Vitamins

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Vitamin A

Vitamin A is a fat-soluble vitamin that exists in different forms, including retinol, retinal, and retinoic acid. Retinol is the primary form of vitamin A found in animal products, while plant-based foods contain carotenoids, which can be converted into vitamin A in the body. The chemical formula of retinol is C20H30O, and it has a molecular weight of 286.45 g/mol.
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)
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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)
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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)
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Vitamin A
Foods: leafy green veggies, liver, fish oil, milk, eggs, colored fruits and veggies (beta carotene in orange,red), fortified foods like grains
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Vitamin A
Retinal
Retinol
Retinoic acid
Carotenoids = (beta-carotene)
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Vitamin A
Antioxidant
Helps vision (absorbs light in retinal receptors)
Immune function (antioxidant)
Cellular growth, dif, communication (esp epithelial cells)
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Vitamin E
Tocopherol
Alpha-tocopherol
Tocotrienol
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Vitamin E
Foods: wheat germ, nuts, seeds, vegetable/plant oils, smaller amounts in fruits and vegetables, fortified foods
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Vitamin E
Antioxidant (helps prevent and treat age related macular degeneration), anti-inflammatory, immune enhancement, inhibits platelet aggregation (stops clots)
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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
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Vitamin E
Toxicities
Enterocolitis in infants
Risk of bleeding/enhanced anticoagulation with warfarin
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Vitamin K
Phylloquinone = K1
Menaquinone = K2
Phytomenadione
Phytonadione
Phylloquinone
Menaquinone
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Vitamin K
Food: 1 - green leafy vegetables (some vegetable/plant oils), 2 - animal products and fermented foods (soybeans); made by gut bacteria
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Vitamin K
coagulant - matures clotting factors, matures prothrombin
Bone metabolism - osteocalcin needs vitamin ...
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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 __)
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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
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Vitamin K
Toxicities
NONE - but menadione (synthetic ___ precursor) can be toxic to infants
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Vitamin D
Calciferol (D1)
Ergocalciferol (D2)
Cholecalciferol (D3)
Calcitriol (active form)
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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
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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
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Vitamin D
Treats: low bone density (osteopenia, osteoporosis), supplement in breast milk
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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
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Vitamin D
Toxicities:
Hypercalcemia, hypercalciuria - bone less, kidney stones, vascular and tissue calcification and heart arrhythmias
Anorexia, weight loss, polyuria, stupor
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Vitamin C
Foods: fruit, vegetables (broccoli, peppers, cauliflower, cabbage), fortified foods
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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)
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Vitamin C
Toxicities
Excessive supplements
Diarrhea, nausea, vomiting, GI discomfort, fatigue
Kidney stones (oxalate)
Inc iron absorption/ worsen hemochromatosis
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Vitamin B1
thiamine
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Vitamin B1
Foods: animal product (liver/organs, poultry, fish, eggs, milk and dairy), legumes, nuts, seeds, fortified grains, breads, cereals
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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
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Vitamin B1
treat deficiencies and can improve ejection fraction in those with heart failure
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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)
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Vitamin B2
Foods: animal product (liver/organs, poultry, fish, eggs, milk and dairy), legumes, vegetables, fortified grains, breads, cereals
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Vitamin B2
riboflavin
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Vitamin B2
ATP energy production - component of FAD and FMN in Krebs Cycle
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Vitamin B2
Req for synthesis of vitamin A, folate, niacin, B6, K
Req for neurotransmitter metabolism (dopa, NE)
Helps maintain normal levels of homocysteine
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Vitamin B2
recommended for migraine prevention (bc plays a role in mitochondrial function)
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Vitamin B3
treat dyslipidemia ( anti-atherosclerotic - anti buildup of fats in arteries), Hartnup's disease (tryptophan deficiency)
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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
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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
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Vitamin B5
pantothenic acid
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Vitamin B5
Foods: animal product (liver/organs, beef, poultry, fish, yogurt, milk), plants - shiitake mushrooms, avocado, sunflower seeds, nuts, fortified grains, breads, cereals
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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
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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
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Vitamin B5
NO toxicities (except mega supplements can cause GI distress)
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Vitamin B6
pyridoxine
Active form = pyridoxal phosphate PLP
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Vitamin B6
Foods: animal product (organs, meat, poultry, fish), plants/legumes (chickpeas), some fruits and vegetables, fortified grains, breads, cereals
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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
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Vitamin B6
Supplement to treat nausea and vomiting in pregnancy
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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
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Vitamin B6
Toxicities - rare from food, from supplement
Peripheral neuropathy, ataxia, nausea
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Vitamin B7
Biotin
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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
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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
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Vitamin B7
Modulation of cell signaling, regulation of gene expression, histone mod
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Vitamin B7
Supplement - used to promote hair, nails skin by stimulating keratin production - but not sufficient evidence
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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
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Vitamin B9
folate
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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)
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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
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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
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Vitamin B9
Deficiencies - malnutrition and malabsorption, HIV, alcoholism, interactions with methotrexate, phenytoin, sulfonamides
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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
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Vitamin B9
Toxicities - excess ___ masks B12 deficiency (both manifest in megaloblastic anemia) but can't correct neuro symptoms of B12
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Vitamin B12
cobalamin
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Vitamin B12
Foods: ONLY animal product, fortified grains, breads, cereals, nutritional yeast, soy and rice milk
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Vitamin B12
Supplement required for vegan/vegetarian
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Vitamin B12
stored long-term (3-4 years)
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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
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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)
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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
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