MicronutrientsMicronutrients Vitamins and MineralsVitamins and Minerals

Dr. Mahmoud SirdahDr. Mahmoud Sirdah

الرحمن الله الرحمن بسم الله بسمالرحيمالرحيم

Classes of NutrientsClasses of NutrientsMacronutrientsMacronutrients

1.1. CarbohydrateCarbohydrate

2.2. ProteinProtein

3.3. Lipids Lipids

4.4. WaterWater

Micronutrients Micronutrients

1.1. Vitamins Vitamins

2.2. MineralsMinerals

Vitamins and minerals are called micronutrients Vitamins and minerals are called micronutrients because we only need them in very small amounts.because we only need them in very small amounts.

That doesn’t mean they aren’t important; in fact That doesn’t mean they aren’t important; in fact we can’t live without vitamins and minerals.we can’t live without vitamins and minerals.

we measured protein, carbohydrate and fat needs we measured protein, carbohydrate and fat needs in grams. However, Vitamins and minerals are in grams. However, Vitamins and minerals are measured in measured in milligrams (mg), micrograms (mcg) milligrams (mg), micrograms (mcg) and international units (IU).and international units (IU).

VitaminsVitamins A vitamin is an organic compound required as a nutrient A vitamin is an organic compound required as a nutrient

in tiny amounts by an organism.in tiny amounts by an organism.

Vitamins serve crucial functions in almost all bodily Vitamins serve crucial functions in almost all bodily processes (immune, hormonal and nervous systems) and processes (immune, hormonal and nervous systems) and must be obtained from food or supplements as our bodies must be obtained from food or supplements as our bodies are unable to make vitamins.are unable to make vitamins.

A compound is called a vitamin when it cannot be A compound is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and synthesized in sufficient quantities by an organism, and must be obtained from the diet. must be obtained from the diet.

Thus, the term is conditional both on the circumstances Thus, the term is conditional both on the circumstances and the particular organism.and the particular organism.

For example, ascorbic acid functions as vitamin C for For example, ascorbic acid functions as vitamin C for some animals but not others, and vitamins D and K are some animals but not others, and vitamins D and K are required in the human diet only in certain circumstances.required in the human diet only in certain circumstances.

Vitamins are classified in two categories: Vitamins are classified in two categories:

• Water-solubleWater-soluble• Fat-solubleFat-soluble

Classification is based on whether or not the Classification is based on whether or not the vitamins can dissolve in water. vitamins can dissolve in water.

Water-soluble vitamins include the B complex Water-soluble vitamins include the B complex of vitamins and vitamin C. of vitamins and vitamin C.

The fat-soluble vitamins include vitamins A, The fat-soluble vitamins include vitamins A, D, E and KD, E and K

The fat-soluble vitaminsThe fat-soluble vitamins

Because they are soluble in fat (lipids), these vitamins tend to Because they are soluble in fat (lipids), these vitamins tend to because stored in the body's fat tissues, fat deposits, and liver.because stored in the body's fat tissues, fat deposits, and liver.

    This storage capability makes the fat-soluble vitamins This storage capability makes the fat-soluble vitamins potentially toxins.potentially toxins.

Care should be exercised when taking the fat-soluble Care should be exercised when taking the fat-soluble vitamins.  The fat-soluble vitamins, especially vitamin A, vitamins.  The fat-soluble vitamins, especially vitamin A, should be consumed with care because of their storage should be consumed with care because of their storage capabilities. capabilities.

They have the potential of building up to harmful levels. Even They have the potential of building up to harmful levels. Even though very few cases of vitamin toxicity have been reported, though very few cases of vitamin toxicity have been reported, concern has grown during recent years as the practice of concern has grown during recent years as the practice of taking taking mega dosesmega doses has become popular. has become popular.

Water-soluble vitaminsWater-soluble vitamins In contrast to the fat-soluble vitamins, the water-soluble vitamins are not In contrast to the fat-soluble vitamins, the water-soluble vitamins are not

easily stored by the body. They are often lost from foods during cooking or easily stored by the body. They are often lost from foods during cooking or are eliminated from the body. are eliminated from the body.

We don’t store water-soluble vitamins in your body very well so they need We don’t store water-soluble vitamins in your body very well so they need to be replaced constantly through your diet. That is one of the reasons we to be replaced constantly through your diet. That is one of the reasons we need to eat good foods every day, not just once in a while. need to eat good foods every day, not just once in a while.

With exception of vitamin B6 and B12, they are readily excreted in urine With exception of vitamin B6 and B12, they are readily excreted in urine without appreciable storage, so frequent consumption becomes necessary. without appreciable storage, so frequent consumption becomes necessary.

They are generally nontoxic when present in excess of needs, although They are generally nontoxic when present in excess of needs, although symptoms may be reported in people taking mega doses of symptoms may be reported in people taking mega doses of niacin, vitamin niacin, vitamin C, or pyridoxine (vitamin B6).C, or pyridoxine (vitamin B6).

All the B vitamins function as coenzymes or cofactors, assisting in the All the B vitamins function as coenzymes or cofactors, assisting in the activity of important enzymes and allowing energy-producing reactions to activity of important enzymes and allowing energy-producing reactions to proceed normally. As a result, any lack of water-soluble vitamins mostly proceed normally. As a result, any lack of water-soluble vitamins mostly affects growing or rapidly metabolizing tissues such as skin, blood, the affects growing or rapidly metabolizing tissues such as skin, blood, the digestive tract, and the nervous system. digestive tract, and the nervous system.

Water-soluble vitaminsWater-soluble vitamins The water-soluble vitamins include vitamins B1, B2, B3, B6, The water-soluble vitamins include vitamins B1, B2, B3, B6,

B12 and vitamin Cas well as Folic acid and Biotin. B12 and vitamin Cas well as Folic acid and Biotin.

Vitamin C has been in the spotlight for many years and is best Vitamin C has been in the spotlight for many years and is best known for its ability to combat colds and its function as an known for its ability to combat colds and its function as an antioxidant.antioxidant.

The B vitamins basically act as coenzymes and are involved The B vitamins basically act as coenzymes and are involved in the metabolism of fat, protein, and carbohydrates. in the metabolism of fat, protein, and carbohydrates.

The water-soluble vitamins are not normally stored in the The water-soluble vitamins are not normally stored in the body in any significant amounts. Therefore, they must be body in any significant amounts. Therefore, they must be consumed in constant daily amounts to avoid depletion and consumed in constant daily amounts to avoid depletion and interference with normal metabolic functioning.interference with normal metabolic functioning.

Coenzymes and CofactorsCoenzymes and Cofactors Coenzymes and cofactorsCoenzymes and cofactors are any non-protein molecules (usually organic are any non-protein molecules (usually organic

molecules or metal ions) that are required by an enzyme for its activity.molecules or metal ions) that are required by an enzyme for its activity.

Enzymes may or may not have a nonprotein molecule attached to them. Enzymes may or may not have a nonprotein molecule attached to them. Some enzymes contain covalently bound carbohydrate groups, which do Some enzymes contain covalently bound carbohydrate groups, which do not affect the catalytic activity, but may influence enzyme stability or not affect the catalytic activity, but may influence enzyme stability or solubility.solubility.

Many enzymes have metal ions, while some others possess low weight Many enzymes have metal ions, while some others possess low weight organic molecules; these are called cofactors /coenzymes, and are essential organic molecules; these are called cofactors /coenzymes, and are essential for enzyme activity.for enzyme activity.

An organic cofactor is commonly known as coenzyme. Cofactors and An organic cofactor is commonly known as coenzyme. Cofactors and coenzymes may be covalently or noncovalently attached to the protein coenzymes may be covalently or noncovalently attached to the protein molecule, called apoenzyme. molecule, called apoenzyme.

Cofactors are often classified as inorganic substances that are required for, Cofactors are often classified as inorganic substances that are required for, or increase the rate of, catalysis.or increase the rate of, catalysis.

coenzymes are organic molecules that are required by certain enzymes to coenzymes are organic molecules that are required by certain enzymes to carry out catalysis. carry out catalysis.

Coenzymes and CofactorsCoenzymes and Cofactors cofactors /coenzymes bind to the active site of the enzyme cofactors /coenzymes bind to the active site of the enzyme

and participate in catalysis but are not considered substrates of and participate in catalysis but are not considered substrates of the reaction. the reaction.

An apoenzyme lacks catalytic activity in the absence of its specific An apoenzyme lacks catalytic activity in the absence of its specific cofactor /coenzymecofactor /coenzyme. .

When a cofactor is so tightly bound to the apoenzyme that it is difficult to When a cofactor is so tightly bound to the apoenzyme that it is difficult to remove it without damaging the enzyme, the cofactor is often called a remove it without damaging the enzyme, the cofactor is often called a prosthetic group. prosthetic group.

Both coenzymes and cofactors generally contribute to enzyme activity as Both coenzymes and cofactors generally contribute to enzyme activity as well as stability. The complex of an apoenzyme and the cofactor is known well as stability. The complex of an apoenzyme and the cofactor is known as holoenzyme.as holoenzyme.

Coenzyme molecules are often Vitamins or are Coenzyme molecules are often Vitamins or are made from vitaminsmade from vitamins

Inactive enzyme Inactive enzyme

Vitamin coenzymeVitamin coenzyme

Active enzymeActive enzyme

cofactorcofactor

EnzymeEnzyme

Substrate Substrate

Vitamins OverviewVitamins Overview What is a vitamin?What is a vitamin? What are the two types of vitamins?What are the two types of vitamins? Where do I get my vitamins?Where do I get my vitamins? How much do I need?How much do I need? Why are the vitamins important? Why are the vitamins important?

• Associated diseases.Associated diseases.

Vitamins OverviewVitamins Overview The term vitamin is derived from the words:The term vitamin is derived from the words:

vitalvital and and amineamine because vitamins are required for life and were because vitamins are required for life and were

originally thought to be amines.originally thought to be amines. Although not all vitamins are amines, they are Although not all vitamins are amines, they are

organic compounds required by humans in small organic compounds required by humans in small amounts from the diet.amounts from the diet.

An organic compound is considered a vitamin if a An organic compound is considered a vitamin if a lack of that compound in the diet results in overt lack of that compound in the diet results in overt symptoms of deficiency.symptoms of deficiency.

Vitamins OverviewVitamins Overview Vitamins are grouped by their biological and Vitamins are grouped by their biological and

chemical activity, not their structure. chemical activity, not their structure. Thus, each "vitamin" may refer to several Thus, each "vitamin" may refer to several vitamervitamer

compounds that all show the biological activity compounds that all show the biological activity associated with a particular vitamin.associated with a particular vitamin.

VitamersVitamers are often inter-converted in the body. are often inter-converted in the body.

Such a set of chemicals are grouped under an Such a set of chemicals are grouped under an alphabetized vitamin "generic descriptor" title, such alphabetized vitamin "generic descriptor" title, such as "vitamin A," which includes the retinoid as "vitamin A," which includes the retinoid compounds (retinal, retinol , retinoic acid and many compounds (retinal, retinol , retinoic acid and many carotenoids carotenoids

Good Sources of Vitamins Good Sources of Vitamins Vitamin Pyramid Vitamin Pyramid

Vitamins BioavailabilityVitamins Bioavailability

Vitamins BioavailabilityVitamins Bioavailability = amount available + amount absorbed = amount available + amount absorbed

Vitamins Bioavailability affected byVitamins Bioavailability affected by Efficiency of digestionEfficiency of digestion Nutrition statusNutrition status Other foods consumed at the same timeOther foods consumed at the same time Method of food preparationMethod of food preparation Source of nutrientSource of nutrient

• synthetic, naturally occurring, fortifiedsynthetic, naturally occurring, fortified

Reference Value DefinitionsReference Value Definitions Estimated Average Requirement (EAR)Estimated Average Requirement (EAR)

• a daily nutrient intake value that is estimated to meet the a daily nutrient intake value that is estimated to meet the requirements of half the healthy individuals in a grouprequirements of half the healthy individuals in a group

• intake at which the risk of inadequacy is 0.5 (50 percent) to intake at which the risk of inadequacy is 0.5 (50 percent) to an individualan individual

Recommended Daily Allowance (RDA)Recommended Daily Allowance (RDA)• the average daily intake level that is sufficient to meet the the average daily intake level that is sufficient to meet the

nutrient requirement of nearly all (97-98%) healthy nutrient requirement of nearly all (97-98%) healthy individuals in a particular life stage and gender groupindividuals in a particular life stage and gender group

• the intake at which the risk of inadequacy is very small—the intake at which the risk of inadequacy is very small—only 0.02 to 0.03 (2 to 3 percent) only 0.02 to 0.03 (2 to 3 percent)

Tolerable Upper Limit (UL)Tolerable Upper Limit (UL)• highest level of a daily nutrient that is likely to pose no risk highest level of a daily nutrient that is likely to pose no risk

of adverse health effects to almost all individualsof adverse health effects to almost all individuals

Two Classifications of Vitamins

Water SolubleWater Soluble Vitamin CVitamin C B VitaminsB Vitamins

ThiaminThiamin RiboflavinRiboflavin NiacinNiacin Pantothenic AcidPantothenic Acid BiotinBiotin Vitamin BVitamin B66

Folic AcidFolic Acid Vitamin BVitamin B1212

Fat SolubleFat Soluble Vitamin AVitamin A Vitamin DVitamin D Vitamin EVitamin E Vitamin KVitamin K

Vitamin Comparisons

Water Soluble Water Soluble

Vits B & CVits B & C

Fat Soluble Fat Soluble

Vits A, D, E, KVits A, D, E, K

AbsorptionAbsorptionDirectly into bloodDirectly into bloodLymph then blood/protein Lymph then blood/protein carriercarrier

StorageStorageShort termShort termLong termLong term

ExcretionExcretionKidneys detect and Kidneys detect and remove in urineremove in urine

Less readily excreted – Less readily excreted – remain in fat storage sitesremain in fat storage sites

ToxicityToxicityPossiblePossibleLikelyLikely

RequirementsRequirementsDaily intakeDaily intakeRegular intakeRegular intake

Fat Soluble Vitamin Functions

Vitamin A

Vitamin D

Vitamin E

Vitamin K

Vitamin A Vitamin A RetinolRetinol Vitamin A is a generic term for a large number of Vitamin A is a generic term for a large number of

related compounds. related compounds. Retinol (an alcohol) and retinal (an aldehyde) are Retinol (an alcohol) and retinal (an aldehyde) are

often referred to as often referred to as preformedpreformed vitamin A. vitamin A. Retinal can be converted by the body to retinoic acid, Retinal can be converted by the body to retinoic acid,

the form of vitamin A known to affect gene the form of vitamin A known to affect gene transcription.transcription.

