Nutrientiology

Lecture 5
A. Magaldadze
The vitamins are essential nutrients needed in tiny amounts in the
diet both to prevent deficiency diseases and to support optimal
health.
The water soluble vitamins are the B vitamins and vitamin C; the
fat-soluble vitamins are vitamins A, D, E, and K.
Water soluble vitamins Fat soluble vitamins

Absorption Directly into the blood First into the lymph, then the
blood
Transport Travel freely Many require protein carriers

Storage Circulate freely in water-filled Stored in the cells associated with

parts of the body fat
Excretion Kidneys detect and remove Less readily excreted; tend to
Excess in urine remain in fat-storage sites
Toxicity Possible to reach toxic levels Likely to reach toxic levels when
when consumed from supplements consumed from supplements
Requirements Needed in frequent doses (perhaps Needed in periodic doses (perhaps
1 to 3 days) weeks or even months)
Fat soluble vitamins
• Being insoluble in the watery GI juices, the fat-soluble
vitamins require bile for their absorption
• Upon absorption, fat-soluble vitamins travel through the
lymphatic system within chylomicrons before entering the
bloodstream, where many of them require protein carriers
for transport.
• Excesses are stored primarily in the liver and adipose tissue.
• thus people can eat less than their daily need for days,
weeks, or even months or years without ill effects.
• because fat-soluble vitamins are not readily excreted, the
risk of toxicity is greater than it is for the water-soluble
vitamins.
 Vitamin A and Beta-Carotene (precursor)
Three different forms of vitamin A are active in the body: retinol, retinal, and
retinoic acid.
These compounds are known as retinoids

Beta-
Retinyl esters
Cleavage at this carotene
(in animal
point can yield (in plant
foods)
two molecules foods)
of vitamin A

Retinol Retinal Retinoic

(supports (participat acid
reproductio es (regulates
n) in vision) growth)
 Vitamin A in Reproduction and
Roles in the Body Growth
In men, retinol participates in sperm
development,
• Promoting vision in women, supports normal fetal
development during pregnancy.
• Participating in protein synthesis and cell differentiation (and Children lacking vitamin A fail to
thereby maintaining
grow.
the health of epithelial tissues and skin) When given vitamin A supplements,
• Supporting reproduction and growth these
children gain weight and grow
taller.
Vitamin A in Vision Vitamin A plays two indispensable roles in
the eye: it helps maintain a crystal-clear outer window, the
cornea, and it participates in the conversion of light energy
into nerve impulses at the retina. Despite its important role in
vision, only one-thousandth of the body’s vitamin A is in the
retina.
Vitamin A in Protein Synthesis and Cell
Differentiation
Vitamin A promotes differentiation of epithelial cells and
goblet cells, one-celled glands that synthesize and
secrete mucus. Mucus coats and protects the epithelial
cells from invasive microorganisms and other harmful
substances, such as gastric juices.
 Vitamin A
Deficiency
• Vitamin A status depends mostly on the adequacy
of vitamin A stores, 90 percent of which are in the
liver.
• Vitamin A status also depends on a person’s
protein status because retinol-binding proteins
serve as the vitamin’s transport carriers inside the
body.
• deficiency symptoms would not begin to appear
until after stores were depleted—one to two years
for a healthy adult but much sooner for a growing
child.
• More than 100 million children worldwide have
some degree of vitamin A deficiency and thus are
vulnerable to infectious diseases and blindness.
 Vitamin A
Deficiency and
Infectious
Diseases

• The severity of the measles often correlates with the degree of

vitamin A deficiency;
• deaths are usually due to related infections such as pneumonia and
severe diarrhea.
• Providing large doses of vitamin A reduces the risk of dying
from these infections.

The World Health Organization and UNICEF have made the control of
vitamin A deficiency a major goal in their quest to improve child
health and survival throughout the developing world. They
recommend routine vitamin A supplementation for all children with
measles in areas where vitamin A deficiency is a problem or where
the measles death rate is high.
Vitamin A supplementation also protects against the complications of
other life-threatening infections, including malaria, lung diseases, and
HIV (human immunodeficiency virus, the virus that causes AIDS).
Vitamin A Deficiency
and Night Blindness
Blindness (Xerophthalmia)

• In night blindness, the retina does not receive enough retinal to regenerate the
visual pigments bleached by light.
• The person loses the ability to recover promptly from the temporary blinding that
follows a flash of bright light at night or to see after the lights go out.
• In many parts of the world, after the sun goes down, vitamin A–deficient people
become night-blind: children cannot find their shoes or toys, and women cannot
fetch water or wash dishes.
• In many developing countries, night blindness is so common that the people have
special words to describe it, for ex.: In Indonesia, the term “chicken eyes” or
“chicken
Total blindness“.
blindness is caused by a lack of vit A at the front of the eye, the cornea.
vitamin A deficiency is the major cause of childhood blindness in the world,
causing more than half a million preschool children to lose their sight each year.
Unfortunately, it’s an irreversible blindness.
Vitamin A Deficiency and
Keratinization

In vitamin A deficiency, the epithelial cells secrete

the protein keratin in a process known as
keratinization.
The extreme of this condition is hyperkeratinization or hyperkeratosis.
When keratin accumulates around hair follicles, the condition is known as
follicular hyperkeratosis.
With less mucus, normal digestion and absorption of nutrients falter, and this,
in turn, worsens malnutrition by limiting the absorption of nutrients.

