Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

Vitamins
-

Characteristic

Chemically unrelated organic nutrients

Classified by their biological and chemical activity and
NOT by their structure
Cannot be synthesized by in sufficient quantities, only in
small quantities
Essential MICROnutrients
Used in chemical reactions in the body, usually as
coenzymes
Do not enter tissue structures nor converted to energy
Act like hormones but are EXOGENOUS
Supplied in the diet because it occurs in natural food
Diverse but act similar with hormones in regulating
cellular metabolism

*Eggs and milk: Most complete protein food, high biological

value
Vitamins are not:
-

Date: January 6, 2015

Polarity
Absorption
Storage
Transport
Deficiency
Toxicity
Excretion

Fat-Soluble
Vitamins
Apolar/
Hydrophobic
Require normal fat
absorption

Water Soluble
Vitamins
Polar

Does not require

normal fat
absorption
In liver or adipose No stable storage
form, except B12
Lipoproteins or
No protein
specific binding
transporters
proteins
Less prone
More prone
More prone
Less prone
Thru feces
Mainly thru
urine

*Macronutrients are all converted to Acetyl CoA or to a

metabolite in Krebs Cycle before giving off energy.

Pep pills
Substitute for natural food that has carbohydrates, fats
and proteins
Components of cell structures

Classification
Vitamins
Fat-Soluble
Vitamin A
Vitamin D
Vitamin E
Vitamin K

MELAI VALEZA

Water-Soluble
-B-Complex
-Energy Releasing
Vitamin B1
Vitamin B2
Vitamin B3
Biotin
Pantothenic
Acid
-Hematopoetic
Folic Acid
Vitamin B12
-Amino Acid Metab
Pyridoxine
Pyridoxal
Pyridoxamine
-Non B-Complex
Vitamin C

VITAMINS 1

Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

Water Soluble Vitamins

Energy Releasing
1. VITAMIN B1 (Thiamine)
- Also called as:
o Anti-neuritic Vitamin
o Anti-beriberi Vitamin
o Aneurin
- Methylated pyrimidine ring bonded thru a
methylene linkage to a thiazole ring

Date: January 6, 2015

Basis for quantitative determination:

o Uses potassium ferricyanide
o Thiochrome is blue and color is
DIRECTLY proportional to Thiamine
content

Coenzyme form:
o Thiamine Pyrophosphate/ Diphosphate/Cocarboxylase
Active Form
Important in metabolism of nerve tissue
Synthesis of Neurotransmitters (Ach)
Regulates nerve-impulse transmissionbbb
Coenzyme in transketolase reactions

*RBC Transketolase: commonly used in measuring thiamine

status of the body

RENI:
o Adults/Adolescents: 0.5mg/100kcal
intake
Sources:
o High protein food like:
Meat/fish
Asparagus
Beans
Nuts
Seeds
Bread
Deficiency
- Rare , and mostly found in individuals:
o Whose energy intake are mostly from
rice
o Eating food with anti-thiamine factor
o Pregnant and lactating
o Who do hard physical labor
Types:

Coenzyme in the decarboxylation of:

o Pyruvate
o Alpha-Ketoglutarate
o Keto acids from branch chain amino
acids (HMP Shunt: Oxidative)
Oxidative part: NADPH (reducing
agent for reduced glutathone)

Energy-releasing
Has central role in Carbohydrate Metabolism
o Functions in Krebs cycle

MELAI VALEZA

1. Dry Beriberi (peripheral manifestation)

a. Loss of appetite
b. Weight loss
c. Muscle wasting
d. Peripheral neuritis with numbness
e. Tingling in lower legs and feet
f. Ataxic gait
2. Wet Beri-beri (cardiac)
a. With symptoms of Dry Beri-beri
b. Edema (due to low protein intake)
c. Foot and wrist drop
d. Heart enlargement

VITAMINS 2

Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

3. Cerebral Beriberi (Wernicke-Korsakoff

Syndrome)
a. Occurs in alcoholics who consume less
food
b. Intelligence disturbance
c. Ataxia
d. Double vision
e. Nystagmus
f. Progresses to Wernicke-Korssakoff
psychosis

Date: January 6, 2015

2. VITAMIN B2 (Riboflavin)
- Also called as:
o Vitamin G
o Lactoflavin
o Heterocyclic isoalloxazine ring attached
to a sugar alcohol, robitol