Retinol, retinal, retinoic acid, and related compounds Retinol, retinal, retinoic acid, and related compounds are known as retinoids (are known as retinoids (VitamerVitamer). ).

Beta-carotene and other carotenoids that can be Beta-carotene and other carotenoids that can be converted by the body into retinol are referred to as converted by the body into retinol are referred to as provitaminprovitamin A carotenoids. A carotenoids.

Vitamin AVitamin A Vital – promote growth and reproduction and Vital – promote growth and reproduction and

maintain healthmaintain health

organicorganic

do not supply caloriesdo not supply calories requiredrequired in the diet in small amounts (micrograms or in the diet in small amounts (micrograms or

milligrams per day) for the maintenance of normal milligrams per day) for the maintenance of normal health and metabolic integrityhealth and metabolic integrity

Vitamin AVitamin A Vitamin A was the first fat-soluble vitamin identified (in 1913). Vitamin A was the first fat-soluble vitamin identified (in 1913).

Vitamin A comprises the Vitamin A comprises the preformedpreformed retinoids ( retinoids (Retinol, retinal, retinoic Retinol, retinal, retinoic acid)acid), plus the precursor forms, the , plus the precursor forms, the provitaminprovitamin A A carotenoidscarotenoids. .

Preformed retinoidsPreformed retinoids is a collective term for retinol, retinal, and is a collective term for retinol, retinal, and retinoic acid, all of which are biologically active. retinoic acid, all of which are biologically active.

The The provitamin A carotenoidsprovitamin A carotenoids include mainly beta-carotene, include mainly beta-carotene, which is converted to retinoids with varying degrees of efficiency.which is converted to retinoids with varying degrees of efficiency.

Retinoids are sensitive to heat, light, and oxidation by air. while Retinoids are sensitive to heat, light, and oxidation by air. while Beta-carotene is relatively more stable. Beta-carotene is relatively more stable.

There is some loss of vitamin A with cooking, but only after boiling There is some loss of vitamin A with cooking, but only after boiling for a comparatively long period.for a comparatively long period.

Vitamin AVitamin A

Retinoids are converted to retinol in the Retinoids are converted to retinol in the intestines and transported with dietary fat to the intestines and transported with dietary fat to the liver, where it is stored. liver, where it is stored.

A special transport protein, A special transport protein, retinolbinding retinolbinding protein (RBP),protein (RBP), transports vitamin A from the transports vitamin A from the liver to other tissues. liver to other tissues.

Carotenoids are absorbed intact at a much lower Carotenoids are absorbed intact at a much lower absorption rate than retinol. Of all the absorption rate than retinol. Of all the carotenoids, beta-carotene has the highest carotenoids, beta-carotene has the highest potential vitamin-A activity.potential vitamin-A activity.

Vitamin A functionsVitamin A functions The active forms of vitamin A have three The active forms of vitamin A have three

basic functions:basic functions: vision,vision, growth and growth and developmentdevelopment of tissues, of tissues, immunityimmunity..

VisionVision.. Vitamin A combines with a Vitamin A combines with a protein called protein called opsinopsin to form to form rhodopsinrhodopsin in in the rod cells of the retina. When vitamin the rod cells of the retina. When vitamin A is inadequate, the lack of rhodopsin A is inadequate, the lack of rhodopsin makes it difficult to see in dim light. makes it difficult to see in dim light.

VisionVisionRetinalRetinal is the key molecule involved in vision and responsible for is the key molecule involved in vision and responsible for

converting the energy in light photons into electrical impulses converting the energy in light photons into electrical impulses in the retinain the retina

The precursor of 11-The precursor of 11-ciscis-retinal is the alcohol all--retinal is the alcohol all-transtrans-retinol -retinol ((Vitamin A).Vitamin A). These molecules (11- These molecules (11-ciscis-retinal or vitamin A) -retinal or vitamin A) cannot be synthesized by mammals and has to be acquired cannot be synthesized by mammals and has to be acquired through the diet. through the diet.

Precursors to Vitamin A are carotenes, which are found in Precursors to Vitamin A are carotenes, which are found in many vegetables including carrots. Perhaps this leads credence many vegetables including carrots. Perhaps this leads credence to the old superstition that carrots help you see better in the to the old superstition that carrots help you see better in the dark - indeed, it is known that a deficiency of Vitamin A leads dark - indeed, it is known that a deficiency of Vitamin A leads to to night blindnessnight blindness and eventually damage to the retinal cells and eventually damage to the retinal cells involved in vision.involved in vision.

VisionVision AllAll--transtrans-retinol is converted to -retinol is converted to

11-11-ciscis-retinal.-retinal. The photosensitive molecule The photosensitive molecule

involved in vision is called involved in vision is called rhodopsinrhodopsin, (also known as visual , (also known as visual purple) which consists of a large purple) which consists of a large protein (having a molecular protein (having a molecular weight of around 38,000) called weight of around 38,000) called opsin, joined to 11-cis-retinal.opsin, joined to 11-cis-retinal.

Opsin does not absorb visible Opsin does not absorb visible light, but when it is bonded with light, but when it is bonded with 11-cis-retinal to form 11-cis-retinal to form rhodopsinrhodopsin, , the new molecule has a very the new molecule has a very broad absorption band in the broad absorption band in the visible region of the spectrum. visible region of the spectrum.

rhodopsinrhodopsin

The rhodopsin cycleThe rhodopsin cycle

Vitamin A functions, continueVitamin A functions, continue Growth and development of tissuesGrowth and development of tissues.. Vitamin A is involved in Vitamin A is involved in

normal cell differentiation specially for epithelial tissue cells normal cell differentiation specially for epithelial tissue cells of Cornea, skin, respiratory lining, GI tract liningof Cornea, skin, respiratory lining, GI tract lining

Vitamin A supports male and female reproductive processes Vitamin A supports male and female reproductive processes and bone growth. and bone growth.

ImmunityImmunity.. Vitamin A is essential for immune function and Vitamin A is essential for immune function and vitamin-A deficiency is associated with decreased resistance vitamin-A deficiency is associated with decreased resistance to infections. to infections.

• Respiratory infections and diarrhea 2-3X more likely in kids Respiratory infections and diarrhea 2-3X more likely in kids with low Vitamin A.with low Vitamin A.

• Bacteria and viruses more likely to invade unhealthy epithelial Bacteria and viruses more likely to invade unhealthy epithelial tissuetissue

The severity of some infections, such as measles and diarrhea, The severity of some infections, such as measles and diarrhea, is reduced by vitamin-A supplementation among those who is reduced by vitamin-A supplementation among those who suffer from vitamin-A deficiency. suffer from vitamin-A deficiency.

Vitamin A functions, continueVitamin A functions, continue It has been suggested that beta-carotene and other carotenoids (also It has been suggested that beta-carotene and other carotenoids (also

called called phytochemicalsphytochemicals) may function as ) may function as antioxidantsantioxidants by by neutralizing neutralizing free radicalsfree radicals..

Free radicals are unstable, highly reactive Free radicals are unstable, highly reactive moleculesmolecules that damage that damage

DNADNA, cause cell injury, and increase the risk of , cause cell injury, and increase the risk of chronicchronic disease. disease.

Beta-carotene has also been associated with reducing the risk of Beta-carotene has also been associated with reducing the risk of lung lung cancercancer. .

Lutein and zeaxanthin, yellow carotenoid pigments in corn and dark Lutein and zeaxanthin, yellow carotenoid pigments in corn and dark green leafy vegetables, may reduce the risk of green leafy vegetables, may reduce the risk of macular macular degeneration of cornea or retina (degeneration of cornea or retina ( الشبكية او القرنية الشبكية تبقع او القرنية (( تبقعand age-related and age-related cataracts (cataracts ( االزرق االزرق الماء ..((الماء

Lycopene, a red carotenoid pigment in tomatoes, may help reduce Lycopene, a red carotenoid pigment in tomatoes, may help reduce the risk of prostrate cancer, the risk of prostrate cancer, cardiovascularcardiovascular disease, and skin disease, and skin damage from sunlight. damage from sunlight.

Repairs skin and promotes the growth of elastin e.g Retain ARepairs skin and promotes the growth of elastin e.g Retain A

Retin A is retinol that Retin A is retinol that Repairs skin and Repairs skin and promotes the growth promotes the growth of elastinof elastin

which foods are rich in vitamin A sources which foods are rich in vitamin A sources (preformed and provitamin A precursors)?(preformed and provitamin A precursors)?

PreformedPreformed RetinoidsRetinoids

• LiverLiver

• FishFish

• Fish oilsFish oils

• Fortified milkFortified milk

• EggEgg

PreformedPreformed RetinoidsRetinoids

• LiverLiver

• FishFish

• Fish oilsFish oils

• Fortified milkFortified milk

• EggEgg

Provitamin A CProvitamin A Carotenoidsarotenoids

• Dark greensDark greens

• Yellow-orangeYellow-orange

• Carrots,Carrots,

• kale (kale (اللفتاللفت), ),

• spinach, spinach,

• squash, squash,

• sweet potatoes, sweet potatoes,

• cantaloupe,cantaloupe,

• peaches,peaches,

• broccoli, broccoli,

• apricotsapricots

Provitamin A CProvitamin A Carotenoidsarotenoids

• Dark greensDark greens

• Yellow-orangeYellow-orange

• Carrots,Carrots,

• kale (kale (اللفتاللفت), ),

• spinach, spinach,

• squash, squash,

• sweet potatoes, sweet potatoes,

• cantaloupe,cantaloupe,

• peaches,peaches,

• broccoli, broccoli,

• apricotsapricots

Essential Nutrient

which foods are rich in vitamin Awhich foods are rich in vitamin A??

VitaminVitamin A AFunctionsFunctions Deficiency Deficiency symptomssymptoms

People at riskPeople at risk SourcesSources ToxicityToxicity

Preformed Preformed retinoids and retinoids and provitamin A provitamin A carotinoids carotinoids

Vision in dim Vision in dim light and color light and color vision, cell vision, cell differentiation differentiation and growth, and growth, immunity immunity

Poor growth, Poor growth, night blindness, night blindness, blindness, dry blindness, dry skin, skin, Xerophthalmia Xerophthalmia (( الملتحمة الملتحمة جفاف ((جفاف

Rare in United Rare in United States but States but common in common in preschool preschool children living children living in poverty in in poverty in developing developing countries, countries, alcoholics alcoholics

Preformed Preformed vitamin A: vitamin A: liver, fortified liver, fortified milk, fish liver milk, fish liver oils oils Provitamin A:Provitamin A: red, orange, red, orange, dark green, and dark green, and yellow yellow vegetables, vegetables, orange fruits orange fruits

Headache, Headache, vomiting, vomiting, double vision, double vision, hair loss, dry hair loss, dry mucous mucous membranes, membranes, bone and joint bone and joint pain, fractures, pain, fractures, liver damage, liver damage, hemorrhage, hemorrhage, coma, coma, teratogenic teratogenic effects (effects ( او او مسخ مسخ

خلقي خلقي تشوه :( :(تشوهspontaneous spontaneous abortions, birth abortions, birth defects. defects.

Vit A deficiency Vit A deficiency

Dietary deficiency of vitamin A is rare in North America and Dietary deficiency of vitamin A is rare in North America and western Europe.western Europe.

it is the leading cause of blindness in children worldwide.it is the leading cause of blindness in children worldwide. Newborn and premature infants, the urban poor, older adults, Newborn and premature infants, the urban poor, older adults,

people with alcoholism or liver disease, and those with fat people with alcoholism or liver disease, and those with fat malabsorption syndrome are all at increased risk.malabsorption syndrome are all at increased risk.

One of the earliest symptoms of vitamin-A deficiency is night blindness. It One of the earliest symptoms of vitamin-A deficiency is night blindness. It is a temporary condition, but if left untreated it can cause permanent is a temporary condition, but if left untreated it can cause permanent blindness. This degeneration is called xerophthalmia blindness. This degeneration is called xerophthalmia الملتحمة الملتحمة جفاف , ,((((جفافand it usually occurs in children after they are weaned. and it usually occurs in children after they are weaned.

