Spoonful of Supplements
Odds & Ends
Now that all the vitamins have been accounted for, there are a few small items to mention before concluding this column.
Trace elements are required in tiny amounts for different functions in the body. Common trace elements include chromium, cobalt, copper, iodine, manganese, molybdenum, selenium, and zinc. Most people are able to obtain these trace elements through a normal diet. Some of them are included in the formulations of daily multivitamins too, just in case.
Currently in the United States, the labeling of vitamins is undergoing a change. Vitamins A, D, and E will have new units of measure in full effect by January 2021. The old unit of measure for all three vitamins is international units (IU). They will be shifting to metric units. Vitamins A and D will use microgram (mcg), while vitamin E is being converted to milligram (mg). The one I see the most is vitamin D. 1000 IU of vitamin D is equivalent to 25 mcg. Doctors are writing orders using both sets of units, so be aware!
The major takeaway from this column is that most people do get sufficient vitamins from their everyday diets. There is always ongoing research about new supplements that might help improve this or that, but they are likely not needed if you eat properly.
I originally wanted to create a HOL class about vitamins, but I'm glad I decided to make it a column instead. Some of the information was repetitive, which would not have made for interesting assignments. It has certainly helped me out quite a bit though. When I need to enter a vitamin onto a patient's profile, I no longer have type "vitamin" and search through the entire list. Now I know to type "asco" for vitamin C (ascorbic acid), "toco" for vitamin E (tocopherol), or "thia" for vitamin B1 (thiamine), which saves time.
I know that the material in this column has not always been the easiest to read, so thank you to those who have read an article or two. I hope you have learned some interesting facts about vitamins and other supplementary supplements!
Vitamin B12: Cyanocobalamin
A B12 shot is practically synonymous to a boost of energy. It is still unclear whether vitamin B12 actually increases one's energy level or simply remedies conditions that result in low energy. However, it is clear that vitamin B12 has many important functions in the body. Vitamin B12 is needed for the formation of red blood cells and DNA synthesis. It is involved in the breakdown of fat and protein to provide energy. Vitamin B12 is also important in protecting nerves from damage.
Although the existence of this B vitamin was suspected for a long time, it took nearly a century to officially name it. An autoimmune disease called pernicious anemia was described by Thomas Addison in the 1850s. Pernicious anemia is when the body cannot make enough red blood cells due to the lack of intrinsic factor, a protein made in the stomach. In 1926, Georges Richard Minot and William Parry Murphy reported that patients with pernicious anemia were cured by ingesting large quantities of raw liver. Shortly after, William Castle postulated that intrinsic factor in the stomach lining is needed to absorb extrinsic factor. This extrinsic factor was isolated from the liver and named vitamin B12 in 1948.
Vitamin B12 contains cobalt, giving it the name cobalamin. Like most vitamins, food is the best source of vitamin B12. Bacteria that reside in the stomach of some animals can produce vitamin B12. In fact, natural cobalamin is only provided by animal sources, such as meat, fish, and dairy. Beef liver and clams provide the most vitamin B12. Vitamin B12 is bound to protein in food and released by acids in the stomach. Only after the vitamin combines with intrinsic factor can the body absorb vitamin B12. Vegetarians may have trouble obtaining sufficient vitamin B12 from their diet, but it is fortified in food, including yeast and cereal.
The main reason that someone needs supplementation is in the case of vitamin B12 deficiency. As mentioned before, this occurs in those with pernicious anemia. Megaloblastic anemia is typically due to vitamin B12 deficiency as well. Be aware that vitamin B12 deficiency may be masked by folic acid in megaloblastic anemia. Older adults are also at risk of vitamin B12 deficiency. They have decreased production of hydrochloric acid in the stomach, making it more difficult to absorb vitamin B12. Similarly, people with stomach issues, other digestive disorders, or recent gastrointestinal surgery tend to require more vitamin B12. Strict vegetarians and vegans usually require additional supplementation, especially women who are pregnant or breastfeeding.
The synthetic form of vitamin B12 that is most commonly used as a dietary supplement is called cyanocobalamin. This is a free form of vitamin B12 that is easy for the body to convert to the active forms quickly. It is not bound to protein, so it can be used immediately. Multiple formulations of vitamin B12 are available, including lozenges and a nasal spray. In addition to the usual tablet form, vitamin B12 comes as a sublingual tablet that dissolves rapidly under the tongue. Some people opt to receive a biweekly or monthly injection.
It may be the final item in the kaleidoscope of vitamins, but vitamin B12 is needed to give the body energy. Nearly all food of animal origin are good sources of vitamin B12. Otherwise, supplement with one of the many forms of cobalamin.
