1. Vitamins (Vit) are cofactors or catalysts in body processes
2. In general, Vit cannot be manufactured by the body
3. Divided into fat soluble and water soluble Vit
   1. There are four known fat soluble Vit: A, D, E, K
   2. There are nine clearly identified water soluble Vit: 8 B Vit and Vit C
   3. Deficiencies in fat soluble Vit can occur singly
   4. In humans, deficiencies in single water soluble Vit are almost never found
4. No clear evidence that vitamin supplements provides any chronic benefit or harm for healthy adults; special cases have shown harms and benefits [16,17]
5. Special attention has been paid to anti-oxidant Vit [1,14]
   1. No benefits of antioxidant Vit for cancer prevention [14]
   2. Meta-analysis of anti-oxidants for gastrointestinal cancer prevention showed ~10% increase [14]
   3. Antioxidant Vit combination did not reduce post-angioplasty restenosis or prevent coronary events in patients with coronary artery disease (CAD) [50]
   4. Anti-oxidant vitamins C + E + ß-carotene had no effect on CAD associated events [58]
   5. Vit C - no evidence for any benefits [29]; high doses may increase renal stones [1]
   6. Vit E - overall no benefit; may increase mortality [72]
   7. ß-carotene (Vit A precursor) - likely harm from supplements [29]
   8. Increased Vit E, and possibly Vit C and ß-carotene intake from foods associated with reduced Alzheimer Disease risk [56,57]
   9. Zinc oxide (80mg/d) in combination with vitamins C (500mg/d) and E (400 IU/d) may retard progression of age related macular degeneration [64]
6. Vascular Disease and B Vit [9,29]
   1. Folic acid supplementation reduces birth defects and anemia
   2. Folic acid conflicting associations with colonic adenomas and colon cancers [30,77]
   3. Vit B6 may reduce atherosclerosis in combination folic acid [25]
   4. No reduction in clinical events or mortality in women at high risk of CAD taking folate + vit B6 + vit B12 supplements for 7.6 years [20]
   5. Folic acid + vit B6 + vit B12 reduces homocysteine but does not reduce clinical endpoints in patients with vascular disease or after myocardial infarction [2,3]
   6. Homocysteine reduction with folate + Vit B12 + Vit B6 reduces major events after percutaneous coronary interventions [60] but probably not restenosis [69]
7. Recommendations for Vitamin Supplements [1,54,55]
   1. In general, well-nourished population does not benefit from vitamin supplementation [16,17]
   2. Folate 0.4-4mg qd must be taken by all pregnant women to reduce neural tube defects [68]
   3. Recommend that Vit D + Calcium intake be high in older persons or persons without sufficient intake; routine supplementation is not beneficial [76]
   4. Vit B12 supplements appear helpful in elderly, who have diminished absorption with up to 20% atrophic gastritis developing without Vit B12 supplements [1]
   5. Avoid high doses Vit A particularly during pregnancy
   6. Avoid high doses of fat-soluble vitamins at any age
   7. Avoid high-dosage (400 IU/day or more) Vit E as it likely increases all-cause mortality [72]
   8. Routine Vit supplementation is not recommended for CAD or cancer prevention [1,65,66]
   9. Multivitamin supplements delayed progression of HIV disease in study in Tanzania [70]

