nmdf121 sn11 lecture wsv1...... aids, heart disease!’ ... (10th ed., chapter 38). philadelphia,...
TRANSCRIPT
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© Endeavour College of Natural Health endeavour.edu.au 1
NMDF121
Session 11
WATER SOLUBLE
VITAMINS PART 1
Naturopathic Medicine
Department
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Topic Summary
• Water Soluble Vitamins
• Introduction to Water Soluble Vitamins
• Vitamin C
• Structure and requirements
• Functions and metabolism
• Therapeutic uses
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Water Soluble Vitamins:
Introduction
“Vitamins can be defined as essential organic compounds
required in very small amounts (micronutrients) that are
involved in fundamental functions of the body such as
growth, maintenance of health, and metabolism.”
(Groff and Gropper, 2000)
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Water Soluble Vitamins:
Introduction
• Vitamins
• differ from carbohydrate, fat and protein in structure,
function and food contents
• similar to the energy-yielding nutrients in that they are
vital to life, organic and available from foods.
Both deficiencies and excesses of supplemental
vitamins can affect health!
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Water Soluble Vitamins: Properties
• Absorbed into portal blood
• Not stored long in body except vitamin B12
• Excreted in urine
• Easily destroyed during
food storage or preparation
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Water Soluble Vitamins:
Preparation
• The organic nature of vitamins means they can be destroyed by exposure to light, oxidation, cooking and storage.
• Preventative measures should be taken• Refrigeration
• Cut fruits and vegetables should be stored in closed containers
• Avoid high temperatures and long cooking times
• Steam as opposed to boil
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Water Soluble Vitamins
Adapted from Groff and Gropper, 2000
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Water Soluble Vitamins
• Deficiency is likely in:
• Anorexia
• Malignancy or other chronic disease
• Coeliac sprue (or other small intestine disease)
• Postsurgical patients receiving inadequate
prolonged nutritional support
• Drugs which antagonise vitamin absorption or
metabolism
• Poor dietary habits
(Garrow et al, 1998)
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Review Questions
1. List the water soluble vitamins.
2. What are the general characteristics of water sol
vitamins?
3. How can we minimise their degradation in foods?
4. In which conditions are water soluble vitamins likely
to become deficient?
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Vitamin C
http://commons.wikimedia.o
rg/wiki/File:VitaminC.png
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Vitamin CFood Amount Vitamin C (mg)
Blackcurrants 1 cup 202
Red pepper (raw) 1 cup, sliced 174
Orange juice, commercial 1 cup 124
Grapefruit juice 1 cup 94
Papaya 1 cup 86
Strawberries/ Green Pepper 1 cup 82
Kiwi fruit, peeled 1 medium 74
Oranges 1 fruit 68
Broccoli, boiled ½ cup 58
(Adapted from Reavley, N. Vitamins
etc. p135)
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Vitamin C
• The human being is one of the
few mammals unable to
synthesise Vitamin C.
• Absorption decreases with
intake
• Oxidation prior to absorption
• Absorption of dehydroascorbate
is thought to occur to a greater
extent than absorption of
ascorbate.
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Vitamin C: Functions
• Antioxidant– Regenerates vitamin E
– Regenerated by niacin, GSH
• Collagen synthesis– with Fe, proline, lysine, glycine
• Carnitine synthesis– from lysine
• Neurotransmitter synthesis – Tyrosine dopamine noradrenalin
– Tryptophan serotonin
(Li and Schellhorn 2007)
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Vitamin C: Functions
• Hormone synthesis
• Sex steroid, thyroid releasing,
adrenal
• Fe, Cu, Cr bioavailability
• Non-heme iron absorption
• Supports immune function
• Antibody and interferon
production
• Prostaglandin metabolism
• White blood cell ‘oxidative burst’
(Li and Schellhorn 2007)
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Vitamin C: Functions
• Diminishes histamine release• Natural antihistamine
• Regulates cholesterol metabolism
• Conversion of cholesterol to bile acids
• Drug and heavy metal metabolism
• Cortisone, aspirin, insulin
• Lead, mercury, arsenic
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Factors Increasing Demand
• Increased physical stress
• Allergies, infection, burns, surgery, chronic illness
• Increased oxidative stress
• Drugs, chemicals, radiation, heavy metals
• Chronic drug use
• Aspirin, OCP, smoking, PPIs
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Factors Increasing Demand
• Certain life stages
• Elderly
• Pregnancy and lactation
• Growth and
development
• Athletes
• Acute or chronic
inflammatory illness
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Vitamin C: Deficiency Disease