Vitamin B9: Folic Acid
The penultimate B vitamin is better known in the supplement world as folic acid. Hardly anyone refers to it as vitamin B9. Folic acid was first identified by researcher Lucy Wills in 1931 as a nutrient required to prevent anemia (low red blood cells) during pregnancy. For a number of years, it was called the Wills Factor. Chemists later extracted folic acid from spinach leaves. "Folic" is derived from the Latin word folium meaning leaf. Like vitamin K, some of the best sources of natural folic acid (folate) are dark-green leafy vegetables.
Folic acid is extremely important early in pregnancy. Mothers can prevent neural tube defects, affecting the brain and the spine, from developing in their babies by having sufficient folic acid intake. In addition to including foods with folic acid in their diet, prenatal vitamins provide expecting mothers with folic acid. It is highly recommended for all women of child-bearing age to ensure that they get enough folic acid every day due to the increasing numbers of unplanned pregnancies as well as for good overall health.
Women are the ones that are strongly encouraged to take folic acid, but everyone should make sure that they obtain adequate amounts of folic acid on a daily basis. Folic acid plays a role in several processes in the body, usually by donating a carbon moiety. It is involved in making genetic material, both DNA and RNA. Folic acid is important in the breakdown of amino acids. As mentioned for vitamin B6, folic acid helps maintain homocysteine levels in the blood, which may be beneficial in reducing the risk of heart disease. The production of new cells through cell division requires folic acid as well.
Along with vitamin B12 deficiency, folic acid deficiency is one of the most common causes of megaloblastic anemia. This condition results in the production of abnormally large red blood cells. Symptoms include fatigue, mouth sores, tongue swelling, and growth problems. Populations at risk of having low levels of folic acid are alcoholics, those suffering from disorders of the digestive system, and people born with a genetic mutation. The MTHFR gene mutation affects an enzyme that converts folic acid into folate, the form of the vitamin that the body is able to use.
Since the 1970s, folic acid has been used as "rescue medication" in cancer treatment. Folic acid can combat some of the toxicity and side effects of methotrexate. Folic acid is also used as an adjunct antidote in cases of methanol poisoning. One of the toxic metabolites, formic acid, a byproduct of the breakdown of methanol is oxidized to carbon dioxide and water by folic acid.
Bacteria in the small intestine produce folate, but scientists are unsure if humans are able to absorb it. Instead, the majority of folic acid is obtained through food. Spinach and other dark leafy green vegetables contain a large amount of folate. Beef liver, asparagus, and Brussels sprouts are also high in folate content. Fruit and fruit juices, especially oranges, are excellent sources as well. Vitamin C even helps the body absorb folate. Nuts, beans, and peas also provide folic acid. Most developed nations now fortify their grain products – bread, pasta, cereal, flour – with folic acid.
Remember to thank your mother for taking folic acid while you were still a work in progress. Whether you have two X chromosomes or not, it is very important for you to meet your daily requirement of folic acid!
Vitamin B7: Biotin
Taking biotin is "in" these days. Like the other B vitamins, vitamin B7 is an essential vitamin that the body requires for multiple functions. Due to its unique structure, biotin acts as a cofactor for several different enzymes needed for critical steps in the breakdown of food. Vitamin B7 plays a role in the regulation of genes and how cells communicate with each other. Biotin has been shown to be important for hair, skin, and nail growth. Companies that produce biotin supplements market it as the "beauty vitamin."
For most adults, the daily recommended intake of vitamin B7 (30 mcg/day) is easily obtainable through diet. The majority of the biotin found in food is bound to protein. Just one serving of organ meat, such as beef liver, is enough to satisfy the body's biotin requirement. Other food sources for vitamin B7 include almonds, eggs, beef, pork, salmon, sweet potatoes, and sunflower seeds. However, there is one interaction to watch out for regarding food and biotin. Avidin, a glycoprotein found in raw egg whites, binds to dietary biotin. This keeps the body from absorbing biotin. The simple remedy to avoid this potential complication is to ensure that all eggs are cooked properly.
Low vitamin B7 is uncommon and generally confined to specific populations. The first signs of biotin deficiency are skin rashes, hair loss, and brittle nails. There is a rare disorder called biotinidase deficiency that prevents the body from releasing free biotin. Newborns are screened for this disorder, so they can receive proper treatment that may be required for life. Alcohol prevents the absorption of vitamin B7, so chronic alcoholics are at risk of biotin deficiency. For unknown reasons, a third of pregnant women tend to have low levels of biotin. Therefore, vitamin B7 is found in many prenatal vitamin formulations.
