GI Vitamins

Question 1

What is B1 (Thiamine) used for?

Answer 1

• TAP Enzymes - Transketolase (HMP Shunt), Alpha-ketoglutarate dehydrogenase (TCA), and Pyruvate dehydrogenase (Glycolysis -> TCA), BCKA Dehydrogenase
• Oxidative decarboxylation
• Pentose phosphate
• Cofactor for ATP synthesis

Question 2

Where do you get B1 ~ what sources?

Answer 2

Liver, eggs, whole grain cereal, rice, wheat, and out layers of grain and seed

Question 3

Deficiency of B1 can result into what?

Answer 3

Beriberi - Ber1 Ber1
Dry Beriberi - polyneuritis, sympattrical muscle wasting
Wet Beriberi - high output cardiac failure - dilated cardiomyopathy and edema
Wernicke - Korsakoff - confusion, apthalmoplegia, ataxia (classic traid) + confabulation, personality change, memroy loss - damage to medial dorsal nucleus of thalamus, mammillary bodies

Impaired glucose breakdown –> ATP depletion, worsened by glucose infusion, highly aerobic tissues (brain and heart) are affected first

Question 4

What are the cause of deficiency of B1?

Answer 4

Chronic Alcoholism and diet of nonenriched rice

Question 5

How do you treat a B1 deficiency?

Answer 5

Thiamin + glucose

Question 6

What vitamins are involved in energy and metaoblism?

Answer 6

B1, B2, B3, B5, B6, and B12

Question 7

Vitamins invovled in RBC health and clotting?

Answer 7

C, B6, Folate, B12, and K

Question 8

Fat versus water deficiencies

Answer 8

Generally fat soluble vitamin deficiency is due to liver, pancreas, or Gi disease abnormalities, while the water soluble vitamins are deficient due to intake issues.

Question 9

Which vitamin type is more toxic if too much is taken into your sexy body?

Answer 9

Fat soluble is more toxic because these accumulate in fat, taking longer to excrete

Question 10

Vitamins that act as antioxidants?

Answer 10

A, C, and E

Question 11

What is the function of vitamin A?

Answer 11

It serves as an antioxidant, constituent of visual pigments (retinal) is essential for normal differentiation of epithelial cells into specialized tissue - and prevents squamous metaplasia - it is used to treat measles, AML, subtype M3

regulation of gene expression, as it can bind to retinoic acid and retinoid X receptors (RAR, RXR) which regulate gene transcription

Question 12

Vitamins involved in regulating gene expression?

Answer 12

A and D

Question 13

Tell me about Fat Soluble Vitamins!

Answer 13

DEAK - daily intake is NOT necessary, because excess vitamins are stored in fat droplets and adipose tissue. Hypervitaminosis is more serious, espeiclaly becuase these vitamins take a long to be eliminated from our body. We can assay levels of vitamins in plasma, tears, or milk. Vitamin K can be measured by PT. These are not diluated by water and require bile satesa nd chylomicrons for absorption

Question 14

What does malabsorption of fat soluble vitamins results in?

Answer 14

Steatorrhea, malabsorption syndromes, such as CF and sprue or mineral oil intake can cause fat - soblue vitamin def.

Question 15

What is Vitamin A

Answer 15

Retinol - so think retin A - used topically for wrinkles and acne - it is found in liver and leafy vegetables

Question 16

What does vitamin D deficiency lead to?

Answer 16

Increased infection risk, weakness, bone pain, rickets, and osteomalacia - it is also associated with reduced sunlight exposure

Question 17

What does too much vitamin D result in?

Answer 17

nausea, vomiting, anorexia, constipation, weakness, weight loss, confusion, arrhythmias, and metastatic calcification - seen in sarcoidosis (increase activation of vitamin D by epitheliod macrophages)

Question 18

What happens if you are vitamin A deficient?

Answer 18

Night blindness, dry skin - deficiency leads to elevated risk of infection, eye problems with night blindness, follicular hyperkeratosis, xerophthalmia

Question 19

What happens if you have too much Vitamin A?

Answer 19

You have arthalgias, fatigue, headaches, skin changes, sore throat, alopecia, teratogenic, vomiting, dizzines, liver problems, and osteoporosis — alcoholics, people with liver problems, hypercholesterolemia, or protein malnutriton are at increased risk

Question 20

What is the function of vitamin K?

Answer 20

It catalyzes gamma carboxylation of glutamic acid residues on various proteins concenered with blood clotting - it is synthesized by the intestinal flora

Question 21

What is K necessary for?

Answer 21

K is for Koagulation - it is necessary fro the synthesis of clotting factors 2, 7, 9, and 10 - and proteins C and S — warfarin is a vitamin K antagonist

Question 22

What happens if you are vitamin K deficienct?

Answer 22

neonatal hemorrhage with increased Pt and PTT but normal bleeding time - neonates have sterile intestines and are unable to synthesize vitamin K - can also occur after prolonged use of broad spectrum antibiotics - vitamin k is not in breast milk, neonates are given vitamin K as an injection at birth to prevent hemorrhage

Question 23

What does B2 (riboflavin) do?

Answer 23

it is a cofactor in oxidation and reduction - used in FAD / FADH2 coenzymes, which are key for redox reactions and especially in glycolysis and the TCA cycle

Question 24

What does deficiency of B2 cause?

