1. ابتسام الشديEbtesam Al-sheddi
Site: faculty.ksu.edu.sa/10252

2. 413 PHG 50% by Dr.Ebtesam S. Al-Sheddi -15 marks midterm exam
20 marks final exam
50% by Dr. Areej Al-Taweel
-15 marks midterm exam
-20 marks final exam
Lab :
30 marks: - Practical exam
PHG

3. Course description The course will cover the following subjects:
Vitamins
Minerals
Allergens
Biologics

4. By the end of the course You should be able to know:
What are the Water soluble vitamins
What are the Fat soluble vitamins
The recommended dose, function, deficiency and the toxicity of each vitamin.
What are the micro and macro-minerals
The recommended dose, function, deficiency and the toxicity of each mineral.
What are allergens and the different types.
What are biologics and the different types

5. Presented By: Ebtesam Al-Sheddi
Vitamins lecture 1
Presented By:
Ebtesam Al-Sheddi

6. When substance is defined as vitamin
Three criteria: 1- Required in small amounts 2- Must be organic chemical. 3- There is specific set of symptoms or specific diseases associated with a deficiency of each vitamin. Could be called cofactors or catalysts or others depending on the functions.

7. 13 Vitamins for good health: 2 groups
Water soluble vitamins B group: B1 thiamin B2 riboflavin B3 niacin B5 pantothenic acid B6 pyridoxine B7 bitoin B9 folic acid B 12 cyanocobalmin Vitamin C ascorbic acid
Fat soluble vitamins Vitamin A Vitamin D Vitamin E Vitamin K

8. Fat versus water soluble vitamins
Fat-soluble vitamins
Dissolve in fat
Require bile acids to be dissolved and then absorbed.
Can be stored in body: liver, adipose tissue.
Toxicity is possible.
Water-soluble vitamins
Dissolve in water.
Easily absorbed.
Not stored in large quantities.
Execrated via urine.
Generally non-toxic.

9. Fat soluble vitamins vitamin A
Generally called retinol. It is a group of compounds with the biological activity of retinol. These compounds include: Provitamin A and Preformed vitamin A

10. Preformed vitamin A
Provitamin A
Animal source
Called retinoids:
Retinol (key player) and retinyl ester.
Consist of 4 isoprene units (C20)
Plant source
Called carotenoids:
α-carotene, β-carotene and β-cryptoxanthin.
Consist of 8 isoprene units (C40)

11. Retinoids and carotenoids are precursors for the biosynthesis of 2 essential metabolites of vitamin A:
11-cis-retinal and all-trans-retinoic acid.

12. Vitamin A functions 11- cis- retinal All trans-retinoic acid
Required for night and color vision.
Formed in retina.
Component of visual pigments (rhodospin rods) that present in retina.
The most bioactive form.
Required for:
regulation of embryonic development and growth and reproduction.
maintenance of epithelial tissue and repair of body tissues.
proper function of immune system
Carotenoids
Serve as antioxidants .

13. Source:
Preformed: liver, milk, ready eat cereal, margarine and egg.
Provitamin: carrot, cantaloupe, sweet potato and spinach.
Recommended daily allowance (RDA) = 4000 – 5000 IU (International Units).
1 IU from 0.3 µg of retinol or 0.6 µg of β-carotene

14. Vitamin A deficiency
More obvious deficiency symptoms than other vitamins
Night blindness
Leading cause of blindness in third world countries
Cell keratinization
Dry skin (treatment and pregnancy?)
Xerophthalmia (dryness of cornea & conjunctiva)
Reproductive failure
Abnormal skeletal development/maintenance
Immune dysfunction
Respiratory infection.

15. Hypervitaminosis A
Skeletal malformations, spontaneous fractures, internal hemorrhages
Overconsumption of beta carotene from food sources may cause skin to turn yellow but is not harmful
Birth defects and miscarriage
Decalcification, joint pain, fragility
Dry itchy skin (caution about acne treatments)
Hair loss
Liver damage

16. Fat soluble vitamins vitamin D
The two major forms are
vitamin D2 or ergocalciferol, plant version vitamin D3 or cholecalciferol, animal version
(Calciferol)

17. Vitamin D2 (made from ergosterol)
Vitamin D3 is made in the skin when 7-dehydrocholesterol reacts with ultraviolet light.
Vitamin D3 is biologically inert, must undergo two hydroxylation reactions to be activated in the body.
Calcitriol (1,25-dihydroxycholecalciferol) is the active form of vitamin D

20. Vitamin D - Functions
Regulation of bone health, calcium, and phosphorus
Regulation of muscle composition and muscle function
Prevention of cancer
Regulation of immune system
Regulation of insulin and blood sugar
Regulation of blood pressure and cardiovascular health

21. Sourses
Vitamin D is naturally produced by the human body when exposed to direct sunlight.
Expose hands, face, arms 2-3 x/week for 5-10
minutes each time.
Milk, yogurt, margarine, cereals, bread, pastries fortified with vitamin D2 and/or vitamin D3.
Egg cod liver oil and salmon
Adequate Intake (AI) for VitaminD
• 5 ug/d (200 IU/day) for adults under age 51
• ug/day ( IU/day) for older adults
–May need combination of fortified foods

22. Vitamin D deficiency
impaired bone mineralization and leads to bone softening diseases, rickets in children and osteomalacia in adults, and possibly contributes to osteoporosis.

