1. 7 Vitamins

2. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-2 Objectives State one or more functions of each of the 13 vitamins discussed. Identify at least two food sources of each of the vitamins discussed. Identify some symptoms of, or diseases caused by, deficiencies of the vitamins discussed.

3. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-3 Facts Organic (carbon-containing) compounds that are essential in small amounts for body processes Do not provide energy Enable the body to use the energy provided by fats, carbohydrates, and proteins Megadoses can be toxic.

4. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-4 Vitamin Types (13) Fat-soluble (4): A, D, E, K Water-soluble (9):  Vitamin C  Vitamin B complex which includes: thiamin (B 1 ), riboflavin (B 2 ), niacin, vitamin B 6, folate, vitamin B 12 (cobalamin), pantothenic acid, biotin

5. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-5 Requirements Vitamin allowances given by weight in milligrams (mg) or micrograms (mcg or  g). Dietary reference intakes (DRIs) have replaced the recommended dietary allowances (RDAs). Tolerable upper limits (UL): maximum level of daily intake unlikely to cause adverse effects

6. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-6 Vitamin Deficiency People prone to vitamin deficiency:  Alcoholics  Poor and incapacitated elderly  Clients with serious diseases that affect appetite  Mentally retarded  Children receiving inadequate care

7. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-7 Deficiency of Fat-Soluble Vitamins Chronic malabsorption diseases  Cystic fibrosis  Celiac disease  Crohn’s disease

8. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-8 Match the following terms with the correct definition. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-8 1. Avitaminosisa. Concentrated form of vitamins 2. Hypervitaminosisb. Without vitamins 3. Vitamin supplementc. Condition caused by ingestion of excess vitamins

9. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-9 Answers  1. b  2. c  3. a Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-9

10. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-10 Avoiding Vitamin Loss Buy fresh, unbruised vegetables and fruits and use them raw when possible. Prepare fresh vegetables and fruits just before serving. Heat canned vegetables quickly and in their own liquid. Follow package directions when cooking frozen vegetables or fruit. (continues)

11. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-11 Avoiding Vitamin Loss Steam, or use as little water as possible. Cover pan and cook for a short period of time. Save cooking liquid for soups, stews, and gravy. Store fruits and vegetables in a cool, dark place. (continued)

12. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-12 Fat-Soluble Vitamins Vitamins A, D, E, K Not lost easily in cooking Lost when mineral oil is ingested Excess amounts are stored in the liver. Deficiencies are slow to appear.

13. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-13 Vitamin A Preformed  Retinol: the active form of vitamin A Provitamin A carotenoids  Beta carotene, lutein, lycopene, and zeaxanthin  Inactive form of vitamin A found in plants; converted to retinol

14. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-14 Functions of Vitamin A Maintains healthy eyes and skin Normal bone growth and reproduction Healthy immune system Antioxidants that protect cells from free radicals

15. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-15 Sources of Vitamin A Preformed vitamin A (retinol)  Fat-containing animal foods: liver, butter, cream, whole milk, cheese, egg yolk Beta carotene  Carrots, sweet potatoes, spinach, broccoli, pumpkin, squash, mango, and cantaloupe

16. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-16 Vitamin A Requirements Commonly listed as retinol equivalents (RE) A retinol equivalent is 1  g retinol or 6  g beta carotene

17. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-17 What are the signs and symptoms you would expect to see with too much vitamin A? What are the signs and symptoms you would expect to see with too little vitamin A? Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-17

18. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-18 Excess  Birth defects, hair loss, dry skin, headaches, nausea, dry mucous mem- branes, liver damage, and bone and joint pain Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-18 Deficit  Night blindness, dry, rough skin, increased susceptibility to infections, and blindness or xerophthalmia

19. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-19 Vitamin D Prohormone: it is converted to a hormone in the body D 2 (ergocalciferol) is formed in plants. D 3 (cholecalciferol) is formed in humans from cholesterol in the skin.

20. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-20 Functions of Vitamin D Promotes calcium and phosphorus absorption in the body Values are given in micrograms or in international units.

21. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-21 Sources of Vitamin D Sunlight: changes provitamin to vitamin D 3 Food sources: milk, fish liver oils, egg yolk, butter, and fortified margarine Most milk in the U.S. has 10  g of vitamin D concentrate added per quart.

22. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-22 What are the signs and symptoms you would expect to see with too much vitamin D? What are the signs and symptoms you would expect to see with too little vitamin D? Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-22

23. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-23 Excess  Deposits of calcium and phosphorus in soft tissues, kidney, and heart damage, and bone fragility Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-23 Deficit  Poor bone and tooth formation, rickets which causes malformed bones and pain in infants  Osteomalacia (softening of bones)  Osteoporosis (brittle, porous bones)

24. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-24 Vitamin E Tocopherols  Alpha (most biologically active)  Beta, delta, and gamma Tocotrienols Given as  -TE (alpha-tocopherol equivalents) 1 mg of  -TE = 1 international unit

25. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-25 Functions of Vitamin E Antioxidant Prevention of hemolytic anemia among premature infants Enhances immune system Retards spoilage of commercial foods

26. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-26 Sources of Vitamin E Vegetable oils: corn, soybean, safflower, and cottonseed, and products made from them, such as margarine Wheat germ, nuts, and green leafy vegetables The U.S. diet is thought to contain sufficient vitamin E.

27. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-27 Your client asks you if it is possible to take too much vitamin E. How would you advise the client? What signs and/or symptoms can result from too little vitamin E? Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-27

28. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-28 Excess  Relatively nontoxic, fat-soluble vitamin  Excess stored in adipose tissue  Avoid long-term megadoses. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-28 Deficit  Serious neurological defects can occur from malabsorption.

29. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-29 Vitamin K Made up of several compounds essential to blood clotting Vitamin K 1 (phylloquinone) Vitamin K 2 (menaquinone) Synthetic vitamin K (menadione) Vitamin K is destroyed by light and alkalis.

30. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-30 Functions of Vitamin K Formation of prothrombin for clotting of blood Candidates likely to receive vitamin K  Newborns immediately after birth  Clients who suffer from faulty fat absorption  After extensive antibiotic therapy  Antidote for an overdose of anticoagulant or treatment of hemorrhage

31. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-31 Sources of Vitamin K Green leafy vegetables such as broccoli, cabbage, spinach, and kale Dairy products, cow’s milk, eggs, meats, fruits, and cereals Bacteria in small intestine synthesizes some vitamin K, but must be supplemented by dietary sources. Measured in micrograms

32. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-32 What signs and/or symptoms can result from too much vitamin K? What signs and/or symptoms can result from too little vitamin K? Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-32

33. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-33 Excess  Anemia can result from excessive amounts of synthetic vitamin K. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-33 Deficit  Defective blood coagulation, which increases clotting time and makes client prone to hemorrhage.

34. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-34 Water-Soluble Vitamins Vitamin B complex and C Dissolve in water Easily destroyed by air, light, and cooking

35. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-35 Vitamin B Complex: Thiamin/B 1 Essential for nerve and muscle action, and metabolism of carbohydrates and some amino acids Sources include unrefined and enriched cereals, yeast, wheat germ, lean pork, organ meats, and legumes (continues)

36. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-36 Vitamin B Complex: Thiamin/B 1 Deficiency symptoms include loss of appetite, fatigue, nervous irritability, and constipation Beriberi is a disease caused by extreme deficiency of vitamin B 1 (continued)

37. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-37 Vitamin B Complex: Riboflavin/B 2 Necessary for the metabolism of carbohydrates, protein, and fats; tissue maintenance (especially the skin around the mouth); and healthy eyes Sources: milk, meats, poultry, fish, enriched breads, cereals, broccoli, spinach, and asparagus (continues)

38. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-38 Vitamin B Complex: Riboflavin/B 2 Deficiency can cause cheilosis (sores on the lips and cracks at the corners of the mouth); glossitis (inflammation of the tongue); dermatitis; and eye strain in the form of itching, burning, and eye fatigue (continued)

39. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-39 Vitamin B Complex: Niacin Generic name for nicotinic acid and nicotinamide A coenzyme in energy metabolism Sources include meats, poultry, fish, peanuts, and legumes Milk and eggs are sources of tryptophan (precursor of niacin) Measured in niacin equivalents (NE) (continues)

40. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-40 Vitamin B Complex: Niacin Excessive amounts of niacin can cause flushing due to vascular dilation, gastrointestinal problems, itching, and liver damage. May be used as a cholesterol-lowering agent under close supervision of a physician because of adverse side effects, which include liver damage and peptic ulcers (continues) (continued)

41. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-41 Vitamin B Complex: Niacin Deficiency symptoms include weakness, anorexia, indigestion, anxiety, and irritability. Pellagra is an extreme deficiency causing sores on the skin, diarrhea, anxiety, confusion, irritability, poor memory, dizziness, and untimely death. (continued)

42. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-42 Pyridoxine, pyridoxal, and pyridoxamine Essential for protein metabolism and absorption, and aids in the release of glucose from glycogen Serves as a catalyst in conversion of tryptophan to niacin; helps synthesize neurotransmitters such as serotonin and dopamine Vitamin B Complex: B 6 (continues)

43. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-43 Vitamin B Complex: B 6 Measured in milligrams Sources include poultry, fish, liver, kidney, potatoes, bananas, spinach, and unrefined whole grains (oats and wheat) Deficiency symptoms include irritability, depression, and dermatitis (continues) (continued)

44. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-44 Vitamin B Complex: B 6 Deficiency in infants can cause various neurological symptoms and abdominal problems Toxicity is rare; may cause temporary neurological problems (continued)

45. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-45 Vitamin B Complex: Folate Folate, folacin, and folic acid are chemically similar compounds, and names are used interchangeably. Needed for DNA synthesis, protein metabolism, and formation of hemoglobin Sources include cereals fortified with folate, green leafy vegetables, legumes, sunflower seeds, fruits such as oranges and strawberries (continues)

46. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-46 Vitamin B Complex: Folate Measured in micrograms Average adult requires 400  g/day 600  g/day required 1 month before conception through first 6 weeks of pregnancy Excess can mask vitamin B 12 deficiency and inactivates phenytoin, an anticonvulsant drug used by epileptics (continues) (continued)

47. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-47 Vitamin B Complex: Folate Deficiency linked to neural tube defects in fetus, such as spina bifida (spinal cord or spinal fluid bulge through the back) and anencephaly (absence of the brain). Other signs include inflammation of mouth and tongue, poor growth, depression and mental confusion, problems with nerve functions, and megaloblastic anemia. (continued)

48. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-48 Cobalamin: contains mineral cobalt Involved in folate metabolism, maintenance of the myelin sheath, and healthy red blood cells To be absorbed, must bind with intrinsic factor in stomach. Sources include animal foods, especially organ meats, lean meat, seafood, eggs, and dairy products Vitamin B Complex: B 12 (continues)

49. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-49 Vitamin B Complex: B 12 Increased need during pregnancy and lactation Deficiency is rare and may be due to congenital problems of absorption or years of a vegetarian diet with no animal foods. Symptoms include megaloblastic anemia, pernicious anemia (if intrinsic factor absent), anorexia, glossitis, sore mouth, tongue, pallor, depression, dizziness, weight loss, neurological system damage (continued)

50. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-50 Vitamin B Complex: Pantothenic Acid Involved in metabolism of carbohydrates, fats, and proteins Essential for synthesis of neurotransmitter acetylcholine, and steroid hormones Sources include meats, poultry, fish, eggs, whole-grain cereals, and legumes Thought to be synthesized by the body (continues)

51. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-51 Vitamin B Complex: Pantothenic Acid Toxicity from excess not confirmed Natural deficiencies unknown Signs include weakness, fatigue, burning sensation in feet (deficiencies produced experimentally) (continued)

52. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-52 Vitamin B Complex: Biotin Coenzyme in synthesis of fatty acids and amino acids Sources include liver, egg yolk, soy flour, cereals, and yeast Synthesized in intestine by micro- organisms (continues)

53. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-53 Vitamin B Complex: Biotin Toxicity from excess unknown Deficiency symptoms include nausea, anorexia, depression, pallor, dermatitis, and increase in serum cholesterol (continued)

54. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-54 Vitamin C: Ascorbic Acid Has antioxidant properties and protects food from oxidation Role in formation of collagen and absorption of nonheme iron Prevents scurvy May be involved with formation or functioning of norepinephrine, some amino acids, folate, leukocytes, the immune system, and allergic reactions (continues)

55. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-55 Vitamin C: Ascorbic Acid Sources include citrus fruits, melon, strawberries, tomatoes, potatoes, red and green peppers, cabbage, and broccoli Stress and cigarette smoking increase need (continued)

56. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-56 What disease results from a deficiency in vitamin C? What are the associated signs and/or symptoms? What results from an excess of vitamin C? Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-56

57. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-57 Scurvy: disease characterized by gingivitis, easy bruising, pinpoint hemorrhages of the skin, poor wound healing, sore joints and muscles, and weight loss. Extreme cases result in death. Found in sailors who lived without fresh fruits and vegetables Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-57

58. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-58 Deficiency of vitamin C: bleeding gums, loose teeth, tendency to bruise easily, poor wound healing, scurvy Excess: diarrhea, nausea, cramps, excessive absorption of food iron, rebound scurvy (when megadoses are stopped abruptly) and possibly oxalate kidney stones; generally considered nontoxic Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-58

59. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-59 Vitamin Supplementation Balanced diet provides nutritional needs of healthy people. No amount of vitamins will build muscles. Vitamins do not provide energy; they help to release the energy provided by nutrients. Heart disease, cancer, and the common cold cannot be cured by vitamin supplements

60. Copyright © 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 7-60 Conclusion Organic compounds that regulate body functions and promote growth Each vitamin has a specific function. Well-balanced diet provides sufficient vitamins to fulfill body requirements. Fat-soluble vitamins: A, D, E, K Water-soluble vitamins: B complex, C