4. Infantile Beriberi
a. Due to low thiamine content of breast
milk
b. Anorexia
c. Tachycardia
d. Vomiting
e. Convulsions
f. Edema
Type of Beriberi
Common symptoms/findings
Neuropsychiatric Hallucinations, aggressiveness
confusion, nystagmus, ataxia,
ophthalmoplegia
Dry-Neurologic
Numbness, muscle weakness,
upper and lower extremity pain,
convulsions, exaggerated tendon
reflexes
Wet-High output Tachycardia, respiratory distress,
CVD
leg edema, right vascular
dilation, lactic acidosis
Gastrointestinal
Nausea, emesis, megajejunum,
constipation, megacolon

Coenzyme forms:
o Flavin mononucleotide (FMN)
With a phosphate group
Seen in ETC Complex 1 and 2
o Flavin Adenine Dinucleotide (FAD)
FAD and FADH2
Colored, fluorescent pigment
Widely used as food additive (B2 fortified)
Heat stable but decomposes in the presence of
visible light
Act as prosthetic group of flavoproteins
Flavoproteins:
o Enzymes in redox reactions
o FAD is required as coenzyme for:
Pyruvate DH (Carb metab)
Succinate DH (Krebs cycle)
Glycerol-3-phosphate DH
(TAG/Phospholipid synthesis)
Acyl CoA DH (fatty acid breakdown)
Glutathione reductase (reduced
glutathione regeneration)
Erythrocyte GSH reductase: For
assaying riboflavin status

*South Beach Diet: Less Carbs, More Protein to burn the

fats. Remember body stores usage: Carbs, Fats, and
proteins are last.

FMN is required for:

L-amino acid oxidase
Cytochrome C reductase
Act as coenzyme for hydrogen transfer

*Thiamine, FAD powers puruvate dehydrogenase and

alpha ketoglutarate
MELAI VALEZA

VITAMINS 3

Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

Vitamin B2 (Riboflavin cont.)

RDA:
o Adults: 2mg/day
o Children: 1.2mg/day
o Pregnant/lactating: 2 mg/day
Sources:
o Milk 1 quart = 1.7mg (3L/day)
o Milk equivalents
Deficiency (Ariboflavinosis)
- Causes:
o Malnutrition
o Malabsorption
o Anorexia
o Chronic alcoholism
- Manifestations:
o Epithelial changes in oral cavity
Since there is rapid cell
turnover in these areas
Cheilosis or perleche: fissuring
of lips
Glossitis: magenta tongue
o Corneal vascularization
o Seborrheic dermatitis
o Photophobia
Angular Stomatitis
|
Glossitis

3. VITAMIN B 3 (Niacin)
- Also called as:
o Nicotinic acid,
o PP Factor
o Nicotinamide
o Niacinamide
- Not strictly a vitamin (since found in a lot of
food sources)
- Coenzyme forms:
o Oxidized: NAD and NADP
o Reduced: NADH and NADPH

Date: January 6, 2015

Phosphate in NADP is the inorganic phosphate

cleaved from ATP
NADP is formed from HMP shunt
Reactions using NAD
(Lactate Dehydrogenase)

Lactate

(Malate Dehydrogenase)

Malate

Pyruvate
Oxaloacetate

(-OH-butyrate Dehydrogenase)

Hydroxybutyrate
(Glucose Dehydrogenase)

Gluconate

(Isocitrate Dehydrogenase)

-ketoglutarate

Glucose
Isocitrate

Acetoacetate

(Gutamate Dehydrogenase)

Glutamate

-ketoglutarate +NH

RDA:
o
o
o
Sources:
o

Adults: 16-20mg/day
Children: 9-16mg/day
Infants: 5-8mg/day

TRYPTOPHAN can be converted to

NAD
60mg Trp = 1mg niacin
Milk and eggs ae rich in Trp
Deficiency (Pellagra)
- Rough Skin; 3Ds

Dermatitis skin exposed to sunlight

o Casals necklace
o Gloves and stockings lesions
Diarrhea
Dementia
Stomatitis, magenta tongue
Severe cases, GIT hemorrhagic

Toxicity
- 1-6 grams used to treat hyperlipidemia
- Dilatation of blood vessels
- Skin flushing
- Skin irritation
- Liver Damage
MELAI VALEZA