1. Other Names
   1. Active forms: retinol, retinal, retinoic acid
   2. Plant derived precursor: ß-carotene
2. Pharmacology
   1. Retinol is major transport and storage form of vitamin
   2. Retinol binding protein (RBP) picks up retinol from liver where it is stored
   3. Retinol-RBP complex travels in blood and it is delivered to target cells
   4. Target cells convert retinol to required forms
3. Normal Functions
   1. Vision - maintain healthy cornea and aides in detection of light
   2. Maintain body linings and skin
   3. Required for normal immune system function
4. Deficiency
   1. Even mild deficiency leads to reduction in light sensitivity (reduced night vision)
   2. Severe deficiency can lead to blindness mainly due to corneal opacification
   3. Abnormal skin, hair and nails - dry, rough, scaley, hard
   4. Increased infections of mucosal surfaces including mouth and intestine (diarrhea)
   5. Anemia
   6. Abnormal growth and development
   7. Kidney stones
5. Overdose [61]
   1. Very unusual with ß-carotene, which is the inactive precursor
   2. Disease is called hypervitaminosis A
   3. Abnormal skin, mucosal surfaces, visual changes
   4. Excessive intake of Vit A associated with osteoporosis and increased hip fracture [31,51]
   5. Can cause hypercalcemia, hyperphosphatemia, suppression of normal PTH secretion
   6. Psychiatric: depression, psychosis has been reported (similar for isotretinoin)
6. Currently Recommended Dosages
   1. Women: 800 (IU) µg/day
   2. Men: 1000 (IU) µg/day
7. Foods high in Vitamin A
   1. Fortified Milk
   2. Leafy vegetables: especially spinach
   3. Sweet potatoes, carrots, apricots
8. Therapeutic Uses [1]
   1. ß-carotene is an antioxidant with inconsistent lipid altering properties in vitro
   2. ß-carotene has increased recurrent MI [4] and lung cancer [5] in smokers
   3. ß-carotene also non-significantly increased primary CV events [7]
   4. No benefit of 50mg qod ß-Carotene on cancer or CAD
   5. No benefit of ß-carotene for prevention of stroke in men [34]
   6. No benefit for 6-9 years for cataract prevention; may be harmful [80]
   7. Negative effect of ß-carotene goes away after discontinuation of agent [67]
   8. No benefit in combination antioxidant therapy for secondary CAD prevention [50]
   9. May have some efficacy in prevention of recurrent head and neck cancers
   10. Retinoic acid derivatives for skin conditions
   11. Trans-retinoic acid for remission induction in acute promyelocytic leukemia (APML)
   12. Isotretinoin - head and neck cancer prevention
   13. ß-carotene is contraindicated in smokers, and should be used with caution in others
   14. Vitamin A supplements may be beneficial in extremely low birthweight infants [35]

B. Vitamin D [15]

1. Other Names
   1. Active Form: 1,25 dihydroxycholecalciferol, dihydroxy Vitamin D
   2. Calcitriol
2. Pharmacology
   1. Normal sources are sunlight, diet, dietary supplements
   2. The liver produces 7-dehydrocholesterol (7-DHC) from cholesterol
   3. Sunlight converts 7-DHC (in the skin) to cholecalciferol (vitamin D3)
   4. Liver vitamin D3 hydroxylase then converts this to 25-hydroxycholecalciferol (25OH-D3)
   5. 25OH-D3 is the major circulating metabolite of Vit D
   6. Kidney 1-hydroxylase converts 25OH-D3 to 1a,25-dihydroxycholecalciferol
   7. Therefore, if sunlight is available, the body can completely manufacture Vitamin D
3. Normal Functions