Symptoms of xerophthalmia include dryness of the cornea and Symptoms of xerophthalmia include dryness of the cornea and eye membranes due to lack of mucus production, which leaves eye membranes due to lack of mucus production, which leaves the eye vulnerable to surface dirt and bacterial infections.the eye vulnerable to surface dirt and bacterial infections.

Vit A deficiencyVit A deficiency

Vitamin-A deficiency can cause follicular hyperkeratosis Vitamin-A deficiency can cause follicular hyperkeratosis (( الجلد شعر جريبات تقرن و الجلد ضخامة شعر جريبات تقرن و a condition in which hair follicles ), a condition in which hair follicles ,(ضخامة

become plugged with keratin, giving a bumpy appearance and a rough, dry become plugged with keratin, giving a bumpy appearance and a rough, dry texture to skin.texture to skin.

In developing countries, the severity of infectious diseases such as measles In developing countries, the severity of infectious diseases such as measles is often correlated to the degree of vitamin-A deficiency. is often correlated to the degree of vitamin-A deficiency.

Providing large doses of vitamin A reduces the risk of dying from these Providing large doses of vitamin A reduces the risk of dying from these infections. infections.

The age range of the target population for vitamin-A intervention The age range of the target population for vitamin-A intervention programs is usually from birth to seven years. programs is usually from birth to seven years.

Administration of high-potency doses in the range of 15,000 to 60,000 Administration of high-potency doses in the range of 15,000 to 60,000 micrograms (μg) are distributed to young children in targeted areas of the micrograms (μg) are distributed to young children in targeted areas of the world to build up liver stores for up to six months. However, consumption world to build up liver stores for up to six months. However, consumption of adequate food sources is the most important long-term solution to of adequate food sources is the most important long-term solution to vitamin-A deficiency.vitamin-A deficiency.

Vit A ToxicityVit A ToxicityNone of the forms of vitamin are easily excreted, so toxicity is a risk for those None of the forms of vitamin are easily excreted, so toxicity is a risk for those

with kidney disease or as people age. with kidney disease or as people age.

Vitamin-A toxicity, called Vitamin-A toxicity, called hypervitaminosishypervitaminosis A, A, It can result from long-term supplementation of two to four times the It can result from long-term supplementation of two to four times the

Recommended Daily Allowance (RDA) for preformed vitamin A. Recommended Daily Allowance (RDA) for preformed vitamin A. Excess intake of preformed vitamin A is a teratogen, meaning it can cause Excess intake of preformed vitamin A is a teratogen, meaning it can cause

birth defects. birth defects. Birth defects associated with vitamin-A toxicity include:Birth defects associated with vitamin-A toxicity include:

cleft palate (cleft palate ( الحنك الحنك انشقاق ((انشقاق heart abnormalitiesheart abnormalities brain malfunction. brain malfunction.

Acute excess intake during pregnancy can also cause spontaneous Acute excess intake during pregnancy can also cause spontaneous abortions. abortions.

Pregnant women should avoid prenatal supplements containing retinal, as Pregnant women should avoid prenatal supplements containing retinal, as well as medications made from retinoids, such as Accutane and Retin-A. well as medications made from retinoids, such as Accutane and Retin-A.

Prolonged and excessive consumption of carotene-rich foods can lead to Prolonged and excessive consumption of carotene-rich foods can lead to hypercarotenemia (hypercarotenemia ( الدم جزرنة الدم فرط جزرنة a clinical condition characterized by ), a clinical condition characterized by ,(فرطdeep orange discoloration of the skin and increased carotene levels in the deep orange discoloration of the skin and increased carotene levels in the blood. This condition is usually harmless.blood. This condition is usually harmless.

Vitamin D (Calciferol)Vitamin D (Calciferol) Common Names: Common Names: Vitamin D; Calciferol, Cholecalciferol, ErgocalciferolVitamin D; Calciferol, Cholecalciferol, Ergocalciferol Forms: Forms: Calciferol, cholecalciferol, ergocalciferol, irradiated ergosterolCalciferol, cholecalciferol, ergocalciferol, irradiated ergosterol Vitamin DVitamin D plays a critical role in the body’s use of calcium and phosphorous. It plays a critical role in the body’s use of calcium and phosphorous. It

increases the amount of calcium absorbed from the small intestine and helps form and increases the amount of calcium absorbed from the small intestine and helps form and maintain bones. Children especially need adequate amounts of vitamin D to develop maintain bones. Children especially need adequate amounts of vitamin D to develop strong bones and healthy teeth.strong bones and healthy teeth.

Vitamin DVitamin D is is Called a “conditional” vitamin.Called a “conditional” vitamin. For most people in sunny regions , sun provides 80-100% of their needs of For most people in sunny regions , sun provides 80-100% of their needs of Vitamin DVitamin D

Vitamin D2 (ergocalciferol) is obtained from plants.

• Vitamin D3 is cholecalciferol derived from animal products

Vitamin DVitamin D

Structures of Vitamin DStructures of Vitamin D There are different forms of vitamin DThere are different forms of vitamin D Vitamin D2 (ergocalciferol)Vitamin D2 (ergocalciferol) vitamin D3 (cholecalciferol) vitamin D3 (cholecalciferol) provitaminsprovitamins Vitamin D is a generic term and indicates a molecule Vitamin D is a generic term and indicates a molecule

of the general structure that contains the 4 fused rings of the general structure that contains the 4 fused rings of steroid with differing side chain structures.of steroid with differing side chain structures.

Technically vitamin D is classified as a seco-steroid. Technically vitamin D is classified as a seco-steroid. Seco-steroids are those in which one of the rings has Seco-steroids are those in which one of the rings has

been broken.been broken. in vitamin D, the 9,10 carbon-carbon bond of ring B in vitamin D, the 9,10 carbon-carbon bond of ring B

is broken, and it is indicated by the inclusion of is broken, and it is indicated by the inclusion of "9,10-seco" in the official nomenclature "9,10-seco" in the official nomenclature

Vitamins D3 & D2Vitamins D3 & D2 Vitamin D2 (ergocalciferol) is obtained from plants.Vitamin D2 (ergocalciferol) is obtained from plants. Vitamin D3 is cholecalciferol derived from animal products Vitamin D3 is cholecalciferol derived from animal products Vitamin D3 (cholecalciferol) can be produced Vitamin D3 (cholecalciferol) can be produced

photochemically by the action of sunlight or ultraviolet light photochemically by the action of sunlight or ultraviolet light from the precursor sterol from the precursor sterol 7-dehydrocholesterol 7-dehydrocholesterol which is which is present in the epidermis or skin of most higher animals.present in the epidermis or skin of most higher animals.

Thus, it is important to appreciate that vitamin D3 can be Thus, it is important to appreciate that vitamin D3 can be endogenously produced and that as long as the animal (or endogenously produced and that as long as the animal (or human) has access on a regular basis to sunlight there is no human) has access on a regular basis to sunlight there is no dietary requirement for this vitamin. dietary requirement for this vitamin.

Vitamin D2 = ergocalciferol (which is equivalently potent to Vitamin D2 = ergocalciferol (which is equivalently potent to vitamin D3 in humans and many mammals) is produced vitamin D3 in humans and many mammals) is produced commercially by the irradiation of the plant sterol ergosterol commercially by the irradiation of the plant sterol ergosterol with ultraviolet light. with ultraviolet light.

Absorption of Vitamin DAbsorption of Vitamin D Vitamin D from foods is absorbed from the upper part of the Vitamin D from foods is absorbed from the upper part of the

small intestine, along with dietary fat, and transported to the small intestine, along with dietary fat, and transported to the liver. liver.

In the skin, ultraviolet (UV) radiation from the sun converts a In the skin, ultraviolet (UV) radiation from the sun converts a cholesterolcholesterol derivative derivative 7-dehydrocholesterol7-dehydrocholesterol to to cholecalciferolcholecalciferol, , which enters the blood stream and is transported to the liver. which enters the blood stream and is transported to the liver.

In the liver, vitamin D is converted to In the liver, vitamin D is converted to calcidiolcalcidiol, an inactive , an inactive form that circulates in blood. Kidneys take up calcidiol and form that circulates in blood. Kidneys take up calcidiol and convert it to an active convert it to an active hormonehormone form of vitamin D called form of vitamin D called calcitriolcalcitriol. .

People with chronic kidney failure have very low levels of People with chronic kidney failure have very low levels of calcitriol and must be routinely treated with this form of the calcitriol and must be routinely treated with this form of the vitamin.vitamin.

Vitamin D –

Skin Cholesterol derivative

Cholecalciferol

blood

Calcidiol (inactive)

blood

Calcitriol (Active hormone form of vitamin D)

5-15 min Sunlight/week

Functions of Vitamin DFunctions of Vitamin D The group known as the D vitamins are required for growth, especially bone The group known as the D vitamins are required for growth, especially bone

growth or "calcification". growth or "calcification". The best-known function of active vitamin D is to help regulate blood levels of The best-known function of active vitamin D is to help regulate blood levels of

calcium and phosphorous. Vitamin D increases absorption of these minerals from calcium and phosphorous. Vitamin D increases absorption of these minerals from the gastrointestinal (GI) tract. In combination with parathyroid hormone, it the gastrointestinal (GI) tract. In combination with parathyroid hormone, it enhances their reabsorption from the kidneys and their mobilization from bones enhances their reabsorption from the kidneys and their mobilization from bones into the blood. into the blood.

Vitamin D can be considered both a vitamin and a hormone.Vitamin D can be considered both a vitamin and a hormone. Vitamin D plays an important role in maintaining adequate blood levels of insulin Vitamin D plays an important role in maintaining adequate blood levels of insulin

and may assist the metabolism of sugar.and may assist the metabolism of sugar. 1,25 dihydroxycholecalciferol (DHCC), the most active form of vitamin D, 1,25 dihydroxycholecalciferol (DHCC), the most active form of vitamin D,

functions to:functions to:» Increase the absorption of calcium from the intestines by stimulating the » Increase the absorption of calcium from the intestines by stimulating the synthesis of calcium-binding protein. This occurs in the brush border of the synthesis of calcium-binding protein. This occurs in the brush border of the intestinal mucosa.intestinal mucosa.» Increase the resorption (» Increase the resorption (ارتشافارتشاف) of calcium from bone.) of calcium from bone.» Increase serum calcium levels. Once this occurs calcium can then be » Increase serum calcium levels. Once this occurs calcium can then be stored in the bones. Thus, even though it initially causes bone resorption, stored in the bones. Thus, even though it initially causes bone resorption, the net effect is to increase calcium deposition in the bonethe net effect is to increase calcium deposition in the bone

Vitamin D helps maintain calcium levels even if dietary intakes are not optimal. Vitamin D helps maintain calcium levels even if dietary intakes are not optimal. Calcitriol controls growth of normal cells and some cancer cells. Adequate Calcitriol controls growth of normal cells and some cancer cells. Adequate vitamin-D status has been linked to a reduced risk of developing breast, colon, and vitamin-D status has been linked to a reduced risk of developing breast, colon, and prostrate cancersprostrate cancers

Primary sources of vitamin DPrimary sources of vitamin D

The primary food sources of vitamin D are milk and The primary food sources of vitamin D are milk and other dairy products fortified with vitamin D.other dairy products fortified with vitamin D.

Egg yolk Egg yolk Vitamin D is also found in oily fish as well as in cod Vitamin D is also found in oily fish as well as in cod

liver oil. liver oil. Vegetables are usually low in vitamin D. Leafy dark Vegetables are usually low in vitamin D. Leafy dark

green vegetables and mushrooms are significant green vegetables and mushrooms are significant sources of vitamin D from non-animal sources. sources of vitamin D from non-animal sources.

In addition to the vitamin D provided by food, we In addition to the vitamin D provided by food, we obtain vitamin D through our skin which makes obtain vitamin D through our skin which makes vitamin D in response to sunlight.vitamin D in response to sunlight.

Although about 10 substances have fat soluble vitamin D Although about 10 substances have fat soluble vitamin D activity, vitamins D2 (or ergocalciferol) and D3 (or activity, vitamins D2 (or ergocalciferol) and D3 (or cholecalciferol) are the two most significant to humans.cholecalciferol) are the two most significant to humans.

Vitamin D3 is found in our diet, while vitamin D2 occurs in Vitamin D3 is found in our diet, while vitamin D2 occurs in yeasts and fungi. Both can be formed from their respective yeasts and fungi. Both can be formed from their respective provitamins by ultraviolet irradiation; in man the provitamin provitamins by ultraviolet irradiation; in man the provitamin (7-dehydrocholesterol), which is found in skin, can be (7-dehydrocholesterol), which is found in skin, can be converted by sunlight to vitamin D3 and thus is an important converted by sunlight to vitamin D3 and thus is an important source of the vitamin. Human beings can utilize both vitamins source of the vitamin. Human beings can utilize both vitamins D2 and D3.D2 and D3.

Vitamin D deficiencyVitamin D deficiency Children in particular need adequate amounts of Children in particular need adequate amounts of

vitamin D to develop strong bones and healthy teeth. vitamin D to develop strong bones and healthy teeth. Symptoms of vitamin D deficiency in growing Symptoms of vitamin D deficiency in growing

children include rickets children include rickets ((الكساحالكساح)) (long, soft bowed (long, soft bowed legs) and flattening of the back of the skull. legs) and flattening of the back of the skull.