Biotin is already present in small amounts in the typical multivitamin. Products designed to strengthen hair, skin, and nails may contain 100 times more biotin than the daily requirement. Since vitamin B7 is water-soluble, most of it is simply eliminated by the body. For the wider community, biotin supplementation is not necessary. Extremely high doses of vitamin B7 (300 mg/day) has been effective for pain relief in individuals battling multiple sclerosis. Biotin has also been studied as an option for unique hair, skin, and nail ailments, such as uncombable hair syndrome (which might run in the Potter family).
Although vitamin B7 toxicity is not a problem, the recent biotin hype has led to issues with laboratory tests. Biotin technology is used in some tests because of vitamin B7's ability to bond to specific proteins. High amounts of biotin in the blood can result in both falsely high or falsely low levels, depending on the test. Abnormal numbers have been seen with hormone levels (like the thyroid hormone), markers of heart health, and vitamin D. Patients are asked to hold their high dose biotin supplements prior to getting lab tests.
Your hair, skin, and nails thank you for including vitamin B7 in your diet, but don't buy into the mega dose biotin hype!
Vitamin B6: Pyridoxine
Appropriately numbered, vitamin B6 is the collective term for six similar compounds. Pyridoxine is the most common supplement form. The active form of vitamin B6, pyridoxal 5’-phosphate (PLP), is a coenzyme in over 100 reactions in the body. It is especially important in reactions that involve breaking down protein to make amino acids. Vitamin B6 is also required for neurotransmitter formation, synthesis of hemoglobin, breakdown of sugar and fat, and gene expression.
Along with folic acid (vitamin B9) and vitamin B12, pyridoxine is one of three B vitamins that may help reduce the risk of heart disease by maintaining the level of homocysteine in the blood. Homocysteine is an amino acid that the body naturally produces and uses. Too much homocysteine can contribute to the narrowing of blood vessels, ultimately leading to heart attack or stroke. Vitamin B6 is a cofactor in the conversion of homocysteine to cysteine, which decreases homocysteine levels.
Vitamin B6 supplementation is an option to provide relief from morning sickness. There is a combination of pyridoxine with the antihistamine doxylamine specifically designed for the management of nausea and vomiting during pregnancy. However, vitamin B6 is not guaranteed to be effective for all expecting mothers so stronger agents may be required.
Pyridoxine is an antidote for a specific type of mushroom poisoning. False morels contain the toxin monomethyl hydrazine (MMH), which is a problem when the mushroom is eaten raw. The false morel Gyromitra esculenta, the beefsteak mushroom, is actually a delicacy in Scandinavia and the Great Lakes region in the United States. When Gyromitra esculenta is purchased in Finland, it comes with instructions for proper preparation.
People being treated for tuberculosis with the antibiotic isoniazid have increased secretion of pyridoxine. The lower levels of pyridoxine in the body can cause a type of anemia characterized by the formation of faulty red blood cells. Malformed red blood cells are not able to transport oxygen properly. Therefore, it is recommended to give vitamin B6 with isoniazid as a precaution.
The majority of the population typically has no problem obtaining enough vitamin B6 on a daily basis. Pyridoxine deficiency is an issue for people with poor kidney function, those who are unable to absorb vitamin B6 because of their digestive systems, and alcoholics. Meat sources of vitamin B6 include fish, beef liver and other organ meats, and poultry. Potatoes and other starchy vegetables also provide pyridoxine. Fruits, excluding the citrus variety, are another good dietary option. Many cereals are fortified with vitamin B6.
No matter what your eating habits are, you should definitely consider including vitamin B6 in your breakfast club!
Vitamin B5: Pantothenic Acid
Have you heard of vitamin B5? The reason why vitamin B5 is not mentioned as often as all of the other B vitamins is because vitamin B5, or pantothenic acid, is literally everywhere. Pantothenic acid comes from the Greek word "pantothen" that translates to "from everywhere." It is extremely rare for people to have low levels of vitamin B5. Therefore, it is not usually necessary to supplement vitamin B5.
Small amounts of vitamin B5 are found in a vast variety of foods, so getting adequate pantothenic acid from the average diet is very feasible. High amounts of vitamin B5 are in whole grains, commonly consumed as cereal; eggs, especially egg yolk; and organ meats, like liver and kidney. Avocados, cashew nuts, peanuts, legumes, broccoli, and milk or yogurt are also good sources of pantothenic acid.
