VIT A D E K

VIT A D E K

1. A PRO VIT; PREFORMED VIT

   • PREFORMED Retinol, Retinaaldehyde, Retinoic Acid PROVITAMIN Variety of carotenes, antioxidants
     • R - REPRODUCTION - gene expression, transcription, enzymes, responses to Vit D, thyroid hormones; E - EYES; D - CELL DIFFERENTIATION immune systems.
   • Source Liver, Egg yolks, whole milk, butter, fish iiver Green, red, yellow veg carrots, Sw potato, mangoes, spinach, squash
   • Units 1 IU=.3 ug Retinol; 1 IU=3.6 ug β-Carotene; i UU-7.2 A carotenoids Infants - 15 yrs 600ug; 11-50+ 700M; 600F Supplemental range - 2400 mcg/d 2500-50,000 IUs short term
   • Plant source loses its ug nutrient through cooking so absorbs 6-60% less likely to be toxic than animal source - which absorbs 70-90% in liver so high levels can cause toxicity
   • Interactions Zinc to make RBP Retinol binding proteins moves Vit A from liver to Tissues. Vit A deficiency is often due to low zinc. Vit A modulates iron metab. Drug Interactions - Hepatoxic and Warfarin
   • THERAPEUTICS: Oral V/it A - Xerophthalmia, Vit A carotenoids - Breast cancer;
   • Deficiency: Vision, night blindness; green light, dim light then night blindness - Xerophthalmia
   • Sx: Hyperkeratosis - upper arms; cysts - endocrine glands, low immunity NK and ↓ Th2 response, rough skin, acne, poor bone growth, poor sense of taste and smell, dry hair
   • Factor contributing: Diabetes, Alcoholism, Hyperthyroidism, Liver disease, cystic fibroisis
   • Toxicity: Sx: Headaches, nausea; inability to ove; Enlarged liver- hyperlipidaemia; Joint pains, tichkening of long bones; Excess dryness, scaling of skin, hair loss

2. D - D2, D3

   • Major source - skin, endogenous synthesis - sunlight, diet is 2nd best. 2 Types D2 plant source and D3 animal source. Plant - Ergosterol - provit D, sunlight exposes ergosterol to ergocalciferol Vit D2. Animals convert 7-dehydrocholesterol to cholecalciferol Vit D3. Both D2 and D3 need to be hydrolxylated in order to function.. Ergocalciferol is 1/3 potent so cholecalciferol is better. Diet source: Oil fish, liver, Eggs, Butter
   • Unit 1 ug of Cholecalciferol = 40 IU 1mth - 3 yrs - 8.5ug; 65+ 10; In between none but now these is recommendation to take suppolements. Supplements: 400 - 1600 IU; 2000-8000 IU short term
   • Absorbed with fat D2 and D3 converts to 25-hydroxyVit D3 in liever and 1,25-dihydroxyvitD3 in kidney - imp to maintain Ca balance in body. Calcitriol most potent metabolite of Vit D.
   • Metabolism process - calcitriol binds to VDR (Vit D response) and RXR Retinoic Acid X Receptor) together with VDRE (Vit D Response Elements) to modulate gene responses
   • FUNCTION - Ca Homeostasis; - Calcitriol neg feedback; PTH - dip in blood Ca triggers synthesis of calcitriol to release Ca from bone
     • Immune system; Gut mucosal inflammation - VDR, Control of cell proliferation; - Inhibition; Insulin secretion ↓ levels
   • THERAPEUTICS: Prevents Rickets, Osteomalacia 25 ug/day infants; 50 ug/day for above Fall prevention in elderly; Gut health - VDR main modulator mucusal inflammation - colitis - mucosal barrier, tight junction; lower IBD; Osteoporosis - Vit D+ Vit Ca reduces postmenopausal bone loss; Breast infants - Vit D supplements - increase bone density; Increased Vit D reduced Cancer risk; Good for autoimmune diseases - MS, IBD
     • Dx: Burning mouth and throat; Cramps diarrhoea, poor immunity; hyperthyroidism, Increased LSH, FSH; Insomnia, Osteoporosis, growth retardation, skeletal absnormalities, softening of bones, teeth
   • Factors influencing Min exposure to Vit D; Liver/kidney disease; poor fat absorption Toxicity: More than 50,000 IU/day; a v high level of endogenous synthesis - sunlight
   • Drug interactions: Barbiurates; anticonvulsants; Antituberculousis drugs;

3. E - TOCOPHEROLS; TOCOTRIENOLS

   • Food source - Veg oils, Nuts, Seeds, Green leafy veg, Fish
     • i IU = .67mg ⍺ tocopherol; 1 mg TE = .5mg β tocopherol; 1mg TE = .1mg y tocopherol Infants - 10 yrs - .4mg/g; Adults 11-50+ 4mg M; 3 mg - F Supplements: 100-800mg/day
       • NUTRIENT INTERACTIONS: Vit C rejuvenates Vit E; Selenium - imp for enzyme glutathione peroxidase & to recover oxidised Vit E
         • ABSORPTION: Vit E best with fat - stored in fat tissue - cell lipid; LOSS - due to light, heat, oxygen, milling of flour - loss 80%
   • METABOLIC FUNCTION: Antioxidant; traps free radicals; limits damage free radicals, although prone to being oxidised - restored to tocopherol by Vit C ; Tocotrienols reduce cholesterol; by reducing HMG CoA reductase.
   • THERAPEUTICS: Vit E deficiency 60-75 IU/d; Dementia - Vit E and C; Dysmenhorrhea - Vit E 200 IU twice daily or 500 IU d 2 days before menstruation and 2-3 days during reduces pain. Male infertility; PMS; Heart disease low athersceloroscis.. Through diet only - reduces asthma, prostrate cancer, CVD, metastatic gastric cancer
     • DRUG INTERACTIONS: Anticoagulants, chemotherapy, statins - combo of Vit C, E, Selenium and beta-carotene blunts rise in HDL)

4. K - (K1, K2, K3)

   • K1 - Phylloquinone - Dk Gr leafy veg K2 - Menaquinones - family of compounds synthesisd byintestinal bacteria; K3 - Menadione - synthetic compound that can be metabolised to D1 - synthetic form
     • FOOD SOURCE - Collard; spinach, Brussel sprouts, soybeans, rapeseed oils
   • 1 ug/kg for new born infants with v low reserve of Vit K Adults - 70-150 ug/d adequate through food
   • K1 - 80% absorbed through diet. K2 - meets 50% of /vit
   • METABOLIC FUNCTION: helps in clotting factor - II, VII, IX, X; formation of bone proteins - osteocalcin.
   • DEFICIENCY: Haemorrohagic disorders, easy bruising, GIt bleeding, haematomas; mucosal bleeding, nose bleeds,, bone abnormalities, osteopenia, osteoporosis, cognitiveimpairment.
   • FACTORS INFLUENCING REQUIREMENTS: Haemorrage insufficient Vit K, Large doses of Vit E and A can interfere with absorption
   • DRUG INTERACTIONS - can interfere with warfarin and anti coagulants