Vitamins Table

Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Coenzyme Thiamine pyrophosphate 1.1-1.2 mg (No UL) Beri-Beri: dry,wet,cerebral ( Wernicke and Korsakoff), Gastrointestinal Dry: Peripheral neuropathy whole grains, pork, legumes, seeds, nuts transketolase, PDH, α-KGDH Increased requirement Notes Water Soluble: most B are absorbed in SI-jejunum : B12 in terminal Ileum Vit B1 (Thiamine) Wet (cardiac): rapid heart rate, enlarged heart, edema, difficulty breathing, CHF Biological half life 10-20 days, deficiency signs develop rapidly during depletion. Thiaminases in food can worsen deficiency Cerebral: May lead to Wernicke encephalopathy: Abnormal eye movements, stance and gait abnormalities, abnormalities in mental function and heavy alcohol intake is main cause of thiamine deficiency- causes megaloblastic anemia Korsakoff psychosisconfabulation, TREAT WITH BOLUS OF THIAMINE BEFORE GIVING GLUCOSE, Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement memory loss and gait abnormalities THEN ORAL THIAMINE SUPPLEMENTATIO N as follow Gastrointestinal : lactic acidosis from PDH inhibition associated with nausea, vomiting, severe abdominal pain Vit B2 Riboflavin redox coenzymes FAD, FMN 1.1-1.3 mg (no UL) Ariboflavinosis (rare) Sore throat, cracked lips, red lips, inflamed tongue, seborrheic dermatitis, Normochromatic, normocytic anemia, corneal vascularization, dermatitis, glossitis, cheilosis, anemia, erythroid, hypoplasia Notes dairy products, eggs, meat/fish, green vegetables succinate dehydrogenase, MCAD, MTHFR pregnancy (prevent preeclampsia), migraine yellow color, fluorescent, destroyed by light exposure. need for metabolize carbs, fats and protein Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Vit B3 – Niacin to coenzymes NADH/NADPH (> 400 enzymes) 14-16 mg; UL 35 mg (skin flushing) Pellagra Black tongue disease meat, whole grains, legumes, seeds lactate dehydrogenase, malate dehydrogenase Can cause INH therapy (tuberculosis), Hartnup disease, carcinoid syndrome Excess use: facial flushing GI: diarrhea, vomiting, abdominal pain Neurologic: headache, apathy, fatigue, depression, disorientation and memory loss 3Ds: diarrhea, dermatitis, dementia/deliri um Increased requirement Notes Pharmacological use for nicotinic acid: lipid lowering, HDL raising Niacin is synthesized by tryptophan which needs B6 multiple vitamersnicotinic acid, nicotinamide, nicotinamide riboside; medications (e.g. isoniazid) can interfere with niacin synthesis 4th D is Dead Hartnup disease: absence of AA transport in PT (loss tryptophan NAD plays a redox role and a nonredox role. Non redox; act as a substrate for NAD+-dependent histone Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme in urine Increased requirement Notes deacetylases (sirtuins) and the poly(ADPribose)polymerases (PARPs). NAD+ is also the substrate for ADP-ribosylation by both human sirtuins and bacterial toxins such as the cholera toxin. Carcinoid syndrome: caused by GI tumors that secretes serotonin: diarrhea flushing, cardiac valve disease: alter trp metabolism Populations at risk: dialysis patient, cancer patients, chronic alcoholics, HIV patients, homeless, anorexia nervosa patients, consumers of diets high in corn and low in animal proteins, patients treated with isoniazid Vit B5Pantothenic Acid Coenzyme A and 4’phosphopantethei ne arm of acylcarrier protein AI 5 mg (no UL set) none, rarely seen in humans. In animals, B5 deficiencies are known to cause adrenal failure and wide distribution in foods all coenzyme A utilizing enzymes Same transporter as biotin and lipoic acid Vitamin Precursor to RDA/AI: /UL: and similar proteins Vit B6- plant Pyridoxine/an imal:pyridoxa l, pyridoxamin e coenzyme pyridoxal phosphate: need for Aminotransferase reaction, neurotransmitter synthesis, Homecyctine to cystathionine ( ctstathionine synthase need it, histadine to histamine ( histidine decarboxylase need it), glycogen phosphorylase need B6, need trp to niacin conversion, synthesis of gamma aminolaevulinic acid ALA ( sideroblastic Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement “burning feet syndrome” RDA 1.3 mg; UL 100 mg (LPI recommend s 2 mg) De facto B6 deficiency by using Isoniazid ( inhibitor of B6 action)- need to supplement with B6. Deficiency is rareLong term supplementation with very high dose ( <1000 mg/day) may result in painful neurological symptoms such as peripheral neuropathy Notes some gut