Vitamin B5 is a precursor of coenzyme A, which has many important functions inside the body. Like the other B vitamins, vitamin B5 is involved in the conversion of food into energy, breaking down proteins, carbohydrates, and fats. Coenzyme A plays a role in the formation of hormones, including testosterone and melatonin. It is vital in the making and transport of fatty acids. Cell communication depends on coenzyme A. It is also part of cholesterol synthesis. A derivative of vitamin B5, pantetine, is being studied for its potential cholesterol lowering properties. Vitamin B5 helps the body use riboflavin (vitamin B2), resulting in decreased stress levels.
As coenzyme A, vitamin B5 is involved in the formation of vitamins A and D. Both of these vitamins are significant in the healing of wounds. With the help of vitamin B5, the healing time of wounds is shortened and the amount of scar tissue is reduced. Healthy skin in general is partly thanks to the moisturizing properties of vitamin B5.
Bacteria in the colon produce vitamin B5, so it appears to be beneficial for the digestive system. However, it is still unknown if the human body can absorb the vitamin B5 made by the good bacteria in the large intestine. In the meantime, make sure you continue to eat normally (or as normally as possible) to get sufficient vitamin B5.
Vitamin B3: Niacin
The third B vitamin was first discovered by the chemist Hugo Weidel while he was studying nicotine. To distance the vitamin from nicotine, the addictive ingredient in cigarettes, the name "niacin" was coined from "nicotinic acid" and "vitamin" (NIcotinic ACid + vitamIN).
Niacin has multiple roles in the body, similar to the other B vitamins. It helps convert food into energy. Vitamin B3 is involved in DNA repair and hormone production. It maintains the digestive and nervous systems. Combined with vitamin A and vitamin E, niacin is rather effective in the treatment of acne.
Since 1955, it has been known that niacin has cholesterol-lowering properties, making it the oldest lipid-lowering drug. Nicotinic acid is the form of vitamin B3 that improves cholesterol levels. Cholesterol is used by the body to make steroids. It is carried through the blood by lipoproteins, made of fat and protein.
In the management of high cholesterol, niacin is best for increasing high-density lipoprotein (HDL) – the "good" cholesterol – and decreasing triglycerides. The major issue in those who have high cholesterol is too much "bad" cholesterol or low-density lipoprotein (LDL). LDL is big and bulky, so it can build up in blood vessels, causing blockages. HDL is denser and smaller. It may even help with the transport of LDL in the bloodstream. Unfortunately, because niacin does not have much of an effect on LDL, it is not the preferred agent in the treatment of high cholesterol. Statins are the first line option, due to their excellent LDL-lowering ability.
Insufficient vitamin B3 may cause nausea, skin and mouth lesions, not enough oxygen in the blood, headaches, or tiredness in general. The extreme case of niacin deficiency is called pellegra. It is typically seen in areas with long-term malnutrition. Pellegra is characterized by the four Ds (one more D than Apparition) – dermatitis (inflammation of the skin), diarrhea, dementia, and death.
Luckily, niacin is easily obtained through food. In developed countries, breakfast cereal is fortified with niacin and is the best source of vitamin B3. High niacin content is found in whole-grain flours, pasta, and sesame seed flour. The spices ginger and tarragon provide a decent amount of vitamin B3, as well as green peppers and portabella mushrooms. Meat options for obtaining niacin include tuna, turkey, pork, venison, and veal.
A common and annoying side effect of niacin is flushing, especially in the face. Niacin flush tends to go away over time. Other methods to manage the embarrassing side effect is to take niacin at bedtime with food or a snack. Taking an aspirin 30 minutes before niacin can help reduce the flushing, if it is permitted by a doctor. It also helps to avoid hot drinks and alcohol at the same time of supplemental vitamin B3 intake.
Niacin may slightly raise blood sugar, which is especially a concern for people with diabetes. It can increase the risk of gout and flare-ups of peptic ulcer disease. In rare cases, liver damage is possible.
Vitamin B3 may have fallen out of favor in the management of cholesterol, but everyone still benefits from its many other effects every day. Remember that breakfast is important and, when in doubt, have some cereal!
Vitamin B2: Riboflavin
When the first flavoproteins were isolated from cow's milk, it was found that they had a bright yellow pigment. The flavin group is a ring structure that gives the oxidized molecule a yellow color. It was given the name flavin from the Latin flavus, meaning blonde or yellow. If a sugar moiety (ribose) is in the flavin structure, it is called riboflavin, otherwise known as vitamin B2.
