WATER-SOLUBLE VITAMINS

Dr. Hj. Wan Nudri Wan Daud, Ph.D

Jabatan Perubatan Masyarakat PPSP / Pusat Islam

The water soluble vitamins are include Vitamin C and B vitamins (thiamin, riboflavin, niacin, biotin, pantothenic acid, vitamin B-6, folate, vitamin B-12)

THIAMIN (B-1)
Function of Thiamin Thiamine as Thiamine Pyrophosphate:

i. aids in the synthesis of neurotransmitters (such as acetylcholine). ii. aids in the energy metabolism. iii. regulates nerve-impulse transmission
3

Thiamin deficiency
i. Beriberi
It common in people whose diet consist mainly of polished white rice which is very low in thiamine because the thiamin-bearing husk has been removed.
If a baby is mainly fed on the milk of a mother who suffer from thiamin deficiency then that child may develop beriberi

Thiamin deficiency
i. Beriberi
Thiamin deficiency affects the cardiovascular, muscular, nervous and gastrointestinal systems.

Two major manifestations: Wet beri-beri : a cardiovascular disease Dry beriberi : a nervous system disease
The signs and symptoms of dry beriberi (no edema present) include weight loss, mental changes, decrease in short-term memory, weakness, nerve degeneration, irritability, loss of nerve transmission resulting in tingling throughout the body, poor arm and leg coordination, and deep pain in the calf muscles.
5

Thiamin deficiency
Dry beriberi (no edema)

A person with wet beriberi (edema present) often develops an enlarged heart and related heart failure.
6

Thiamin deficiency
ii. Wernicke-Korsakoff Syndrome

Another thiamin deficiency disease found mainly among people with alcoholism.
It is characterized by constant involuntary movement of the eyeball (jerky eye), paralysis of the eye muscle, staggering, and mental confusion.

 Thiamin
Food sources Yeast , legumes, pork, beef, chicken, duck, watermelon, soy milk. (Highly Refined foods contain almost no thiamin)
Recommended Intakes (RNI) Men : 1.2 mg/day Women : 1.1 mg/day Pregnant women : 1.4 mg/day Toxicity No danger

RIBOFLAVIN (B-2)
Function
Riboflavin is a component of two coenzyme : flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). Through these two coenzyme, riboflavin functions as a catalyst for redox reactions in numerous metabolic pathways and in energy production; support normal vision and skin health.
9

RIBOFLAVIN (B-2)
Deficiency
Ariboflavinosis: The signs and symptoms include weakness, fatigue, cracking of tissue at the corners of the mouth (cheilositis), inflammation of the mouth (stomatitis), eye disorder (inflammation of eyelids, reddening of cornea), inflammation of the tongue (glossitis) and throat, skin lesions, various eye and nervous system disorders, and confusion.
10

Deficiency of vitamin B
Glossitis- inflammation of the tongue, the tongue become smooth due to atrophy of the tissue

11

RIBOFLAVIN (B-2)
Food sources Milk and milk products, enriched white bread, rools and crackers, eggs, meats, liver, mushrooms, spinach, and other leafy vegetables. Recommended Intakes Men : 1.3 mg/day Women : 1.1 mg/day Pregnant women : 1.4 mg/day Toxicity No toxicity
12

NIACIN
Niacin normally exist in two forms - nicotinic acid and nicotinamide.

The body can easily convert nicotinic acid to nicotinamide, which is the major form of niacin in the blood.
Two coenzyme form of niacin are nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP)

13

NIACIN
Function
The coenzyme form of niacin, NAD and NADP used in energy metabolism; supports health of skin, nervous system and digestive system

Deficiency
Pellagra. The effects of pallegra are known as the 3Ds dementia, diarrhea, and dermatitis. Early symptoms include diminished appetite, weight loss, and weakness.
14

Deficiency of niacin
In the dermatitis of pallegra, the skin darkens and flakes away as if were sunburn.
The dermatitis of pellagra is bilateral and symmetrical and occur only on those parts of the body exposed to the sun
15

NIACIN
Food sources
Enriched white bread, rolls, crackers, and breakfast cereals, mushroom, wheat bran, tuna, chicken, turkey, beef, anchovies, peanuts and other nuts. For most people, about half or more of niacin needs are supplied by the body s synthesis of niacin from tryptophan. Each 60 mg of tryptophan contributes to the synthesis of approximately 1 mg of niacin
16

NIACIN
Recommended Intakes Men : 16 mg/day of NEs (niacin equivalents) Women: 14 mg/day of NEs Pregnant women : 18 mg/day of NEs

Toxicity No side effect niacin from foods. Niacin in the form of nicotinic acids (drug) can decrease LDL, and triglycerides and increase HDL. However megadoses of nicotinic acids can cause side effects including flushing of the skin, itching, nausea and liver damage.
17

