1. Biochemistry Vitamins 1. Water soluble vitamins
1. Water soluble vitamins
2. Fat soluble vitamins
LNut1 (Nutrition.doc)

2. Objectives: To recognize vitamins by name
To recognize vitamins by name
To understand their distribution in various food sources
To understand their role in metabolism
To understand the signs and symptoms of diseases resulting from deficiencies
LNut3 (Nutrition.doc)

3. Vitamins A group of organic nutrients required in small
quantities for a variety of biochemical
functions and which , generally , cannot be
synthesized by body and must therefore be
supplied in the diet.

4. Water soluble vitamins
1. B-complex vitamins
a) B-vitamins in energy metabolism
Thiamine (B1)
Riboflavin (B2)
Niacin (B3)
Biotin
Pantothenic acid
b) B-vitamins in methyl group metabolism conversions
Folic acid
Cobalamin (B12)
c) B-vitamins in metabolic conversions
Pyridoxine (B6)
Pyridoxal
Pyridoxamine
2. Vitamin C
LNut6 (Nutrition.doc)

5. LNut15 (9Nutrition.cdx)

6. LNut16 (Champe and Harvey, Fig 9.3, p. 106)
Champe and Harvey, p. 106

7. LNut17 (11Nutrition.cdx)

8. Thiamine Food sources and distribution:
Whole grain, meats, legumes (peas, beans and lentils)
Signs and symptoms of deficiency
Beri-beri: severe deficiency
Primarily in areas where polished rice is primary food source
Symptoms include dry skin, irritability, disorderly thinking and progressive paralysis
Wet beriberi-cardiovascular symptoms, cardiac failure
Infants: onset can be rapid, resulting in tachycardia and death
(look to nutritional status of mother)
Wernicke-Korsakoff syndrome:
Primarily associated with severe alcoholism.
Symptoms include apathy, loss of memory
Wandering eye movement
Toxicities, contraindications, and other notes
Only known use in treating deficiency
Commonly given to alcoholics in ER(emergency room)
Excess of any one B-vitamin can cause deficiency of others.
LNut18 (Nutrition.cdx)

9. Rubin and Farber, Pathology - 2nd edition, p. 329
LNut19 (Rubin and Farber, Fig. 8-31, p. 329)
Rubin and Farber, Pathology - 2nd edition, p. 329

10. LNut20 (12Nutrition.cdx)

11. Riboflavin Food sources and distribution:
Food sources and distribution:
Milk, cheese, meat, leafy vegetables, breads, cereals
Signs and symptoms of deficiency
Sore throat, glossitis, cheilosis (red lips)
Anemia, neuropathy
Toxicities, contraindications and other notes
Only known use in treating deficiency
Excess intake can cause yellow urine
Excess can interfere with B1 & B6
LNut21 (Nutrition.doc)

12. Rubin and Farber, Pathology - 2nd edition, p. 331
LNut22 (Rubin and Farber, Fig. 8-33, p. 331)
Rubin and Farber, Pathology - 2nd edition, p. 331

13. LNut23 (13Nutrition.cdx)

14. niacin Food sources and distribution:
Food sources and distribution:
Fish, meat, poultry, cereal, nuts
Tryptophan in diet can serve as alternative source
Signs and symptoms of deficiency
Pellagra (pella agra: rough skin)
3D’s: dermatitis, diarrhea, dementia
red, swollen tongue
observed in chronic alcoholics
symptoms reverse within 24H of administration
Toxicities, contraindications and other notes
Harnup’s disease: defective renal and intestinal transport of tryptophan
Fast growing tumors can exhaust tryptophan supply
Excess can cause high BP and uric acid, cardiac arrhythmias
Can lower cholesterol
LNut24 (Nutrition.doc)

15. Rubin and Farber, Pathology - 2nd edition, p. 330
LNut25 (Rubin and Farber, Fig. 8-32, p. 330)
Rubin and Farber, Pathology - 2nd edition, p. 330

16. LNut26 (14Nutrition.cdx)

17. biotin Food sources and distribution:
Food sources and distribution:
Can be synthesized by intestinal bacteria
Found in most foods
Signs and symptoms of deficiency
Very rare, include dermatitis, muscle pain
Toxicities, contraindications, and notes
Chronic consumption of raw eggs can induce deficiency.
Chronic inflammatory bowel disease can cause deficiency.
LNut27 (Nturition.doc)