Vitamin D deficiency in adults is called osteomalacia Vitamin D deficiency in adults is called osteomalacia (( العظام تلين او العظام لين تلين او which leads to muscular ), which leads to muscular ,(لينweakness and weak bones. weakness and weak bones.

rickets in childrenrickets in children

Osteomalacia and osteoporosis in adultsOsteomalacia and osteoporosis in adults

Vitamin D

Deficiency: Children = Ricket’s DiseaseAdults = Osteomalacia Calcium absorption; Blood Calcium

= bone deficiency

Toxicity: 10x RDA Calcium absorption; Blood Calcium

= Calcium deposits on soft tissue eg kidney stones

RDA: 5 μg/dl 5 μg/dl (19-30 yrs)

Long-term deficiency of vitamin D affects the skeletal system. Long-term deficiency of vitamin D affects the skeletal system. In children, vitamin-D deficiency leads to rickets, a condition In children, vitamin-D deficiency leads to rickets, a condition in which bones weaken and bow under pressure. in which bones weaken and bow under pressure.

In adults, vitamin-D deficiency causes In adults, vitamin-D deficiency causes osteomalaciaosteomalacia, or "soft , or "soft bones," increasing the risk for fractures in hip, spine, and other bones," increasing the risk for fractures in hip, spine, and other bones.bones.

Vitamin-D deficiency also contributes to Vitamin-D deficiency also contributes to

osteoporosisosteoporosis(( العظام العظام هشاشة -In elderly persons, vitamin-. In elderly persons, vitamin .((هشاشةD supplementation reduces the risk of osteoporotic fractures.D supplementation reduces the risk of osteoporotic fractures.

Infants are born with stores of vitamin D that last about six Infants are born with stores of vitamin D that last about six months. Breast milk contains very little vitamin D, however, months. Breast milk contains very little vitamin D, however, and infants beyond six months of age who are exclusively and infants beyond six months of age who are exclusively breastfed must obtain vitamin D via exposure to sunlight or a breastfed must obtain vitamin D via exposure to sunlight or a supplement given under the guidance of a physician.supplement given under the guidance of a physician.

Vitamin D deficiencyVitamin D deficiency

Vitamin D deficiencyVitamin D deficiency Older adults are especially at risk for vitamin-D deficiency for several Older adults are especially at risk for vitamin-D deficiency for several

reasons. The skin, liver, and kidneys lose their capacity to synthesize and reasons. The skin, liver, and kidneys lose their capacity to synthesize and activate vitamin D with advancing age, and older adults typically drink activate vitamin D with advancing age, and older adults typically drink little or no milk, a major dietary source of vitamin D. little or no milk, a major dietary source of vitamin D.

Older adults also rarely venture outdoors, and when they do, they apply Older adults also rarely venture outdoors, and when they do, they apply sunscreen to exposed areas of the body, further contributing to the decline sunscreen to exposed areas of the body, further contributing to the decline in vitamin-D synthesis in the skin.in vitamin-D synthesis in the skin.

Sunscreens with a sun protection factor (SPF) of 8 and above prevent Sunscreens with a sun protection factor (SPF) of 8 and above prevent vitamin-D synthesis. Sunscreen should be applied only after enough time vitamin-D synthesis. Sunscreen should be applied only after enough time has gone to provide sufficient vitamin-D synthesis. has gone to provide sufficient vitamin-D synthesis.

Exposure to the sun does not cause vitamin-D toxicity, and for most Exposure to the sun does not cause vitamin-D toxicity, and for most people, exposing the hands, face, and arms on a clear summer day for people, exposing the hands, face, and arms on a clear summer day for fifteen minutes a few times a week should provide sufficient Vitamin D.fifteen minutes a few times a week should provide sufficient Vitamin D.

Dark-skinned people require longer sunlight exposure because melanin, a Dark-skinned people require longer sunlight exposure because melanin, a skin pigment, is a natural sunscreen.skin pigment, is a natural sunscreen.

Vitamin D deficiencyVitamin D deficiency Dietary recommendations assume that no Dietary recommendations assume that no

vitamin D is available from exposure to vitamin D is available from exposure to sunlight. Thus, people who do not venture sunlight. Thus, people who do not venture outdoors or who live in northern or outdoors or who live in northern or predominantly cloudy climates need to pay predominantly cloudy climates need to pay attention to dietary sources. attention to dietary sources.

Plants are poor sources of vitamin D, so strict Plants are poor sources of vitamin D, so strict vegetarians must meet their vitamin-D needs vegetarians must meet their vitamin-D needs through exposure to sunlight, fortification, or through exposure to sunlight, fortification, or supplementation.supplementation.

Vitamin D is most likely to have toxic effects when consumed in excessive Vitamin D is most likely to have toxic effects when consumed in excessive amounts through supplementation.amounts through supplementation.

vitamin D is the most potentially toxic vitamin in human nutrition, with an vitamin D is the most potentially toxic vitamin in human nutrition, with an upper limit (UL) of 50 micrograms per day. We can obtain the vitamin in upper limit (UL) of 50 micrograms per day. We can obtain the vitamin in an inactive form from food and sunlight exposurean inactive form from food and sunlight exposure

Excess vitamin D raises blood calcium levels, resulting in calcium Excess vitamin D raises blood calcium levels, resulting in calcium precipitation in soft tissues and stone formation in the kidneys, where precipitation in soft tissues and stone formation in the kidneys, where calcium becomes concentrated in an effort to excrete it.calcium becomes concentrated in an effort to excrete it.

The adult DRI for vitamin D is 5 micrograms per day of cholecalciferol or The adult DRI for vitamin D is 5 micrograms per day of cholecalciferol or 200 international units (IU) of vitamin D (1 microgram of calciferol equals 200 international units (IU) of vitamin D (1 microgram of calciferol equals 40 IU of vitamin D).40 IU of vitamin D).

However, because of vitamin D's potential toxicity, caution must be taken However, because of vitamin D's potential toxicity, caution must be taken not to consume too much. Excess Vitamin D intake may lead to vomiting, not to consume too much. Excess Vitamin D intake may lead to vomiting, diarrhea , kidney damage, high blood calcium levels, increased frequency diarrhea , kidney damage, high blood calcium levels, increased frequency in urination, nausea, loss of appetite and weight loss, muscle weakness, in urination, nausea, loss of appetite and weight loss, muscle weakness, dizziness, calcification of heart, blood vessels and lungs; and possibly dizziness, calcification of heart, blood vessels and lungs; and possibly death.death.

symptoms reverse after overdosing is discontinued.symptoms reverse after overdosing is discontinued.

Vitamin D toxicityVitamin D toxicity

Vitamin EVitamin E vitamin-E was firstly associated with reproductive failure in rats in vitamin-E was firstly associated with reproductive failure in rats in

19221922 Vitamin E comprises a family of eight naturally occurring Vitamin E comprises a family of eight naturally occurring

compounds: compounds: • tocopherols (tocopherols (alpha-, beta-, gamma-, and delta-) alpha-, beta-, gamma-, and delta-) • tocotrienols (alpha-, beta-, gamma-, and delta-). tocotrienols (alpha-, beta-, gamma-, and delta-).

The chemical name of vitamin E, is derived from The chemical name of vitamin E, is derived from toco,toco, meaning meaning "related to childbirth.“"related to childbirth.“

The tocopherols, are a closely related group of biologically active The tocopherols, are a closely related group of biologically active compounds. The active tocopherols are named in order of their compounds. The active tocopherols are named in order of their potency. Thus, alpha-tocopherol is the most active.potency. Thus, alpha-tocopherol is the most active.

alpha- tocopherol is the only one to have vitamin-E activity in the alpha- tocopherol is the only one to have vitamin-E activity in the human body. It is also the most common form of vitamin E in food.human body. It is also the most common form of vitamin E in food.

Vitamin E is highly susceptible to destruction by oxygen, metals, Vitamin E is highly susceptible to destruction by oxygen, metals, light, and deep-fat frying. As a result, prolonged food storage lowers light, and deep-fat frying. As a result, prolonged food storage lowers the vitamin-E content of food.the vitamin-E content of food.

Chemical structure of Vitamin EChemical structure of Vitamin E

Overview of Vitamin E Overview of Vitamin E Unlike vitamins A and D, Vitamin E, Vitamin E, is not

stored primarily in liver but instead stored primarily within body fat.

Virtually every tissue has some vitamin E within cell membrane

Absorption is dependent on the absorption of dietary fat

Absorption is dependent on bile and pancreatic enzyme for absorption

Much excreted via bile and urine

Overview of Vitamin EOverview of Vitamin E The vitamin E The vitamin E α-Tocopherolα-Tocopherol is necessary for normal growth. is necessary for normal growth. The main function of alpha-tocopherol in humans appears to be that of an The main function of alpha-tocopherol in humans appears to be that of an

antioxidantantioxidant(protects cells from toxic compounds, heavy metals, radiation, and (protects cells from toxic compounds, heavy metals, radiation, and free radicals).free radicals).

free radicals are formed primarily in the body during normal metabolism and free radicals are formed primarily in the body during normal metabolism and also upon exposure to environmental factors, such as cigarette smoke or also upon exposure to environmental factors, such as cigarette smoke or pollutants. pollutants.

Fats, which are an integral part of all cell membranes, are vulnerable to Fats, which are an integral part of all cell membranes, are vulnerable to destruction through oxidation by free radicals. destruction through oxidation by free radicals. 

The fat-soluble vitamin E, alpha-tocopherol, is distinctively suitable to catch free The fat-soluble vitamin E, alpha-tocopherol, is distinctively suitable to catch free radicals and thus prevent a chain reaction of lipid destructionradicals and thus prevent a chain reaction of lipid destruction of cell membranes of cell membranes and other fats of the tissues. and other fats of the tissues.

The vitamin E The vitamin E α-Tocopherolα-Tocopherol enhances retinal development; protects vitamin A enhances retinal development; protects vitamin A in eyes protecting vitamins C, red blood cells and essential fatty acids from in eyes protecting vitamins C, red blood cells and essential fatty acids from destruction. destruction.

Taking antioxidant supplements, vitamin E in particular, might help prevent Taking antioxidant supplements, vitamin E in particular, might help prevent heart disease and cancer.heart disease and cancer.

Everybody needs E. This hard-working vitamin maintains a lot of our body's Everybody needs E. This hard-working vitamin maintains a lot of our body's tissues, like the ones in our eyes, skin and liver. It protects our lungs from tissues, like the ones in our eyes, skin and liver. It protects our lungs from becoming damaged by polluted air. becoming damaged by polluted air.

Overview of Vitamin EOverview of Vitamin E absorption of vitamin E requires adequate absorption absorption of vitamin E requires adequate absorption

of dietary fat. of dietary fat. the percentage of absorption declines as the amount the percentage of absorption declines as the amount

consumed is increased. consumed is increased. Vitamin E is stored mainly in adipose tissue, while Vitamin E is stored mainly in adipose tissue, while

some is stored in the muscle. The remaining vitamin some is stored in the muscle. The remaining vitamin E is found in cell membranes in tissue.E is found in cell membranes in tissue.

Vitamin E interrupts free-radical chain reactions by Vitamin E interrupts free-radical chain reactions by getting oxidized, thus protecting cell membranes getting oxidized, thus protecting cell membranes from free-radical attack. from free-radical attack.

oxidative stress is highly involved in the development oxidative stress is highly involved in the development of cancer, arthritis, cataracts, heart disease, and in the of cancer, arthritis, cataracts, heart disease, and in the process of aging itself. process of aging itself.

Overview of Vitamin EOverview of Vitamin E Many of the anti-oxidant properties of Vitamin E have been

hypothesized to protect from chronic diseases (i.e. heart, lung cancer, parkinsons, alzheimer’s,etc).

However, it is not yet documented whether supplementation with large doses of vitamin E offers protection against heart disease and cancer beyond that provided by positive dietary and lifestyle changes.

Several other functions of alpha-tocopherol have been identified that are not likely related to its antioxidant capacity.

alpha-tocopherol is known to inhibit the activity of protein kinase C, an important cell-signaling molecule.

Alpha-tocopherol appears to also affect the expression and activities of molecules and enzymes in immune and inflammatory cells.

Additionally, alpha-tocopherol has been shown to inhibit platelet aggregation and to enhance vasodilatation !!!!!!!

Sources of Vitamin ESources of Vitamin E About 20% of vit E in the diet comes from veg. oilsAbout 20% of vit E in the diet comes from veg. oils Fruits and veggiesFruits and veggies Fortified cereals and grain productsFortified cereals and grain products Wheat germ oilWheat germ oil Corn and soybean oilCorn and soybean oil NutsNuts SeedsSeeds animal fat NOT good source - almost none thereanimal fat NOT good source - almost none there Destroyed easily by heat.Destroyed easily by heat.