bacteria may synthesize pantothenic acid Defincency symptoms : seborrheic dermatitis, microcytic anemia, epileptiform convulsions, depression and confusion; inflammation of the tongue and ulcers of the mouth Toxicity: Sensory neuropathy – pain /numbness in legs, sometimes difficulties walking fish, poultry, nuts, legumes, potatoes, bananas delta-ALA synthase, cystathionine beta-synthase women on birth control, heavy drinkers, some medications needed to make niacin from tryptophan (see esp isoniazid) Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement Notes AI 30 ug Deficiency Deficiency of symptoms : conjunctivitis, neurological abnormalities, glossitis, alopecia, Nausea and loss of appetite , scaly red rash around the eyes, nose, mouth and genital area liver, egg yolk, whole grains all carboxylases pregnancy, holocarboxylase and biotinidase deficiencies egg white contains avidin, which binds biotin Impaired cell division and growth (megaloblastic anemia), sore mouth, diarrhea, weight loss, heartburn, constipation, and a burning red tongue, neural tube defect ( spina bifida), raise stomach pH interferes with absorption so green leafy vegetables (foliage), citrus fruits, legumes anemia) Vit B7- Biotin coenzyme biotin (covalently attached) carboxylation enzyme: pyruvate carboxylate, acetyl coA carboxylase, propionyl coA carboxylase Vit B9- Folic acid/folate coenzyme tetrahydrofolate (single carbon transfers) RDA 400 ug; 600 ug in prenatal vitamins; UL 1000 ug deficiency Biotin synthesized by intestinal flora dihydrofolate reductase, methionine synthase pregnancy, heavy drinkers, smokers, drug interactions, malabsorptive conditions, cancer several genetic diseases related to folate metabolism will be discussed in precision nutrition class Mutiple vitamers of folic acid Folic acid- oxidize, stable form un supplements, more bioavailable must Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement antacid, acid reducing medicine, and alcohol interfere with absorption Notes be reduced by DHFR which has limited capacity- toxic in high does- cannot cross BBB but can block THF transport into CNS Methyl THF- main Circulating form and thus main dietary form from food Folinic acid (Leucovorin) 5formyl THF- can cross BBB Vit B12Cobalamin methyl cobalamin (main circulating form), 5deoxyadenosyl cobalamin RDA 2.4 ug (no UL); (LPI recommend s adults > 50 yrs take 100-400 ug/day of supplement al vitamin B12) pernicious anemia (intrinsic factor def) Deficiency- due to malabsorption due to atrophic gastric or weak acid stomach Deficiency: Leads to nerve damage ( peripheral neuropathy), Megaloblastic anemia, Inflammation of tongue ( atrophic glossitis) Eventually severe nerve damage and dementia steamed clams and mussels, animal products Deficiency is treated with IM injections or nasl spray; mild methionine synthase, methylmalonylCoA mutase vegans, GI surgery Stored in liver, total body stores >2500 ug, daily turnover slow B12 is light sensitive Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement Notes prolyl hydroxylase, dopamine betahydroxylase malnutrition, malabsorption, kidney disease, and smokers 80% tissue saturation at 200 mg (LPI recommendation: 400 mg) deficiency can be treated with high dose oral B12. Vit CAscorbic acid- oxidize form transported via GLUT1 and GLUT3; reduced form: transported by SVCT1 and SVCT2 Reduced form acts directly as redox coenzyme and antioxidant RDA 75-90 mg; UL 2000 mg (minor GI issues) Scurvy No ascorbate – weak collagen (use Vit C serum if you want to keep your youth) Deficiency: serous concentration of less that 11.4uM. Excessive intake – increase oxalate levels Crokscrew hairs, perifollicular hemorrhage, gingival bleeding. poor wound healing loose teeth, joint pain, altered bone formation, listessenss, general malaise, periungual hemorrhagebleeding under or around nails citrus fruits, strawberrie s, peppers, broccoli Neurons have 10mM of ascorbate (highest) Heat destroys ascorbate. Excessive intake GI problems , headaches, insomnia Choline ( not a vitamin) not a coenzyme or vitamin, but is a vitamin-like essential nutrient AI 425-550 mg; UL 3,500 mg Deficiency: vegans may be in risk Impaired VLDL secretion and accumulation of fat in the liver eggs, meat, cruciferous vegetables, peanuts, acetylcholine, phosphatidylcholi ne, sphingomyelin, pregnancy essential for optimal brain development and influences cognitive function in Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency HIGH DOSES Symptoms Best dietary source Example enzyme (steatosis), leads to liver damage (NAFLD). Young infants may suffer growth retardation and suboptimal cognitive development dairy products betaine (oxidized choline). Increased requirement Notes later life. However, it is absent from most prenatal vitamins and >90% of expectant mothers consume less than the RDA. Vit c facilitates uptake of Dietary (nonheme) iron by reducing ferric to ferrous iron High doses: FISHY ODOR, VOMITING, SALIVATION, INCREASED SWEATING, and MILD hypotension Lipid Soluble Vit A – Retinol Beta-carotene precursor to retinol, which is then precursor to retinal (vision cofactor) and retinoic acid (hormone) RDA 700900 retinol activity equivalents (RAE); UL 3000 RAE 1 IU of retinol is Night blindness deficiency toxicity (hypervitaminosis A) Night blindness: impaired dark adaptation, thickening of conjunctiva (bitot spots), xerophthalmia ( dry eyes) , eventually corneal ulcers, Retinol: liver and fish oils betacarotene: orange and green vegetables, a child eating less than a bottle of children flavored vitamins can have life-threatening toxicity. Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency equivalent to 0.3 RAE Vit DCholecalcifer ol Vit ETocopherols precursor to calcitriol, the most active form of Vit D RDA 600800 IU; UL 4000 IU (LPI recommend s 2000 IU) rickets (children)/osteomala cia (adults) RDA 15 mg; UL 1,000 mg (possible bleeding) Deficiency- poor bone, teeth, and cartilage formation Human deficiency result from genetic abnormalities in a tocopherol transfer protein (a TTP) or in lipoprotein synthesis – also associate with a characteristic syndrome, ataxia with vitamin E deficiency, AVED Symptoms Best dietary source scarring and blindness, also prone to infectious disease, follicular hyperkeratosis such as sweet potato and spinach Marked genu varum, decrease bone opacity, poor bone mineralization , beaded ribs, rachitic rosary fatty fish and fish liver oils Failure to placentation, neuromuscular impairments, hemolytic anemia, retinopathy, reduced immunity, and enhanced inflammation. vegetable oils, nuts and seeds, and green/leafy vegetables Example enzyme Increased requirement Notes renal 25hydroxyvitamin D3-1αhydroxylase enzyme (CYP27B1) autoimmune disorders, elderly made from cholesterol Eight structural forms of vitamin E but body prefers alpha-tocopherol Primary function is as a lipid-soluble antioxidant to protect membrane lipids and lipoprotein particles, esp LDL, from ROS Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement Notes Oxygen use in preterm infants – eye problems due to oxidative stress lessened by vit E. Vit KPhylloquinon es- need for blood clotting, skeletal formation and prevention of soft tissue and vascular calcification for gammaglutamylcarboxyla se (GGCX) AI 90-120 ug (no UL) Deficiency- causes : Biliary tract disease interfering with enterohepatic circulation, leading decreased absorption of vit Antibiotic intakes , poor nutritional status : malabsorption, chronic disease or poor oral intake un patients who are acutely ill green leafy vegetables, animal livers, fermented foods Reduced GGCX activity may contribute to bone mineralization defects and abnormal soft tissue calcification synthesized by human intestinal microbiota, stored in very small amounts that are rapidly depleted Minerals Iodine Use in Thyroid hormone RDA 150 ug Iodine deficiency ID: common cause of preventable brain damage in the world Learning disabilities, developmental abnormalities (myelination of Iodized salt Treat Graves with : correcting high thyroid hormone levels with antithyroid Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Hypothyroidism CNS before and shortly after birth ) goiter Graves disease: autoimmune disorder stimulating growth of thyroid gland and excess secretion of T3 and T4 ( hyperthyroidism ) Hashimoto thyroiditis autoimmune disorder where antibodies against thyroid peroxidase or thyroglobulin cause thyroid failure (primary hypothyroidism) ; labs: Elevated TSH, low T4, low T3 Thyroid autoantibodies ID: leads to low T3 production, which leads to high TSH, which promotes glandular tissue growth to form a goiter Graves disease; Consistent with thyrotoxicosis: fatigue; warm, moist skin; palpitations; dyspnea on exertion; heat intolerance; weight loss; restlessness, irritability, anxiety Hashimoto T: Best dietary source