VITAMINS 4

Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

4. VITAMIN B6 (Pyridoxine)
- Pyridoxine: MAIN B6 but with 6 vitamers,
depending on attached compounds.

o
o
o
o
-

Pyridoxine: alcohol
Pyridoxal: aldehyde
Pyridoxamine: amino acid
If a phosphate group is attached to the
ring, add -5-phosphate

Also called as:

o Amino acid metabolism vitamin
o Rat anti-dermatitis factor
o Adermin
o Rat anti-pellagra factor
o Vitamin H
o Rat anti-acrodynia factor
Precursor of pyridoxal phosphate
Coenzyme for several enzymes in amino acid
metabolism
Coenzyme forms:
o Pyridoxal phosphate
o Pridoxinamine phosphate
o 4-pyridoxic acid: major excretory
product
Important in:
o Amino acid metabolism
o Ceramide synthesis
o Neurotransmitter synthesis
Serotonin, dopamine, epinephrine,
norepinephrine and GABA
o Histamine synthesis
o Porphyrin synthesis (hemoglobin)
o Glycogenolysis: phosphorylation
Coenzyme in protein metabolism
o Decarboxylation
o Conversion of 3-hydroxykynurenin to
3-OH-anthranilic acid
o Conversion of Tryptophan to
serotonin
o Deamination serine and threonine
o Transamination as amino group
carrier
o Trans-sulfuration transfer of sulfur
from methionine to serine to form
cysteine

MELAI VALEZA

Date: January 6, 2015

o
o
o

Conversion of cysteine to pyruvate

Interconversion of glycine and serine
Decarboxylation of -amino-ketoadipic to -aminolevulinic acid
(ALAS for heme formation)
- Coenzyme in carbohydrate and fat
metabolism
o Conversion of linoleic acid to
arachidonic acid
o Co-factor in the activity of
phosphorylase
o Cofactor in the metabolism of
unsaturated fatty acids and cholesterol
o Synthesis of sphingolipids necessary for
myelin formation
- Enzymes:
o Amino transferases (AA Breakdown)
o Glycogen phosphorylase (Glycogen
Breakdown)
o Serine dehydratase (feeding serines
breakdown product to
gluconeogenesis)
o ALA synthase (Porphyrin Synthesis)
- Essential for the maintenance of the integrity
of:
o Neuronal tissues
o Production of antibodies
o Bone development
- RDA: Roughly proportional to protein content
of diet
o Adults: 2.2mg/day or 0.2mg/g of
protein intake
o Children:1.2mg/day
o Infants: 3mg/day
o Increased in pregnancy and lactation
Sources:
o Whole grains, corn, and legumes
o Poultry and fish
o Potatoes
o Organ meats
o Eggs
Deficiency (Vitamin B6 deficiency)
- Due to isoniazid intake
- Clinical features:
o Epileptiform seizures: due to poor
brain development
o Pellagra-like skin lesions
o GIT involvement: distension, vomiting,
diarrhea
o Anemia hypochromic and microcytic
since hemoglobin formation is
impaired
o Acrodynia in rats
- Biochemical finding:
o Increased excretion of urinary oxalates
- Widely used assessment method:
o Activation of erythrocyte
aminotransferases by pyridoxal
phosphate added in vitro, expressed
as activation coefficient
VITAMINS 5

Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

5. VITAMIN B5 (Panthotenic acid)

- Also called as:
o EVERYWHERE vitamin: found in almost
every food
o Filtrate factor
o Royal Jelly: artificial Vit. B12

-Alanine Part

- Component of Coenzyme A (CoA or CoAsh)

Pyruvate + CoAsh
Acetyl CoA
-Ketoglutarate + CoAsh
Succinyl CoA
Fatty Acid + CoAsh
Fatty Acyl CoA
Ketoacyl CoA + CoAsh
Acyl CoA + Acetyl CoA
- Has a role in:
o Detoxification of Benzoic Acid
o Synthesis of bile salts
- As Acetyl CoA
o Combines with oxaloacetic acid to
form citric acid: first step in TCA
o Combines with choline to form
acetylcholine
o Combines with sulphonamide drugs to
facilitate excretion
o Precursor of cholesterol/steroid
hormones
o Activates amino acids: Valine, Leucine
and Isoleucine
o Essential in lipid metabolism
- As Succinyl CoA:
o Involved in heme biosynthesis
- As Acyl carrier protein:
o Involved in fatty acid biosynthesis
Activates fatty acids
o Involved in extramitochondrial
lipogenesis
- RDA:
o Adults: 5-10mg/day
o Children: 4-5mg/day
o Infants: 1-2mg/day
Deficiency
o Rare: found in almost all natural food
o Most symptoms mimic those of other
vitamin B deficiencies