Like the other B vitamins, riboflavin is important in converting food into energy for the body. Vitamin B2 is also critical in the production of red blood cells and maintaining collagen, which is needed for healthy hair and skin. Riboflavin is the precursor to coenzymes used in the body – flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). It is able to fight free radicals as an antioxidant, so vitamin B2 is being studied in the prevention of early aging, including delaying the development cataracts.
Riboflavin deficiency is rare, but often coincides with deficiencies in other B vitamins, such as thiamine. Signs of a lack of vitamin B2 include cracks in the corners of the mouth, a sore throat, and sensitivity to light. Many people who do not receive enough riboflavin get migraine headaches. In fact, it is believed that riboflavin supplementation may be good for migraine prevention, but further research is still required.
Sufficient vitamin B2 is easily obtained through the diet. Fortified cereals, milk, and eggs are good sources of riboflavin. It is also found in nuts, like almonds, wild rice, and legumes. Green leafy vegetables, especially spinach, provide vitamin B2. Other vegetable sources include broccoli and Brussels sprouts. Lean meats, beef, and salmon are additional food options to get riboflavin.
One concern with riboflavin is that light will inactivate it – both ultraviolet and visible light. If you've ever wondered why milk is typically sold in opaque containers instead of transparent ones, now you know. Mystery solved!
Vitamin B1: Thiamine
As a vitamin workhorse in the body, it is not surprising that thiamine was identified early on. Thiamine was one of the first compounds to be classified as a vitamin in the 1930s. Since it was the first B vitamin discovered, thiamine is appropriately called vitamin B1.
Thiamine is the precursor to an important cofactor that is required to convert the food we consume into energy. It aids in secreting hydrochloric acid in the stomach to ensure proper digestion and maintains the muscle tone throughout the digestive tract. Vitamin B1 can improve heart function and is also good for the liver. It is key in the development of myelin sheaths, which surround the nerves to give them protection. Thiamine even has antioxidant properties, decreasing stress levels in the body.
Supplementation with vitamin B1 and other nutrients may prevent or delay the development of cataracts. Thiamine is believed to have a positive effect on memory, so it is often used as part of the treatment regimen for Alzheimer's disease. The increase in energy that vitamin B1 provides can be a morale booster for individuals battling depression.
For the majority of the world, thiamine is easily obtained through a normal diet. Lentils, whole grains and pork are the top food sources of thiamine. It is also found in red meat, yeast, wheat germ, legumes and spinach. However, overcooking and long-term refrigeration can destroy vitamin B1. Certain types of raw fish and shellfish contain chemicals that inactivate thiamine.
Vitamin B1 deficiency is seen in hereditary metabolic disorders like Leigh's disease and maple syrup urine disease. Severe thiamine deficiency leads to a disease called beriberi, resulting from a buildup of pyruvic acid in the bloodstream. The body is unable to breakdown food properly, resulting in the accumulation of an unwanted compound. For dry beriberi, the nerves and muscles are affected. Those deficient in vitamin B1 may experience tingling in the hands and feet and decreased muscle function. Other symptoms include mental confusion and difficulty speaking. Wet beriberi impacts the heart, possibly causing heart failure. Shortness of breath, rapid heart rate and swollen lower legs are potential effects.
Chronic alcoholics are at an increased risk of developing a brain disorder called Wernicke-Korsakoff Syndrome, caused by a lack of thiamine. Wernicke-Kosakoff Syndrome is actually two separate conditions that often occur together. Wernicke's encephalopathy affects vision, coordination and balance. Double vision and rapid eye movement may be seen. Korsakoff's syndrome involves memory, including the loss of memory, inability to form new memories and hallucinations. It is also called Korsakoff psychosis.
This was not meant to deter you from enjoying a nice summer cocktail, but rather to encourage you to keep up your vitamin B1 intake. You may benefit from a thiamine energy boost!
Vitamin B Complex
A popular selling point for energy drinks is that they contain large amounts of B vitamins (among a slew of other substances). Boosting energy levels is only one reason to increase vitamin B intake. As a group, the B vitamins have several important functions, ranging from aiding the immune system to making red blood cells to maintaining healthy brain operation. Many are cofactors in the body, helping convert food into usable energy.
The vitamin B complex is comprised of eight different compounds:
While it is possible to isolate each B vitamin, they are commonly found together in food. Vitamin B complex is the name given to any dietary supplement that contains all eight B vitamins. All of the B vitamins are water-soluble. Vitamin B12 is only available through animal sources, so vegetarians typically require supplementation. Other populations that may be at risk of low B vitamin levels are the elderly, alcoholics, heart failure patients, and those who have undergone recent obesity surgery.