   1. Calcium and phosphorus absorption from the gut
   2. Normal bone formation and maintenance (promotes osteoblast function)
   3. Stimulates calcium retention by the kidneys
   4. Normally has a reciprocal relationship with serum parathyroid hormone (PTH) levels
   5. With calcium, prevents secondary hyperparathyroidism and osteopenia due to high PTH [75]
4. Early Deficiency: Rickets [8,15]
   1. Deficiency early in life prior to closure of epiphyseal plate leads to rickets
   2. Low calcium at growth plate causes cartilage hyperplasia with wide epiphyseal plate
   3. Usually due to nutrient deficiency, primarily vitamin D or less commonly, calcium
   4. May be due to disroders of gut, pancreas, liver, kidney or metabolism
   5. Iron deficiency and/or handling iron in the gut may also contribute
   6. Short stature and weak, deformable bones
5. Late Deficiency: Osteomalacia [15]
   1. Deficiency after closure of epiphyseal plate is called osteomalacia
   2. Soft, weak bones with wide osteoid seams on histology
   3. Much increased risk for complicated fractures
   4. Persons with little exposure to sunlight are at increased risk for deficiency
   5. Immune system dysfunction also occurs with deficiency
6. Chronic Deficiency: Osteoporosis
   1. Increased osteoporosis with normal aging, particularly in women without Vit D supplements
   2. Serum levels of 25OH-D3 <26ng/mL associated with increased fracture risk
   3. Supplements with Vit D associated with 20-30% reduction in fracture risk
   4. VIt D supplements may also reduce falls by increasing muscle strength [15]
   5. Vit D supplements reduce all-cause mortality in adults and older individuals: 400 IU/d for adults 50-70 years, 600 IU/d for >70 years old [79]
7. Overdose
   1. Main problem is hypercalcemia and possible hyperphosphatemia
   2. Taking more than 4-5 times the recommended dose can lead to symptoms
   3. Hypercalciuria and renal stones can occur, as well as osteoporosis
8. Currently Recommended Dosages [1,79]
   1. Children: 10µg (400 IU) / day
   2. Men and Women Age 51-70: 10µg or 400 IU / day
   3. Post-menopausal women: 700-800 IU/day (~20µg/d)/day Vit D (with calcium) [12]
   4. Men and Women Age >70: 600 IU / day [1]
   5. Most persons do not require supplements to maintain adequate serum levels [76]
9. Foods High in Vit D
   1. Milk is now fortified with Vit D in order to insure adequate intake in children
   2. Adults on a normal diet generally do not require additional Vit D
   3. Those without good exposure to sunlight should eat eggs and drink milk
10. Therapeutic Uses
    1. Large doses may be given for hypoparathyroidism to improve calcium metabolism
    2. Calcitriol (and others) for chronic renal failure
    3. Vitamin D >700 IU/d + calcium reduces fractures and improves bone density [12]
11. Vitamin D and Hospital Inpatients [27]
    1. Low levels of vitamin D were found in >50% of medical inpatients
    2. Severely deficient 25-hydroxyvitamin D was found in ~20% of medical inpatients
    3. Vitamin D deficiency is a risk factor for osteopenia and bone fractures
    4. Daily supplementation with 800 IU of vitamin D may not be sufficient to increase serum Vitamin D levels to normal
12. Risk Factors for Low Vitamin D [27]
    1. Inadequate vitamin D intake
    2. Winter season (reduced exposure to ultraviolet light)
    3. Housebound status
13. Maintaining adequate Vit D and calcium maintains serum PTH in the (low) normal range [75]

