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VITAMINS

Substantial individual variation. The adult human brain Weight: about 3 lb (1.5 kg) Volume of around 1130-1260 cm3, Substantial individual variation.

PROTECTION BY LOCATION It is protected by the thick bones of the skull, suspended in cerebrospinal fluid, and isolated from the blood stream by the blood-brain barrier.

Susceptible to many types of damages and diseases. Most common forms are physical damage Closed head injuries such as a blow to the head, A stroke, or Poisoning by a wide variety of chemicals that can act as neurotoxins.

Other problems Infection of the brain is rare because of the barriers that protect it, but is very serious when it occurs.

Brain is also susceptible to degenerative disorders Like, Parkinson's disease, Multiple Sclerosis, and Alzheimer's disease. psychiatric conditions, such as schizophrenia and depression, are widely thought to be caused at least partially by brain dysfunctions, although the nature of such brain anomalies is not well understood. Here Vitamins come to play role

What are Vitamins ? Vitamins are naturally occurring organic compounds, present in very small quantity in diet and which are essential for normal growth and health.

Later on it was found that Normal metabolic functions cannot be executed without these compounds If deficient, certain specific metabolic disorders are seen. Participate as coenzyme in various enzyme catalyzed reaction. Vitamins do not provide energy.

TILL DATE 14 different vitamins have been isolated so far and purified into crystalline form.

CLASSIFICATION OF VITAMINS Based on their solubility in solvent.

Storage Water Soluble: Not stored in our bodies. Must therefore be present in diet to an appreciable extent for normal health and growth. Fat Soluble: Are stored, if taken in excess. Stores are sufficient to meet the demand of our body for almost 6 months, if no vitamins are taken through diet.

THIAMIN B 1

Biochemical Role B1 forms the coenzyme Thiamine Diphosphate also called thiamine pyrophosphate By the reaction Thiamine + ATP = TPP + AMP. The enzyme required for this conversion is Thiamine diphosphotransferase. TPP is coenzyme for Alfa Keto-acid Oxidative de-carboxylation.

Functions Thiamin is vital for key reactions in energy metabolism, especially carbohydrate metabolism and therefore its requirement in diet is related to energy intake. In carbohydrate metabolism, thiamin functions in oxidative de-carboxylation of pyruvic acid to form acetyl coenzyme A, which then enters kreb’s cycle.

Pentose Phosphate pathway TPP is also a coenzyme for the tranketolase which is involved in PPP of glucose metabolism. In thiamine deficiency there is accumulation of of the substrates of the reaction co-catalysed by TPP i.e. Pyruvic Acid, Lactic Acid Pentose sugar and the alfa ketoacids derivatives of Amino acids.

Deficiency Disease ( BERIBERI) Deficiency disease of B1 has been divided into three syndromes on the basis of most common clinical features; Dry beriberi with predominantly Neuromuscular symptoms Wet beriberi, with Neuromuscular signs and Edema, less common form but fatal. Cardiac beriberi, with cardiac decompensation

Beriberi

Deficiency Diseases Chronic alcoholism can also lead to thiamin deficiency, the disease produced is termed wernicke’s syndrome.

Symptoms of Dry Beriberi Numbness, tingling, burning pain in extremities Pains and cramping in the leg muscles Difficulty with speech Problems walking Disturbed sense of balance

Symptoms of Wet Beriberi Fast heart rate Swollen feet and legs Enlarged heart Enlarged and tender liver Shortness of breath Congestion in the lungs

Symptoms of Infantile Beriberi Restlessness Difficulty sleeping Diarrhea Swollen arms and legs Muscle wasting in arms and legs Silent cry Heart failure

Systems affected by deficiency: GIT Nervous System Cardiovascular System Musculoskeletal System

Risk Factors for Deficiency Alcoholism Cirrhosis Malabsorption Diabetes Kidney Diseases Chronic Infections

Those at Risk are: Elderly people Nutritionally inadequate diets Stress Prolonged illness Surgeries Those who diet or fast frequently Tobacco Users

Toxic effects Human have limited toxic reaction to thiamin. The sign include Edema Sweating Tremors Tachycardia Fatty liver/ tumors and Vascular Hypotension

TALK OF THE DAY

ROLE OF VITAMINS IN MENTAL HEALTH

NUTRITIONAL FACTS Patients today often are over or well-fed but undernourished. A growing body of literature links dietary choices to brain health and the risk of psychiatric illness. Vitamin deficiencies can affect psychiatric patients in several ways: deficiencies may play a causative role in mental illness and exacerbate symptoms psychiatric symptoms can result in poor nutrition vitamin insufficiency—defined as subclinical deficiency—may compromise patient recovery.

We can safely conclude that Vitamins are necessary for healthy life. B vitamins are required for proper functioning of the methylation cycle, monoamine production, DNA synthesis, and maintenance of phospholipids such as myelin Fat-soluble vitamins A, D, and E play important roles in genetic transcription, antioxidant recycling, and inflammatory regulation in the brain.

The methylation cycle Vitamins B2, B6, B10, and B12 directly impact the functioning of the methylation cycle. Deficiencies pertain to brain function, as neuro-transmitters, myelin, and active glutathione are dependent on one-carbon metabolism

Role of the 3 essential water-soluble vitamins (B1, B2, B6, B10, B12, and C) and 3 fat-soluble vitamins (A, D, and E) in brain metabolism and psychiatric pathology is important.