Sources Vitamin E

Vitamin E deficiencyVitamin E deficiency Vitamin E deficiency has been observed in individuals with:Vitamin E deficiency has been observed in individuals with:

• severe malnutritionsevere malnutrition• genetic defects affecting the alpha-tocopherol transfer genetic defects affecting the alpha-tocopherol transfer

proteinprotein• fat malabsorption syndromesfat malabsorption syndromes• children with liver diseases who have an impaired capacity children with liver diseases who have an impaired capacity

to absorb dietary fat and therefore fat-soluble vitamins, to absorb dietary fat and therefore fat-soluble vitamins, may develop symptomatic vitamin E deficiencymay develop symptomatic vitamin E deficiency..

Severe vitamin E deficiency results mainly in neurological Severe vitamin E deficiency results mainly in neurological symptoms, including impaired balance and coordination symptoms, including impaired balance and coordination (ataxia), injury to the sensory nerves (peripheral neuropathy), (ataxia), injury to the sensory nerves (peripheral neuropathy), muscle weakness (myopathy), and damage to the retina of the muscle weakness (myopathy), and damage to the retina of the eye (pigmented retinopathy). For this reason, people who eye (pigmented retinopathy). For this reason, people who develop peripheral neuropathy, ataxia, or retinitis pigmentosa develop peripheral neuropathy, ataxia, or retinitis pigmentosa should be screened for vitamin E deficiencyshould be screened for vitamin E deficiency

Vitamin E deficiencyVitamin E deficiency children who have born with severe vitamin E children who have born with severe vitamin E

deficiency and are not treated with vitamin E deficiency and are not treated with vitamin E rapidly develop neurological symptoms.rapidly develop neurological symptoms.

While, individuals who develop While, individuals who develop malabsorption of vitamin E in adulthood may malabsorption of vitamin E in adulthood may not develop neurological symptoms for 10-20 not develop neurological symptoms for 10-20 years.years.

Vitamin E and disease preventionVitamin E and disease prevention Cardiovascular diseaseCardiovascular disease

• Increased vitamin E consumption has been found to be associated with Increased vitamin E consumption has been found to be associated with decreased risk of myocardial infarction (heart attack) or death from decreased risk of myocardial infarction (heart attack) or death from heart diseaseheart disease

CataractsCataracts• CataractsCataracts which appear to be formed by protein oxidation in the lens of which appear to be formed by protein oxidation in the lens of

the eye; such oxidation may be prevented by antioxidants like alpha-the eye; such oxidation may be prevented by antioxidants like alpha-tocopherol.  Direct association was reported between vitamin E tocopherol.  Direct association was reported between vitamin E consumption and the incidence and severity of cataracts. increased consumption and the incidence and severity of cataracts. increased vitamin E intake protects against cataract development.vitamin E intake protects against cataract development.

Immune FunctionImmune Function• Alpha-tocopherol has been shown to enhance specific aspects of the Alpha-tocopherol has been shown to enhance specific aspects of the

immune response that appear to decline as people ageimmune response that appear to decline as people age . . CancerCancer

• Many types of cancer are thought to result from oxidative damage to Many types of cancer are thought to result from oxidative damage to DNA caused by free radical formulation . The ability of alpha-DNA caused by free radical formulation . The ability of alpha-tocopherol to neutralize free radicals formulated the hypothesis that tocopherol to neutralize free radicals formulated the hypothesis that Vit E could help in the cancer prevention, however results are not yet Vit E could help in the cancer prevention, however results are not yet confirmedconfirmed

Safety and toxicity aspects of vit ESafety and toxicity aspects of vit E

RDA: 15 mg/dl (19-30 yrs) Few side effects have been noted in adults taking supplements Few side effects have been noted in adults taking supplements

of less than 2,000 mg of alpha-tocopherol daily.of less than 2,000 mg of alpha-tocopherol daily. However, most studies of toxicity or side effects of alpha-However, most studies of toxicity or side effects of alpha-

tocopherol supplementation have lasted only a few weeks to a tocopherol supplementation have lasted only a few weeks to a few months, and side effects occurring as a result of long-term few months, and side effects occurring as a result of long-term alpha-tocopherol supplementation have not been adequately alpha-tocopherol supplementation have not been adequately studied. studied.

The most worrisome possibility is that of impaired blood The most worrisome possibility is that of impaired blood clotting, which may increase the likelihood of hemorrage in clotting, which may increase the likelihood of hemorrage in some individuals.some individuals.

Therfore it is recommended to discontinuing high-dose Therfore it is recommended to discontinuing high-dose vitamin E supplementation one month before elective surgery vitamin E supplementation one month before elective surgery or teeth extraction to decrease the risk of hemorrhageor teeth extraction to decrease the risk of hemorrhage

DrugDrug InteractionsInteractions Use of vitamin E supplements may increase the risk of bleeding in Use of vitamin E supplements may increase the risk of bleeding in

individuals taking anticoagulant drugs, such as warfarin (Coumadin); individuals taking anticoagulant drugs, such as warfarin (Coumadin); antiplatelet drugs; and non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet drugs; and non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen, and others.including aspirin, ibuprofen, and others.

Also, individuals on anticoagulant therapy (blood thinners) or individuals Also, individuals on anticoagulant therapy (blood thinners) or individuals who are vitamin K deficient who are vitamin K deficient should notshould not take alpha-tocopherol supplements take alpha-tocopherol supplements without close medical supervision because of the increased risk of without close medical supervision because of the increased risk of hemorrhage.hemorrhage.

A number of medications may decrease the absorption of vitamin E, A number of medications may decrease the absorption of vitamin E, including cholestyramine (chol-less), colestipol (colestid), isoniazid (anti including cholestyramine (chol-less), colestipol (colestid), isoniazid (anti T.B), mineral oil, orlistat (xenical antiobesity), sucralfate (ulsanic gastric T.B), mineral oil, orlistat (xenical antiobesity), sucralfate (ulsanic gastric ulcer), and the fat substitute, olestra. Anticonvulsant drugs, such as ulcer), and the fat substitute, olestra. Anticonvulsant drugs, such as phenobarbital, phenytoin, or carbamazepine, may decrease plasma levels phenobarbital, phenytoin, or carbamazepine, may decrease plasma levels of vitamin E.of vitamin E.

Vitamin KVitamin K Was first discovered in 1929, by the Danish researcher Henrik Was first discovered in 1929, by the Danish researcher Henrik

Dam.Dam. He noted that vitamin K played a critical role in He noted that vitamin K played a critical role in blood blood

clottingclotting, and he named it vitamin "K" for ", and he named it vitamin "K" for "KoagulationKoagulation." ." Vitamin K is the clotmaster! Vitamin K is the clotmaster! Used by the liver for the formation of prothrombinUsed by the liver for the formation of prothrombin There are two naturally occurring forms of vitamin K.There are two naturally occurring forms of vitamin K. Vitamin K comprises a family of compounds known as Vitamin K comprises a family of compounds known as

quinones.quinones. These include These include phylloquinonephylloquinone from plants sources from plants sources menaquinonesmenaquinones from animal sources. from animal sources. Phylloquinone is the most biologically active form. Phylloquinone is the most biologically active form.

Menaquinones are also synthesized by Menaquinones are also synthesized by bacteriabacteria in the in the intestine and absorbed, contributing about 10 percent of total intestine and absorbed, contributing about 10 percent of total vitamin-K needs. vitamin-K needs.

Vitamin-K absorption depends on normal consumption and Vitamin-K absorption depends on normal consumption and digestion of dietary fat. It is primarily stored in the liver.digestion of dietary fat. It is primarily stored in the liver.

Chemical structure of Vitamin KChemical structure of Vitamin K

Overview of Vitamin KOverview of Vitamin K Vitamin K is found in green leafy vegetables and also, in small Vitamin K is found in green leafy vegetables and also, in small

amounts, in cereals, fruits, and meats. amounts, in cereals, fruits, and meats. Bacteria in the intestines also produce vitamin K, so the absolute Bacteria in the intestines also produce vitamin K, so the absolute

dietary requirement is not known. dietary requirement is not known. This vitamin is needed for the formation of prothrombin , which is This vitamin is needed for the formation of prothrombin , which is

required for the formation of blood clots.required for the formation of blood clots. It is possible for people who regularly take antibiotics that destroy It is possible for people who regularly take antibiotics that destroy

the bacteria in the intestines (normal flora) to be at increased risk for the bacteria in the intestines (normal flora) to be at increased risk for Vitamin k. Vitamin k.

A deficiency would cause an increase in bleeding and hemorrhages. A deficiency would cause an increase in bleeding and hemorrhages. Vitamin K appears to be relatively nontoxic, but high intakes of Vitamin K appears to be relatively nontoxic, but high intakes of

synthetic forms may cause jaundice.synthetic forms may cause jaundice. Supplemental doses also interfere with anticoagulant drugs. Supplemental doses also interfere with anticoagulant drugs. People taking warfarin (a blood thinner) must be aware that vitamin People taking warfarin (a blood thinner) must be aware that vitamin

K or foods containing vitamin K may reduce the effectiveness of K or foods containing vitamin K may reduce the effectiveness of their medication.their medication.

Overview of Vitamin KOverview of Vitamin K Vitamin K has also been linked to bone density.Vitamin K has also been linked to bone density. People with low levels of vitamin K have lower bone density, which can People with low levels of vitamin K have lower bone density, which can

be improved with vitamin K supplementation.be improved with vitamin K supplementation. women obtaining a minimum of 110 micrograms of vitamin K are at women obtaining a minimum of 110 micrograms of vitamin K are at

significantly lower hip fracture risk than women who have a lower intake.significantly lower hip fracture risk than women who have a lower intake. Different Studies also found a relationship between higher vitamin K Different Studies also found a relationship between higher vitamin K

intake and reduced hip fracture risk.intake and reduced hip fracture risk. Vitamin K is found in so many foods, and with bacterial production in the Vitamin K is found in so many foods, and with bacterial production in the

small intestine, it would seem difficult to not get enough. small intestine, it would seem difficult to not get enough.

particularly children and young adults, does not obtain sufficient vitamin particularly children and young adults, does not obtain sufficient vitamin K.K.

Newborn babies lack the intestinal bacteria to produce vitamin K and need Newborn babies lack the intestinal bacteria to produce vitamin K and need a supplement for the first week. a supplement for the first week.

Also, people with chronic diarrhea may be unable to absorb enough Also, people with chronic diarrhea may be unable to absorb enough vitamin K through the intestine. These groups of people need to take vitamin K through the intestine. These groups of people need to take additional Vitamin K to ensure a proper level in the body. additional Vitamin K to ensure a proper level in the body.

Although a tolerable upper intake level has not been established for Although a tolerable upper intake level has not been established for vitamin K, excessive amounts can cause the breakdown of red blood cells vitamin K, excessive amounts can cause the breakdown of red blood cells and liver damage. Large doses are not advised. and liver damage. Large doses are not advised.

Sources of Vitamin KSources of Vitamin K Naturally produced by the bacteria in Naturally produced by the bacteria in

the intestines,the intestines, Good food sources of vitamin K are:Good food sources of vitamin K are: green vegetables such as turnip (green vegetables such as turnip (لفتلفت), ),

spinach, cauliflowerspinach, cauliflower ( (قرنبيطقرنبيط)), cabbage and , cabbage and broccoli, and certain vegetables oils including broccoli, and certain vegetables oils including soybean oil, cottonseed oil, canola oil and soybean oil, cottonseed oil, canola oil and olive oil. olive oil.

Animal foods, in general, contain limited Animal foods, in general, contain limited amounts of vitamin K. amounts of vitamin K.

Deficiency vitamin K Deficiency vitamin K A primary deficiency of vitamin K is rare, but a secondary A primary deficiency of vitamin K is rare, but a secondary

deficiency may result from fat malabsorption syndrome. deficiency may result from fat malabsorption syndrome. vitamin K deficiency results in impaired blood clotting, vitamin K deficiency results in impaired blood clotting,

usually demonstrated by laboratory tests that measure clotting usually demonstrated by laboratory tests that measure clotting time. Symptoms include easy bleeding that may be manifested time. Symptoms include easy bleeding that may be manifested as nosebleeds, bleeding gums, blood in the urine, blood in the as nosebleeds, bleeding gums, blood in the urine, blood in the stool, or extremely heavy menstrual bleeding. stool, or extremely heavy menstrual bleeding.

In infants, vitamin K deficiency may result in life-threatening In infants, vitamin K deficiency may result in life-threatening bleeding within the skull (intracranial hemorrhagebleeding within the skull (intracranial hemorrhage

Prolonged use of antibiotics can destroy the intestinal bacteria Prolonged use of antibiotics can destroy the intestinal bacteria that produce vitamin K, precipitating deficiency in individuals that produce vitamin K, precipitating deficiency in individuals at risk. at risk.

Newborn infants are born with a sterile intestinal tract and Newborn infants are born with a sterile intestinal tract and those who are breastfed, may run the risk of vitamin-K those who are breastfed, may run the risk of vitamin-K deficiency, since breast-milk production takes a few days to deficiency, since breast-milk production takes a few days to establish and breast milk is naturally low in this vitamin. establish and breast milk is naturally low in this vitamin.

To prevent hemorrhaging, infants should receive injections of To prevent hemorrhaging, infants should receive injections of vitamin K within six hours of birth.vitamin K within six hours of birth.

Toxicity Toxicity vitamin K vitamin K High doses of vitamin K can reduce the effectiveness High doses of vitamin K can reduce the effectiveness

of anticoagulant of anticoagulant drugs (drugs (Vit K antagonistsVit K antagonists) ) such as such as warfarin (Coumadin), which is used to prevent blood warfarin (Coumadin), which is used to prevent blood clotting. People taking these drugs should maintain a clotting. People taking these drugs should maintain a consistent daily intake of vitamin K. consistent daily intake of vitamin K.