• Scurvy
–Bleeding Gums
–Easy bruising
–Loose and decaying
teeth
–Joint pain
– Impaired wound
healing
http://upload.wikimedia.org/wikipedia/comm
ons/1/1a/Scorbutic_tongue.jpg
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Vitamin C: Deficiency Symptoms
• Capillary fragility (Gibson 2005)
• Fatigue, weakness, irritability (Leggot 1986)
• Splinter hemorrhages near distal ends of nails (Heimburger
2006)
• Perifollicular hyperkeratosis on the lateral aspects of the
upper arms and the thighs (Ryan 1996)
• Ruptured small blood vessels – petechiae (Shenkin 2006)
• Joint pain, bone and connective tissue disorders (Gibson
2005)
• Poor wound healing (Shenkin 2006)
• Bleeding gums and loosened teeth (Leggot 1986)
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Vitamin C: Deficiency Symptoms
• Anaemia – small cell type
• Frequent infections
• Muscle degeneration and pain
• Hysteria and depression
• Rough, brown scaly and dry skin
• Blotchy bruises
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Vitamin C - Deficiency Symptoms
Rolfes, Pinna & Whitney 2009
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Toxicity Symptoms
• Diarrhoea
• Indicates tissue fluids have been saturated with
ascorbic acid
• >5-10g/day
• Hemolysis
• In people with an inherited disease of enzyme
deficiency
• Occurred with doses of at least 6g
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Toxicity Symptoms
• Enhances aluminum and iron absorption
• Caution in hemochromatosis, thalassemia major, sickle cell
disease (Shils et al, 2005)
• Very high intake increases oxalate and urate excretion
• May promote the development of kidney stones
• Rebound scurvy
• The body gets accustomed to long-term high doses, then issues
occur when this regime is discontinued
(Peckenpaugh 2010)
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RDI
Therapeutic Range
• 250-10,000mg
divided into multiple
doses
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Tolerable Upper Intake Levels (ULs) for Vitamin C
Age Male Female Pregnancy Lactation
0–12 months Not possible to establish* Not possible to establish*
1–3 years 400 mg 400 mg
4–8 years 650 mg 650 mg
9–13 years 1,200 mg 1,200 mg
14–18 years 1,800 mg 1,800 mg 1,800 mg 1,800 mg
19+ years 2,000 mg 2,000 mg 2,000 mg 2,000 mg
*Formula and food should be the only sources of vitamin C for infants.
(Jacob 2002)
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Absorption
• Oral vitamin C produces tissue and plasma
concentrations that the body tightly controls.
• Approximately 70%–90% of vitamin C is
absorbed at moderate intakes of 30–180
mg/day.
• Doses above 1 g/day, tissue absorption falls to
less than 50% and absorbed, unmetabolized
ascorbic acid is excreted in the urine(Jacob 2002)
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Activity
o View the following presentation on Linus Pauling: High
dose vitamin C is a cure for cancer, aids, heart disease!’
(19mins)
http://www.youtube.com/watch?v=OfuXHJh3LMY
• In small groups discuss your views about this video
• Present your groups views to the class group
• Online students should discuss their views in the
relevant weekly forum
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Activity
• Considering what we have so far learned about
vitamin C answer the following question –
‘How much vitamin C, if any, should healthy
people be taking, and how much is too much in
diseased states?’
Discuss your thoughts initially in small groups
then present findings to the class
Online students should discuss their thoughts in
the relevant weekly forum
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Therapeutic Uses
• Antioxidant • Cardiovascular disease (Nakamura et al, 2006)
• Smokers (Bruno et al, 2006)
• Atherosclerosis (May 2013)
• Heavy metal toxicity (Peckenpaugh 2010)
• Hypoxia (Sureda et al, 2004)
• Oxidative stress in athletes (Mastaloudis et al, 2004)
• Cancer (Peckenpaugh 2010)
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Therapeutic Uses
• Immune modulation• Hepatitis C (Murakami et al, 2006)
• Asthma (Fogarty et al, 2006)
• Infections (Douglas et al, 2004)
• Frequent colds and flus (Rolfes
2009)
• Allergic disorders (Johanna 2013)
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Supplemental Forms
• Ascorbic Acid
• Pure Vitamin C
• Cheap but may cause gastric irritation
• Low pH/acidic
• Calcium or Magnesium Ascorbate
• Mineral bound non-acid form of vitamin C
• May exacerbate effects of low stomach acid when taken in close
proximity to meals
• Research has found no difference in plasma or
urinary excretion levels with either form(Johnson 1996)
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Assessment of Nurtriture
• Plasma and serum vitamin C
• Respond to dietary intakes
• Used to assess recent intake
• White blood cell vitamin C
• Reflect body stores
• Difficult to perform
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Review Questions
1. What products does vitamin C assist in synthesising in
the body?
