Chapter 7: M.G.Rajanandh, Dept. of Pharmacy Practice, SRM College of Pharmacy, SRM University
Chapter 7: M.G.Rajanandh, Dept. of Pharmacy Practice, SRM College of Pharmacy, SRM University
Chapter 7: M.G.Rajanandh, Dept. of Pharmacy Practice, SRM College of Pharmacy, SRM University
VITAMINS
M.G.Rajanandh,
Dept. of Pharmacy Practice,
SRM College of Pharmacy,
SRM University.
What are vitamins ?
• Nutrients that our body does not
make on its own. Thus we must
obtain them from the foods we eat,
or via vitamin supplements.
They are essential for providing
good health and are necessary
for many life functions.
Supplements, what are they?
• Defn: synthetic or natural substances which
can be purchased as pills, tablets, capsules,
wafers, powders, or liquids.
Top 10 ?’s asked
about Vitamin
Supplements
Should I get my vitamins from food or
supplements?
• A diet high in fiber and low in fat is the best way to meet daily nutritional needs.
• If you closely follow the “food pyramid” then you should meet the RDA
(Recommended Dietary Allowances) for vitamins and nutrients.
• Supplements are best when accompanied by a well balanced diet.
• Supplements should not replace a healthy diet.
• Food provides calories and energy that are required for daily activities, vitamin
supplements do not provide energy or calories.
V
Do I need a multivitamin supplement?
• It does not hurt to get a little to take a
multivitamin daily to ensure proper nutrition.
• Most college students are not eating a well
balanced diet and could use the added
nutrition of a multivitamin.
• When choosing a supplement, select one that
meets 100‐300% of the RDA.
What do Multivitamins contain?
• A multivitamin should contain fat‐soluble
vitamins A, D, E; water‐soluble vitamins B1,
B2, B6, B12, niacin, pantothenic acid, biotin,
folic acid , and Vitamin C.
• They will also usually have minerals such as
zinc, magnesium, copper, and calcium in
them.
What does RDA mean?
• Recommended Dietary Allowances
• These are suggested levels of essential
nutrients considered adequate to meet
nutritional needs of healthy individuals.
What are antioxidants?
• Defn: Substances that fight off free‐radicals in
our bodies.
• Free radicals are compounds within our
bodies that may lead to chronic disease
and/or are involved in cell tissue damage.
• Examples of vitamins that contain antioxidants
are… C, E, and Beta Carotene.
What is the difference between fat‐soluble
and water‐soluble vitamins?
• Fat‐soluble are stored in the liver and fatty
tissues. These are not readily excreted
from the body.
• Water‐soluble vitamins travel in the blood
and are stored in limited amounts. These
are readily excreted from the body through
urine.
What factors should I consider before
taking a vitamin supplement?
• Do you eat foods high in vitamins and
minerals?
• Are you dieting?
• Do you follow the Food Guide Pyramid?
• Do you smoke and/or drink regularly?
• Are you pregnant?
• Are you over 50 years old?
• Are you taking prescription drugs?
Can I take too many vitamins?
• For the most part vitamin supplements are
safe to take.
• Follow the recommended dosages on the
label of the bottle.
• Fat‐soluble vitamins are more likely to be toxic
to your health if taken in excess, because they
are stored in the body, where as water‐soluble
are excreted.
Should I take my vitamins with food?
• It is advised to take your vitamins with a snack
or meal to avoid stomach irritation.
• The presence of carbohydrates and proteins
stimulate digestive enzymes that will allow for
better absorption of nutrients for the
supplements. (Iron should be taken on an
empty stomach)
Stress & Nutrition of Your Body
• Stress can cause your body to excrete
nutrients rather than using them to perform
vital functions.
• Stress can also cause the production of free
radicals which play a role in the development
of cancer, heart disease, and aging.
Supplements that aid in suppressing
stress
• Increasing serotonin levels in the brain wards
off stress related symptoms like depression,
irritability, and frustration.
• The mineral magnesium can help to regulate
serotonin levels.
• Antioxidant supplements can also break up
free radicals that cause harm to your body.
The B Vitamins
B‐1, B‐2, B‐3, B‐6, B‐12
B‐1 Thiamin (Vitamin F)
• Important in:
– Producing energy from carbohydrates
– proper nerve function
– stabilizing the appetite
– promoting growth and good muscle tone
– ATP production
Sources of B‐1
• Pork
• Fish
• Liver
• Legumes
• Nuts
• Whole grain or enriched breads and cereals
Recommendations
• Men 14+ • 1 broiled pork chop,
1.2 mg/day • 1.25 cups corn flakes
• Women 14‐18
1.0 mg/day OR
• Women 19+ • 1 baked potato (w/
1.1 mg/day skin)
• 0.5 cup of lentils
• 1 cup raisin bran
Warnings
• B‐1 is nontoxic even at high dosages
B‐1 Deficiency
• Loss of appetite
• Weakness & Feeling tired
• Insomnia
• Loss of weight
• Depression
• Heart & Gastrointestinal problems
Who’s at Risk?