23. Hypervitaminosis D Hypercalcemia High blood pressure
Anorexia, nausea and vomiting
These symptoms are often followed by polyuria, polydepsia, weakness, nervousness, pruritus, and eventually renal failure

24. Fat soluble vitamins Vitamin E
The term vitamin E refers to a family of eight related compounds, the tocopherols and the tocotrienols
The four major forms of vitamin E are designated a, b, d, g, that have varying levels of biological activity
Alpha- (or α-) tocopherol is the most active form
Termed an antioxidant

26. Vitamin E
Protects cell membranes and other fat-soluble parts of the body (LDL cholesterol) from oxidation
May reduce the risk of heart disease
May also discourage development of some types of cancer
Promotes normal growth and development
Promotes normal red blood cell formation
Acts as anti-blood clotting agent
Plays some role in the body’s ability to process glucose
Also been known to aid the process of wound healing

27. Sources Plant sources Cereal grains
wheat germ oil, almonds, sunflower seeds, sunflower oil, safflower oil, hazelnuts, peanut butter, peanuts, corn oil, spinach, broccoli, soybean oil, kiwi and mango. Vegetable and seed oils
Little in animal sources
Beef fed high levels of vitamin E right before slaughter to improve shelf life can be source
The RDA (recommended daily allowance) for vitamin E is 15 mg of d-alpha-tocopherol for adult men and women (1 mg of d-alpha-tocopherol is equal to 1.5 IU, so the RDA is equal to 22.5 IU).

28. Vitamin E Toxicity
Wide range of safe intake compared to other fat soluble vitamins (toxicity rare)
Extreme high doses (50- to 100-fold above recommended intakes) may affect the blood clotting effects of vitamin K and may lead to increased risk of hemorrhage

29. Fat soluble vitamins Vitamin K
K1, phylloquinone
Chloroplasts in plants
K2, menaquinone
Bacterial synthesis
K3, menadione
Synthetic, water soluble form
Complexed to improve stability
Vitamin K2

30. Physiological Effects of Vitamin K
Vitamin K serves as an essential cofactor for a carboxylase that catalyzes carboxylation of glutamic acid residues on vitamin K-dependent proteins. These proteins are involved in:
1) Coagulation 2) Bone Mineralization 3) Cell growth

31. Coagulation The transformation of liquid blood into a solid gel
Stops blood flow in the damaged area
Fibrin is the final protein which produces a meshwork to trap RBC and other cells

32. Vitamin K Dependent Coagulation
Certain clotting factors/proteins require calcium to bind for activation
Calcium can only bind after gamma carboxylation of specific glutamic acid residues in these proteins
The reduced form of vitamin K2 (vitamin KH2) acts as a cofactor for this carboxylation reaction.
These proteins are known as “Vitamin K dependent” proteins

33. Vitamin K Dependent Proteins
factor II (prothrombin)
factor VII (proconvertin)
factor IX (thromboplastin component)
factor X (Stuart factor)
protein C & protein S
Protein Z

34. Clotting Cascade

35. Gamma Carboxy Glutamic Acid
Vitamin K Cycle
Vitamin KH2
Glutamic Acid
Reductase
Vitamin K
Vitamin K Dependent
Carboxylase
Warfarin Inhibits
Epoxide
Reductase
Gamma Carboxy Glutamic Acid
Vitamin K Epoxide

36. Dietary Sources
The best food sources of vitamin K are green leafy vegetables.
Milk and liver.
Daily requirement:
Life Stage
Age 
  Males (mcg/day)
Females (mcg/day)
Infants
0-6 months
2.0
 Infants
7-12 months
2.5
Children 
  1-3 years 30
Children
4-8 years  55
9-13 years 60
Adolescents
14-18 years 75
Adults
19 years and older
120 90
Pregnancy
18 years and younger  -
19 years and older
Breast-feeding

37. Vitamin K Deficiency
Results in impaired blood clotting and, potentially, bleeding.
Vitamin K deficiency can result from:
a lack of vitamin k in the diet
disorders that reduce fat absorption
Taking certain drugs, including anticonvulsants and some antibiotics
Use of coumarin anticoagulants
Salicylates
Large doses of vitamin E
Hepatic insufficiency

38. Symptoms of Vitamin K Deficiency
Bruising from bleeding into the skin
Nosebleeds
Bleeding gums
Bleeding in stomach
Blood in urine
Blood in stool
Tarry black stool
Extremely heavy menstrual bleeding
In infants, may result in intracranial hemorrhage

39. Vitamin K Deficiency in Infants
Newborns are prone to vitamin K deficiency because…
Vitamin K and lipids are not easily transported across the placental barrier
Prothrombin synthesis in the liver is an immature process in newborns, especially when premature.
The neonatal gut is sterile, lacking the bacteria that is necessary in menaquinone synthesis.
Breast milk is not a good source of vitamin K
Results in a hemorrhagic disease called vitamin K deficiency bleeding (VKDB)
This disease is associated with breastfeeding, maladsorption of lipids, or liver
disorders.

40. Vitamin K Deficiency in Adults
Uncommon in adults because normal bacteria found in the gut synthesize Vitamin K2
and the vitamin may be consumed from several food sources.
Contributing Factors:
Biliary obstruction
Maladsorption
Cystic fibrosis
Resection of small intestine
Increases risk of bleeding in individuals who suffer from Vitamin K deficiency:
Coumarin anticoagulants
Certain antibiotics

41. Vitamin K - Toxicity Not common except with over-supplementation
Phylloquinone and menaquinone are relatively nontoxic
Jaundice; brain damage
Menadione toxic to skin and respiratory tract in high doses