vit & minerals

• Vitamin A (Retinol, Retinal, Carotenoids) 

  • Component of the visual pigment
  • Regulates cell differentiation
  • Maintains epithelial tissue
  • Supports gametogenesis in men
  • Antioxidant
  • S: liver, eggs, milk, butter, carrots

  Therapeutic Applications (AMA) 

  • Severe acne 
  • Measles 
  • Acute Promyelocytic Leukemia

  Deficiency 

  • Nyctalopia (night blindness)
  • Keratomalacia (corneal degeneration)
  • Bitot’s spots
  • Keratinization of the skin

  Toxicity 

  • Teratogenic (cleft palate, cardiac abnormalities)
  • Excessive desquamation of the skin (scaliness)
  • Alopecia
  • Hepatomegaly, cirrhosis
• Vitamin D (Cholecalciferol, Ergocalciferol)

  • Normalizes Ca++ serum levels in response to hypocalcemia
  • S: D3 - Fatty fish, liver, egg yolk 

                       D2 - milk, butter

  Therapeutic Applications 

  • Treatment & prevention of bone disorders
  • Supplementation in breastfed infants

  Deficiency 

  • Rickets
  • Rachitic rosary
  • Osteomalacia

  Toxicity 

  • Loss of appetite, stupor, nausea, thirst
  • Hypercalcemia
  • Hypercalciuria
• Vitamin E (Tocopherol)

  • Antioxidant
  • S: Vegetable oils, nuts, seeds

  Therapeutic Applications

  • Skin creams 

  Deficiency 

  • Hemolytic anemia
  • Nerve and muscle membrane damage → weakness

  Toxicity 

  • Risk of enterocolitis in infants
  • Least toxic of all fat-soluble vitamins
• Vitamin K (Phylloquinone, Menadione) 

  • Cofactor necessary for maturation of several clotting factors (CF: II, VII, IX, X)
  • S: Leafy green vegetables, synthesized by gut bacteria

  Therapeutic Applications 

  • vitamin K injection in newborns
  • Reversal of warfarin toxicity

  Deficiency 

  • Hemorrhagic disease of the newborn
  • Seen in those with prolonged antibiotic use
  • Rare in adults

  Toxicity 

  • Hemolytic anemia and jaundice
• Vitamin B1 (Thiamine)

  • Cofactors for
  • ⍺-ketoglutarate dehydrogenase → TCA cycle
  • Pyruvate dehydrogenase → oxidation of pyruvate
  • Transketolases → Pentose phosphate pathway
  • Branched-chain ketoacid dehydrogenase → BCAA synthesis
  • S: pork, fish, seafood, beef, fortified foods (rice, cereals, bread, flour)

  Deficiency 

  • Wet beriberi
  • Dry beriberi
  • Wernicke-Korsakoff syndrome
  • Seen in Alcoholism

  Toxicity : None
• Vitamin B2 (Riboflavin)

  • Cofactor forms
  • Flavin adenine dinucleotide (FAD)
  • Flavin mononucleotide (FMN)
  • S: milk, eggs

  Deficiency 

  • Cheilosis / Stomatitis
  • Glossitis
  • Corneal vascularization

  Toxicity : None
• Vitamin B3 (Niacin)

  • Cofactor forms
  • Nicotinamide adenine dinucleotide (NAD) 
  • Nicotinamide adenine dinucleotide phosphate (NADP)
  • Derived from Tryptophan
  • S: milk, eggs

  Deficiency 

  •  Pellagra
  • Diarrhea
  • Dementia
  • Dermatitis
  • Seen in Hartnup disease

  Toxicity 

  • Podagra (Gout)
  • Facial flushing
  • Hyperglycemia
• Vitamin B5 (Pantothenic Acid)

  • Component of the following
  • Coenzyme A
  • Acyl carrier protein
  • Cofactors for
  • ⍺-ketoglutarate dehydrogenase → TCA cycle
  • Pyruvate dehydrogenase → oxidation of pyruvate
  • S: eggs, liver, yeast

  Deficiency 

  • Burning foot syndrome – nutritional melalgia
  • Rare

  Toxicity : None
• Vitamin B6 (Pyridoxine)