• Homeless & Malnourished
• Alcoholics
• People with malabsorption conditions
B‐2 Riboflavin
• Important in:
– energy production
– carbohydrate, fat, and protein metabolism
– formation of antibodies and red blood cells
– cell respiration
– maintenance of good vision, skin, nails, and hair
– alleviating eye fatigue
Sources of B‐2
• Large amounts in
– dairy
– eggs
– meats
• Small amounts in
– leafy green vegetables
– enriched grains
Recommendations
• Men 14‐70 • 1 cup raisin bran
1.3 mg/day • 1 cup milk
• Women 14‐70 • 1 egg
1.0 mg/day OR
• 71+ • 1 small extra lean hamburger
Larger doses • 1 cup plain yogurt
• 0.5 cup fresh cooked spinach
• 1 cup cottage cheese
Warnings
• B‐2 is nontoxic at supplemental and dietary
levels.
• Light can destroy riboflavin, so purchase milk
in opaque containers.
B‐2 Deficiency
• Itching and burning eyes
• Cracks and sores in mouth and lips
• Bloodshot eyes
• Dermatitis
• Oily skin
• Digestive disturbances
Who’s at Risk?
• People with cataracts
• People with Sickle Cell Anemia
• Alcoholics
B‐3 Niacinamide & Niacin
• Important in:
– energy production
– maintenance of skin and tongue
– improves circulation
– maintenance of nervous system
– health of the digestive track
B‐3 Niacinamide & Niacin
• Two Types
– Niacinamide (Nicotinamide)
• does not regulate cholesterol
– Niacin (Nicotinic Acid)
• highly toxic in large doses
• Inosital Hexaniacinate is a supplement that gives the
cholesterol regulation without high toxicity
Recommendations
• Men 14+ • 1 cup rice
16 mg/day • 4 oz. broiled salmon
• Women 14+ • 1 tbsp peanut butter
14 mg/day • 1 bagel
• OR
• 1 small extra lean hamburger
• 0.5 cup grape nuts cereal
Warnings
• In doses of only 50‐100 mg nicotinic acid
can cause dilation of blood vessels and
potentially painful tingling (“niacin flush”),
diarrhea, nausea, vomiting, and long term
liver damage.
• Nicotinamide is almost always safe to take,
although a few cases of liver damage have
been reported in doses of over 1000
mg/day.
B‐3 Deficiency
• Pellegra
– disease caused by B‐3 deficiency
– rare in Western societies
• gastrointestinal disturbance, loss of appetite
• headache, insomnia, mental depression
• fatigue, aches, and pains
• nervousness, irritability
Who’s at Risk?
• Most people get plenty of B‐3 from their diet
because it is added to white flour.
B‐6 Pyridoxine
• Important in:
– Production of red blood cells
– conversion of tryptophan to niacin (B‐3)
– immunity
– nervous system functions
– reducing muscle spasms, cramps, and numbness
– maintaining proper balance of sodium and
phosphorous in the body
Recommendations
• Men 14‐50
1.3 mg/day • 1 chicken breast
• Men 50+ • 0.5 cup cooked spinach
1.7 mg/day • 1 cup brown rice
• Women 14‐18 OR
1.2 mg/day • 1 baked potato with skin
• Women 19‐50 • 1 banana
1.3 mg/day
• 4 oz. lean sirloin
• Women 50+
1.5 mg/day
Warnings
• High doses of B‐6 may be recommended to
treat PMS, carpal tunnel syndrome, and sleep
disorders, but continued use of high doses
may result in permanent nerve damage.
• Pregnant women should always consult their
doctor before taking this supplement and all
others.
B‐6 Deficiency
• nervousness, insomnia
• loss of muscle control, muscle weakness
• arm and leg cramps
• water retention
• skin lesions
Who’s at Risk?
• very rare
• alcoholics
• patients with kidney failure
• women using oral contraceptives
B‐12 Cobalamin
• Important in:
– proper nerve function
– production of red blood cells
– metabolizing fats and proteins
– prevention of anemia
– DNA reproduction
– energy production?