C. Vitamin E

1. Other Names: tocopherol, alpha-tocopherol
2. Pharmacology [1,44]
   1. Transported by plasma lipoproteins (mainly LDL and HDL)
   2. Comprises 8 naturally occurring compounds (tocopherols and tocotrienols)
   3. Gamma-tocopherol is main form in food and is clearly an anti-oxidant
   4. Alpha-tocopherol is main form in supplements and may block gamma-tocopherol effects
3. Normal Functions [41]
   1. Major anti-oxidant protection, probably most important in the body
   2. Inserts into cell membranes and reduces oxidation of lipid molecules
   3. Protects LDL-cholesterol from oxidation in vitro and possibly in vivo
   4. Key role in lung anti-oxidant protection
   5. The lipid peroxide in cell membrane can only be scavenged by vitamin E
   6. Scavenging hydroxyl radicals generates a vitamin E-free radical complex
   7. Vitamin C is a natural antioxidant that can remove the free radical from vit E complex
   8. Maintain normal active immune responses, particularly in elderly
   9. In healthy persons, no effect of 200-400 IU/d Vit E on lipid peroxidation [47]
4. Deficiency
   1. Rare condition, mainly in persons with mutation in hepatitic tocopherol transfer protein
   2. Anemia due to red blood cell damage
   3. Neurological deficits (in genetic deficiency form)
   4. Immune dysfunction
   5. Poosible risk for Fibrocystic Breast Disease
5. Overdose
   1. Interference with blood-clotting action of Vitamin K (potential for hemorrhage)
   2. Potentiation of warfarin effects
   3. Doses of 400IU/day or more associated with increased all-cause mortality [72]
   4. Dose of 400 IU/day associated with increased risk of heart failure [11]
6. Currently Recommended Dosages
   1. Most persons receive at least 100 IU (100mg) per day with normal diet
   2. No clear benefits to supplementation of Vit E
   3. Overall probable harms of 400 IU/day or higher doses of Vit E [11]
   4. For persons on warfarin, stable doses of Vitamin E must be maintained
7. Foods High in Vitamin E
   1. Polyunsaturated vegetable oils (and margerines) are high in Vitamin E
   2. Fruits and vegetables (uncooked)
   3. Fortified cereals and grains
   4. Vitamin E is easily destroyed by heating or oxidation
8. Therapeutic Uses [7]
   1. Prevention of CAD with Vit E has not been confirmed [7,11,41,43,65]
   2. Overall, Vitamin E and other antioxidant vitamins have had no beneficial effect for prevention of CAD in general populations [7,43,65,66,74]
   3. Overall morality may be increased with doses 400 IU/day and higher [11,72]
   4. No benefit to 600 IU natural Vit E qod for prevention of CAD, cancer; no effect on mortality [74]
   5. No clear role for secondary prevention of CAD in smokers [4,26]
   6. Vit E 400IU/day increased risk of heart failure [11]
   7. Vit E 300mg per day did not reduce secondary vascular events in post-MI patients [36]
   8. No benefit for prevention of stroke in men [34]
   9. In patients at high risk of CAD, Vitamin E 400 IU/d for median of 4.5 years had no effect on CV or overall mortality [43]
   10. Vit E 800 IU/day for 1.5 years reduced CAD 50% in dialysis patients [46]
   11. Alpha-tocopherol 50mg qd reduced prostate cancer risk 12% [67]
   12. Vit E supplements may improve response to infectious diseases
9. Combinations of Vit E and other Antioxidants [65,66]
   1. Vit E (400 IU bid) + Vit C (500mg bid) did not prevent atherosclerosis progression in post-menopausal women [62]
   2. Vit C + E (1000 IU) blocked acute vascular effects of homocysteine [33]
   3. Vit E (400IU bid) and C (500mg bid) prevented coronary intimal thickening in first year after heart transplant [52]
   4. Combined Vit E + C + ß-carotene + selenium did not reduce CV events in patients with known CAD and normal LDL cholesterol levels [50]
   5. Combined Vit E, ß-carotene, and Vitamin C for 5 years did not reduce catarct formation [80]
   6. Vit E and C reduce PAI-1 to PAI-2 ratio in pre-eclamptic women [37]
   7. Antioxidant vitamins have generally not shown benefit in prevention of CAD [7]
   8. Combined Vit C and E supplements did not reduce risk of pre-eclampsia or perinatal complications [6,13]

D. Vitamin K

1. Other Names
   1. Anti-hemophilic factor
   2. Phylloquinone, naphthoquinone
   3. Menadione is a synthetic substitute for vitamin K
2. Pharmacology
   1. Vitamin K is injested in most foods
   2. Bacteria in colon synthesize Vitamin K as well [63]
   3. Transported by plasma lipoproteins (mainly VLDL)
3. Normal Functions
   1. Major cofactor in synthesis of 4 blood clotting proteins
   2. These are: Prothrombin (Factor II), Factor VII, Factor IX, and Factor X
   3. Also involved with vitamin D in synthesis of certain bone proteins
4. Deficiency
   1. Antibiotics which reduce gut bacterial levels can precipitate Vitamin K deficiency [63]
   2. This is more pronounced in persons with inadequate dietary intake
   3. Inadequate vitamin K can lead to or promote bleeding diathesis (hemorrhaging)
5. Overdose
   1. Red cell hemolysis
   2. Jaundice
   3. Brain damage
   4. Reversal of anti-coagulation effects of warfarin
6. Currently Recommended Dosages: most foods contain adequate vitamin K
7. Foods High in Vitamin K
   1. Green leafy vegetables
   2. Cabbage-type vegetables
   3. Milk
8. Therapeutic Uses
   1. Reversal of over-coagulation with warfarin [59]
   2. Correction (often partial) of coagulopathy from liver failure
   3. Administration to newborns to prevent bleeding

