Vitamins

Last updated: 13.02.2020

Summary

Vitamins are a group of chemically diverse organic compounds that an organism requires for normal metabolism. Apart from a few exceptions (e.g., vitamin D), the human body cannot synthesize vitamins on its own in sufficient amounts and must, therefore, ensure a steady supply through the diet. Vitamins are micronutrients that do not provide energy (like macronutrients) but instead have very specific biochemical roles. They can be coenzymes in various reactions (B vitamins, vitamins A and K) and/or antioxidants that protect the cell and its membrane from free radicals (vitamins C and E). They can also enable cell signaling (vitamin A) and gene transcription (vitamins A and E) or function as hormones (e.g., vitamin D). Vitamins are classified into fat-soluble vitamins, which the body can store, and water-soluble vitamins, which, with the exception of vitamins B9 (folate) and B12 (cobalamin), the body cannot store over significant periods of time and, therefore, require continuous intake. A balanced diet typically supplies the body with all vitamins it requires. Deficiencies occur mainly due to malnutrition, malabsorption disorders, or restrictive diets (e.g., vitamin B12 deficiency in a vegan diet).

Overview of vitamins

Fat-soluble vitamins Water-soluble vitamins
Vitamins
Sources
  • Mainly diet
  • Intestinal flora: small amounts of vitamin K are synthesized by intestinal bacteria
  • Vitamin D is predominantly synthesized in the body
  • Mainly diet
  • Intestinal flora: small amounts of vitamin B7, B9, and B12 are synthesized by intestinal bacteria
Absorption
  • Absorption depends on intestinal and pancreatic function
  • Require lipids for absorption
  • Absorption in the intestine via specific luminal transporters
Storage
  • Not stored in the body, except vitamins B9 and B12, which are stored in the liver
    • Hepatic stores of B9 last for approx. 3-4 months, whereas hepatic stores of B12 last for approx. 3-4 years.
Functions
  • Function primarily as
Deficiency
Excess
  • Excess accumulation is possible (due to oversupplementation) → toxicity
  • Accumulation and subsequent toxicity are exceedingly rare
  • No toxicity has been described for vitamins B1, B2, B5, B7, B9, and B12.

Accumulation and toxicity occur almost exclusively with fat-soluble vitamins.

Fat-soluble vitamins

Name

Active forms Sources Functions Deficiency Toxicity
Vitamin A (retinol)
  • Retinal
  • Retinoic acid
Vitamin D (calciferol)
  • Cholecalciferol (provitamin D3): fish, milk, plants, exposure to sunlight
  • Ergocalciferol (provitamin D2): plants, fungi, yeast, fortified foods (e.g., milk, cereals, formula)
  • Calcium and phosphate homeostasis
  • ↑ Absorption of Ca2+ and PO43- in the intestine
  • ↑ Bone resorption at high levels
  • ↑ Bone mineralization at low levels
Vitamin E (tocopherol)
  • Meat, eggs, oils, leafy vegetables
  • Antioxidant
Vitamin K (phytomenadione)
  • Green vegetables, broccoli, spinach
  • Synthesized by intestinal flora

To remember the fat-soluble vitamins, think: “The fat cat is in the ADEK” (pronounced “attic”).

Vitamin A (retinol)

Characteristics

  • Synonyms: retinol
  • Active forms: retinal, retinoic acid
  • Sources
    • Plant sources; : as inactive provitamin (esp. beta-carotene) in yellow and leafy vegetables, e.g., spinach, kale, carrots
    • Animal sources: in storage form; , e.g., in liver, kidney, fish, eggs, butter
  • Storage: : in hepatic cells; (Ito cells) within the perisinusoidal space (of Disse)

Functions

Retinal is a major component of the retinal pigment rhodopsin in rods, which is necessary for vision, while retinoic acid and retinol are involved mainly in gene transcription and tissue maintenance!

Retinol (vitamin A) for your retinA.

Vitamin A deficiency [1]

Vitamin A toxicity

Isotretinoin is highly teratogenic. A negative pregnancy test and two forms of contraception are required before prescribing to women.

Therapeutic uses

Vitamin A should be given to patients with measles to boost their immune system and reduce the risk of complications and mortality, especially in countries where vitamin A deficiency is endemic.

References:[3][4][5]

Vitamin D (calciferol)

Characteristics

Vitamin D is the only vitamin that the human body can produce entirely on its own!

Functions

Vitamin D deficiency [6]

Vitamin D toxicity

Therapeutic uses

Vitamin E (tocopherol)

Characteristics

Functions

Vitamin E deficiency

Vitamin E toxicity

Therapeutic uses

Vitamin K (phytomenadione)

Characteristics

  • Synonyms
  • Active form: vitamin K hydroquinone; activation occurs via enzyme epoxide reductase
  • Sources
    • Leafy green vegetables (vitamin K1)
    • Eggs, dairy, and meat (vitamin K2)
    • Synthesized in small amounts by intestinal flora
  • Storage: liver

Functions

Warfarin inhibits the vitamin K-dependent synthesis of clotting factors and proteins!

