Vitamins (copy)

Vitamin A

Deficiencies
Rare due to inadequate intake, fat malabsorption
dry/inflamed eyes (xerophthalmia), night blindness (nyctalopia), family conjunctiva (bitot spots)
Dry, scaly skin (xerosis cutis) or hair
Inc susceptibility to infection (immunosuppression)

Vitamin A

Treats:
Skin disorders, severe acne (isotretinoin)
Promyelocytic leukemia (all-trans retinoic acid)
Prevent and treat age related macular degeneration (carotenoids)
Measles (when deficient)

Vitamin A

Toxicities:
Inc intracranial pressure, dizziness, nausea, headaches, blurred vision
Skin irritation, dry skin, alopecia
Fetal deformations (cardiac, cleft palate) w/ isotretinoin
Excessive beta carotene - carotenodermia (orange skin)

Vitamin A

Foods: leafy green veggies, liver, fish oil, milk, eggs, colored fruits and veggies (beta carotene in orange,red), fortified foods like grains

Vitamin A

Retinal
Retinol
Retinoic acid
Carotenoids = (beta-carotene)

Vitamin A

Antioxidant
Helps vision (absorbs light in retinal receptors)
Immune function (antioxidant)
Cellular growth, dif, communication (esp epithelial cells)

Vitamin E

Tocopherol
Alpha-tocopherol
Tocotrienol

Vitamin E

Foods: wheat germ, nuts, seeds, vegetable/plant oils, smaller amounts in fruits and vegetables, fortified foods

Vitamin E

Antioxidant (helps prevent and treat age related macular degeneration), anti-inflammatory, immune enhancement, inhibits platelet aggregation (stops clots)

Vitamin E

Deficiencies
Bc of fat malabsorption (low birthweight premies)
Hemolytic anemia, acanthocytosis (misshapen RBC), muscle weakness, skeletal myopathy, ataxia, dec proprioception, vibration sensation
Neuropathy, retinopathy
Impaired immune response

Vitamin E

Toxicities
Enterocolitis in infants
Risk of bleeding/enhanced anticoagulation with warfarin

Vitamin K
Phylloquinone = K1
Menaquinone = K2

Phytomenadione
Phytonadione
Phylloquinone
Menaquinone

Vitamin K

Food: 1 - green leafy vegetables (some vegetable/plant oils), 2 - animal products and fermented foods (soybeans); made by gut bacteria

Vitamin K

coagulant - matures clotting factors, matures prothrombin
Bone metabolism - osteocalcin needs vitamin ...

Vitamin K

Low availability of vit __ in breast milk so given to newborns
Now should consume consistent amount of vitamin __ when on warfarin (before used to say no vit __)

Vitamin K

Deficiencies
Bc of fat malabsorption, prolonged antibiotic use (blocks vitamin K metabolism because digested in gut)
In newborns - hemorrhagic disease (unable to synthesize in gut, doesn't cross placenta, low in breast milk)
Causes: bleeding/hemorrhage, easy bruising, increased PT/INR (nosebleeds, bleeding gums, blood in urine and stool, black stools, heavy menstrual bleeding)
Can contribute to osteoporosis or osteopenia

Vitamin K

Toxicities
NONE - but menadione (synthetic ___ precursor) can be toxic to infants

Vitamin D

Calciferol (D1)
Ergocalciferol (D2)
Cholecalciferol (D3)
Calcitriol (active form)

Vitamin D

Foods: fatty fish and fish oil (little n milk, cheese, and eggs), mushrooms (and fungi), fortified milk, dairy, cereal, orange juice, formula
Also sunlight

Vitamin D

Bone health- inc absorption of Ca+ and P+, inc bone remineralization at low levels and resorption at high levels
Cell growth and differentiation, immune, anti-inflammatory
Endocrine and cardiovascular functions

Vitamin D

Treats: low bone density (osteopenia, osteoporosis), supplement in breast milk

Vitamin D

Deficiencies:
when deficient associated with diseases and conditions but supplements don't help
Due to malabsorption, less sun exposure, liver or kidney disease that alters metabolism, darker skin color
Rickets in children (bowlegs, craniotables - softening of bones in skull)
Osteomalacia (soft/weak) and osteoporosis in adults
Associated w/ hypocalcemia (tetany/spasms/numb/seizure)
Inc prevalence of chronic disease

Vitamin D

Toxicities:
Hypercalcemia, hypercalciuria - bone less, kidney stones, vascular and tissue calcification and heart arrhythmias
Anorexia, weight loss, polyuria, stupor

Vitamin C

Foods: fruit, vegetables (broccoli, peppers, cauliflower, cabbage), fortified foods

Vitamin C

Reducing agent, antioxidant (protects from free radical damage)
Helps in regeneration of antioxidants (like vit E)
Inc bioavailability and absorption of Fe (reduces to Fe2+)
Enzyme cofactor - synthesis of collagen (hydroxylation of proline and lysine), carnitine, catecholamines (converts dopamine to norepinephrine)
???may prevent cancer, CVD, enhance immunity and healing