Recommendations
• Men and Women • 1 chicken breast
14+ • 1 hard boiled egg
2‐3 mcg/day • 1 cup plain low fat yogurt
OR
• 1 cup milk
• 1 cup raisin bran
Warnings
• Vegetarians need to look for fortified sources
(soy milk, supplements).
• Elderly often have trouble absorbing.
B‐12 Deficiency
• anemia
• nerve damage
• hypersensitive skin
Who’s at Risk?
• pernicious anemia
– B‐12 injections often taken regularly
• HIV
• Chronic Fatigue Syndrome
Vitamin A
What is Vitamin A?
• Fat‐soluble
• Retinol
– One of the most active, usable forms
• Found in animal and plant sources
What does it do?
• Vision
– Generates pigments for the retina
– Maintains surface lining of eyes
• Bone growth
• Reproduction
• Cell division and differentiation
• Healthy Skin
• Regulate Immune System
Where does it come from?
• Animal Sources
– Eggs
– Meat
– Cheese
– Milk
– Liver
– Kidney
– Cod
– Halibut fish oil
Plant Sources
• Carrots
• Sweet Potatoes
• Cantaloupe
• Pink Grapefruit
• Apricots
• Broccoli
• Spinach
• Pumpkin
What do these plants have in
common??
• Most are orange or yellow in color
• Beta‐Carotene is precursor of Vitamin A
• Masked in some green plants
How much is enough?
• Children
2000 – 3500 I.U.
• Men
5000 I.U.
• Women
4000 I.U.
Signs of Deficiency
• Night blindness
• Decreased resistance to
infections
• Extremely dry skin, hair or nails
Who Is At Risk For Deficiency?
• Young children
• Children with inadequate health care
• Adults in countries with high incidences of
vitamin A deficiency or measles
• Adults or children with diseases of the
pancreas, liver, intestines, or inadequate fat
digestion/absorption
Too Much Can Be Toxic!!
• Hypervitaminosis A leads to toxic symptoms:
– Dry, itchy skin
– Headaches and fatigue
– Hair loss
– Liver damage
– Blurred vision
– Loss of appetite
– Skin coloration
Other Side Effects
• Severe birth defects
– Women of child‐bearing age should not consume more than
8000 IU per day
– Retin‐A (acne cream) or Accutane can cause birth defects
– Retinol is most dangerous form because the body will not
convert as much beta‐carotene to vitamin A unless needed
but it can still be harmful
• Skin can take on a yellow/orange glow
• Most cases of vitamin A overdose occur from supplements
but can occur from diet
• RDA is considering establishing an Upper Limit
Foods High In Vitamin A
Retinol
– Liver (3 oz)
30,325 IU (610% DV)
– Fortified milk (1 c)
1,355 IU (10% DV)
… Foods High In Vitamin A
Beta‐Carotene
– Carrot (1 raw) 20,250 IU
(410% DV)
– Carrot juice (1/2 c) 12,915 IU (260%
DV)
– Mango (1 raw) 8,050 IU
(160% DV)
– Sweet Potatoes (1/2 c) 7,430 IU (150%
DV)
– Spinach, boiled (1/2 c) 7,370 IU
(150% DV)
– Cantaloupe (1 c) 5,160 IU (100%DV)
– Vegetable Soup (1 c) 3,005 IU
(60% DV)
Polar Bear Liver
One ounce of polar bear liver contains
enough vitamin A (retinol) to kill a person!
Vitamin A, Beta‐Carotene, and Cancer
• Surveys suggest that diets rich in vitamin A and beta‐carotene
can lower the risk for cancer (especially lung cancer)
• However, one study was stopped because subjects with
increased beta‐carotene had a 46% higher risk of dying from
lung cancer
• Another study showed that smokers were more likely to
develop lung cancer if they took beta‐carotene supplements
• Beta‐carotene supplements are not advisable except in rare
situations
Vitamin E
Vitamin E
What is it?
• Fat soluble
• Antioxidant
– Reduce the energy of the free radical
– Stop the free radical from forming in the
first place
– Interrupt an oxidizing chain reaction to
minimize the damage of free radicals
Vitamin E
What does it do?
• 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
Vitamin E
Heart disease:
• Two studies published in the New England
Journal of Medicine by Harvard researchers
• Of 127,000 health professionals, those who
took large doses of Vitamin E had a 40% lower
risk of heart disease
Vitamin E
What’s the difference?
• Alpha Tocopherol
• Tocopherol
• Tocopheryl (Acetate, Succinate)
Vitamin E
What’s the difference?
• “d” = natural
• “dl” = synthetic
Vitamin E
Where does it come from?