2. What signs might a person with a vitamin C deficiency
display?
3. Which factors increase the demands for vitamin C?
4. What are the main researched conditions for the
therapeutic use of vitamin C?
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Activity
• Consider your vitamin C intake from the previous 2
diet diaries you have entered into your diet analysis
programme and answer the following questions –
1. Are there any notable differences between the 24hour and 3
day average intake?
2. Which foods in your diet have the highest levels of vitamin
C?
3. In which instances would you recommend increased intakes
from the RDI? Think specific and patient related and also
from a more general context
4. Is there any specific dietary recommendations you would
make to optimise your intake? Include specific food choices
and quantities to reach your target.
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References
Anderson, J., & Young, L. (2008). Water soluble vitamins. Retrieved from
http://www.ext.colostate.edu/PUBS/FOODNUT/09312.html
Bruno, R. S., Leonard, S. W., Atkinson, J., Montine, T. J., Ramakrishnan, R., Bray, T. M., & Traber, M.
G. (2006). Faster plasma vitamin E disappearance in smokers is normalized by vitamin C
supplementation. Free Radical Biology & Medicine, 40(4), 689-697. Retrieved from
https://login.ezproxy.endeavour.edu.au:2443/login?url=http://search.ebscohost.com/login.a
spx?direct=true&db=mdc&AN=16458200&site=eds-live&scope=site
Douglas, R. M., & Hemilä, H. (2005). Vitamin C for preventing and treating the common cold. Plos
Medicine, 2(6), e168. Retrieved from
https://login.ezproxy.endeavour.edu.au:2443/login?url=http://search.ebscohost.com/login.a
spx?direct=true&db=mdc&AN=15971944&site=eds-live&scope=site
Fogarty, A., Lewis, S. A., Scrivener, S. L., Antoniak, M., Pacey, S., Pringle, M., & Britton, J. (2006).
Corticosteroid sparing effects of vitamin C and magnesium in asthma: a randomised trial.
Respiratory Medicine, 100(1), 174-179. doi:10.1016/j.rmed.2005.03.038
Garrow, J.S., & James, W.P.T. (2000). Human nutrition and dietetics (9th ed.). Edinburgh, Scotland:
Churchill Livingstone.
Gibson, R. (2005). Principles of nutritional assessment (2nd ed.). New York, NY: Oxford University
Press.
Heimburger D, Shils M, McLaren D (2006) Clinical manifestations of nutrient deficiencies and
toxicities: a resume. In M. Shills & M. Shike (Eds.) Modern Nutrition in Health and disease
(10th ed., chapter 38). Philadelphia, PA: Lippincott Williams & Wilkins.
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ReferencesHenry, E. B., Carswell, A., Wirz, A., Fyffe, V., & McColl, K. L. (2005). Proton pump inhibitors reduce the
bioavailability of dietary vitamin C. Alimentary Pharmacology & Therapeutics, 22(6), 539-
545. doi:10.1111/j.1365-2036.2005.02568.x
Jacob, R. A., & Sotoudeh, G. (2002). Vitamin C Function and Status in Chronic Disease. Nutrition in
Clinical Care, 5(2), 66-74. doi:10.1046/j.1523-5408.2002.00005.x
Gostner, J., Ciardi, C., Becker, K., Fuchs, D., & Sucher, R. (2014). Immunoregulatory impact of food
antioxidants. Current Pharmaceutical Design, 20(6), 840-849. Retrieved from
https://login.ezproxy.endeavour.edu.au:2443/login?url=http://search.ebscohost.com/login.a
spx?direct=true&db=mdc&AN=23701561&site=eds-live&scope=site
Johnston, C., & Luo, B. (1994). Comparison of the absorption and excretion of three commercially
available sources of vitamin C. Journal of The American Dietetic Association, 94(7), 779-
781. Retrieved from
https://login.ezproxy.endeavour.edu.au:2443/login?url=http://search.ebscohost.com/login.a
spx?direct=true&db=rzh&AN=107416251&site=eds-live&scope=site
Leggott, P. J., Robertson, P. B., Rothman, D. L., Murray, P. A., & Jacob, R. A. (1986). The effect of
controlled ascorbic acid depletion and supplementation on periodontal health. Journal of
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