Vitamin C

Deficiencies:
Weakened blood vessels and connective tissue bc lack of collagen and iron def anemia
Swollen gums, subcutaneous bleeding of gums, weakened immunity, poor wound healing, anemia = fatigue, easy bruising and petechiae (bleeding under skin), joint pain, edema, hair and tooth loss (corkscrew hair)

Vitamin C

Toxicities
Excessive supplements
Diarrhea, nausea, vomiting, GI discomfort, fatigue
Kidney stones (oxalate)
Inc iron absorption/ worsen hemochromatosis

Vitamin B1

thiamine

Vitamin B1

Foods: animal product (liver/organs, poultry, fish, eggs, milk and dairy), legumes, nuts, seeds, fortified grains, breads, cereals

Vitamin B1

ATP energy production:
Branched-chain ketoacid dehydrogenase
Alpha-ketoglutarate dehydrogenase (TCA)
Pyruvate dehydrogenase (glycolysis to TCA)
Transketolase (synthesis of ribose units for DNA and RNA in PPP)
Nerve function - thiamine triphosphate

Vitamin B1

treat deficiencies and can improve ejection fraction in those with heart failure

Vitamin B1

Deficiencies - alcoholism, malnutrition, GI disorders
Dry Beirberi - neuro
Peripheral neuropathy, muscle wasting, leg cramps
Wet Beriberi - cardio
Heart failure, cardiomyopathy, edema
Wernicke encephalopathy - acute/life threatening/reversible
Confusion, ophthalmoplegia, nystagmus, ataxia, neuropathy
Korsakoff syndrome -alcoholism
amnesia/false memories, personality changes, psychosis
Wernicke-Korsakoff: alcoholism, HIV-related)

Vitamin B2

Foods: animal product (liver/organs, poultry, fish, eggs, milk and dairy), legumes, vegetables, fortified grains, breads, cereals

Vitamin B2

riboflavin

Vitamin B2

ATP energy production - component of FAD and FMN in Krebs Cycle

Vitamin B2

Req for synthesis of vitamin A, folate, niacin, B6, K
Req for neurotransmitter metabolism (dopa, NE)
Helps maintain normal levels of homocysteine

Vitamin B2

recommended for migraine prevention (bc plays a role in mitochondrial function)

Vitamin B2

Deficiencies (rare in isolation) - alcoholism, malnutrition, GI disorders, thyroid disorders
Oral: mouth and lip sores (cheilosis- fissures at corners), inflammation of mouth (stomatitis), and tongue (glossitis-magenta bright red)
Skin lesions, alopecia, itchy eyes, corneal vascularization

Vitamin B2

NO toxicities (can cause bright yellow urine)

Vitamin B3

Niacin
Nicotinic acid
Nicotinamide

Vitamin B3

Foods: animal product (liver/organs, poultry, fish, eggs, milk and dairy), legumes, vegetables, fortified grains, breads, cereals

Vitamin B3

Produced from tryptophan

Vitamin B3

Involved in 200+ redox reactions
ATP production (glycolysis, Krebs cycle) - component of NAD+ and NADP+
Synthesis of fatty acids, cholesterol, DNA, steroid hormones, vitamins (C,folate)

Vitamin B3

treat dyslipidemia ( anti-atherosclerotic - anti buildup of fats in arteries), Hartnup's disease (tryptophan deficiency)

Vitamin B3

Deficiencies - pellagra, (rare in isolation) - alcoholism, malnutrition, GI disorders, dialysis, HIV, because:
Defective tryptophan absorption - Hartnup's disease
Metabolism - carcinoid syndrome
Meds interfering with tryptophan metabolism
Symptoms: 3-4 Ds - dermatitis, diarrhea (vomiting and glossitis), dementia (headache, apathy, fatigue, depression), even death

Vitamin B3

Toxicities RARE - only from supplements
red/flushed face,itching, nausea and vomiting, hyperglycemia, hyperuricemia (gout), liver damage (jaundice, elevated liver enzymes), dizziness, fatigue, low BP

Vitamin B5

pantothenic acid

Vitamin B5

Foods: animal product (liver/organs, beef, poultry, fish, yogurt, milk), plants - shiitake mushrooms, avocado, sunflower seeds, nuts, fortified grains, breads, cereals

Vitamin B5

Found everywhere - synthesis of CoA and succinyl CoA
In Krebs cycle, metabolism of cholesterol and fats, steroid hormones, acetylcholine and ketones, and synthesis of heme

Vitamin B5

Deficiencies: rare in isolation, malnutrition
Symptoms: dermatitis, alopecia, peripheral neuropathy - numbness and burning of hands and feet, nausea, vomiting, loss of appetite, anorexia, enteritis, abdominal cramping
Irritability and restlessness, headache, fatigue