• wheat germ oil
• vegetable oils
• nuts and seeds
• whole grains
• egg yolk
• leafy green vegetables
Specific Food Sources
• vegetable oils
– Corn, cottonseed, and peanut oil
• nuts and seeds
– Almonds, hazelnuts, sunflower seeds,
walnuts, and margarine
• whole grains
– whole‐wheat flour, wheat germ
• Vegetables and fruits
– Spinach, lettuce, onions, blackberries, apples,
and pears
Vitamin E
Recommended Daily Allowances (RDA):
Children
0‐12 months 3‐4 mg 9‐12 IU
1‐7 years 6‐7 mg 15‐21 IU
11‐18 8 mg 24 IU
Males
18+ 10 mg 30 IU
Females
18+ 8 mg 24 IU
pregnant 12 mg
lactating 11 mg
3‐4
6‐7
8
10
8
2
3
mg
mg
mg
mg
mg
mg
mg
Vitamin E
Other effects:
• Taking more than RDA of vitamin
E improves the immune system in
the elderly
– Jean Mayer (USDA Human Nutrition Research
Center) & Simin Meydani, D.V.M. , Ph.D.
(Nutritional Immunology Laboratory)
– The Journal of the American Medical
Association
Vitamin E
Who is likely to be deficient?
• Severe vitamin E deficiencies are
rare
• Lack of vitality
• Lethargy
• Apathy
• Inability to concentrate
• Muscle weakness
Vitamin E
Can you take too much?
• No harmful effects at 50 times
RDA (1200 – 1500 IU)
• At 2,400 IU per day, may cause
bleeding due to its clot‐
preventing ability
• May reduce body’s supply of
vitamin A
• May alter immune system
• Vitamin E toxicity is rare
Vitamin E
Natural foods or supplements?
• Natural form more bioavailable
• Easier to obtain the amount
needed from supplements
Vitamin E
Who should take supplements?
• People over the age of 55
• Smokers
• People who abuse alcohol
• Anyone with inadequate caloric
or nutritional dietary intake or
increased nutritional
requirements
Vitamin E
Miscellaneous:
• Freezing may destroy Vitamin E
• Extreme heat causes Vitamin E to break down
• Avoid deep‐fat frying foods that are natural
sources of Vitamin E
• Reduces potential toxicity of Vitamin A ‐
Excessive doses causes Vitamin A depletion
Vitamin C
Vitamin C
• Ascorbic acid (Toxic to viruses,bacteria, and
some malignant tumor cells)
• Antioxidant
• water‐soluble
What are C’s functions in the body?
• Protects you body from free radicals
• helps form connective tissue that hold your bones, muscles, and tissues
together (collagen)
• aids in the healing of wounds
• aids the body in absorbing iron from plant sources
• helps to keep your gums healthy
• helps your body to fight infections
• aids in the prevention of heart disease
• helps prevent some forms of cancer
Harmful effects in larger
doses:
(over 1000mg/ dose)
• Diarrhea
• gastrointestinal discomfort
• rebound Scurvy
• Avoid chewable tablets (may
cause damage to teeth)
• Since Vitamin C is water‐soluble excess
amounts that the body does not need will be
excreted, but larger doses can cause some
problems. . .
Vitamin C daily recommendations
• LINK
• http://www.women‐of‐
faith.com/health/supplements/vitc.ht
m
Recommended Dietary Intake
• Men: 60mg/day • Take divided doses of the vitamin
twice daily to get the best results,
• Women: 60mg/day and less excretion.
• Pregnant women: • Smoking, oral contraceptives,
95mg/day steroids, excessive alcohol
consumption, and analgesics
• Children: 45mg/day
increase the need for this vitamin
Sources of Vitamin C
• Guava, Broccoli, Cantaloupe, Red Bell Pepper,
Orange Juice, Strawberries, Tomato Juice, Raw
Tomato, Sweet Potato, Tangerine, Spinach,
Leafy Greens, Berries, Citrus Fruits
• LINK (list of fruits &veggies that are good
sources of C)
• www.heartinfo.org/nutrition/vitc42898.htm
Deficiency of C causes:
• Weight loss
• fatigue and joint pain
• scurvy (bruising easily, bleeding gums, and
tendency for bones to fracture)
• reduced resistance to colds and infections
• slow healing of wounds and fractured bones
Fact or Fiction: Vitamin C
causes Kidney Stone formation
• Department of Nutrition, Harvard School of
Public Health
• Study done on 45,251 men that had no previous cases of
kidney stones. Some subjects took up to 30 times the RDA
values, and showed no increased risk of kidney stone
formation.