Koagulation isn't the same without Vitamin K!

Vitamin K deficiency [10]

Vitamin K toxicity

Therapeutic uses

Water-soluble vitamins

Name Active forms Sources Functions Deficiency Toxicity
Vitamin B1 (thiamine)
  • Whole grain cereals (e.g., whole wheat, brown rice), yeast, pork, legumes
  • No toxicity has been described
Vitamin B2 (riboflavin)
  • Meat, fish, eggs, milk, green vegetables, yeast
  • No toxicity has been described
Vitamin B3 (niacin)
  • Meat (liver), cereals, seeds, legumes
Vitamin B5 (pantothenic acid)
  • No toxicity has been described
Vitamin B6 (pyridoxine)
  • Meat, nuts, whole grains, vegetables

Vitamin B7 (biotin)

  • Eggs, meat, fish, seeds, nuts
  • Cofactor for carboxylases, transcarboxylases, and decarboxylases
  • No toxicity has been described
Vitamin B9 (folate)
  • Green leafy vegetables, dried legumes
  • No toxicity has been described

Vitamin B12 (cobalamin)

  • Cobamamide
  • Methylcobalamin
  • Meat and dairy products
  • No toxicity has been described
Vitamin C (ascorbic acid)
  • Citrus fruits, strawberries, tomatoes, potatoes, cabbage, spinach

Vitamin B₁ (thiamine)

Characteristics

  • Synonyms: thiamine
  • Active form: thiamine pyrophosphate (TPP); activation via intracellular phosphorylation of thiamine
  • Sources: whole grain cereals (e.g., whole wheat, brown rice), yeast, pork, legumes[12]
  • Transport in blood: mainly via blood cells; only ∼10% is free or bound to albumin

Functions

To remember the enzymes that thiamine is a cofactor for, think: “Thiamine PATs your Back!” (Pyruvate dehydrogenase, Alpha-ketoglutaric acid dehydrogenase, Transketolase, Branched-chain ketoacid dehydrogenase).

Vitamin B1 deficiency [13]

In malnourished or alcohol-dependent patients, always administer thiamine before giving dextrose to decrease the risk of precipitating or exacerbating Wernicke encephalopathy.

Vitamin B1 deficiency causes Ber1Ber1.

References: [15]

Vitamin B₂ (riboflavin)

Characteristics

  • Synonyms: riboflavin
  • Active forms: flavin mononucleotide (FMN), flavin adenine dinucleotide (FAD)
  • Sources: meat, fish, eggs, milk, green vegetables, yeast [12]

Functions

Vitamin B2 deficiency [16]

The 2 C's of Vitamin B2 deficiency are Corneal vascularization and Cheilitis!

References: [17]

Vitamin B₃ (niacin)

Characteristics

Functions

Vitamin B3 deficiency [12]

The four D's of Pellagra: Dermatitis, Diarrhea, Dementia, Death

Vitamin B3 toxicity

Therapeutic use

Vitamin B₅ (pantothenic acid)

Characteristics

Functions

Vitamin B5 deficiency [12]

Vitamin B5 is pento-thenic acid!

Vitamin B₆ (pyridoxine)

Characteristics

  • Synonyms: pyridoxine
  • Active form: pyridoxal phosphate (PLP)
  • Sources: nuts, whole grains, vegetables, yeast, meat (esp. liver and poultry) [12]

Functions

Vitamin B6 deficiency [19]

Vitamin B6 toxicity

Although rare, excess pyridoxine can lead to irreversible sensory neuropathy.

Therapeutic use

Vitamin B₇ (biotin)

Characteristics

  • Synonyms: biotin
  • Sources
    • Plants (e.g., soy products, nuts), animal products (e.g., liver, egg yolk, dairy products)
    • Small amounts are synthesized by intestinal flora

Functions

Biotin is a coenzyme in all carboxylase enzyme complexes that are not vitamin K-dependent!

Vitamin B7 deficiency

Eating raw eggs (contain avidin) impairs the resorption of biotin. Biotin loves avidin!

Vitamin B₉ (folate)

Characteristics

  • Synonyms: folic acid, folate
  • Active form: tetrahydrofolic acid (THF)
  • Sources
    • Leafy green vegetables, fortified foods (e.g., bread, flour, and cereal)
    • Small amounts are synthesized in intestinal flora
  • Resorption: jejunum via specific transporters
  • Transport in blood: via folate-binding transport proteins
  • Storage: small reserve in the liver (enough for approx. 3–4 months)

Foliage (leafy green vegetables) contains Folate!