Vitamin B5

NO toxicities (except mega supplements can cause GI distress)

Vitamin B6

pyridoxine
Active form = pyridoxal phosphate PLP

Vitamin B6

Foods: animal product (organs, meat, poultry, fish), plants/legumes (chickpeas), some fruits and vegetables, fortified grains, breads, cereals

Vitamin B6

Protein metabolism:
Transamination of amino and keto acids, ALT, AST
Decarboxylation reactions (-CO2)
Synthesis of heme, niacin, histamine, glutathione, etc.
Neurotransmitter synthesis (serotonin, EPI, NE, DOPA, GABA)
Involved in homocysteine metabolism (with B12, folate)
Role in immune function

Vitamin B6

Supplement to treat nausea and vomiting in pregnancy

Vitamin B6

Deficiencies - rare in isolation, malnutrition, GI prob, alcoholism, HIV, dialysis, med interactions
risk factor for vascular and inflammatory diseases (Microcytic anemia, sideroblastic anemia (low Hgb, excess iron))
nausea, vomiting, inflammation of mouth and tongue (glossitis, cheilosis)
convulsions, irritability, peripheral neuropathy

Vitamin B6

Toxicities - rare from food, from supplement
Peripheral neuropathy, ataxia, nausea

Vitamin B7

Biotin

Vitamin B7

Foods: animal product (liver/organs, beef, pork, fish, eggs, milk and dairy), plants - sweet potato and avocado, seeds, nuts, yeast, fortified grains, breads, cereals

Vitamin B7

Cofactor for multiple carboxylase enzymes (add C) - in synthesis and oxidation of fatty acids, gluconeogenesis, catabolism of branched chain AA
Pyruvate carboxylase, acetyl-CoA carboxylase

Vitamin B7

Modulation of cell signaling, regulation of gene expression, histone mod

Vitamin B7

Supplement - used to promote hair, nails skin by stimulating keratin production - but not sufficient evidence

Vitamin B7

Deficiencies:
Bc malnutrition, alcoholism, parenteral nutrition w/out supplement, long term antibiotics and avidin (protein in raw egg whites) inhibit ____ absorption
Symptoms: alopecia, scaly red rash around eyes, nose, mouth, genitals
Brittle nails
Depression, lethargy, hallucinations, numbness and tingling of extremities, seizures

Vitamin B9

folate

Vitamin B9

Foods: animal product (organs, meat, poultry, fish, eggs, dairy), legumes, vegetables (leafy green), fruits fortified grains, breads, cereals (deficiency common in those who avoid gluten)

Vitamin B9

Converted to tetrahydrofolic acid (THF) - coenzyme for 1-carbon methyl transfer
Needed for DNA synthesis, cell division, heme synthesis, B-12-homocysteine conversion

Vitamin B9

Supplement: fortified to reduce neural tube defects pre and during pregnancy (otherwise low birthweight, preterm delivery, fetal growth retardation); insufficient evidence to support prevention of cancer, CVD, and cog decline

Vitamin B9

Deficiencies - malnutrition and malabsorption, HIV, alcoholism, interactions with methotrexate, phenytoin, sulfonamides

Vitamin B9

Deficiencies:
high homocysteine and associated w/anemia, CVD, cog decline
Macrocytic, megaloblastic anemia - fatigue, weakness, heart palpitations, shortness of breath
nausea, vomiting, constipation, loss of appetite, weight loss, glossitis, cheilosis
Changes in skin, hair, nails
No neurological symptoms

Vitamin B9

Toxicities - excess ___ masks B12 deficiency (both manifest in megaloblastic anemia) but can't correct neuro symptoms of B12

Vitamin B12

cobalamin

Vitamin B12

Foods: ONLY animal product, fortified grains, breads, cereals, nutritional yeast, soy and rice milk

Vitamin B12

Supplement required for vegan/vegetarian

Vitamin B12

stored long-term (3-4 years)

Vitamin B12

Cofactor for methionine synthase (homocysteine -> methionine) which is a methyl donor to make proteins, lipids, hormones, DNA, RNA, hemoglobin, RBCs
Role in neurological functio

Vitamin B12

Deficiencies
because - alcoholism, malnutrition, GI disorders, dialysis, HIV, H. pylori, atrophic gastritis, lack of intrinsic factor imp in breaking down ____(pernicious anemia), medication interactions (metformin so when given with diabetes also give ____ supplement, PPIs)

Vitamin B12

Deficiencies: Macrocytic, megaloblastic anemia - fatigue, weakness
Neurological - peripheral neuropathy (numbness, tingling), poor balance, confusion, poor memory, dementia, depression
Nausea, vomiting, constipation, loss of appetite, weight loss, glossitis, cheilosis
Can lead to high homocysteine and methylmalonic acid (MMA) - associated with CVD and cog decline