Megadose supplements of vitamin A and E can pose a Megadose supplements of vitamin A and E can pose a risk to vitamin-K status. Vitamin A interferes with risk to vitamin-K status. Vitamin A interferes with absorption of vitamin K, and large doses of vitamin E absorption of vitamin K, and large doses of vitamin E decrease vitamin K–dependent clotting factors, thus decrease vitamin K–dependent clotting factors, thus promoting bleeding. promoting bleeding.

Toxicity from food is rare, because the body excretes Toxicity from food is rare, because the body excretes vitamin K much more rapidly than other fat-soluble vitamin K much more rapidly than other fat-soluble vitamins.vitamins.

Water soluble vitaminsWater soluble vitamins

Vitamins are essential micronutrients.Vitamins are essential micronutrients. vitamin elimination from the diet must result vitamin elimination from the diet must result

in a more-or-less clearly defined deficiency in a more-or-less clearly defined deficiency disease, and restoration must cure or prevent disease, and restoration must cure or prevent that deficiency diseasethat deficiency disease

Water vs. FatWater vs. Fat

Water SolubleWater Soluble Vitamin CVitamin C B VitaminsB Vitamins

• ThiaminThiamin• RiboflavinRiboflavin• NiacinNiacin• Pantothenic AcidPantothenic Acid• BiotinBiotin• Vitamin BVitamin B66

• Folic AcidFolic Acid• Vitamin BVitamin B1212

Fat SolubleFat Soluble Vitamin AVitamin A Vitamin DVitamin D Vitamin EVitamin E Vitamin KVitamin K

Water Soluble Vitamin FunctionsWater Soluble Vitamin Functions

Water Soluble VitaminsWater Soluble Vitamins Vitamin CVitamin C B VitaminsB Vitamins

• Thiamin (BThiamin (B11))

• Riboflavin (BRiboflavin (B22))

• NiacinNiacin

• Vitamin BVitamin B66

• Folic AcidFolic Acid

• Vitamin BVitamin B1212

• Pantothenic AcidPantothenic Acid

• BiotinBiotin

Skin, bones, infections

Release energy from MACROnutrients:

Vitamin C (ascorbic acid)Vitamin C (ascorbic acid) Our bodies need vitamin C to keep it in good working condition. Our bodies need vitamin C to keep it in good working condition. vitamin C helps hold body cells together, aids in wound healing, assists in bone and vitamin C helps hold body cells together, aids in wound healing, assists in bone and

tooth formation, and strengthens the blood vessel walls. tooth formation, and strengthens the blood vessel walls. Vitamin C is also crucial to the functioning of our immune system, and it helps Vitamin C is also crucial to the functioning of our immune system, and it helps

improve the absorption and utilization of iron. (Enhances absorption of iron improve the absorption and utilization of iron. (Enhances absorption of iron (protects it from oxidation) – tip: take vitamins with orange juice)(protects it from oxidation) – tip: take vitamins with orange juice)

Our bodies cannot make vitamin C and our capacity to store vitamin C is limited. Our bodies cannot make vitamin C and our capacity to store vitamin C is limited. We must, therefore, take in some daily. We must, therefore, take in some daily. Some conditions have been shown to increase vitamin C requirements:Some conditions have been shown to increase vitamin C requirements:

• environmental stress, environmental stress, • use of certain drugs (such as oral contraceptives), use of certain drugs (such as oral contraceptives), • tissue healing of wounds, tissue healing of wounds, • growth (children and pregnant women), growth (children and pregnant women), • fever and infection, and fever and infection, and • smoking.smoking.

Megadoses of vitamin C can be help prevent or possibly even cure a case of the Megadoses of vitamin C can be help prevent or possibly even cure a case of the common cold. Vitamin C also serves as a powerful antioxidant. It works common cold. Vitamin C also serves as a powerful antioxidant. It works synergistically with vitamin E as a free-radical scavenger.synergistically with vitamin E as a free-radical scavenger.

Studies suggest that vitamin C may reduce the risk of certain cancers, heart disease Studies suggest that vitamin C may reduce the risk of certain cancers, heart disease and cataracts. Recent studies also suggest that the combination of vitamins C and E and cataracts. Recent studies also suggest that the combination of vitamins C and E in high doses can help reduce the risk of developing Alzheimer’s disease. in high doses can help reduce the risk of developing Alzheimer’s disease.

Functions of Vitamin CFunctions of Vitamin C Vitamin C is required for the synthesis of collagen, an Vitamin C is required for the synthesis of collagen, an

important structural component of blood vessels, tendons, important structural component of blood vessels, tendons, ligaments, and bone.ligaments, and bone.

Vitamin C also plays an important role in the synthesis of the Vitamin C also plays an important role in the synthesis of the Neurotransmitter, norepinephrine. Neurotransmitter, norepinephrine.

Neurotransmitters are critical to brain function and are known Neurotransmitters are critical to brain function and are known to affect mood.to affect mood.

In addition, vitamin C is required for the synthesis of In addition, vitamin C is required for the synthesis of carnitinecarnitine (a small molecule that is essential for the transport of fat to (a small molecule that is essential for the transport of fat to mitochondria for conversion to energy.mitochondria for conversion to energy.

  Vitamin C is also a highly effective antioxidant.Vitamin C is also a highly effective antioxidant. Even in small amounts vitamin C can protect proteins, lipids Even in small amounts vitamin C can protect proteins, lipids

(fats), carbohydrates, and DNA & RNA from damage by free (fats), carbohydrates, and DNA & RNA from damage by free radicals that can be generated during normal metabolism as radicals that can be generated during normal metabolism as well as through exposure to toxins and pollutants (e.g. well as through exposure to toxins and pollutants (e.g. smoking). smoking).

Vitamin C may also be able to regenerate or potentiate other Vitamin C may also be able to regenerate or potentiate other antioxidants such as vitamin Eantioxidants such as vitamin E

Functions of Vitamin CFunctions of Vitamin C The argument over megadoses of vitamin C to The argument over megadoses of vitamin C to

prevent or cure the common cold and other prevent or cure the common cold and other disorders has not been resolved. disorders has not been resolved.

Vitamin supplements will not necessarily Vitamin supplements will not necessarily provide extra energy, clear up skin problems, provide extra energy, clear up skin problems, or prevent and cure the common cold, heart or prevent and cure the common cold, heart disease, and cancer. Unlike scurvy, these disease, and cancer. Unlike scurvy, these problems are not the result of a vitamin C problems are not the result of a vitamin C deficiency. What is known is that the only deficiency. What is known is that the only disease a vitamin will cure is the one caused disease a vitamin will cure is the one caused by a deficiency of that vitamin.by a deficiency of that vitamin.

Sources of Vitamin CSources of Vitamin C Eating vitamin C-rich foods is the best method to ensure an Eating vitamin C-rich foods is the best method to ensure an

adequate intake of this vitamin.adequate intake of this vitamin. While many common foods contain vitamin C, While many common foods contain vitamin C, the best the best

food sources are citrus fruitsfood sources are citrus fruits. One orange, a kiwi fruit, cup . One orange, a kiwi fruit, cup of grapefruit juice each supply enough vitamin C for one of grapefruit juice each supply enough vitamin C for one day.day.

Vitamin C can be found in fresh fruits and vegetables: Vitamin C can be found in fresh fruits and vegetables: strawberries, peppers, tomatoes, leafy green vegetables and strawberries, peppers, tomatoes, leafy green vegetables and potatoes. potatoes.

It is not found in meat or animal products. It is not found in meat or animal products. Vitamin C is present in some processed foods, too. Vitamin C is present in some processed foods, too. Since ascorbic acid is an antioxidant, it doesn’t last long in Since ascorbic acid is an antioxidant, it doesn’t last long in

the presence of oxygen. This means that once you cut or the presence of oxygen. This means that once you cut or peel fruits and vegetables and expose them to air, the peel fruits and vegetables and expose them to air, the vitamin C content will diminish. vitamin C content will diminish.

Sources of Vitamin CSources of Vitamin C

Vitamin C intakeVitamin C intake3000

2000

200

125110100907530100

UL Men

UL Women

Limited absorption and little increase in blood concentration

Rec for Men Smokers

Rec for Women Smokers

Saturates Tissues

RDA Men

RDA Women

Supports metabolism

Prevents Scurvy

Common food Common food sourcessources

Major Major functionsfunctions

Deficiency Deficiency symptomssymptoms

OverconsumptOverconsumption symptomsion symptoms

Stability in Stability in foodsfoods

Citrus fruits, Citrus fruits, broccoli, broccoli, strawberries, strawberries, melon, green melon, green pepper, pepper, tomatoes, tomatoes,

dark green dark green vegetables, vegetables, potatoes.potatoes.

Formation of Formation of collagen (a collagen (a component of component of tissues), helps tissues), helps hold them hold them together; together; wound healing; wound healing; maintaining maintaining blood vessels, blood vessels, bones, teeth; bones, teeth; absorption of absorption of iron, calcium,; iron, calcium,; production of production of brain brain hormones, hormones, immune immune factors; factors; antioxidant.antioxidant.

Bleeding gums; Bleeding gums; wounds don't wounds don't heal; bruise heal; bruise easily; dry, easily; dry, rough skin; rough skin; scurvy; sore scurvy; sore joints and joints and bones; bones; increased increased infections.infections.

Nontoxic under Nontoxic under normal normal conditions; conditions; rebound scurvy rebound scurvy when high when high doses doses discontinued; discontinued; diarrhea, diarrhea, bloating, bloating, cramps; cramps; increased increased incidence of incidence of kidney stones.kidney stones.

Most unstable Most unstable under heat, under heat, drying, storage; drying, storage; very soluble in very soluble in water, leaches water, leaches out of some out of some vegetables vegetables during cooking; during cooking; alkalinity alkalinity (baking soda) (baking soda) destroys destroys vitamin C.vitamin C.

Vitamin C DeficiencyVitamin C Deficiency Severe vitamin C deficiency has been known for many Severe vitamin C deficiency has been known for many

centuries as the potentially fatal disease, Scurvy (centuries as the potentially fatal disease, Scurvy ( او الحفر او داء الحفر داء .( .(االسقربوطاالسقربوط

By the late 1700's the British navy was aware that scurvy could By the late 1700's the British navy was aware that scurvy could be cured by eating oranges or lemons, even though vitamin C be cured by eating oranges or lemons, even though vitamin C would not be isolated until the early 1930's. would not be isolated until the early 1930's.

Symptoms of scurvy include bleeding easily, hair and tooth Symptoms of scurvy include bleeding easily, hair and tooth loss, joint pain and swelling. Such symptoms appear to be loss, joint pain and swelling. Such symptoms appear to be related to the weakening of blood vessels, connective tissue, related to the weakening of blood vessels, connective tissue, and bone, which contain collagen.and bone, which contain collagen.

Early symptoms of scurvy such as fatigue may result from Early symptoms of scurvy such as fatigue may result from diminished levels of carnitine , needed to derive energy from diminished levels of carnitine , needed to derive energy from fat, or decreased synthesis of the norepinephrine.fat, or decreased synthesis of the norepinephrine.

Scurvy is rare in developed countries because it can be Scurvy is rare in developed countries because it can be prevented by as little as 10 mg of vitamin C daily . However, prevented by as little as 10 mg of vitamin C daily . However, recent cases have occurred in children and the elderly on very recent cases have occurred in children and the elderly on very restricted dietsrestricted diets

Safety & Toxicity of Vitamin CSafety & Toxicity of Vitamin C A number of possible problems with very A number of possible problems with very

large doses of vitamin C have been large doses of vitamin C have been suggested, mainly based on in vitro suggested, mainly based on in vitro experiments, including genetic mutations , experiments, including genetic mutations , birth defects, kidney stone , increased birth defects, kidney stone , increased oxidative stress , excess iron absorption, oxidative stress , excess iron absorption, vitamin B-12 deficiency, and erosion of vitamin B-12 deficiency, and erosion of dental enamel. dental enamel.

However, none of these adverse health However, none of these adverse health effects have been confirmed, and there is effects have been confirmed, and there is no reliable scientific evidence that large no reliable scientific evidence that large amounts of vitamin C (up to 10 grams/day amounts of vitamin C (up to 10 grams/day in adults) are toxic or detrimental to in adults) are toxic or detrimental to health. health.

B vitamins (B-complex) B vitamins (B-complex) These vitamins are widely distributed in foods. Their These vitamins are widely distributed in foods. Their influence is felt in many parts of the body.influence is felt in many parts of the body.They function as They function as coenzymescoenzymes that help the body obtain that help the body obtain energy from food. energy from food. They also are important for normal appetite, good They also are important for normal appetite, good vision, healthy skin, healthy nervous system and red vision, healthy skin, healthy nervous system and red blood cell formation.blood cell formation.Beriberi, pellagra and pernicious anemia are three Beriberi, pellagra and pernicious anemia are three well-known B-vitamin deficiencies. well-known B-vitamin deficiencies. These diseases are not a problem in the United States, These diseases are not a problem in the United States, but occasionally they occur when people omit certain but occasionally they occur when people omit certain foods or overeat certain foods at the expense of others. foods or overeat certain foods at the expense of others.