Before getting into each B vitamin, let's understand why there is no vitamin B4. As compounds were being discovered, quite a few were originally classified as vitamins. However, upon further research, they were found not to fit the definition of a vitamin. Vitamins are organic compounds that are essential to the body, but cannot be made in the body. Vitamin B4 is actually adenine, one of the four DNA bases. Some of the B vitamins also had their own letters at one point, before it was decided that they should be grouped together. For example, biotin was vitamin H before it was reclassified as vitamin B7.
In addition to increasing energy, B vitamins are believed to help relieve stress. That's not a bad reason to supplement with vitamin B complex!
Vitamin E: Radical Scavenger
While other vitamins are cofactors or have specific functions in the body, vitamin E is unique in that its main (and only, for the most part) role is as an antioxidant. Vitamin E is an important antioxidant and even prevents the other vitamin antioxidants, vitamin A and vitamin C, from oxidation.
Oxidation chemical reactions in the body may produce harmful free radicals with free electrons as side products. These free radicals are highly reactive and can cause damage throughout the body. Vitamin E protects the fatty cell membranes from attacks and keeps red blood cells from getting ruptured.
Vitamin E is an ingredient in various creams, providing temporary relief to minor skin conditions, such as diaper rash, burns, sunburn, and chapped or dry skin. It is also used in shampoos, since vitamin E promotes hair growth and betters the overall health of hair.
The active form of vitamin E is alpha-tocopherol. It reacts with free radicals and prevents further reactions from occurring. At least eight different tocopherols and tocotrienols exhibit the antioxidant activity of alpha-tocopherol. Vitamin E is commonly expressed in alpha-tocopherol equivalents (ATE).
Vitamin E is one of the four fat-soluble vitamins, stored in fat tissue. The absorption of vitamin E depends on the presence of bile. Vitamin E deficiency is rare. Those with issues absorbing fat may require supplementation.
The general population gets sufficient vitamin E from their diet. The vitamin E found in food is predominantly gamma-tocopherol rather than alpha-tocopherol. Vegetable oils have the highest amount of vitamin E content. Wheat germ oil is the best source of vitamin E, followed by canola oil, sunflower oil, and safflower oil. Almonds are also a good source of vitamin E.
Dessert is one of the best courses for vitamin E intake. If you ever need an excuse to eat dessert, just say you're getting your daily requirement of vitamin E!
Vitamin A: Night Vision
As you read this, especially if you are reading this in low light, you have vitamin A to thank, as it is critical to vision. Vitamin A refers to the group of fat-soluble compounds called retinoids, which includes retinol, retinal, and retinyl esters. The retinal form of vitamin A is a component of rhodopsin, also known as visual purple. Rhodopsin is required to see in low light and at night. The first sign of vitamin A deficiency is difficulty seeing at night.
Vitamin A deficiency is mainly a concern in developing countries due to the lack of access to food containing the nutrient. Vitamin A is important in the development of babies, so pregnant women need to ensure they get enough. Young children in areas with limited access to vitamin A are most susceptible to develop xerophthalmia, or night blindness. Low levels of vitamin A is also a risk factor for severe measles. Additional doses of vitamin A are recommended for children who contract measles in developing nations.
In addition to vision, vitamin A has many other functions in the body. It is involved in gene transcription and immune function, such as the production and activity of white blood cells. Vitamin A plays a role in cell growth and differentiation, which is important in the normal function of the heart, lungs, kidneys, and other organs. Vitamin A helps maintain mucus membranes and aids in wound healing. Prescription strengths of the vitamin A derivatives, tretinoin and, most commonly, isotretinoin, are used in the treatment of severe acne. Like vitamin C, vitamin A is an antioxidant and has been considered for cancer research.
For the most part, humans are able to obtain sufficient vitamin A through their diet. Vitamin A is available preformed through animal sources: meat, fish, and dairy products. Liver, including beef liver and cod liver oil, is an excellent source of vitamin A. Milk and cereal are fortified with vitamin A as well.
Vitamin A from plants are called provitamin A carotenoids. They are metabolized further in the body to retinoids. The most common type of carotenoid is beta-carotene. It is easily recognized by a bright yellow to orange hue. Carrots are commonly associated with vitamin A and good eye health. Autumn favorites like sweet potato and butternut squash provide beta-carotene. Orange fruits, including cantaloupe, apricots, papaya, and mango are an option as well. Other vegetables that contain vitamin A are broccoli, peas, spinach, and kale.
Before you head out for a night of mischief, you may want to consider a meal with some vitamin A.
