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by: Mr. Judah Stracke


Mr. Judah Stracke
GPA 3.61


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Class Notes
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This 9 page Class Notes was uploaded by Mr. Judah Stracke on Thursday September 17, 2015. The Class Notes belongs to MEL 7570 at Florida State University taught by Staff in Fall. Since its upload, it has received 45 views. For similar materials see /class/205438/mel-7570-florida-state-university in Medical Science Electives at Florida State University.

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Date Created: 09/17/15
1 Iquot l Iquot 5 Explain the DRI The goal of the DRI is to prevent chronic diseases not to prevent defiencys The focus is now on malnutrition from over nutrition DRI started in 1835 with lemons on ships Then first RDA was in 1949 with the focus to prevent defiency in the military Changed because it was too broad focus on healthy people and too many fat unhealthy people Now have EAR RDA AI and UP What are vitamins and difference between fat and water soluble They are micronutrients that must be supplied from the diet Needed for normal function and their absence cause certain symptoms with each one The body can make some but not in appreciable amounts Fat soluble is obviously soluble in fat stored in the body in large amounts so it s not required every day Since it s stored defiency takes a long time to occur Most have precursors and only higher organisms need them Can be toxic at low amounts but still way higher than the UL Water soluble are stored minimally excreted in the urine so defiency can happen much faster Absorbed into blood since water soluble and both simple and complex organisms need Since they aren t really stored they are only toxic at mega doses 100x DRI Thiamin What is the active form of this vitamin Only active as Thiamin pyrophosphate which is also known as Thiamin di and triphosphate So TPP also TDP and TI39P Need a phosphate to be active What are the source It s in most foods Liver and yeast are the richest sources followed by meats and whole grains Polished rice is a terrible source There is an enzyme Thiaminase present in raw fish and caffeine that destroy thiamin It is stable in cooking How is it absorbed It has to be in its free Thiamin to be absorbed In the blood it travels as a monophosphated form and bound to albumin Everything vitamin from now on is absorbed by active transport at low concentrations and passive diffusion at high What are its functions It is involved in the krebb cycle mainly by decarboxylating pyruvate to Acetyl CoA Also alpa ketoglutarate to Succinly CoA and the decarboylation of the branch chain amino acids Also in the synthesis of the pentases and NAPH which are involved in making nucleic acids So DNA synthesis In nerve function too but mechanism is not clear What is the defiency and the risk groups Those at risk are the elderly alcoholics and people who eat strictly raw fish Defiency is BeriBeri and there are 4 types Easy to remember cause really only two one affects the cardiovascular and the other is the nervous system So have wet beriberi which is the cardiovascular then dry beriberi which are the nerves Severe is called Wernike s orakoff and it happens in chronic alcoholics There are two possible symptoms to this Korsakoff phsycosis and Wernickes encephalopathy It can cause death if untreated The DRI is 12 mg daily Riboflavin What is the active form Active as Flavin mononucleotide and Flavin Adenine Diphosphate So FMN and FAD What are the sources Mostly in dairy and milk products grains and meats It is also stable in cooking and is light sensitive How is it absorbed Kind of a back and forth thing Must be free flavin to absorb so the HCL cleaves out the proteins it s then phosphylated to FMN in the mucosa then travels to the serosa surface and is dephosphylated back to flavin travels to the liver and phophylated again to FAD Stored in the liver What are the functions FAD so it s in glycolysis as an electron transporter Also in the reduction on glutationin to GSS reduced form What is the defiency The risk groups are elderly alcoholics People with increased needs like pregnant and lactating and trauma patients Babies with hyperbilurbiemia on photo therapy I guess the therapy destroys it Defiency cause oral lesions glossititis and stomatitis How to assess it and what is the DRI To check the values look at the activity of the RBC glutathionin reductase Since need FAD to reduce it and NADPH is a reactant meaning if no FAD then the NAPH won t be used And the NAPH is easy to measure l Iquot S Niacin What is the active form Active as nicatinamide and nicotinic acid What are the sources Meats and fish are the best source since they have free nicotinamide Corn suck dick as a source because it s low in tryptophan But treating the corn with limewater can release the niacin in it The liver can also make it with 60mg of tryptophan What are the functions About 200 reactions but mainly as NAD NADH NAP NAPH NAD is the electron carrier in glycolysis NADH is the molecule when its reduced NAP is involved In the hexose shunt nucleic acids NAPH is involved in many pathways beta oxidation cholesterol synthesis Also can be used to lower cholesterol but side effect is painful Niacin flush caused by release of histadine What is the defiency The risk groups are the people with the higher needs Some drugs can interfere with absorbtion such as Izonaid for tuberculosis There also is a genetic disease where the patient can t metabolize tryptophan Hartnup disease ts autosomal recessive Defiency is Pellagra It s the 4 D s Dermatitis Diarrhea Dementia and Death What is the DRI It is 14 NE or niacin equivalents 1 NE is equal to either 1mg niacin 60mg tryptophan and 6000mg protein Folic Acid What is the synthesis and shit It s made from 9 different precursors such as PABA glutamic acide Pterdine The body can make all except Pterdine acid How is it absorbed S P Equot 9 l Iquot It must be absorbed as a monoglutamate form so the polyglutamate is hydrolyzed with a conjugase The conjugase is also Zinc dependent so you need Zinc to absorb Folic acid Some foods have conjugase inhibitors though like oranges cabbage lentin Then it is reduced in the liver to its active form THF Minimal storage of 1128 mg What are the functions