1. Other Names: Thiamin
2. Pharmacology
   1. Good oral absorption from most foods
   2. Excess is excreted in urine with little body storage
3. Normal Functions
   1. Energery metabolism
   2. Nerve and muscle functions
4. Deficiency
   1. Relatively common in alcoholics and other malnourished persons
   2. Severe disease called "beriberi"
   3. Cardiac Dysfunction: edema, heart failure, arrhythmias
   4. Neuromuscular degeneration, mental confusion, paralysis
   5. Wernicke Encephalopathy - especially in alcoholism, hyperemesis gravidarum
5. Overdose - none reported
6. Currently Recommended Dosages: 1.2-1.5mg/day
7. Foods High in Vitamin B1
   1. Pork (ham) are highest in thiamin
   2. Breads and cereals are often fortified with thiamin

B. Vitamin B2

1. Other Names: Riboflavin
2. Pharmacology
   1. Good oral absorption from many foods
   2. Not stored in the body
3. Normal Functions
   1. Facillitates normal energy metabolism in the body
   2. Normal vision and skin health
4. Deficiency
   1. Cracks at corners of mouth (cheilosis)
   2. Magenta colored tongue
   3. Hypersensitivity to light (photophobia)
   4. Corneal reddening
5. Overdose - not reported
6. Currently Recommended Dosages: 1.2-1.7 mg/day
7. Foods High in Vitamin B2
   1. Dairy: milk, yogurt, cottage cheese
   2. Leafy green vegetables
   3. Meat
   4. Whole-grain or enriched breads/cereals

C. Vitamin B3

1. Other Names: Niacin, nicotinamide, niacinamide
2. Pharmacology
   1. Excellent oral absorption
   2. Can be produced from tryptophan metabolism
3. Normal Functions
   1. Facillitates normal energy metabolism in the body
   2. Normal skin, nervous system, digestion
4. Deficiency
   1. Severe deficiency very uncommon now, called "pellagra"
   2. Abnormal skin - photosensitive red flaky rash
   3. Diarrhea
   4. Neurologic: irritability, confusion, psychosis, delirium, and seizures
   5. Black, smooth tongue
5. Overdose
   1. Flushing, plethora, hypotension
   2. Hepatitis - may be severe or even fatal with very high doses
   3. Diarrhea, nausea, ulcer irritation, vomiting
   4. Fainting, dizziness can occur
6. Currently Recommended Dosages: 15-20 mg/day
7. Foods High in Vitamin B3
   1. Foods high in protein (due to tryptophan conversion): meat, poultry, fish
   2. Enriched breads and cereals
   3. Mushrooms, asparagus, green leafy vegetables
8. Therapeutic Uses
   1. Indicated for the treatment of high LDL, low HDL, high triglyceride cholesterol disorders
   2. Dose-dependent reductions in LDL, triglycerides, and increases in HDL
   3. However, most patients experience moderate to severe side effects at these high doses
   4. Cholesterol lowering doses are 500mg po bid to 1000mg po tid

D. Vitamin B6

1. Other Names: Pyridoxine, pyridoxal, pyridoxamine
2. Pharmacology
   1. Good oral absorption from many foods
   2. Not stored in the body
3. Normal Functions
   1. Coenzyme used in amino acid and lipid metabolism
   2. Needed for conversion of tryptophan to niacin
   3. Important in red blood cell formation
   4. Helps maintain normal (low) serum homocysteine levels with folate
4. Deficiency
   1. Microcytosis ± anemia
   2. Smooth tongue (glossitis)
   3. Irritability, muscle twitching, seizures
   4. Contributes to increased homocysteine levels [28]
5. Overdose
   1. Bloating, fatigue, irritability
   2. Impaired memory, numbness, nerve damage, ataxia
   3. Loss of reflexes, weakness
6. Currently Recommended Dosages: 1.6-2.0 mg/day
7. Foods High in Vitamin B6
   1. Green and leafy vegetables, legumes
   2. Fish, meats, poultry
   3. Fruits
   4. Whole grains
8. Therapeutic Utility
   1. Treatment of homocystinuria
   2. Reduction of serum homocysteine levels in adults
   3. Usually used in combination with folate ± Vit B12 for homocysteine reduction (see below)
   4. Reduction of serum homocysteine did not reduce primary or post-MI vascular events [2,3]
   5. Dose of 50mg po qd to bid alleviates general symptoms of premenstrual syndrome [40]
   6. Given with isoniazid to prevent Vit B6 deficiency