Function

Vitamin B9 deficiency [20]

Unlike vitamin B12 deficiency, folate deficiency is not associated with neurologic symptoms.

Therapeutic uses

  • Prenatal supplementation (0.4 mg per day)

Folic acid supplementation is recommended at least one month before conception and during the entire 9 months of pregnancy.

Vitamin B₁₂ (cobalamin)

Characteristics

Vitamin B12 is the only water-soluble vitamin that is stored in the body in significant amounts!

Functions

Vitamin B12 deficiency

Therapeutic uses

  • Prenatal supplementation for vegetarians (2 μg per day)

Vitamin C (ascorbic acid)

Characteristics

  • Synonyms: ascorbic acid, ascorbate
  • Active form: ascorbate
  • Sources: fruits and vegetables
  • Resorption
    • Passive resorption via oral mucosa
    • Active resorption in the intestine (especially jejunum)
  • Transport in blood: mainly free, only very small amounts as dehydroascorbate
  • Storage: no specialized vitamin C stores; high concentrations in organs that require vitamin C as a cofactor (e.g., adrenal gland)

Functions

Vitamin C deficiency [12]

Vitamin C deficiency results in sCurvy due to impaired Collagen synthesis.

Vitamin C toxicity

Therapeutic use

References

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  2. Goebel SU. Malabsorption. In: Katz J, Malabsorption. New York, NY: WebMD. http://emedicine.medscape.com/article/180785-overview#a5. Updated: December 16, 2014. Accessed: December 14, 2016.
  3. Pazirandeh S, Burns DL. Overview of vitamin A. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-vitamin-a#H10. Last updated: October 26, 2016. Accessed: December 14, 2016.
  4. Ansstas G. Vitamin A Deficiency. In: Griffing GT, Vitamin A Deficiency. New York, NY: WebMD. http://emedicine.medscape.com/article/126004-clinical#b5. Updated: October 12, 2016. Accessed: December 14, 2016.
  5. Drezner MK. Patient education: Vitamin D deficiency (Beyond the Basics). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/vitamin-d-deficiency-beyond-the-basics#H9. Last updated: June 9, 2015. Accessed: December 14, 2016.
  6. Pazirandeh S, Burns DL. Overview of vitamin E. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-vitamin-e#H7. Last updated: October 3, 2016. Accessed: December 12, 2016.
  7. Le T, Bhushan V. First Aid for the USMLE Step 1 2015. McGraw-Hill Education ; 2014
  8. Pazirandeh S, Burns DL, Lipman TO, Motil KJ, Hoppin AG. Overview of Vitamin K. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-vitamin-k. Last updated: April 13, 2016. Accessed: December 14, 2016.
  9. Nguyen-Khoa D-T. Beriberi (Thiamine Deficiency). In: Khardori R, Beriberi (Thiamine Deficiency). New York, NY: WebMD. http://emedicine.medscape.com/article/116930-overview#showall. Updated: July 1, 2016. Accessed: December 15, 2016.
  10. Xiong GL. Wernicke-Korsakoff Syndrome. In: Bienenfeld D, Wernicke-Korsakoff Syndrome. New York, NY: WebMD. http://emedicine.medscape.com/article/288379-overview#showall. Updated: April 18, 2016. Accessed: December 12, 2016.
  11. Gill RS. Riboflavin Deficiency. In: Griffing GT, Riboflavin Deficiency. New York, NY: WebMD. http://emedicine.medscape.com/article/125193-overview. Updated: August 9, 2016. Accessed: December 16, 2016.
  12. Pazirandeh S, Burns DL. Overview of water-soluble vitamins. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-water-soluble-vitamins?source=search_result&search=niacin%20deficiency&selectedTitle=1~32. Last updated: November 9, 2016. Accessed: December 16, 2016.
  13. Ehrlich SD. Vitamin B5 (Pantothenic acid). http://umm.edu/health/medical/altmed/supplement/vitamin-b5-pantothenic-acid. Updated: July 16, 2013. Accessed: December 15, 2016.
  14. Frye RE. Pyridoxine Deficiency. In: Griffing GT, Pyridoxine Deficiency. New York, NY: WebMD. http://emedicine.medscape.com/article/124947-overview#a4. Updated: September 15, 2016. Accessed: December 15, 2016.
  15. Schick P. Megaloblastic Anemia. In: Besa EC, Megaloblastic Anemia. New York, NY: WebMD. http://emedicine.medscape.com/article/204066-overview#a1. Updated: October 29, 2016. Accessed: December 15, 2016.
  16. Schrier SL. Clinical Manifestations and Diagnosis of Vitamin B12 and Folate Deficiency. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-vitamin-b12-and-folate-deficiency. Last updated: July 15, 2016. Accessed: December 15, 2016.
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