Answer 24

Cheilosis - inflammation of lips, scaling and fissures at the corners of the mouth and corneal neo-vascualrization - also glossitis and photosensitivity

Question 25

What does deficiency of B3 cause? What’s the classic diet with B3 deficiency?

Answer 25

The 3 D’s!!!! Diarrhea, Dermatitis, and Dementia — this is the triad of pellagra - in addition you can have slow metabolism, decreased cold tolerance, decreased sleep, decreased appetite , and decreased muscle strength and glossitis

Diet: Corn that is not pre-treated with alkali

Question 26

What does vitamin D do?

Answer 26

It regulates the vitamin D receptor, which is a nuclear receptor involved in 200 genes ranging in function from mineral homeostasis to cell growth and differentiation - it increases intestinal absorption of calcium and phosphate and increase bone mineralization

Question 27

What does vitamin E do?

Answer 27

It is stored in lipid membranes so that it can accept and reduce free radicals - it protects erythrocyes and membranes from free radical damage, E is for Erythrocytes - it needs to be regenerated to its active form by vitamin C

Question 28

Deficiency in Vitamin E?

Answer 28

Increases fragility of erythrocytes (hemolytic anemia) muscle weakness, posterior column, and spinocerebellar tract demyelination

Question 29

B6 deficiency?!

Answer 29

This is rare but can present with microcytic, hypochromic anemia and can look like pellagra because B6 is needed to convert tryptophan to niacin to NAD. Other presenting signs are dermatitis, cheilosis, glossitis, depression, confusion, immune failure, irritability, headache, palpitations, dyspnea, and neural tube defects?

Question 30

What does B9 (folate) do? Where is it found in the diet?

Answer 30

It is found in leafy vegetables - folate foliage!!! It is absorbed in the jejunum (IFC)

converted to tetrahydrofolate (THF) a coenzyme for 1-carbon transfer / methylation reactions - it is important for the synthesis of nitrogenous bases in DNA and RNA, and is key in RBC formation

Question 31

What does deficiency of folate cause?

Answer 31

results in ineffective erythropoiesis with macrocytic anemai - no neurologic symptoms (as opposed to vitamin B12) - most common deficiency in the US - is seen in alcoholism and pregnancy — supplement folic acid in early pregnancies to reduce neural tube defects

Question 32

What is B12? Why should we care?

Answer 32

Cobalamin - absorbed in the Ileum (IFC)

key for the synthesis of nucleic acid and for formation of RBCs - it works in conjunction with folate for both —- absorption of B12 requires intrinsic factor, which is obtained form MEAT! (EAT YOUR HOT DOGGY DOG ~ assuming it is Kosher and is all beef)

Question 33

What prevents us from absorbing B12?

Answer 33

B12 absorption is interfered with by oral contraceptives, as well as gout and diabetic medication used chronically. PPIs and H2RAs (achlorhydria) block the acid metabolism of cobalamin, preventing absorption. Also, pernicious anemia.

Question 34

What does B 12 deficiency lead to?

Answer 34

leads to megaloblastic anemia with weakness and pale skin - neurologic disorders are common and these irreversible , including anorexia, decreases in body weight, taste, smell, and memory - tingling, depression, numbness, irritability, impotence, and hallucination.

B12 is involved in conversion of methyl-THF to THF and homocysteine to methionine - thus deficiency causes anemia and hypercoagulability (respectively)

Question 35

What is pernicious anemia?

Answer 35

it is an autoimmune disease where there is atrophy of the gastric mucosa, which results in achlorydria and vitamin B12 deficiency due to a lack of intrinsic factor. The auto-antigen is some part of the parietal cell (IF, proton pump, etc.)

Question 36

What does the vitamin C in our orange juice, which you don’t drink enough of, do?!

Answer 36

It reduces iron (III) to iron (II) so that it can be absorbed better in the gut, and also so that it can be used in hemoglobin. Thus, when you don’t drink your OJ and vitamin C is low, there can be iron def anemia - Vitamin C is an antioxidant that can react with perocyl radicals directly, or can restore the antioxidant properites or vitamin E

Question 37

What does Niacin B3 do?

Answer 37

used in NAD and NADP cofactors, which are key in carb and fat metaoblism? It is derived from trytophan - synthesis requires B6 — Nad is derived from Niacin

Question 38

What happens if you don’t take in vitamin C

Answer 38

you get SCURVY! which is swollen gums, bruising, hemarthrosis, anemia, poor wound healing and weakened immune response —- you get sCurvy due to a Collagen synthesis defect

Question 39

What does excess B3 (niacin) do?

Answer 39

facial flushing - due to pharmacologic doses for treatment of hpyerlipidemia

Question 40

What does B5 (pentathenic acid) do?

Answer 40

It is an essential component of CoA, which is key for lipgenesis and cellular respiration as part of carb, protein, and fat metabolism - deficiency is very rare

Question 41

What does B6 (pyridoxine) do?

Answer 41

The active form is needed for tranaminations, decarboxylations, deaminations, racemization. Key processes include heme synthesis, nuclei acid syntheisis and processing of vitamin B12

Question 42

What can too much VITAMIN C DO TO YOUR BODY!?

Answer 42

it can cause your tummy to be upset, you could get stones in your kidney, and it can increase iron absorption