MELAI VALEZA

Date: January 6, 2015

6. VITAMIN B7 (Biotin)
- Also called as:
o Anti-egg white injury factor

Widely distributed in natural food

From synthesis of bacteria: deficiency is caused
by defects in utilization and not dietary
Long-term antibiotic treatment or excess raw
egg consumption
o AVIDIN protein in raw egg
combining very tightly with BIOTIN,
preventing its absorption
o Lecithin in yolk increases LDL
Coenzymes for carboxylation reactions

Acetyl CoA

Acetyl CoA carboxylase

Malonyl CoA

Propionyl CoA Propionyl carboxylase Methylmalonyl CoA

Pyruvate

Pyruvate carboxylase

Oxaloacetic acid

- Carrier of activated carbon dioxide

- RDA: 400g/day
Source:
o Almost all food, liver, milk, egg yolk
Deficiency:
o Uncommon
o Due to raw egg avidin
o MEN:
Fine scaly skin desquamation
Anorexia
Nausea
Lassitude
Muscle pains
Depression/hallucination
Alopecia (36 y/o)
Graying of hair
o In rats:
Spectacled-eye appearance
Kangaroo posture
Retarded growth
Loss of hair
Loss of muscular control

VITAMINS 6

Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

Hematopoetic Vitamins
7. VITAMIN B9 (Folic Acid)
- Also called as:
o Folate
o Folacin
o PTA (Pteroglutamic acid)

Initially oxidized, with NADPH, it can

become Dihydrofolic acid
With another reduction reaction with
NADPH, it will become Tetrahydrofolic Acid
Indirectly, decreased niacin can decrease
folic acid.
Involved in one-carbon metabolism
(tetrahydrofolic acid)
Carrier of one-carbon group moieties
Methyl: most reduced form

Date: January 6, 2015

Sources:
o
Green leafy vegetables
o
Liver
o
Lima beans
o
whole grains and cereals
Deficiency
- Growth failure
- Megaloblastic anemia: rapid cell turnover
- Neural tube defects (spina bifida)

8.
VITAMIN B12 (Cobalamin)
- Anti-pernicious anemia vitamin
- Extrinsic Factor of Castle
- Erythrocyte Maturation Factor
- Consists of:
o
Corrin ring system central portion similar to
porphyrin ring
o
5,6-dimethylbenzimidazole riboside
o
Aminopropanolol
o
Propionicacid
o
Cobalt (center)

Methylene: intermediate

Most
oxidized

N5-methyl-THFA
N5-N10-methylene
THFA

N10-formyl THFA

Most prevalent form

transported in blood
Provides methyl group in
thymidine formation for
DNA synthesis and RBC
formation
Provides C atom that
becomes C2 of purine
nucleus
Histidine catabolism
Thymidine synthesis

- For the synthesis of methionine

- Isomerization of methymalonyl CoA
- Involved in:
o
transfer of methyl group from methyl THFA to
homocysteine to form methionine
o
Rearrangement of methylmalonyl CoA to
succinyl CoA (FA Biosynthesis)
o
Homocysteine causes atherosclerosis

N5-formimino THFA
N15-hydroxymethyl
THFA
- Essential in the biosynthesis of thymidine,
amino acids and purines
- Sulfonamides are given to stop bacterial cell
growth, inhibiting folic acid.
- Methotrexate competitively inhibits
dihydrofolate in cancer cells

MELAI VALEZA

VITAMINS 7

Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

- Forms:
Cobalamin
Cyanocobalamin
Hydroxocoblamin

Methylcobalamin
5-deoxyadenosyl
cobalamin
-

Date: January 6, 2015

Without cyanide
With cyanide
With hydroxyl group;
more active in enzyme
systems ;retained
longer in body
Major form in plasma
Readily binds to
plasma-binding
proteins