18. LNut28 (15 Nutrition.cdx)

19. pantothenic (B5) Food sources and distribution: Ubiquitous
Food sources and distribution:
Ubiquitous
Easily destroyed by heating
Signs and symptoms of deficiency
Very rare
Neuromuscular degeneration
Toxicities, contraindications and other notes
Megadose can cause diarrhea and water retention
LNut29 (Nutrition.doc)

20. B-complex vitamins in energy metabolism and neuropathologies
LNut30 (Nutrition.doc)

21. B-complex vitamins and energy metabolism:
Review
B-complex vitamins and energy metabolism:
Thiamine B1 TPP, pyruvate dehydrogenase
Riboflavin B2 FAD, FADH2
Niacin B3 NAD+, NADH
Pantothenic acid coenzyme A
Biotin decarboxylation reactions
(decarboxylase)
LNut32 (Nutrition.doc)

22. LNut33 (16Nutrition.cdx)

23. LNut34 (17Nutrition.cdx)

24. Pyridoxine (B6) Food sources and distribution:
Food sources and distribution:
Meat, whole-grain breads and cereals, vegetables
Signs and symptoms of deficiency
Skin lesions
Convulsive disorders resulting from low levels of GABA
Needed for NAD+ synthesis
Toxicities, contraindications and other notes
Excess can lead to sensory nerve destruction, loss of feeling in fingers, legs
Extra pyridoxine needed when using ISONAZIDE for treatment of TB
ISONAZIDE binds covalently to pyridoxal phosphate
LNut35 (Nutrition.doc)

25. LNut37 (Champe and Harvey, Fig. 22.12, p. 250)
Champe and Harvey, p. 250

26. LNut38 (pyrimidinesynthesis 11)

27. LNut39 (pyrimidinesynthesis 11a)

28. LNut40 (pyrimidinesythesis 12)

29. LNut41 (L3.27)
Stryer, Fig 29-16

30. Folic acid Food sources and distribution: Fresh green vegetables
Food sources and distribution:
Fresh green vegetables
Cooking can destroy folic acid
Signs and symptoms of deficiency
Hemolytic anemias
Toxicities, contraindications and other notes.
Critical for pregnant women
Megadose can interfere with Zinc absorption.
May interfere with antiepileptic meds (phenobarbitol)
LNut42 (Nutrition.doc)

31. LNut43 (L3.26)
Rubin E, Pathology, p1379

32. Goodman Gilman, A. The Pharmacological Basis of Therapeutics, p.1245
LNut44 (L3.28)
Goodman Gilman, A. The Pharmacological Basis of Therapeutics, p.1245

33. LNut45 (Champe and Harvey, Fig. 28.11, p. 327)
Champe and Harvey, p. 327

34. LNut46 (10Nutrition.cdx)

35. Cobalamin (B12) Food sources and distribution:
Food sources and distribution:
Synthesized only by microorganisms
Deficiency usually results from absorption problem, not availability
Signs and symptoms of deficiency:
Pernicious anemia
Megaloblastic anemia
Neurologic dysfunction
Can result in abnormal fatty acid accumulation in membranes
Toxicities, contraindications and other notes
Substantial stores of B12 are found in the body.
Could take years to develop deficiency.
Caution with patients who have had GI(gastro-intestinal) surgery.
LNut47 (Nutrition.doc)

36. LNut48 (Rubin and Farber, Fig. 20-20, p. 1020)
Rubin and Farber, p. 1020

37. Vitamin C Food sources and distribution: Citrus fruits, potatoes
Food sources and distribution:
Citrus fruits, potatoes
Signs and symptoms of deficiency:
Scurvy results from deficiency in collagen hydroxylation
Results in spongy gums, loose teeth and bleeding under the skin
Toxicities and contraindications:
Can cause oxidation, particularly in presence of free metals
Can be toxic with hemodialysis patients, iron storage diseases
Ascorbate is metabolized to oxalate which can form insoluble precipitates with Ca++
Result in low Ca++, kidney stones, heart deposits.
LNut52 (Nutrition.doc)

