) Food Sources: Widespread in foods Widespread in foods

66 Pantothenic Acid Deficiency: Rare Fatigue Fatigue GI distress GI distress Insomnia, depression Insomnia, depression Apathy, irritable Apathy, irritable Increased sensitivity to insulin Increased sensitivity to insulin Toxicity: none known

67 Vitamin C Functions: Collagen synthesis Collagen synthesis Part of scar tissuePart of scar tissue Strengthens blood vesselsStrengthens blood vessels Provides matrix for bone growthProvides matrix for bone growth Antioxidant Antioxidant Need for healthy immune system Need for healthy immune system

68 Vitamin C Functions: Need for thyroxine production Need for thyroxine production Regulates body temperature and metabolic rateRegulates body temperature and metabolic rate Enhances iron absorption Enhances iron absorption Need to make hemoglobin Need to make hemoglobin

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

70 Vitamin C Food sources*: Citrus fruits Citrus fruits Strawberries, melon Strawberries, melon Vegetables Vegetables Tomatoes, dark green leafy vegetables, potatoes, broccoli…Tomatoes, dark green leafy vegetables, potatoes, broccoli… *Heat and oxygen sensitive Page 329

71 Vitamin C Deficiency:  Scurvy Poor wound healing- Increased infection Poor wound healing- Increased infection Weakness Weakness Bleeding gums Bleeding gums Loose teeth Loose teeth Broken blood vessels Broken blood vessels Loss of appetite Loss of appetite Joint pain and fragile bones Joint pain and fragile bones Anemia Anemia

72 Deficiency Symptoms

73 Vitamin C Populations at increased risk: Alcoholics Alcoholics Elderly Elderly Babies and toddlers fed only milk/cereals Babies and toddlers fed only milk/cereals Smokers Smokers After illness or stress After illness or stress Fever and stress deplete vitamin C storesFever and stress deplete vitamin C stores

74 Vitamin C Toxicity Symptoms: Diarrhea Diarrhea Cramps, nausea Cramps, nausea Headaches, insomnia Headaches, insomnia May interfere with lab tests and meds May interfere with lab tests and meds Increased risk kidney stones Increased risk kidney stones Over-absorption of iron Over-absorption of iron

75 Fat Soluble Vitamins AADDEEKKAADDEEKK

76 Vitamin A Chemical nature: Active forms of vitamin A – preformed vit. A Active forms of vitamin A – preformed vit. A RetinolRetinol Retinoic acidRetinoic acid RetinalRetinal Precursor form – provitamin A Precursor form – provitamin A Beta-caroteneBeta-carotene Converted to active vitamin A as neededConverted to active vitamin A as needed

77  Vitamin A plays a role in Gene expressionGene expression VisionVision Maintenance of body linings and skinMaintenance of body linings and skin Need to build healthy epithelial and mucous tissue Need to build healthy epithelial and mucous tissue Immune defensesImmune defenses Growth of bones and of the bodyGrowth of bones and of the body Normal development of cellsNormal development of cells Plays a role in cell differentiation Plays a role in cell differentiation ReproductionReproduction

78 Vitamin A - Functions  Vitamin A plays two roles in eye sight: Process of light perception at the retina Process of light perception at the retina Maintenance of a healthy cornea Maintenance of a healthy cornea

79 Beta-Carotene Functions beta-carotene; Can be converted to active vitamin A as needed Can be converted to active vitamin A as needed Antioxidant Antioxidant

80 Vitamin A Recommended intake: RAE micrograms/day RAE micrograms/day RAE = retinol activity equivalents RAE = retinol activity equivalents Older unit is IU = International UnitsOlder unit is IU = International Units See page 360 for conversions between these unitsSee page 360 for conversions between these units UL 3000 RAE UL 3000 RAE UL refers to active vitamin A only, not beta- caroteneUL refers to active vitamin A only, not beta- carotene

81 Vitamin A Food Sources Vitamin A (preformed vit. A): All animal sources All animal sources In fatty portion of the foodIn fatty portion of the food Dairy productsDairy products EggsEggs Meat, liverMeat, liver Fortified skim milk and margarineFortified skim milk and margarine

82 Beta-Carotene (pro-vit A) Food Sources: All plant sources All plant sources Yellow/orange/red fruits and vegetables Yellow/orange/red fruits and vegetables Carrots, apricots, cantaloupe, mangos, pumpkin, sweet potato, winter squash, peppers……Carrots, apricots, cantaloupe, mangos, pumpkin, sweet potato, winter squash, peppers…… Dark green leafy vegetables Dark green leafy vegetables Spinach, kale, broccoli, beet greens (but not the beet!)Spinach, kale, broccoli, beet greens (but not the beet!)