RDA:
o Children: 2g/day
o Adults: 3g/day
o Pregnancy and lactation: 4g/day

Sources
o Synthesized b bacterial flora
o Liver, whole milk, eggs
o Oysters, fresh shrimps, pork, chicken
Deficiency
- Abnormal fatty acid synthesis
- Cell membrane defects/neurological
abnormalities
- Pernicious anemia
o No healthy RBC
o Megaloblastic/macrocytic anemia
o Mucosal atrophy and inflammation of
the tongue, mouth and pharynx
- Causes:
o Chronic dietary deficiency of vitamin
B12
o Poor absorption due to lack of
intrinsic factor
Antibodies in gastric juice
Low/lack of secretion of
parietal cells in stomach
Extensive small intestine
resection
- Increased requirements as in pregnancy

Involved in the conversion of folic acid

to active
o Inhibits melanin formation by boosting
glutathione activity
- Major Function:
o Coenzyme in formation of tissue
collagen or intracellular cement
substance
- RDA:
o Adults: 60mg/day
o Children: 40mg/day
Sources
o Citrus fruits
o Tomatoes
o Strawberries
o Green vegetables
o Guava fruit
o Green pepper
Deficiency: (Scurvy)
- Spongy gums
- Poor wound healing
- Splinter hemorrhages in nails
- Petechial, subcutaneous hemorrhages
- Scorbutic rosary beads-swelling at the ends of
long bones (Bones: Collagen Type 1)

9. VITAMIN C (Ascorbic Acid)

- Also called as:
o Anti-scorbutic acid
- Very sensitive to oxidation
- Keeps iron in ferrous form (reduced)
- Rapidly destroyed by alkalines
- Freezing has no deleterious effects
- Strong reducing agent
- Lost when vegetables are dried
- Destroyed in pasteurization
- Has a role in:
o Hydroxylation of proline and lysine to
hydroxyproline and hydroxylysine
o Hydroxylation of tryptophan
o Synthesis of norepinephrine
o Tyrosine metabolism
MELAI VALEZA

VITAMINS 8

Far Eastern University Nicanor Reyes Medical Foundation

School of Medicine

2014MD-1E

Vitamins
Lecturer: Dr. Mari-Ann Bringas

FAT-SOLUBLE Vitamins
- With long hydrocarbon chains that make them
fat soluble
1. VITAMIN A (Retinols)
- Also called as:
o -carotenes (Provitamin)
needs bile acids
-

Retinol and retinoic acid act like steroid

hormones
Retinaldehyde is a component of Rhodopsin
(Rods)
Retinoic acid participates in glycoprotein
synthesis
Function:
o Maintenance of reproduction
o Maintenance of vision
o Promotion of growth
o Gene expression (like hormones)
Binds to RAR receptorsfor
protein synthesis

Treatment of psoriasis, acne, cancer

Acne: banned Tretinoin creams

o
o

Liver, kidney, cream, butter, egg yolk

Yellow and dark green vegetables

Sources:

Date: January 6, 2015

Calcium deposition in organs, arteries

Cause kidney stones

3. VITAMIN K
- Also called as:
o Phylloquinone (plants)
o Menaquinone (intestinal bacterial flora)
- For Post-translational modification of various
blood clotting factors (Factors 2,7,9,10)
o Carboxylates osteocalcin to be gamma
glutamyl carboxylate
o Carboxylation activates clotting factors
- Inhibited by warfarin
Sources
o Cabbage
o Cauliflower
o Spinach
o Egg yolk
o liver
4. VITAMIN E (alpha tocopherol)
- Anti-oxidant
Sources
o Vegetable oils, liver, eggs
Deficiency:
- Heart disease
- Defective cell membrane
- Cataract formation
Toxicity
- No toxicity at 300mg/day

2. VITAMIN D (CHOLECALCIFEROL)
- 1,25-dihydroxycholecalciferol (active)
- Stimulates gene expression or repress gene
transcription
- Regulates plasma levels of calcium and
phosphorus
- Increases plasma calcium:
o Mobilize calcium stores
o Decreases calcium excretion
o Increases calcium reabsorption
- Enzyme in skin, activated by the sun
- Too much exposure to sun do not cause
toxicity
*to be discussed in conference
Sources
o Liver
o Kidney
o Fatty fish
o Egg yolk
Deficiency
- Rickets (children)
- Osteomalacia (adults)
Toxicity
- Most toxic
MELAI VALEZA

VITAMINS 9