Keratinization doesn’t occur in the GI tract, but mucus-producing cells diminish

in number and mucus production declines.
Similar changes in the cells of other epithelial tissues weaken defenses,
making infections of the respiratory tract, the GI tract, the urinary tract, the
vagina, and possibly the inner ear likely.
Vitamin A Toxicity as a deficiency of vitamin A affects all body systems,
so does a toxicity
 Symptoms of toxicity begin to develop when all the binding proteins are swamped, and
AcuteAToxicity
free vitamin damagesSymptoms
the cells.
 Such Blurred vision, nausea,
effects are unlikely when a person depends on a balanced diet for nutrients, but
vomiting,
toxicity vertigo; increase
is a real possibility of
when concentrated amounts of preformed vitamin A in
foodspressure inside
derived from skull,fortified foods, or supplements is consumed.
animals,
mimicking
 Children are mostbrain tumor;
vulnerable to toxicity because they need less vitamin A and are more
headaches;
sensitive muscle
to overdoses.
incoordination
 An Upper Level has been set for preformed vitamin A.
Bone Defects - fractures and
osteoporosis
◆ Multivitamin supplements typically provide:
Birth Defects - High intakes
• 750 μg (2500 IU)
(10,000
• 1500 μg (5000 IU)
IU of supplemental vitamin A
◆ For perspective, the RDA for vitamin A is 700
daily) before the seventh week
μg for women and 900 μg for men.
of pregnancy appear to be the
Even multivitamin supplements provide more
most damaging.
vitamin A than most people need.
Teratogenic effect.
Liver problems
 Vitamin A Recommendations
Not for Acne Adolescents need to know that
massive doses of vitamin A have no beneficial
effect on acne.
The prescription medicine Accutane (isotretinoin)
is made from vitamin A but is chemically
different.
It is highly toxic, however, especially during
growth, and has caused birth defects in infants
when women have taken it during their
pregnancies.
For this reason, women taking Accutane must
begin using two effective forms of
contraception at least one month before
taking the drug and continue using
contraception at least one month after
discontinuing its use.
With one ounce of beef liver providing
more than three times the RDA for
vitamin A, intakes can rise quickly.
Vitamin D calciferol is different from all the other nutrients in that the body can synthesize
it, with the help of sunlight, from a precursor that the body makes from cholesterol. vitamin D is not an
essential nutrient; given enough time in
the sun, people need no vitamin D from foods.

vitamin D is actually a hormone—a compound

In the skin:
manufactured by one part of the body that causes another
7-dehydrocholesterol
part to respond.
(a precursor made in
vitamin D has a binding protein that carries it to the target the
organs—most notably, the intestines, the kidneys, and liver from cholesterol)
the bones. Ultraviolet
light from
All respond to vitamin D by making the minerals needed the sun
for bone growth and maintenance available.
Vitamin D’s special role in bone growth is to maintain blood Previtamin
concentrations of calcium and phosphorus. D3 liver:
In the
Inactive form
Hydroxylation
Vitamin D raises blood concentrations of these minerals in
three ways:
25-hydroxy vitamin
1. It enhances their absorption from the GI tract; In the
D3
2. their reabsorption by the kidneys, and kidneys: Hydroxylatio
n
3. mobilization from the bones into the blood. 1,25-dihydroxy vitamin
D3
(active form)
 Vitamin D Deficiency a vitamin D deficiency creates a calcium
deficiency and increases the risks of several chronic diseases, most notably osteoporosis.
Rickets - young, breastfed, black
Factors that contribute to vitamin D deficiency: children are the ones most likely to be
 dark skin, affected.
 Breastfeeding without supplementation, bones fail to calcify normally, causing
 lack of sunlight, growth retardation and skeletal
 not using fortified milk. abnormalities.
 Vitamin D supplementation helps to reduce the The bones become so weak that they
risks of falls and fractures in elderly persons. bend.
beaded ribs.
Osteomalacia In adults, the poor
mineralization of bone results in the painful
bone disease steomalacia. The bones
become increasingly soft, flexible, brittle,
and deformed.
Osteoporosis Any failure to synthesize
adequate vitamin D or obtain enough from
foods sets the stage for a loss of calcium
from the bones, which can result in
fractures.
 Vitamin D Toxicity
Excess vitamin D raises the concentration
of blood calcium.
Excess blood calcium tends to precipitate in
the soft tissue, forming stones, especially in
the kidneys
where calcium is concentrated in the effort
to excrete it.
Calcification may also harden the blood
vessels and is especially dangerous in the
major arteries of the heart and lungs,
where it can cause death.
 Adequate Intake (AI)
Vitamin D Adults: 5 μg/day (19–50 yr)
200 IU
Recommendations and 10 μg/day (51–70 yr) 400 IU
Sources 15 μg/day (>70 yr)
Upper Level
Adults: 50◆μg/day (2000
Factors IU)may
that
 The fortification of milk with vitamin D is the best guarantee
that people will meet their needs and underscores the
limit sun exposure
importance of milk in a well-balanced diet. and,
 Without adequate sunshine, fortification, or supplementation, therefore, vitamin D
a vegan diet cannot meet vitamin D needs. synthesis:
 The sun imposes no risk of vitamin D toxicity; prolonged • Geographic
exposure to sunlight degrades the vitamin D precursor in the
skin, preventing its conversion to the active vitamin location
 Prolonged exposure to sunlight present the risk of skin • Season of the
cancer. year
 Sunscreens help reduce these risks, but unfortunately, • Time of day
sunscreens with sun protection factors (SPF) of 8 and higher • Air pollution
also prevent vitamin D synthesis.
• Clothing
 exposing hands, face, and arms on a clear summer day for 5
to 10 minutes two or three times a week should be sufficient
• Tall buildings
to maintain vitamin D nutrition. • Indoor living
Vitamin E – alpha-tocopherol