83 Vitamin A Deficiency Symptoms – eye sight related Night blindness Night blindness Blindness Blindness Leading cause of blindness worldwideLeading cause of blindness worldwide ~ ½ million children go blind each year due to a vitamin A deficiency~ ½ million children go blind each year due to a vitamin A deficiency Children with a vitamin A deficiency are more likely to die from complications from measles Children with a vitamin A deficiency are more likely to die from complications from measles

84 Eyesight

85 Vitamin A Deficiency: Keratinization  dry, cracked skin Keratinization  dry, cracked skin Reduced secretions Reduced secretions GI tractGI tract BladderBladder LungsLungs Above symptoms increase risk of infection Above symptoms increase risk of infection

86 Skin And Body Linings  The skin in vitamin A deficiency

87 Vitamin A Deficiency: Anemia Anemia Slow bone growth Slow bone growth Painful joints Painful joints Cracked, cracked teeth Cracked, cracked teeth Delayed sexual maturity Delayed sexual maturity

88 Vitamin A Toxicity: Teratogenic Teratogenic “monster producing”“monster producing” GI distress, weight loss GI distress, weight loss Bone issues Bone issues Joint painJoint pain Stunted bone growth and moreStunted bone growth and more

89 Vitamin A Toxicity: Headaches, pressure inside skull Headaches, pressure inside skull Blurred vision Blurred vision Fatigue, muscle weakness Fatigue, muscle weakness Skin rashes Skin rashes Dry, cracked, bleeding lips Dry, cracked, bleeding lips Dry, brittle hair Dry, brittle hair

90 Vitamin A  Vitamin A toxicity can be fatal Polar bear liver story Polar bear liver story  Symptoms go away quickly if diet changes  Toxicity is never from beta-carotene sources Beta-carotene toxicity….. Beta-carotene toxicity…..

91 Beta-carotene toxicity! Beta-carotene toxicity!

92 Vitamin D Chemical nature: Vitamin D is a sterol Vitamin D is a sterol Body can make from cholesterol Body can make from cholesterol Requires sunlight exposureRequires sunlight exposure 5-10 minutes – light skinned5-10 minutes – light skinned Hour or more if dark skinnedHour or more if dark skinned Synthesis of vitamin D Synthesis of vitamin D Involves sunlight, skin, liver, kidneyInvolves sunlight, skin, liver, kidney

93 Vitamin D Functions: Bone mineralization Bone mineralization Works with other nutrientsWorks with other nutrients Vitamins A, C. K Vitamins A, C. K Several minerals Several minerals

94 Vitamin D Functions: Regulates calcium and phosphorus levels Regulates calcium and phosphorus levels Stimulates Ca and P absorption in SIStimulates Ca and P absorption in SI Regulates movement of Ca and P in/out of bonesRegulates movement of Ca and P in/out of bones Stimulates kidneys to retain Ca and PStimulates kidneys to retain Ca and P All of the above are related to bone mineralizationAll of the above are related to bone mineralization

95 Vitamin D Other Functions: Acts as a hormone Acts as a hormone Not fully understoodNot fully understood Many target organs:Many target organs: Brain and CNS Brain and CNS Muscle Muscle Reproductive cells… Reproductive cells…

96 Vitamin D Recommended intake: Depends upon sun exposure and skin color Depends upon sun exposure and skin color 5-10 micrograms/day (AI) 5-10 micrograms/day (AI) UL: 50 mcg/day UL: 50 mcg/day

97 Vitamin D Food sources*: Fortified milk and margarine Fortified milk and margarine Butter Butter Egg yolks Egg yolks Liver Liver Fatty fish and fish oils Fatty fish and fish oils * animal sources

98 Vitamin D Deficiency: Bone abnormalities Bone abnormalities Kids  ricketsKids  rickets Adults  osteomalciaAdults  osteomalcia