To learn about more cool facts about
Vitamin C, log on to:
• LINK
• www.cforyourself.com
Food or Supplement?
• The Mayo Clinic states that “your body needs macronutrients (proteins,
carbohydrates, and fat) for energy and micronutrients (vitamins and
minerals) for many functions. Whole foods are an excellent choice.”
They also stated that “an orange provides not only vitamin C but also
carotene, calcium, and free sugars for energy. A vitamin C supplement is
lacking these.”
• The American Heart Association “recommends that healthy individuals
obtain adequate nutrient intakes from food eaten in variety and
moderation, rather than from supplements.”
Congressional Mandate for the ODS:
• To explore the role of dietary supplements to improve health care
• To promote scientific study of dietary supplements in maintaining
health and preventing chronic disease.
• To conduct and coordinate research on dietary supplements at the
National Institute of Health.
• To collect & compile databases of federally funded research &
scientific papers on dietary supplements.
• To coordinate funding for research on dietary supplements.
• To provide advice to other HHS agencies related to dietary
supplements.
ODS Scientific Goals:
• 1: Evaluate the role of dietary supplements in the prevention of disease
and reduction of risk factors associated with disease.
• 2: Evaluate the role of dietary supplements in physical and mental health
and in performance.
• 3: Explore the biochemical and cellular effects of dietary supplements on
biological systems and their physiological impact across the life cycle
• 4: Improve scientific methodology as related to the study of dietary
supplements.
• 5: Inform and educate scientists, health care providers, and the public
about the benefits and risks of dietary supplements.
Definition and Classification
• Non‐caloric organic nutrients
• Needed in very small amounts
• Facilitators – help body processes proceed;
digestion, absorption, metabolism, growth
etc.
• Some appear in food as precursors or
provitamins
Definition and Classification
• 2 classes, Table 7.1
– Fat soluble:
– Water soluble:
Definition and Classification
• Fat soluble vitamins
– Found in the fats and oils of food.
– Absorbed into the lymph and carried in blood with
protein transporters = chylomicrons.
– *Stored in liver and body fat and can become toxic
if large amounts are consumed.
Definition and Classification
• Water soluble vitamins
– Found in vegetables, fruit and grains, meat.
– Absorbed directly into the blood stream
– Not stored in the body and toxicity is rare. Alcohol
can increase elimination, smoking, etc. cause
decreased absorption.
Fat Soluble Vitamins
• Vitamin A (precursor – beta carotene)
– 3 forms: retinol (stored in liver), retinal, retinoic acid
– Roles in body:
• Regulation of gene expression
• Part of the visual pigment rhodopsin, maintains clarity of cornea
(yes eating carrots is good for your eyesight)
• Required for cell growth and division ‐ epithelial cells, bones and
teeth
• Promotes development of immune cells, especially “Natural Killer
Cells”
• Antioxidant
Fat Soluble Vitamins
• Vitamin A
– Deficiencies cause:
• Night blindness, xerophthalmia (keratin deposits in
cornea), macular degeneration.
• Skin and mucous membrane dryness and infection,
keratin deposits.
• Anemia
• Developmental defects – bones, teeth, immune system,
vision
Fat Soluble Vitamins
• Vitamin A
– Toxicities (RetinA/Accutaine, single large doses of
supplements, eating excessive amounts of liver)
cause:
• Fragile RBCs, hemorrhage
• Bone pain, fractures
• Abdominal pain and diarrhea
• Blurred vision
• Dry skin, hair loss
• Liver enlargement
Fat Soluble Vitamins
• Vitamin A
– DRI: 700(women)‐900(men) micrograms/day, UL
3000 micrograms
– Sources, see snapshot 7.1
Snapshot 7-1, p, 219
Fat Soluble Vitamins
• Vitamin D – precursor is cholesterol,
converted by UV from sunlight exposure,
therefore is a “non‐essential” vitamin.
– Roles:
• Increases calcium absorption in bone, intestines,
kidney. Promotes bone growth and maintenance.
• Stimulates maturation of cells – heart, brain, immune
system, etc.
Fat Soluble Vitamins
• Vitamin D
– Deficiencies: rickets (children), osteomalacia
(adults). What are some of the causes of
deficiencies?
– Toxicities (5X DRI)
• Loss of calcium from bone and deposition in soft
tissues.
• Loss of appetite, nausea and vomiting, psychological
depression.
Bowed legs
–
Characteristi
c of rickets
Enzyme
Muscles and
other tissues Bone tissues
metabolize make new
protein. blood cells.