B vitamins (B-complex)B vitamins (B-complex) B vitamins are needed for conversion of food B vitamins are needed for conversion of food

to energy. to energy. They do not provide the energy, that comes They do not provide the energy, that comes

from the macronutrients, but the B vitamins from the macronutrients, but the B vitamins are essential helpers. are essential helpers.

When you are deficient in any of the B When you are deficient in any of the B vitamins you will feel fatigued and some B vitamins you will feel fatigued and some B vitamin deficiencies will lead to anemia. vitamin deficiencies will lead to anemia.

B complex vitamins also help you withstand B complex vitamins also help you withstand stress, keep your cardiovascular system stress, keep your cardiovascular system healthy and will boost your immune system.healthy and will boost your immune system.

B VitaminsB Vitamins

1.1. Thiamin (BThiamin (B11))

2.2. Riboflavin (BRiboflavin (B22))3.3. NiacinNiacin

4.4. Vitamin BVitamin B6 6

5.5. Folic AcidFolic Acid

6.6. Vitamin BVitamin B12 12

7.7. Pantothenic AcidPantothenic Acid8.8. BiotinBiotin

Coenzymes:Catalysts in Biochemical Pathways

Thiamin (Vitamin B1)Thiamin (Vitamin B1) Thiamin (Vitamin B1)Thiamin (Vitamin B1) functions as the coenzyme thiamin pyrophosphate (TPP) functions as the coenzyme thiamin pyrophosphate (TPP)

in the metabolism of carbohydrate. Thiamin is also needed for healthy muscles in the metabolism of carbohydrate. Thiamin is also needed for healthy muscles and normal nervous system function and conduction of nerve impulses.and normal nervous system function and conduction of nerve impulses.

A deficiency of thiamine will cause fatigue and decreased mental alertness. A A deficiency of thiamine will cause fatigue and decreased mental alertness. A severe deficiency will cause a nervous system disorder called severe deficiency will cause a nervous system disorder called beriberiberiberi .. People People with beriberi may have nerve damage in their hands and feet or heart damage. with beriberi may have nerve damage in their hands and feet or heart damage.

Thiamin deficiency causes beriberi, which is frequently seen in parts of the world Thiamin deficiency causes beriberi, which is frequently seen in parts of the world where polished (white) rice or unenriched white flour are predominantly eaten. where polished (white) rice or unenriched white flour are predominantly eaten.

There are three basic expressions of beriberi : childhood, wet, and dry. There are three basic expressions of beriberi : childhood, wet, and dry. • Childhood beriberi stunts or inhibits growth in infants and children. Childhood beriberi stunts or inhibits growth in infants and children. • Wet beriberi is the classic form, with swelling due to fluid retention Wet beriberi is the classic form, with swelling due to fluid retention

(edema) in the lower limbs that spreads to the upper body, affecting (edema) in the lower limbs that spreads to the upper body, affecting the heart and leading to heart failure.the heart and leading to heart failure.

• Dry beriberi affects peripheral nerves, initially causing tingling or Dry beriberi affects peripheral nerves, initially causing tingling or burning sensations in the lower limbs and progressing to nerve burning sensations in the lower limbs and progressing to nerve degeneration, muscle wasting and weight loss.degeneration, muscle wasting and weight loss.

Thiamine-deficiency disease in North America commonly occurs in people Thiamine-deficiency disease in North America commonly occurs in people with heavy with heavy alcohol consumptionalcohol consumption..

It is caused by poor food intake and by decreased absorption and increased It is caused by poor food intake and by decreased absorption and increased excretion caused by alcohol consumption.excretion caused by alcohol consumption.

Thiamin (Vitamin B1)Thiamin (Vitamin B1) Wernicke-KorsakoffWernicke-Korsakoff syndrome syndrome is another thiamine deficiency is another thiamine deficiency

disorder. In this case, the brain and nervous system are disorder. In this case, the brain and nervous system are affected so that a person has nerve damage and impaired affected so that a person has nerve damage and impaired mental ability. This disease is most commonly found in people mental ability. This disease is most commonly found in people who drink lots of alcohol on a regular basis. Replacing the who drink lots of alcohol on a regular basis. Replacing the deficient thiamine improves the symptoms. deficient thiamine improves the symptoms.

Thiamine is found in whole grains, legumes, lean meat, fish Thiamine is found in whole grains, legumes, lean meat, fish and fortified breads and cereals. and fortified breads and cereals.

Fruits and vegetables contain smaller amounts of thiamine. Fruits and vegetables contain smaller amounts of thiamine. Your daily requirement for thiamine may be increased if you Your daily requirement for thiamine may be increased if you eat a lot of sugar or in a heavy alcohol drinker. eat a lot of sugar or in a heavy alcohol drinker.

Riboflavin (Vitamin B2)Riboflavin (Vitamin B2) Riboflavin (vitamin B2)Riboflavin (vitamin B2) is a component of two coenzymes—flavin is a component of two coenzymes—flavin

mononucleotide (FMN) and flavin adenine dinucleotide (FAD)—that act mononucleotide (FMN) and flavin adenine dinucleotide (FAD)—that act as hydrogen carriers when carbohydrates and fats are used to produce as hydrogen carriers when carbohydrates and fats are used to produce energy. energy.

Riboflavin (vitamin B2)Riboflavin (vitamin B2) is helpful in maintaining good vision and healthy is helpful in maintaining good vision and healthy hair, skin and nails, and it is necessary for normal cell growth.hair, skin and nails, and it is necessary for normal cell growth.

Riboflavin (vitamin B2)Riboflavin (vitamin B2) is stable when heated in ordinary cooking, unless is stable when heated in ordinary cooking, unless the food is exposed to ultraviolet radiation (sunlight). To prevent riboflavin the food is exposed to ultraviolet radiation (sunlight). To prevent riboflavin breakdown, riboflavin-rich foods such as milk, milk products, and cereals breakdown, riboflavin-rich foods such as milk, milk products, and cereals are packaged in opaque containers. are packaged in opaque containers.

Riboflavin deficiency causes a condition known as Riboflavin deficiency causes a condition known as ariboflavinosisariboflavinosis (Riboflavin deficiency ), which is marked by cheilosis ((Riboflavin deficiency ), which is marked by cheilosis ( و الشفتين و تشقق الشفتين تشقق oily scaling of the ) (cracked lips at the corners of the mouth), oily scaling of the ,(cracked lips at the corners of the mouth) (حرشفتهماحرشفتهماskin, and a red, sore tongue, ulcers in the mouth, dry skin and a sore throat.skin, and a red, sore tongue, ulcers in the mouth, dry skin and a sore throat.

In addition, In addition, cataractscataracts may occur more frequently with riboflavin may occur more frequently with riboflavin deficiency. deficiency.

A deficiency of A deficiency of Riboflavin (vitamin B2)Riboflavin (vitamin B2) is usually a part of multinutrient is usually a part of multinutrient deficiency and does not occur in isolation.deficiency and does not occur in isolation.

In North America, it is mostly observed in alcoholics, elderly persons with In North America, it is mostly observed in alcoholics, elderly persons with low income or depression, and people with poor eating habits, particularly low income or depression, and people with poor eating habits, particularly those who consume highly refined and fast foods and those who do not those who consume highly refined and fast foods and those who do not consume milk and milk productsconsume milk and milk products

Sources of Sources of Riboflavin B2Riboflavin B2

Riboflavin is easily obtained from a healthy Riboflavin is easily obtained from a healthy diet and can be found in dairy products, diet and can be found in dairy products, legumes, green leafy vegetables and nuts.legumes, green leafy vegetables and nuts.

Riboflavin can be destroyed fairly easily by Riboflavin can be destroyed fairly easily by light. This is the reason milk is sold in cartons light. This is the reason milk is sold in cartons or opaque bottles. Riboflavin is also reduced or opaque bottles. Riboflavin is also reduced by by alkaline alkaline conditions, so soaking legumes in conditions, so soaking legumes in baking soda and water before cooking them baking soda and water before cooking them destroys some riboflavin. destroys some riboflavin.

Niacin (Vitamin B3)Niacin (Vitamin B3) Niacin (Vitamin B3)Niacin (Vitamin B3) exists in two forms: nicotinic acid and exists in two forms: nicotinic acid and

nicotinamide.nicotinamide. There are two coenzyme forms of There are two coenzyme forms of Niacin (Vitamin B3)Niacin (Vitamin B3) : :

• nicotinamide adenine dinucleotide (NAD+)nicotinamide adenine dinucleotide (NAD+)• nicotinamide adenine dinucleotide phosphate (NADP+).nicotinamide adenine dinucleotide phosphate (NADP+). • They (NAD+ and NADP+) both help break down and utilize proteins, They (NAD+ and NADP+) both help break down and utilize proteins,

fats, and carbohydrates for energy. fats, and carbohydrates for energy. Niacin (Vitamin B3)Niacin (Vitamin B3) is essential for growth and is involved in is essential for growth and is involved in

hormonehormone synthesis. synthesis. Both forms are readily absorbed from the stomach and small intestine.Both forms are readily absorbed from the stomach and small intestine. Good sources for Good sources for Niacin (Vitamin B3)Niacin (Vitamin B3) are are Protein, milk, fish, Protein, milk, fish,

chicken; whole grainschicken; whole grains Niacin is stored in small amounts in the Liver and transported to Niacin is stored in small amounts in the Liver and transported to

tissues, where it is converted to coenzyme forms. Any excess is tissues, where it is converted to coenzyme forms. Any excess is excreted in urine. excreted in urine.

Niacin is one of the most stable of the B vitamins. It is resistant to heat Niacin is one of the most stable of the B vitamins. It is resistant to heat and light, and to both acid and alkali environments. and light, and to both acid and alkali environments.

Niacin (Vitamin B3) deficiency Niacin (Vitamin B3) deficiency

The human body is capable of converting The human body is capable of converting the a.a tryptophan to niacin when needed. the a.a tryptophan to niacin when needed. However, when both tryptophan and niacin However, when both tryptophan and niacin are deficient, tryptophan is used only for are deficient, tryptophan is used only for protein synthesis.protein synthesis.

Pellagra (Pellagra ( تخشن او الحصاف او تخشن بيالجرا او الحصاف او بيالجرا Diarrhea, Dermatitis, Dementia ( (الجلدالجلد( خبل او Death results from a results from a ,(خرفcombined deficiency of niacin and combined deficiency of niacin and tryptophan.tryptophan.

Long-term deficiency leads to CNS Long-term deficiency leads to CNS dysfunction manifested as confusion, dysfunction manifested as confusion, apathy (lack of concern), disorientation, apathy (lack of concern), disorientation, and eventually coma and death.and eventually coma and death.

Pantothenic Acid (B5)Pantothenic Acid (B5) Pantothenic acid is released from coenzyme A in food Pantothenic acid is released from coenzyme A in food

in the small intestine. After absorption, it is transported in the small intestine. After absorption, it is transported to tissues, where coenzyme A is resynthesized. to tissues, where coenzyme A is resynthesized.

Coenzyme A is essential for the formation of energy as Coenzyme A is essential for the formation of energy as adenosine triphosphate (ATP) from carbohydrate, adenosine triphosphate (ATP) from carbohydrate, protein, alcohol, and fat.protein, alcohol, and fat.

Coenzyme A is also important in the synthesis of fatty Coenzyme A is also important in the synthesis of fatty acids, cholesterol, steroids, and the neurotransmitter acids, cholesterol, steroids, and the neurotransmitter acetylcholine, which is essential for transmission of acetylcholine, which is essential for transmission of nerve impulses to musclesnerve impulses to muscles

Sources of Pantothenic acid B5 Sources of Pantothenic acid B5 Sources include: Liver, kidney, meats, egg yolk, Sources include: Liver, kidney, meats, egg yolk,

whole grains, legumes; also made by intestinal whole grains, legumes; also made by intestinal bacteria. bacteria.

Deficiency syndrome are Uncommon due to Deficiency syndrome are Uncommon due to availability in most foods.availability in most foods.

Dietary deficiency occurs in conjunction with other Dietary deficiency occurs in conjunction with other B-vitamin deficiencies. In studies, experimentally B-vitamin deficiencies. In studies, experimentally induced deficiency in humans has resulted in induced deficiency in humans has resulted in headache, fatigue, impaired muscle coordination, headache, fatigue, impaired muscle coordination, abdominal cramps, and vomiting.abdominal cramps, and vomiting.

Pantothenic acid is stable in moist heat. It is Pantothenic acid is stable in moist heat. It is destroyed by vinegar (acid), baking soda (alkali), and destroyed by vinegar (acid), baking soda (alkali), and dry heat. Significant losses occur during the dry heat. Significant losses occur during the processing and refining of foods. processing and refining of foods.

Vitamin B6 (Vitamin B6 (pyridoxal, pyridoxine, and pyridoxamine)pyridoxal, pyridoxine, and pyridoxamine)

Vitamin B6 is present in three forms: pyridoxal, pyridoxine, and Vitamin B6 is present in three forms: pyridoxal, pyridoxine, and pyridoxamine. pyridoxamine.

All forms can be converted to the active vitamin-B6 coenzyme in All forms can be converted to the active vitamin-B6 coenzyme in the body.the body.