Example enzyme Increased requirement Notes medications or radioactive iodine (most common) or surgery, followed by thyroid hormone replacement Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement Notes Fatigue; constipation; cold, dry skin; weight gain; cold intolerance; depression, dementia; hair loss; thickened, brittle nails; slow speech Magnesium RAD 320420; 350mg UL Can have deficiency loss of appetite, nausea, vomiting, fatigue, weakness, tingling, muscle contractions, cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms. Too much: diarrhea, nausea, abdominal cramping green leafy vegetables, legumes, beans, seeds and nuts Very abundant element in both solid compound and dissolved form. Always in divalent form and interacts with polyphosphates, eg Mg-ATP. Risk of deficiency from GI, renal, and endocrine disorders Adult humans have 22-26 g Mg, 60% in skeleton, 39% intracellular, and 1% extracellular Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement Notes (~1 mM). Mg commonly used to treat preeclampsia and restless leg syndrome. Manganese Not a precursor but need it for activities of glutamine synthetase in astrocytes, arginase, and MnSOD. RDA 1.8-2.3 mg; UL 11 mg Can have deficiency skeletal deformation and inhibits production of collagen in wound healing. Manganese overexposure in factories is associated with manganism, a rare neurological disorder. Manganese has several oxidation states but the most stable is +2 Manganese important in macronutrient metabolism, bone formation and free radical defense systems. Mn+2 can compete with Mg+2 and is also very similar to Ca+2 and Zn+2. High intake of other minerals can inhibit Mn intake. Vitamin Zinc Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source RDA 8-11 mg; UL 40 mg Deficiency Too much: (nausea, vomiting) is high in animal products (red meats, shellfish). Acrodermatitis enteropathy (AE) is a disorder of zinc absorption caused by mutations in the SLC39A4 gene. Deficiency: growth retardation, loss of appetite, impaired immune function AE: The lack of zinc can cause skin inflammation with a rash (pustular dermatitis) around the mouth and/or anus; diarrhea; and abnormal nails (nail dystrophy). Irritability and emotional disturbances can also occur. Oral zinc therapy is indicated. Example enzyme Increased requirement Notes Zinc is a component of many proteins. It is particularly important in immune health and wound healing. Dietary zinc deficiency is common in the developing world where main food source is grains or legumes. Phytic acid (IP6), high in seeds and nuts, impairs absorption of iron and zinc. High intake of zinc can compete with copper for absorption, and will induce metallothionine in intestinal cells. Zinc supplementation is used to treat Wilson’s disease Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms Best dietary source Example enzyme Increased requirement Notes and age-related macular degeneration. Molybdenum Selenium Molybdenum is a part of molybdopterin, a redox cofactor synthesized from GTP and required for function of xanthine oxidase, sulfite oxidase, aldehyde oxidase and mitochondrial amidoxime reducing component (mARC). These metabolize sulfurcontaining amino acids, purines, and xenobiotics. RDA 45 mcg; UL 2,000 mcg Involve in reproduction, thyroid hormone metabolism, DNA synthesis, and protection from oxidative damage/stress and infection RDA 55 mcg; UL 400 Genetic defects in formation of molybdopterin impairs sulfite metabolism and causes sulfite buildup leading to encephalopathy and seizures; usually fatal within days of birth legumes (black eyed peas), liver Molybdenum found in two valence forms, +4 and +6. Only Group V transition metal known to be essential. Can treat Wilson’s disease with tetrathiomolybdate (Coprexa)complexes with copper and facilitates elimination Deficiency Too much increase susceptibility to some illnesses, male infertility, exacerbate iodine deficiency (deiodinase) Brazil nuts (very high, can overdose), green vegetables, mushrooms , fish glutathione peroxidase and two dozen other selenoproteins Selenium exists in two forms: inorganic (selenate and selenite) and organic (selenomethionine and selenocysteine) Vitamin Precursor to RDA/AI: /UL: Clinical name of deficiency Symptoms too much : neuropathy RDA: Recommended dietary allowance AI: Adequate intake UL: Tolerable upper intake level Best dietary source Example enzyme Increased requirement Notes