38. LNut53 (18Nutrition.cdx)

39. Rubin and Farber, Pathology - 2nd edition, p. 333
LNut54 (Rubin and Farber, Fig. 8-34, p. 333)
Rubin and Farber, Pathology - 2nd edition, p. 333

40. LNut55 (19Nutrition.cdx)

41. Wernicke-Korsakoff syndrome: Vit B1 Pellagra: Vit B3
Review:
Diseases associated/resulting from deficiencies in water soluble vitamins:
BeriBeri: Vit B1
Wernicke-Korsakoff syndrome: Vit B1
Pellagra: Vit B3
Pernicious anemia: B12
Megaloblastic anemia: B12
Scurvy: Vit C
LNut56 (Nutrition.doc)

42. Fat-soluble vitamins Vitamin A Vitamin D Vitamin E Vitamin K
Vitamin A
Vitamin D
Vitamin E
Vitamin K
LNut57 (Medical Biochemistry.doc)

43. Vitamin A Food sources and distribution:
Food sources and distribution:
Low fat dairy products, deep yellow, orange vegetables
Function: Vitamin A(retinol) is the precursor of retinel, the light-sensitive group in rhodopsin and other visual pigments.
Signs and symptoms of deficiency:
Night blindness, dry eyes and skin
Slow growth in children
Lowered resistance to infection
Toxicities and contraindications:
Overdose can result in dry skin, headache
Can result in birth defects in pregnant women
Can cause liver damage
Vitamin A derivatives (isotretinoin, accutane) can cause
birth defects and has been associated with suicide.
LNut59 (Medical Biochemistry.doc)

44. LNut60 (20Nutrition.cdx)

45. Rubin and Farber, Pathology - 2nd edition, p. 328
LNut61 (Rubin and Farber, Fig. 8-30, p. 328)
Rubin and Farber, Pathology - 2nd edition, p. 328

46. LNut63 (Bugs Bunny)

47. LNut64 (http://www.cnn.com/2002/US/01/08/plane.suicide.mother/index.html)

48. Goodman and Gilman, The Pharmacological Basis of Therapeutics, p. 1599
LNut65 (Goodman and Gilman, Fig. 64-2, p. 1599)
Goodman and Gilman, The Pharmacological Basis of Therapeutics, p. 1599

49. Vitamin D Food sources and distribution:
Food sources and distribution:
Egg yolks, fortified milk, fish oil, sun exposure
Function: A metabolite of vitamin D is a hormone that regulates the metabolism of calcium and phosphorus.
Signs and symptoms of deficiency:
Rickets in children
Osteomalacia (osteoporosis) in adults
Toxicities and contraindications:
The most toxic of vitamins in excess
Calcium deposits in heart, hypertension, high cholesterol
Fragile bones
LNut66 (Medical Biochemistry.doc)

50. LNut67 (21Nutrition.cdx)

51. Robbins, Pathologic Basis of Disease – 5th Edition, p. 1221
LNut68 (Robbins, Fig. 27-9, p. 1221)
Robbins, Pathologic Basis of Disease – 5th Edition, p. 1221

52. Vitamin E Food sources and distribution:
Food sources and distribution:
Poultry, seafood, seeds, nuts, whole wheat
Function:  Reacts with and neutralizes reactive oxygen species such as hydroxyl , radicals before they can oxidize unsaturated membrane lipids, damaging cell structure(antioxidant)
Signs and symptoms of deficiency:
very rare , Unknown in humans, in animal may cause infertility
Toxicities and contraindications:
Excessive bleeding, reduced sexual function
LNut69 (Medical Biochemistry.doc)

53. LNut70 (22Nutrition.cdx)

54. Vitamin K Food sources and distribution: Made by intestinal bacteria
Food sources and distribution:
Made by intestinal bacteria
Spinach, leafy vegetables, oats, bran, potatoes
 Function: required for normal blood clotting(blood coagulation)
Signs and symptoms of deficiency:
Excess bleeding, bleeding gums
Toxicities and contraindications:
Jaundice in infants
LNut71 (Medical Biochemistry.doc)

55. LNut72 (23Nutrition.cdx)