99 Vitamin D Populations at risk for deficiency: Inner-city kids Inner-city kids Dark skinned Dark skinned Live in a northern climate Live in a northern climate Limited sun exposure Limited sun exposure Elderly Elderly Kidney or liver disease Kidney or liver disease Vegans Vegans

100 Vitamin D Toxicity: Very toxic Very toxic Can be lethalCan be lethal Milk storyMilk story Toxicity is never from sun exposure Toxicity is never from sun exposure

101 Vitamin D Toxicity  Symptoms: Calcium deposits in soft tissue Calcium deposits in soft tissue Muscles, lungs, heartMuscles, lungs, heart Kidney stones Kidney stones Calcium deposits on walls of arteries Calcium deposits on walls of arteries Joint pain Joint pain Frequent urination Frequent urination GI distress GI distress

102 Vitamin E Chemical nature: A type of tocopherol A type of tocopherol 4 forms 4 forms Alpha, beta, gamma, deltaAlpha, beta, gamma, delta Alpha-tocopherol is the most active formAlpha-tocopherol is the most active form Other forms have very limited bioactivityOther forms have very limited bioactivity

103 Vitamin E Functions: Antioxidant Antioxidant Component of animal cell membranesComponent of animal cell membranes Protects unsaturated fatty acids in cell membranesProtects unsaturated fatty acids in cell membranes Other roles are not clearly defined, but likely exist Other roles are not clearly defined, but likely exist

104 Vitamin E Recommended intake: 15 mg/day 15 mg/day Need more if eat more polyunsaturated fats Need more if eat more polyunsaturated fats most students did not meet their vitamin E requirement on the day analyzed most students did not meet their vitamin E requirement on the day analyzed

105 Vitamin E Food sources*: Vegetable oils Vegetable oils Nuts and seeds Nuts and seeds Whole grains Whole grains Green leafy vegetables Green leafy vegetables Liver Liver Wheat germ Wheat germ Egg yolks *easily destroyed by heat and oxygen Egg yolks *easily destroyed by heat and oxygen

106 Vitamin E Deficiency: Rare as most vitamin E is recycled Rare as most vitamin E is recycled See in premature babies See in premature babies Transferred from mom to baby in last weeks of pregnancyTransferred from mom to baby in last weeks of pregnancy Cystic fibrosis patients Cystic fibrosis patients Due to poor fat absorptionDue to poor fat absorption

107 Vitamin E  Symptoms deficiency: Hemolytic anemia Hemolytic anemia RBC break openRBC break open Neurological problems with prolonged deficiency Neurological problems with prolonged deficiency Loss of coordinationLoss of coordination Vision and speech problemsVision and speech problems Does not prevent/cure MDDoes not prevent/cure MD

108 Vitamin E Vitamin E may help with: Leg cramps Leg cramps Intermittent claudicationIntermittent claudication Fibrocystic breasts disease Fibrocystic breasts disease “lumpy” breasts“lumpy” breasts

109 Vitamin E Toxicity: Rare Supplements recommended by many, but not above the UL = 1000 mg Supplements recommended by many, but not above the UL = 1000 mg 200 mg supplement probably enough200 mg supplement probably enough May interfere with blood clotting May interfere with blood clotting Stop taking supplements prior to surgeryStop taking supplements prior to surgery Other symptoms: nausea, fatigue, blurred vision Other symptoms: nausea, fatigue, blurred vision

110 VITAMIN K Functions: Need for synthesis of blood clotting proteins Need for synthesis of blood clotting proteins Plays a role in regulation of calcium levels Plays a role in regulation of calcium levels

111 Vitamin K Recommended intake: mcg/day mcg/daySources: Made by GI tract bacteria Made by GI tract bacteria Dark green leafy vegetables, cabbage family Dark green leafy vegetables, cabbage family Liver Liver Milk Milk

112 Vitamin K Deficiency: rare Symptoms: Symptoms: Bleeding, hemorrhagingBleeding, hemorrhaging Bone weaknessBone weakness Populations at risk Populations at risk BabiesBabies After long-term antibiotic treatmentAfter long-term antibiotic treatment CFCF

113 Vitamin K Toxicity: rare Occurs with supplement overuse Occurs with supplement overuse Take with caution, even if prescribedTake with caution, even if prescribed Symptoms: Symptoms: RBC break openRBC break open JaundiceJaundice Brain damageBrain damage Interferes with anti-clotting medsInterferes with anti-clotting meds


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