Absorption Of Vitamins And Minerals

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Vitamins are small molecules essential for:

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DNA and protein synthesis
Enzyme and transporter function
Many other metabolic processes

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Vitamins are aquired

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from the diet
Intact GI tract and absorption processes are necessary for adequate vitamin nutriture
Failure to absorb enough vitamins can lead to selective/global deficiency states and diseases.

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Water Soluble Vitamins Include

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Thiamine (B1)
Riboflavin (B2)
Niacin (B3)
Pyridoxine (B6)
Folic Acid (B9)
Cobalamin (B12)
Ascorbate (C)
Biotin
Pantothenic Acid

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Fat soluble vitamins include

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Retinol (A)
Calciferol (D)*
Tocopherol (E)
Menaquinones (K)*
*=semi vitamins

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Macro Minerals Include

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Sodium (Na)
Potassium (K)
Calcium (Ca)
Magnesium (Mg)
Iron (Fe)
Chloride (Cl)
Phosphorus (PO4)
Sulfur (SO4)

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Trace Minerals Include

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Chromium (Cr)
Cobalt (Co)
Copper (Cu)
Iodine (I)
Manganese (Mn)
Molybdenum (Mo)
Selenium (Se)
Zinc (Zn)

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Vitamin C Function

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Aqueous phase antioxidant.
Cofactor for collagen biosynthesis facilitates iron absorption. Role in activation of folate

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Vitamin C Deficiency Disease

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Scurvy. Severe peridontal disease. Cutaneous hemorrhage, poor wound healing.
Cigarrette smokers and malnourished at risk.

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Vitamin C Pharmacologic Uses

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Clinical trials in atherosclerosis, cancer, neurodegenerative diseases, lung disease have shown little to no efficacy

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Vitamin C Supplement use

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The most popular supplement
Wide use as antioxidant, anti- viral, and immunomodulator
Little hard evidence of efficacy

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Folic Acid (folate) Function

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cofactor in methyl transfer reactions. Synthesis of DNA, glutathione, hormones, phospholipids, and neurotransmitters.

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Folic acid deficiency disease

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neural tube defects and megaloblastic anemia.
Populations at risk for deficiency include those with sever malabsorption, drug and food antagonists, poor diet in the elderly

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Pharmacologic use of Folic Acid

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Adequate amounts of folate before conception and during pregnancy prevent neural tube defects such as spina bifida

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Dietary supplement use of Folic Acid

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A wide variety of processed foods are fortified with folate as a public health measure

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Fat souluble vitamins differ from water soluble vitamins in that

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Absorption of fat soluble vitamins requires the presence and efficient absorption of dietary fat
Have a complex absorption itinerary
Solubilized by bile in mixed micelles
Transported into enterocytes, packaged along  with fat into chylomicrons, and secreted into lymph
Taken up by the liver in chylomicron remnants
Re-secreted into plasma on transport proteins
Fat soluble vitamins can be stored
Fat soluble vitamins in excess can be toxic
The body can synthesize vitamins D and K

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Vitamin A (retinol) function

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visual pigment synthesis, maintains ocular structures, epithelial cell function, bone and growth development, reproduction

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Vitamin A deficiency Disease

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Keratomalacia, hyperkeratosis. populatons at risk include those with malabsorption syndromes, poor diet in the elderly, and some third world countries.

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Pharmacologic use of Vitamin A

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Analogs are used topically for acne and other skin disorders
-Carotene Trial: study was halted due to increased cancers in the treatment group

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Dietary Supplement use of vitamin A

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Used with caution because of the potential for serious toxicity

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Toxicity of Vitamin A

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Hypervitaminosis A syndrome
Hepatotoxicity (polar explorers)
Teratogenic effects

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Vitamin D Function

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increaes intestinal Ca++ absorption, bone mineralization

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Vitamin D Deficiency Disease

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Ricketts and Osteoporosis

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Pharmocologic Use of Vitamin D

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Used to treat hypocalcemia after parathyroidectomy
Used as an adjunct in treating osteopenia and osteoporosis
Populations at risk include those with fat malabsorption syndromes, the elderly and homebound, sever kidney disease

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Dietary Supplement Use of Vitamin D

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Used in combo with Ca++ supplements for bone health

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Toxicity of Vitamin D

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Hypercalcemia, weakness
Kidney stones

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Vitamin E function

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Membrane Antioxidant. Free radical lipid oxidation, breaks chain reaction, regeneration of vitamin E

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Vitamin E deficiency Disease

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Hemolytic Anemia. Very Rare: seen only with severe fat amlabsorption.
Populations at risk include those with: Cystic fibrosis,
Severe pancreatic insufficiency,
Short bowel syndromes,
Total Parenteral Nutrition,
Genetic abnormalities,

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Pharmacologic use of Vitamin E

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Prevents pulmonary oxygen toxicity in premature infants?
No activity in Parkinson’s disease, atherosclerosis, and cancer prevention studies

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Dietary Supplement Use

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Widespread use as antioxidant
Little evidence of efficacy
May function as a pro-oxidant?

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Toxicity of Vitamin E

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Generally safe
High doses may cause diarrhea and clotting abnormalities

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Vitamin K Function

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Hepatic synthesis of factors VII, IX, X, prothrombin, proteins S and C
Bone homeostasis

Reduced vitamin K (KH2) is an essential cofactor for converting Glu residues in target proteins to -glutamic acid (Gla)
Brain development
Synthesis of bone modulating proteins osteocalcin and MGP

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Vitamin K Deficiency disease

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bruisability and bleeding. Populations at risk include Fat malabsorption syndromes
Patients on chronic antibiotics
Short bowel syndromes

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Pharmacologic use of Vitamin K

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Acute reversal of coumarin induced anticoagulation
Stabilization of anticoagulation in patients taking coumarin Rx

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Calcium Function

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Increase in Vit D absorption

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Calcium deficiency Disease

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Osteoporosis. populations at risk include Women, esp. post-menopause
Fat malabsorption syndromes
Short bowel syndromes
Chronic steroid use

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Pharmacologic Use of Calcium

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Prevention of Osteoporosis
Treatment of Osteoporosis
Antacid for Rx of GERD
Bile salt diarrhea
Oxalate kidney stones