Pyridoxal phosphate (PLP) is the predominant biologically active Pyridoxal phosphate (PLP) is the predominant biologically active form. form.

Vitamin B6 is not stable in heat or in alkaline conditions, so cooking Vitamin B6 is not stable in heat or in alkaline conditions, so cooking and food processing reduce its content in food. and food processing reduce its content in food.

Both coenzyme ( Both coenzyme ( Pyridoxal phosphate (PLPPyridoxal phosphate (PLP) and free forms ) and free forms ((pyridoxal, pyridoxine, and pyridoxamine)pyridoxal, pyridoxine, and pyridoxamine) are absorbed in the small are absorbed in the small intestine and transported to the liver, where they are phosphorylated intestine and transported to the liver, where they are phosphorylated and released into circulation, bound to albumin for transport to and released into circulation, bound to albumin for transport to tissues. tissues.

Vitamin B6 is stored in the muscle and only excreted in urine when Vitamin B6 is stored in the muscle and only excreted in urine when intake is excessive.intake is excessive.

Functions of Vit B6Functions of Vit B6 Pyridoxal phosphate (PLP)Pyridoxal phosphate (PLP) participates in amino acid participates in amino acid

synthesis and the interconversion of some amino synthesis and the interconversion of some amino acids. acids.

Pyridoxal phosphate (PLP)Pyridoxal phosphate (PLP) catalyzes a step in the catalyzes a step in the synthesis of Hbsynthesis of Hb

Pyridoxal phosphate (PLP)Pyridoxal phosphate (PLP) helps maintain blood helps maintain blood glucose levels by facilitating the release of glucose glucose levels by facilitating the release of glucose from liver and muscle glycogen. from liver and muscle glycogen.

Pyridoxal phosphate (PLP)Pyridoxal phosphate (PLP) also plays a role in the also plays a role in the synthesis of many neurotransmitters important for synthesis of many neurotransmitters important for brain function. This has led some physicians to brain function. This has led some physicians to prescribe megadoses of B6 to patients with prescribe megadoses of B6 to patients with psychological problems such as depression psychological problems such as depression

Sources and deficiency Sources and deficiency

Meats, fish, chick, spinach, potatoes, bananas, Meats, fish, chick, spinach, potatoes, bananas, avocados, sunflower seeds, whole grains and avocados, sunflower seeds, whole grains and cereals, legumes, green, leafy vegetables.cereals, legumes, green, leafy vegetables.

Dermatitis, anemia, convulsion , depression, Dermatitis, anemia, convulsion , depression, confusion , decline in immune function confusion , decline in immune function

Biotin (Vitamin B8) Biotin (Vitamin B8) Biotin is the most stable of B vitamins. Biotin is the most stable of B vitamins. It is commonly found in two forms: the free vitamin It is commonly found in two forms: the free vitamin

and the protein-bound coenzyme form called and the protein-bound coenzyme form called biocytin. biocytin.

Biotin is absorbed in the small intestine, and it Biotin is absorbed in the small intestine, and it requires digestion by enzyme biotinidase, which is requires digestion by enzyme biotinidase, which is present in the small intestine. present in the small intestine.

Biotin is synthesized by bacteria in the large intestine Biotin is synthesized by bacteria in the large intestine , but its absorption is questionable. , but its absorption is questionable.

Biotin containing coenzymes participate in key Biotin containing coenzymes participate in key reactions that produce energy from carbohydrate and reactions that produce energy from carbohydrate and synthesize fatty acids and protein.synthesize fatty acids and protein.

Sources and deficiency Sources and deficiency Sources include: Liver, kidney, egg yolk, milk, most fresh Sources include: Liver, kidney, egg yolk, milk, most fresh

vegetables, Whole grains, nuts and seeds also made by vegetables, Whole grains, nuts and seeds also made by intestinal bacteria. intestinal bacteria.

AvidinAvidin is a protein in raw egg white, which can bind to the is a protein in raw egg white, which can bind to the biotin (B8) in the stomach and decrease its absorption. biotin (B8) in the stomach and decrease its absorption. Therefore, consumption of raw whites is of concern due to the Therefore, consumption of raw whites is of concern due to the risk of becoming biotin deficient. Cooking the egg white, risk of becoming biotin deficient. Cooking the egg white, however, destroys avidin.however, destroys avidin.

Deficiency may develop in infants born with a genetic defect Deficiency may develop in infants born with a genetic defect that results in reduced levels of biotinidase. In the past, biotin that results in reduced levels of biotinidase. In the past, biotin deficiency was observed in infants fed biotin-deficient deficiency was observed in infants fed biotin-deficient formula, so it is now added to infant formulas and other baby formula, so it is now added to infant formulas and other baby foods.foods.

deficiency uncommon under normal circumstances; fatigue; deficiency uncommon under normal circumstances; fatigue; loss of appetite, nausea, vomiting; depression; muscle pains; loss of appetite, nausea, vomiting; depression; muscle pains; anemia. anemia.

infants: Dermatitis, convulsions, hair loss (alopecia), infants: Dermatitis, convulsions, hair loss (alopecia), neurological disorders, impaired growth neurological disorders, impaired growth

Folic Acid, Folate, Folacin (Vitamin B9)Folic Acid, Folate, Folacin (Vitamin B9) Folacin or folate, as it is usually called, is the form of vitamin Folacin or folate, as it is usually called, is the form of vitamin

B9 naturally present in foods, whereas folic acid is the B9 naturally present in foods, whereas folic acid is the synthetic form added to synthetic form added to fortifiedfortified foods and supplements. foods and supplements.

Both forms are absorbed in the small intestine and stored in Both forms are absorbed in the small intestine and stored in the liver. the liver.

The folic acid form, however, is more efficiently absorbed and The folic acid form, however, is more efficiently absorbed and available to the body. When consumed in excess of needs, available to the body. When consumed in excess of needs, both forms are excreted in urine and easily destroyed by heat, both forms are excreted in urine and easily destroyed by heat, oxidation, and light.oxidation, and light.

All forms of this vitamin are readily converted to the All forms of this vitamin are readily converted to the coenzyme form called coenzyme form called tetrahydrofolate (THFA).tetrahydrofolate (THFA).

tetrahydrofolate (THFA) tetrahydrofolate (THFA) plays a key role in the synthesis of plays a key role in the synthesis of DNADNA and and RNARNA, and in interconversions of amino acids. , and in interconversions of amino acids.

Folate also plays an important role in the synthesis of Folate also plays an important role in the synthesis of neurotransmitters. Meeting folate needs can improve mood neurotransmitters. Meeting folate needs can improve mood and mental functions.and mental functions.

Sources and deficiency Sources and deficiency Folic Acid, (Vitamin B9)Folic Acid, (Vitamin B9)

Liver, kidney, dark green leafy vegetables, meats, Liver, kidney, dark green leafy vegetables, meats, fish, whole grains, fortified grains and cereals, fish, whole grains, fortified grains and cereals, legumes, citrus fruits.legumes, citrus fruits.

folate deficiency is one of the most common vit folate deficiency is one of the most common vit deficiencies.deficiencies.

Early symptoms are nonspecific and include Early symptoms are nonspecific and include tiredness, irritability, and loss of appetite.tiredness, irritability, and loss of appetite.

Severe folate deficiency leads to macrocytic anemia, Severe folate deficiency leads to macrocytic anemia, a condition in which cells in the bone marrow cannot a condition in which cells in the bone marrow cannot divide normally and red blood cells remain in a large divide normally and red blood cells remain in a large immature form called immature form called macrocytes.macrocytes. Large immature Large immature cells also appear along the length of the cells also appear along the length of the gastrointestinal tract, resulting in abdominal pain and gastrointestinal tract, resulting in abdominal pain and diarrhea. Megaoblastic (macrocytic) anemia, diarrhea. Megaoblastic (macrocytic) anemia, abdominal pain, diarrhea, birth defects abdominal pain, diarrhea, birth defects

Sources and deficiency Sources and deficiency Folic Acid, (Vitamin B9)Folic Acid, (Vitamin B9) Pregnancy is a time of rapid cell multiplication and DNA Pregnancy is a time of rapid cell multiplication and DNA

synthesis, which increases the need for folate. Folate synthesis, which increases the need for folate. Folate deficiency may lead to neural tube defects such as spina bifida deficiency may lead to neural tube defects such as spina bifida (failure of the spine to close properly during the first month of (failure of the spine to close properly during the first month of pregnancy) and anencephaly (closure of the neural tube during pregnancy) and anencephaly (closure of the neural tube during fetal fetal developmentdevelopment, resulting in part of the cranium not being , resulting in part of the cranium not being formed). formed).

Seventy percent of these defects could be avoided by adequate Seventy percent of these defects could be avoided by adequate folate status before conception, and it is recommended that all folate status before conception, and it is recommended that all women of childbearing age consume at least 400 micrograms women of childbearing age consume at least 400 micrograms (μg) of folic acid each day from fortified foods and (μg) of folic acid each day from fortified foods and supplements. Other groups at risk of deficiency include elderly supplements. Other groups at risk of deficiency include elderly persons and persons suffering from alcohol abuse or taking persons and persons suffering from alcohol abuse or taking certain prescription certain prescription drugsdrugs..

Vitamin B12 (cyanocobalamin)Vitamin B12 (cyanocobalamin)

Vitamin B12Vitamin B12 is found in its free-vitamin form, called is found in its free-vitamin form, called cyanocobalamincyanocobalamin, and in two active coenzyme forms. , and in two active coenzyme forms.

Absorption of Absorption of Vitamin B12Vitamin B12 requires the presence of intrinsic requires the presence of intrinsic factor, a protein synthesized by acid-producing cells of the factor, a protein synthesized by acid-producing cells of the stomach.stomach.

Vitamin B12Vitamin B12 is absorbed in the terminal portion of the small is absorbed in the terminal portion of the small intestine (the ileum).intestine (the ileum).

Most of body's supply of Most of body's supply of Vitamin B12Vitamin B12 is stored in the liver. is stored in the liver. Vitamin B12Vitamin B12 is efficiently conserved in the body, since most is efficiently conserved in the body, since most

of it is secreted into of it is secreted into bilebile and reabsorbed. This explains the and reabsorbed. This explains the slow development (about two years) of deficiency in people slow development (about two years) of deficiency in people with reduced intake or absorption. with reduced intake or absorption.

Vitamin B12Vitamin B12 stable when heated and slowly loses its activity stable when heated and slowly loses its activity when exposed to light, oxygen, and acid or alkaline when exposed to light, oxygen, and acid or alkaline environments. environments.

Function of Vitamin B12 (cyanocobalamin)Function of Vitamin B12 (cyanocobalamin)

Vitamin B12Vitamin B12 coenzymes help recycle folate coenzymes coenzymes help recycle folate coenzymes involved in the synthesis of DNA and RNA, and in the normal involved in the synthesis of DNA and RNA, and in the normal formation of red blood cells. formation of red blood cells.

Vitamin B12Vitamin B12 prevents degeneration of the myelin sheaths that prevents degeneration of the myelin sheaths that cover nerves and help maintain normal electrical conductivity cover nerves and help maintain normal electrical conductivity through the nerves.through the nerves.

Sources and deficiencySources and deficiency Sources include: Meat, fish, poultry, ready-to-eat fortified breakfast Sources include: Meat, fish, poultry, ready-to-eat fortified breakfast

cereals, eggs, fermented dairy products (cheese, yogurt, etc). cereals, eggs, fermented dairy products (cheese, yogurt, etc). Vitamin-B12Vitamin-B12 deficiency results in deficiency results in pernicious anemiapernicious anemia ( ( الوبيل الدم الوبيل فقر الدم which which ,(,(فقر

is caused by a genetic problem in the production of intrinsic factor. When is caused by a genetic problem in the production of intrinsic factor. When this occurs, folate function is impaired, leading to macrocytic anemia due this occurs, folate function is impaired, leading to macrocytic anemia due to interference in normal DNA synthesis. to interference in normal DNA synthesis.

Unlike folate deficiency, the anemia caused by vitamin-B12 deficiency is Unlike folate deficiency, the anemia caused by vitamin-B12 deficiency is accompanied by symptoms of nerve degeneration, which if left untreated accompanied by symptoms of nerve degeneration, which if left untreated can result in paralysis (can result in paralysis (الشللالشلل) and death.) and death.

Since vitamin B12 is well conserved in the body, it is difficult to become Since vitamin B12 is well conserved in the body, it is difficult to become deficient from dietary factors alone, unless a person is a strict vegan and deficient from dietary factors alone, unless a person is a strict vegan and consumes a diet devoid of eggs and dairy for several years. consumes a diet devoid of eggs and dairy for several years.

Deficiency is usually observed when B12 absorption is hindered by disease Deficiency is usually observed when B12 absorption is hindered by disease or surgery to the stomach or ileum, damage to or surgery to the stomach or ileum, damage to gastric mucosagastric mucosa by by alcoholism, or prolonged use of anti-ulcer medications that affect secretion alcoholism, or prolonged use of anti-ulcer medications that affect secretion of intrinsic factor. of intrinsic factor.

Age-related decrease in stomach-acid production also reduces absorption Age-related decrease in stomach-acid production also reduces absorption of B12 in elderly persons. These groups are advised to consume fortified of B12 in elderly persons. These groups are advised to consume fortified foods or take a supplemental form of vitamin B12foods or take a supplemental form of vitamin B12