Vit E is a fat-soluble antioxidant

and one of the body’s primary
defenders against the adverse
effects of free radicals.

Vitamin E protects the vulnerable

components of the cells and their
membranes from destruction.

Vitamin E may reduce the risk of

heart disease by protecting low-
density lipoproteins (LDL) against
oxidation and reducing
inflammation.
In human beings, a primary deficiency of vitamin E (from poor
dietary intake) is rare. Deficiency is usually associated with
diseases of fat malabsorption such as cystic fibrosis.

Without vitamin E, the red blood

cells break open and spill their
contents, probably due to
oxidation of the polyunsaturated Vitamin E
fatty acids in their membranes.
Deficiency
This classic sign of vitamin E
deficiency, known as erythrocyte
hemolysis.

Prolonged vitamin E deficiency also causes

neuromuscular dysfunction involving the spinal
cord and retina of the eye. Common symptoms
include loss of muscle coordination and
reflexes and impaired vision and speech.
Vitamin E treatment corrects these neurological
symptoms of vitamin E deficiency, but it does
not prevent or cure the hereditary muscular
dystrophy that afflicts young children.
The Upper Level for vitamin E (1000 milligrams) is more than 65 times
greater than the recommended intake for adults (15 milligrams).
Extremely high doses of vitamin E may interfere with the blood-clotting
action of vitamin K and enhance the effects of drugs used to oppose blood
clotting, causing hemorrhage.

Vitamin E
Recommendations Because vitamin E is
Fat-soluble readily destroyed by
vitamin E is heat processing (such
found as deep-fat frying) and
predominantly oxidation, fresh or
in vegetable oils, lightly processed foods
seeds, and nuts. are preferable sources.

smokers may RDA

have a higher Adults: 15
Requirement. mg/day
Vitamin K - K stands for the Danish word
koagulation

Like vitamin D, vitamin K can be obtained from a

nonfood source. Bacteria in the GI tract synthesize
vitamin K that the body can absorb.
Vitamin K acts primarily in blood clotting.
Newborn infants present a
unique case of vitamin K
Vitamin K is essential for the activation of prothrombin,
nutrition because they are
made by the liver as a precursor of the protein
born with a sterile intestinal
thrombin.
tract, and the vitamin K–
When any of the blood-clotting factors is lacking, producing bacteria take weeks
hemorrhagic disease results. to establish themselves.
Vitamin K also participates in the synthesis of bone proteins. At the same time, plasma
Without vitamin K, the bones produce an abnormal protein prothrombin concentrations
that cannot bind to the minerals that normally form bones, are low.
resulting in low bone density. To prevent hemorrhagic
disease in the newborn, a
single dose of vitamin K.
Vitamin K Deficiency Vitamin K Toxicity
A primary deficiency of vitamin K is
rare, but a secondary deficiency may
occur in two circumstances. Toxicity is not common, and
1. whenever fat absorption falters, as no adverse effects have been
occurs when bile production fails, reported with high intakes
vitamin K absorption diminishes.
of vitamin K.
2. Second, some drugs disrupt vitamin
K’s synthesis and action in the body:
antibiotics kill the vitamin K– Therefore, an Upper Level has
producing bacteria in the intestine, not been established.
and anticoagulant drugs interfere
with vitamin K metabolism and
activity.

When vitamin K deficiency does

occur, it can be fatal.
Vitamin K Recommendations and Sources

Notable food
sources of
vitamin K include
green vegetables
such as collards, Adequate
spinach, bib Intakes (AI)
lettuce, brussels Men: 120 μg/day
sprouts, and Women: 90
cabbage and μg/day
vegetable
oils such as
soybean oil and
canola oil.
The end
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