B1 (thiamine): Glycolysis, TCA Deficiency Rare; 7% in heart failure patients Insufficiency 5% total, 12% of older women Symptoms Wernicke syndrome, memory impairment, confusion, lack of coordination, paralysis At-risk patients Older adults, malabsorptive conditions, heavy alcohol use. Those with diabetes are at risk because of increased clearance Dietary sources Fish, beans, lentils, nuts, rice, and wheat. Raw fish, tea, and betel nuts impair absorption

CHEMISTRY Thiamine is derived from substituted pyrimidine and thiazole which are coupled by a methylene bridge. It is rapidly converted to its active form thiamin pyrophosphate (TPP) in the brain and liver by specific enzymes, Thiamin diphosphotransferase

Thiamin structure

Food sources Important sources of Vitamin B1 are: Fish, Beans, Lentils, Nuts, Rice, Meat, wheat, and milk

SENSITIVITY Thiamin can be easily lost during cooking owing to its solubility in water, Destroyed in presence of alkali and sensitivity to prolonged exposure to heat.

Absorption & Metabolism The bound forms of Thiamin are split in gastro-intestinal tract during digestion . Absorbed mainly from duodenum and jejunum. Very little Thiamin is stored in body when thiamin intake is in excess of needs it is excreted in urine

Recommended Dietary Allowances Infants less than 6 months 0.3 mg/day 6 months to 1 year 0.4 mg/day 1 – 3 years 0.7 mg/day 4 – 6 years 0.9 mg/day 7 – 10 years 1.0 mg/day 11 – 14 years 1.3 mg/day

Recommended Dietary Allowances 15 – 50 years Males 1.5 mg/day – Females1.1 mg/day Over 60 years Males 1.2 mg/day – Females 1.0 mg/day Pregnant ladies 1.5 mg/day Lactating 1.6 mg/day

RIBOFLAVIN B2

Major source of Energy in Living organisms Living organisms including humans derive most of their energy from oxidation-reduction reactions. These are processes which involve the transfer of electrons. Flavin coenzymes participate in redox reactions in numerous metabolic pathways.

Major source of Energy in Living organisms Flavins are critical for the metabolism of carbohydrates, fats, and proteins. Helps in releasing energy from carbohydrates. FAD is part of the electron transport (respiratory) chain, which is central to energy production.

OTHER FUNCTIONS B-2 is important for body growth and RBCs production In treating anemia, adding Vitamin B-2 to iron supplements, increase its effectiveness. Flavins also participate in the metabolism of some vitamins , minerals, drugs and toxins

OTHER FUNCTIONS Riboflavin also helps to shore up the immune system by reinforcing antibody reserves, the body's first line of defense against infection. In addition, the body uses extra riboflavin to keep tissue in good repair and speed healing of wounds, burns and other injuries.

Added Benefits of B-2 Carpal tunnel syndrome patients may benefit when B-2 and B-6 combination therapy is given. Epithelial and mucosal tissues require riboflavin for their maintenance . B-2 is also involved in oxidative degradation of short chain fatty acids. It also has a role in transfer of oxygen from plasma to tissues.

B2 (riboflavin): FMN, FAD cofactors in glycolysis and oxidative pathways. B6, folate, and glutathione synthesis 10% to 27% of older adults <3%; 95% of adolescent girls Fatigue, cracked lips, sore throat, bloodshot eyes Older adults, low intake of animal and dairy products, heavy alcohol use Dairy, meat and fish, eggs, mushrooms, almonds, leafy greens, and legumes

Added Benefits of B-2 Riboflavin is helpful for maintaining the skin, nails, eyes, mouths, lips and tongue. It is required for normal vision and prevention of cataracts. Riboflavin is also thought to decrease the duration and frequency of migraine headaches in some people, When used with beta blockers

Riboflavin deficiency Deficiency can result in: Skin lesions Light sensitivity Eye disorders Inflamed mouth or tongue, and Cracks and sores at the mouth's corner.

Low levels of B-2 Arthritis Colon cancer Heart disease Carpal tunnel syndrome Multiple sclerosis Anxiety, stress and fatigue

Arthritis

Carpal Tunnel Syndrome

Peshawar Medical College Multiple sclerosis Peshawar Medical College

Glossitis

Why Called Riboflavin ? It is named riboflavin because of its structural similarity to Ribose (Sugar) and its relationship to the flavins.

Chemical structure of Riboflavin

Flavin Adenine Dinucleotide

Food Sources The richest sources of riboflavin include organ meats such as liver, kidney and heart. Milk, yeast, cheese, fish, eggs and dark green leafy vegetables are also rich sources. Flour and cereals are enriched with riboflavin.

Absorption and Metabolism Riboflavin is rapidly absorbed form upper part of small intestine and then phosphorylated in intestinal wall to its active form.

Distribution and excretion Riboflavin is found in all cells of the body but maximum concentration is found in liver and kidneys. With an increase in intake above needs, vitamin is excreted by kidneys.

Recommended Dietary Allowances (RDA) Daily intake of 0.6 mg per 1000 calories for persons of all ages is recommended

RECOMMENDED DAILY INTAKE Life stage Age Males mg/day Females mg/day Infants 0—12 months 0.3-0.4 Children 1-3 0.5 4-8 0.6 9-13 0.9 Adolescents 14-18 1.3 1.0 Adults 19+ 1.1 Pregnancy All ages 1.4 Lactation 1.6

Response to Physical state Riboflavin is Heat stable but light sensitive. It is easily destroyed by light, and foods stored in clear containers will lose their riboflavin content in a short period of time. It can leach into cooking water

Deficiency of vitamin B2 Deficiency of riboflavin is one of the most common deficiency disease A shortage of this vitamin may manifest itself as cracks and sores at the corners of the mouth, eye disorders, inflammation of the mouth/ tongue, and skin lesions. Dermatitis, dizziness, hair loss, insomnia, light sensitivity, poor digestion, retarded growth, and slow mental responses have also been reported.