E. Vitamin B12 [19]

1. Other Names: Cyanocobalamin
2. Pharmacology
   1. Bound in stomach by intrinsic factor (made by parietal cells)
   2. Complex of intrinsic factor+B12 bound to receptors in ileum and absorbed there
   3. Inside cell, converted to two active cofactors: adenosylcobalamin and methylcobalamin
3. Normal Functions
   1. Required in new cell synthesis, particularly red blood cells
   2. Required for normal nerve cell function
   3. Adenosylcobalamin is cofactor for mitochondrial methylmalonyl-coenzyme A mutatase (MMCAM)
   4. MMCAM is involved in catabolism of odd-chain fatty acids and some amino acids
   5. Methylcobalamin is coenzyme for cytosolic methionine (Met) synthase
   6. Met synthase converts homocysteine to Met
   7. Met is used in methylation and DNA synthesis
4. Deficiency [71]
   1. Elevated levels of homocysteine and methylmalonic acid which lead to lethargy, hypotonia, developmental delay, seizures, megaloblastic anemia
   2. Megaloblastic (Pernicious) Anemia
   3. Peripheral neuropathy [71]
   4. Occurs in chronic atrophic gastritis, gastrectomy, short bowel syndrome (ileal resection)
   5. Common in elderly, 10-30% [1]
   6. About 2% of patients with pernicious anemia have gastric carcinoma
   7. May contribute to increased homocysteine levels [28]
   8. Several genetic mutations lead to lack of MMCAM or methylcobalamin
   9. Methylmalonic aciduria and homocystinuria can occur with severe defective B12 metabolism [19]
5. Overdose: no symptoms reported
6. Currently Recommended Dosages: 2.0 µg/day
7. Foods High in Vitamin B12
   1. Meat, fish, poultry
   2. Milk, cheese
   3. Eggs
8. Administration of Vitamin B12
   1. Intramuscular injections monthly 1000U maintenance
   2. Nasal cyanocobalamin (500µg per 0.1mL)
   3. Supplements strongly recommended in older people, who often have reduced levels [1]
9. Used with vit B6 and folate to reduce homocysteine but questionable clinical benefit [9]

F. Folic Acid

1. Other Names: folacin, pteroylglutamic acid
2. Pharmacology
   1. Good oral absorption from many foods
   2. Not stored in the body
3. Normal Functions
   1. Used in new cell synthesis
   2. Critical for normal neural tube development (closure)
   3. Required for normal red blood cell development
4. Deficiency
   1. Megaloblastic Anemia
   2. Neural Tube defects in newborns [38]
   3. Increased serum homocysteine levels [28]
5. Overdose - may mask Vitamin B12 deficiency (Pernicious anemia)
6. Currently Recommended Dosages
   1. Pregnant Women: 400-4000µg/day [68]
   2. Nonpregnant Women: 200µg/day
   3. Men: 180µg/day
   4. Nonpregnant women who consumed >1000µg/day total folate had a 45% reduced risk of developing hypertension than those who consumed <200µg/day [21]
7. Foods High in Folic Acid
   1. Leafy green vegetables
   2. Legumes and seeds
8. Therapeutic Uses
   1. Clear prevention of (>50%) neural tube defects during fetal development [38,39]
   2. With vit B6 and B12, reduces serum homocysteine (HC) levels [9,28,32]
   3. Increased folate intake associated with reduced arterial vascular events and stroke [78]
   4. HC lowering therapy had no effect on venous thromboembolism rates in women [53]
   5. Increased folate associated with reduced risk for colon cancer in women [30] and men [45]
   6. In a randomized prevention study, folate showed no benefit on colonic adenomas [77]
   7. Folate supplements reduced morbidity after percutaneous coronary interventions [60]
   8. HC reduction with folate+Vit B6+Vit B12 did not reduce restenosis rates [69]
   9. HC reduction is not associated with reduced primary or post-MI events in patients with vascular disease [2,3,9,18]
   10. Folate and mecobalamin (Vitamin B12) supplements associated with 75% reduction in risk of hip fracture in Japanese patients with stroke after 2 years [73]
   11. Folic acid supplementation 800µg/day for 3 years improved domains of cognitive function that tend to decline with age, mainly in patients with low vitamin B12 levels [10]
   12. HC reduction is not recommended for preventing vascular events [2,3,9,18]
9. Folic acid fortification of food supply has likely contributed to reduced neural tube defects in both US [49,68] and Canada [22]