Vitamin K: Leafy Greens
Since the letter C was already being used for ascorbic acid, K was taken from the German term Koagulationsvitamin. Vitamin K is extremely important in coagulation, or blood clotting. One of the four fat-soluble vitamins (A-D-E-K), vitamin K is stored in fat tissue and the liver. Vitamin K also plays a role in maintaining strong bones.
An important step in the coagulation cascade is the activation of clotting factor II, a protein called prothrombin. Prothrombin requires vitamin K to be activated to thrombin. When an injury occurs, thrombin signals platelets to clump at the site of the injury to prevent blood loss. Thrombin is also involved in the conversion of fibrin. Fibrin is cross-linked over the platelets at the wound site, resulting in the formation of a blood clot. With insufficient vitamin K, individuals are at risk of experiencing uncontrolled bleeding.
Vitamin K1 is found naturally as phylloquinone in chlorophyll. Leafy greens – spinach, kale, cabbage, dark green lettuce – are among the best food sources of vitamin K. Herbs, broccoli, asparagus, and other green foods also contain a good amount of vitamin K. The synthetic version of vitamin K1 is phytonadione. Another major source of vitamin K is bacteria. The good bacteria living in the large intestine produce vitamin K2, or menaquinone. Remember that antibiotics kill off ALL bacteria, good and bad. If you need to take a course of antibiotics for any reason, you might need to increase your leafy green consumption to maintain an adequate vitamin K level. To replenish the helpful bacteria in your digestive system, yogurt is a delicious option!
Babies are born without bacteria in their gut. They also do not receive sufficient vitamin K from their mothers through breast milk. Newborns in many countries receive vitamin K injections until they can make their own. This is done to prevent the possibility of bleeding, especially in the brain. Other populations that require vitamin K supplementation are those who are at risk of vitamin K deficiency. Poor absorption of vitamin K is seen in people with gallbladder or biliary disease, cystic fibrosis, celiac disease, and Crohn's disease. Low vitamin K levels are common in those with liver disease and after serious burns.
Vitamin K is the antidote to warfarin overdoses. Warfarin is a blood thinner used medically to prevent blood clots, especially if the clot travels to different parts of the body and cuts off blood circulation. Warfarin has somewhat of a negative reputation because of the associated bleeding risk. It was even once used as rat poison! However, warfarin has also been around for a long time and medical professionals are well aware of how to monitor the warfarin level in patients.
Warfarin is one of the medications with an interesting history. A mysterious disease plagued cattle in the Northern United States and Canada in the early 1920s, causing the cattle to bleed heavily. It was determined that hay made from sweet clover was the culprit. A team of University of Wisconsin chemists eventually isolated the compound in 1940. Coumarin is the molecule found in many plants and also responsible for the enticing smell of freshly cut grass. While most drugs are known by their chemical name, the "warf-" in warfarin is taken from the acronym for the Wisconsin Alumni Research Foundation (WARF), the group that provided the financial support for the research.
The most important counseling point for anyone who is prescribed warfarin is to keep the greens in the diet consistent. Many people think they must avoid consuming all food with vitamin K if they are taking warfarin, but that is not the case! The vegetables provide other nutrients that are important to the body and should not be completely cut out. The warfarin dose can be adjusted as necessary. Vitamin K intake is important for everyone, so remember to consistently eat your leafy greens!
Vitamin D: Sunny Delight
Vitamin D is classified as a vitamin, but it does not quite fit the official definition. A vitamin is a nutrient that an organism requires in small amounts to survive. However, the organism is unable to make that nutrient on its own. The necessary levels of a vitamin are typically acquired through food.
Humans actually do possess the ability to synthesize their own vitamin D. When exposed to direct sunlight, the cholesterol on the surface of the skin is converted to vitamin D3 (or cholecalciferol), which is an inactive form of vitamin D. This vitamin D3 is then converted again in the liver before finally being converted to the active form, calcitriol, by the kidneys. The body can produce enough vitamin D from regular sun exposure just two to three times a week. This is why vitamin D is also known as the sunshine vitamin.
Remember that skin must be exposed to direct sunlight and not covered with clothing for vitamin D production to occur. Sunblock nearly blocks out all vitamin D synthesis. For those who sunburn easily, not to worry! It only takes five to ten minutes in direct sunlight a couple of times a week to get the sufficient amount of vitamin D. Skin coloration does affect vitamin D production. People with darker skin pigments are unable to absorb the ultraviolet rays needed to make vitamin D.