VITAMIN B-6
Vitamin B-6 is required for the activity more than 100 different enzymes involved in carbohydrate, protein, and fat metabolism. Function 1. Metabolism of amino acids and protein
2. Metabolism of carbohydrates 3. Synthesis of red blood cells 4. Neurotransmitter synthesis eg: serotonin, norepinephrin 5. Participate in the conversion of the amino acid tryptophan to niacin 6. Participate in the synthesis of the amino acid cystein from homocystein
18

VITAMIN B-6
Food sources Animal foods: Meat, fish and poultry (readily absorb) Plant foods: whole grain, bananas, spinach, potatoes Recommended Intakes Men : 1.3 1.7 mg/day (US RDA) Women : 1.3 1.5 mg/day

(Not available in the RNI Malaysia)

19

VITAMIN B-6
Deficiency Anemia, crack corners of the mouth, Weakness, Irritability, Insomnia, reduced immune function, high blood homocystein, growth failure, impaired motor function, and convultion Toxicity Depression, fatigue, irritability, headache, nerve damage, muscle weakness

20

FOLATE (FOLIC ACID)

Functions 1. Part of the coenzymes (tetrahydrofolate and dihydrofolate) involved in DNA synthesis 2. Facilitates metabolism of homocysteine
Deficiency Megaloblastic anemia, diarrhea, inflammation of the tongue, poor growth, neural tube defect, weakness, fatigue, difficulty in concentration, irritability, headache, palpitation, shortness of breath
21

FOLATE (FOLIC ACID)

Food sources
Liver, fortified breakfast cereals, spinach, and other leafy green vegetables. Food processing and preparation can destroy 50 to 90% of the folate in food.

Recommended Intakes:

Men : 400 g per day Women : 400 g per day Pregnant women : 600 g per day
22

FOLATE (FOLIC ACID)

Toxicity
- Masks a vitamin B-12 deficiency symptoms - respiratory distress, redness of the skin, and itching - Individual with epilepsy who are treated with typical medication may experience resumption of seizures if given large amount supplemental folate

23

B-12 (Cobalamin)
Food sources The only reliable source of the vitamin B-12 for human is animal foods meat, fish, poultry, cheese, eggs, shellfish, fermented foods Functions 1. Needed for folate metabolism 2. Necessary for maintaining nervous system

24

B-12 (Cobalamin)
Deficiency Vitamin B-12 deficiency contributes to a secondary folate deficiency. A deficiency of either folate or vitamin B-12 results in the same symptoms such as megaloblastic anemia, and others. Elderly and Vegans who eat no animal foods are at risk for vitamin B-12 deficiency Recommended Intakes 2.0 g/day for men and women (US RDA) Toxicity None
25

VITAMIN C
Function 1. For formation of collagen fibrous structural protein of connective tissues 2. For cure and prevention of the common cold 3. As an antioxidant 4. Improves iron absorption 5. Increases immune function 6. Synthesis of other vital cell compounds such as carnitine, norepinephrine, neurotransmitter, and hormone (thyroxin and steroid). 7. In disease prevention cancer
26

VITAMIN C
Deficiency
Scurvy. Sign and symptom appear after 20 to 40 days of vitamin C-free diet, and include fatigue, the gum bleeding easily around the teeth, and capillaries under the skin break spontaneously, producing pinpoint hemorrhage. Other symptoms include opening of previously healed wounds, bone pain, fracture and diarrhea, and depression.

27

VITAMIN C
Food sources
Citrus fruits, potatoes, and green vegetables. The most nutrient-dense of vitamin C are green pepper, cauliflower, broccoli, strawberries, papayas, oranges, tomato, spinach and other green vegetables

Recommended Intakes (RNI)

Adults men & women Pregnant mother : : 70 mg/day 80 mg/day
28

VITAMIN C
Toxicity
An intake greater than 1 g/day can lead to nausea, abdominal cramps, diarrhea and over consumption of iron. Large amount vitamin C excreted in the urine obscure the results of tests used to detect diabetes, giving a false positive results in some instance and a false negative in others.
29

Vitamin and Mineral Supplements

Most people no need supplements. Most people can obtain the vitamin and minerals they need if they eat a healthy diet. Supplements should be prescribed by a qualified health / medical personnel. An overdose of certain vitamin or mineral supplements especially the fat soluble vitamin can lead to toxicity problems.

30

Vitamin and mineral supplementation should be considered for certain groups of people: 1. Women with excessive bleeding during menstruation may need extra iron. 2. Women who are pregnant or breastfeeding may need extra iron, folate and calcium 3. People with very low energy intakes need a range of vitamins and minerals 4. Some vegetarians may need extra calcium, iron, zinc, and vitamin B-12
31

5. Newborns, under the direction of a physician, need a single dose of vitamin K 6. People with limited milk intake and sunlight exposure may need extra vitamin D

7. Individuals with lactose intolerance or allergies to dairy products may need extra calcium
8. Individuals with certain medical condition and those who use certain medication also require supplementation with specific vitamins and minerals under the direction of a physician.
32

Thank You

33