G. Pantothenic Acid

1. Other Names: Dexpanthenol (pantothenyl alcohol)
2. Pharmacology
   1. Good oral absorption from many foods
   2. Not stored in the body
3. Normal Functions: coenzyme in energy metabolism
4. Deficiency
   1. Vomiting and intestinal problems
   2. Insomnia and fatigue
5. Overdose
   1. Over 20gm per day probably required for symptoms
   2. Mild diarrhea and water retention can occur at this dose
6. Currently Recommended Dosage: 5-10mg daily
7. Foods High in Pantothenic Acid: most foods

H. Biotin

1. Other Names: none
2. Pharmacology
   1. Good oral absorption from many foods
   2. Not stored in the body
3. Normal Functions
   1. Coenzyme in energy metabolism
   2. Required in fat and glycogen synthesis
   3. Normal amino acid metabolism
4. Deficiency
   1. Abnormal cardiac funciton
   2. Fatigue
   3. Loss of appetite, nausea
   4. Dry rash, loss of hair
5. Overdose: no symptoms reported
6. Currently Recommended Dosage
7. Foods High in Biotin: most foods

I. Vitamin C

1. Other Names: Ascorbic Acid
2. Pharmacology
   1. Good oral absorption from many foods
   2. Not stored in the body
3. Normal Functions
   1. Scavenges hydroxyl and superoxide radicals and stops free radical reactions
   2. Required for normal collagen synthesis - three enzymes catalyzing hydroxylations
   3. Carnitine biosynthesis
   4. Cofactor for dopamine ß-monooxygenase
   5. Cofactor for peptidyl-glycine alpha-monooxygenase (amidation of peptide hormones)
   6. Tyrosine metabolism (4-hydroxyphenylpyruvate dehydrogenase)
   7. Thyroxine synthesis (T4)
   8. Normal iron absorption
   9. Anti-oxidant function (probably as adjunct to vitamin E)
   10. Extracts oxygen radical from vitamin E-oxygen radical complex
   11. Resistance to infections
4. Deficiency [23,24]
   1. Disease is called "Scurvy"
   2. Rash - rough skin, blotchy bruses
   3. Microcytic Anemia
   4. Atherosclerotic Plaques
   5. Pinpoint hemorrhages (weakened skin collagen)
   6. Bleeding gums, ginvival hyperplasia, loose teeth
   7. Muscle degeneration, pain
   8. Depression, hysteria
   9. Bone pain and fragility, joint pain
   10. Failed wound healing
   11. Increased infections
5. Overdose
   1. Acidosis with very high doses (>1gm/day)
   2. Nausea, diarrhea, and other abdominal symptoms
   3. Various skin rashes
   4. Excessive urination
   5. Fatigue
6. Currently Recommended Dosages [32]
   1. RDA is now 120mg/day for adults
   2. Safe dose is <1 gm per day
   3. Five servings of fruits and/or vegetables per day will provide enough vitamin C
   4. These foods may also reduce the risk of cancer [32]
7. Foods High in Vitamin C
   1. Citrus and other fruits including oranges, grapefruit, strawberries
   2. Most vegetables including broccoli, red pepper, green pepper
8. Therapeutic Uses
   1. No efficacy in prevention of coronary disease
   2. May have mild to moderate additive activity with Vitamin E
   3. Combined vitamins C (1000mg) + E blocked acute vascular effects of homocysteine [33]
   4. In general, a great number of studies have failed to show benefit of very high dose
   5. Doses in the 120 -1000mg/day range may help prevent some cancers [32]
   6. Adding vitamin C to meals rich in iron can improve iron absorption
   7. Vitamin C has some efficacy in preventing reflex sympathetic dystrophy (RSD) in wrist fracture patients [42]
   8. No benefit for prevention of stroke in men [34]
   9. Plasma ascorbic acid concentrations inversely related to mortality from all causes [48]

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