A crucial component in Skele-Gro, vitamin D is important to the development and maintenance of bones and teeth. Calcitriol is a hormone that regulates calcium and phosphate levels in the blood, both of which are required to keep bones healthy. Rickets, a disease that gives a bow-legged appearance due to soft bones, is commonly seen in children who do not receive adequate vitamin D. Adults, especially older adults, with vitamin D deficiency are more likely to experience bone fractures when they fall. Slippery conditions in the winter leads to more falls! Make sure to take extra precautions when walking through snow and ice.
Although vitamin D is fat soluble and can be stored in the body, it has a short half-life of two weeks. Vitamin D stores can run low, particularly in the winter when there are fewer hours of sunlight in a day. Some people even argue that there might be a link between seasonal affective disorder (SAD) – depression in the winter months – and low vitamin D levels. Calcitriol also plays a role in neuromuscular and immune function. Populations at higher risk of developing vitamin D deficiency include the elderly, infants, people with dark skin, and people who get little sun exposure, such as those living at higher latitudes.
Sunlight is the most efficient method to obtain vitamin D, but it also can be obtained from food. Vitamin D intake is measured in micrograms (mcg) and International Units (IU). One microgram is equal to 40 IU. Depending on age, the recommended intake of vitamin D ranges from 400 IU to 800 IU. Fish oil, especially cod liver oil, and fatty fish (herring, swordfish, salmon) are the best food sources of vitamin D3. Milk is fortified with vitamin D3 in most countries. A large chicken egg provides 44 IU of vitamin D3. Portabello and shiitake mushrooms are good sources of vitamin D2, or ergocalciferol.
For the remainder of the winter, try to include some vitamin D in your diet. The shortest day of the year has passed, so the hours of sunlight will continue to increase. Soon it will be warm enough for you to spend time outside and make your own vitamin D!
Vitamin C: The Scurvy Cur-e
Historically, voyages by sea were often cut short because the health of sailors tended to deteriorate quickly. They would become extremely weak and tire easily. Bruising and bleeding also occurred frequently. This condition is called scurvy. It plagued those at sea (including pirates!) for centuries, making exploration and trade difficult.
A British naval surgeon named James Lind noticed that sailors who ate citrus fruits would be cured of scurvy. He conducted a controlled experiment, providing one group of sailors who developed scurvy some oranges and lemons to eat. Sure enough, the sailors who received the citrus were scurvy-free after a few days. Eventually, the British navy required that lemons and limes must be given to the crew at sea.
Scurvy is now known to be caused by a vitamin C deficiency, which refers to low levels of vitamin C in the body. Vitamin C, also called ascorbic acid, is an essential vitamin that performs many important functions in the body. It is an antioxidant, blocking damage to DNA. High dose vitamin C is being considered as an option or possible addition to the treatment of certain cancers. Vitamin C is extremely important in collagen formation. Collagen is found in multiple types of tissue, including skin, cartilage, tendons, ligaments, and blood vessels. Proper healing from wounds requires collagen. Vitamin C also has a role in bone and teeth maintenance and helps acidify urine.
Since vitamin C is water soluble, the body is unable to store it. Humans cannot produce vitamin C themselves and must get it from outside sources, typically through food. Besides citrus fruits, great sources of vitamin C include green peppers, strawberries, tomatoes, broccoli, and sweet potatoes, an autumnal favorite. Light and heat decrease the vitamin C level in food. It is best to eat fruits and vegetables fresh or lightly cooked in order to get the most vitamin C.
Although vegetarians typically do not have trouble obtaining adequate vitamin C, they are at risk of having low levels of iron. Red blood cells need iron to transport oxygen throughout the body. The highest amount of iron comes from heme sources, including meat, poultry, fish, and seafood. Nonheme iron, found in egg yolks, vegetables, grains, nuts, seeds, and iron-fortified foods, is not well-absorbed by the body. Vitamin C helps enable a higher percentage of iron from nonheme sources to be released, so it is recommended to eat a mix of foods containing vitamin C and iron during the same meal in order to increase iron absorption.
The dropping temperatures of autumn is a reminder that the peak of cold season is fast approaching. A common myth is that taking vitamin C can cure a cold. Unfortunately, there is no evidence that vitamin C has any effect on the common cold. It may help reduce the length of a cold, but only if the vitamin C is taken regularly on a daily basis before the person catches the cold. Zinc, on the other hand, has shown to be effective if taken during the first few days of a cold. Zinc should only be for short-term use – less than five days. The most tolerable preparations of zinc are syrups and lozenges.
Vitamin C is very safe at recommended levels, which differ depending on several factors such as age and sex. Children, pregnant women, and smokers tend to require more vitamin C. The maximum daily amount of vitamin C is 2000 mg. Food is the best way to get vitamin C, so remember to eat some fruits and vegetables every day!