  • Cofactor for
  • Aminotransferases → Transamination
  • δ-ala synthase → Heme synthesis
  • Glycogen phosphorylase → Glycogenolysis
  • S: potatoes and other starchy vegetables, non-citrus fruits, meat

  Deficiency 

  • Peripheral neuropathy
  • Sideroblastic anemia
  • Seen in Isoniazid toxicity & in those that use oral contraception

  Toxicity : Sensory neuropathy
• Vitamin B7 (Biotin – H)

  • Cofactors for
  • Pyruvate carboxylase → Gluconeogenesis
  • Acetyl CoA carboxylase → lipogenesis
  • S: eggs, liver, yeast

  Deficiency 

  • Dermatitis, glossitis, Enteritis
  • Alopecia
  • Seen in antibiotic use / excessive ingestion of egg whites

  Toxicity : None
• Vitamin B9 (Folic Acid)

  • Methyl group transfer for synthesis of nitrogenous bases
  • S: fresh green vegetables, liver

  Deficiency 

  • Megaloblastic anemia
  • Neural tube defects in fetus

  Toxicity : None
• Vitamin B12 (Cobalamin)

  • Methyl group transfer for synthesis of nitrogenous bases
  • S: animal products (meat, milk, eggs, oysters, shrimp)

  Deficiency 

  • Megaloblastic anemia
  • Seen in malabsorption, pernicious anemia, veganism

  Toxicity : None
• Vitamin C (Ascorbic Acid)

  • Cofactor for
  • Proline & Lysine hydroxylase → collagen synthesis
  • Dopamine beta-hydroxylase → epinephrine biosynthesis 
  • Antioxidant
  • S: fruits & vegetable

  Deficiency 

  • Scurvy
  • Scorbutic rosary
  • Weakened immune response

  Toxicity : None
• Calcium

  • Most abundant mineral
  • Found in the bones & teeth
  • Regulates muscle contractions
  • Regulates blood clotting
  • D: Osteoporosis
  • E: Kidney stones, constipation
• Phosphorus

  • 2nd most abundant mineral
  • Found in bones & teeth
  • Component of phospholipids
  • Part of most metabolic pathways
  • Buffer system
  • D: unknown
  • E: calcification of non skeletal tissues (kidney)
• Iron

  • 3-4 g in the human body
  • 2/3 present in hemoglobin
  • Transferrin – transport protein
  • Ferritin – storage form of iron
  • Hemosiderin – partially digested ferritin, increases when iron stores are high
  • D: Iron deficiency anemia – MC micronutrient deficiency WW
  • E: Hemochromatosis – iron overload → organ damage
• Zinc

  • 1.5–2.5g in the human body
  • Constituent of over 300 enzymes
  • Carbonic anhydrase
  • Lactate dehydrogenase 
  • Carboxypeptidase, etc.
  • D: poor wound healing, acrodermatitis enteropathica
  • E: gastric ulcer, pancreatitis, pulmonary fibrosis
• Copper

  • 80-110 mg in the human body
  • Cofactor of enzymes that utilize Oxygen
  • Cytochrome oxidase
  • Dopamine β-hydroxylase
  • Superoxide dismutase, etc.
  • Ceruloplasmin – transport protein
  • D: Menkes Syndrome – impaired transfer from intestine to blood
  • E: Wilson Disease – impaired copper breakdown
• Iodine

  • 15-20 mg in the human body
  • Constituent of thyroid hormones
  • D: hypothyroidism, cretinism 
  • E: hyper or hypothyroidism
• Magnesium

  • Required for many oxidation-phosphorylation reactions
  • D: Tremors, convulsions, tetany 
  • E: Diarrhea, hypocalcemia, respiratory depression
• Manganese

  • Stimulates the activity of many enzymes
  • D: Impaired growth
  • E: Manganese Madness (psychosis)
• Fluorine

  • Incorporated into the organic substance of bones & teeth
  • D: Dental Caries
  • E: Fluorosis, increased bone density, calcifications of muscle insertions
• Selenium

  • Essential for tissue respiration 
  • Antioxidant (part of GPO)
  • D: Myalgia, myopathy
  • E: -