It is use in one carbon transfers in the synthesis of the purines and pyridimes Nucleic acids and in some AA metabolism such as the glycineserin but the important one is the methionine regeneration What are the sources Green leafy veggies oranges yeast It is destroyed with cooking 5095 What is the defiency The risk groups are those that prolonging the cooking Alcoholics pregnant and lactating women are also at risk And some intestinal diseases such as Celiac disease Some drugs also interfere with the absorption such as methotrexate in chemo some antimicrobials and Dilantin an anticonvulsant The defiency causes megaloblastic RBC large and immature How to assess and what is the DRI There are 2 ways You can check the RBC folate level but this only shows long term You can check the plasma folate levels it will be as 5methyl THF The DRI is 400 ug and 600 ug in pregnant women Expressed in DFE lug folate 17ug synthetic folate and synthetic has better bioavailability Also learn the whole FolateCobalaminMethionine reaction Cobalamin What is its active form They forms are also known as corrinoids and they are multiple forms They all has 4 rings surrounding the cobalamin The two active forms are 5deoxyadenosylcobalamin which has 4 deoxys and methylcobalamin which has 4 methyls All the other forms can also be converted into these How is it absorbed This vitamin has the most complicated absorption So first the pepsin releases the cobalamin from its ring and the cobalamin bounds to an quotRquot protein and then travels to the small intestine In the first part the duodenum the quotRquot protein is hydrolyzed and then the cobalamin binds then something called Intrinsic Factor which is made in the stomach Now it gets absorbed in the ileum where the receptors are Once the cobalamin is in the blood it then binds to either Transcobalmin 12 or 3 Although 2 is the most common one And then it is stored in the liver mostly and some in the muscles Stored better than most water soluble vitamins so defiency take several years to occur Bacteria in the intestinal also can make a little What are the functions Works with folate in that whole methione reaction Also in DNA synthesis and myelin synthesis for the neurons What is the defiency t rarely occurs in the diet mostly in some absorption problem This is easy to see when you look at how many molecules are involved in its absorption Those that can t make the Intrinsic Factor since as patients with gastrectomys or impaired mucosa are at risk Or they have a lower surface area for absorption with a blind loop or ilealitis Pancreatis and parasites don t help either Of course alcoholics and elderly also Defiency always occurs in stages So first you get low serum Trancoblamin 2 levels Then you get low RBC levels Then you get lower DNA synthesis greater homocysteine levels these are bad Anemia and neuropathy And finally you get Pernicious Anemia which is characterized by appearance of megaloblastic RBC s and GI abnormalities What are the sources Animal in animal products About 30 is destroyed in cooking What is the DRI It is 2426 ug daily Pyridoxine Explain the synthesis There are multiple vitamersquot such as Pyridoxine Pyridoxal Pyrdoxamine and PyridoxalS phosphate PyridoxalSphosphate PLP is the active form The other vitamers can synthesis PLP Pyridoxine is mainy in veggies and has a low bio availability pyridoxal and pyrdoxamine are in animals and are unstable Finally the synthetic form is called pyridoxine hydrochloride What are the sources Mostly present in chicken pork fish and eggs Dairy is a low source Seeds nuts and whole grains also have it It is destroyed with cooking freezing canning and milling What are the functions PLP is a coenzyme in about 60 AA reactions mostly in transanimations Also in the synthesis of heme in the making of niacin from tryptophan in the making of histamine for histadine synthesis of carnitine taurine and dopamine Involved in the cleavage of homocysteine and PLP mediates the uptake of the steroid hormones by binding to the receptors What is the defiency Equot l Iquot 5 Those at risk are elderly alcoholics can t convert to PLP patiets on dialysis Some drugs interfere such as I LUI I Iquot and It is rare in the US and takes about 2 months to develop First you get a poor appetite weakness and sleeplessness The micro hypochromic anemia RBC have lack of color so lack of hemoglobin central and peripheral disorders from the lack of p u serotoninlypeu39 glucose39 39 39 growth and r problems What is the DRI For men it is 2mg and women it is 16 Dependant on protein intake 016 g for every 1 g protein Vitamin C What are its redox capabilities Vitamin C is a big antioxidant meaning it reduces a lot of free radicals which has a free electron and can damage DNA and cells The free radicals are called Reactive Oxygen Species or ROS Also reduce ferric Fe 3 and cupric Cu 3 to their 2 forms which are needed for other reactions but if the 2 are free in the blood for too long they can react free radicals How is it absorbed and excreted The two forms are ascorbic acid and dehydroascorbate and ascorbic can be oxidized to dehydroascorbate So ascorbic might be oxidized while being absorbed and the dehydroascorbate is absorbed to a greater extent It is stored in the eye brain or adrenal gland And the ascorbic or dehydroascorbate is metabolized in the liver to oxalic 4 c threonic acid xylose xylonite or lyxonate What are the functions Vitamin C has a lot First it is involved in collegen formation specifically it hydroxylizes proline and lysine nad keeps iron in its 2 reduced state Also in carnitine synthesis fat metabolism it Hydroxylizes trimethyllysine and butyrobetaine to carnitine Other reducing agents can be used though and again iron in it 2 form is required It is involved In tyrosine and phenylalanine synthesis It is used in cholesterol degradation in forming bile Coenzyme in Folate to THF Synthesis of the adrenal steroids and improves the immune response What are the sources Citrus fruits and veggies Very sensitive to heat and storage What is the DRI It is 90 mg in men and 75 mg in women Who is at risk for the defiency The elderly alcoholics smokers patients with malabsorption cancer patients with decreased appetite N l Iquot S P l Iquot How do you assess it There are two ways One is to check for an early defiency and that is to look at the plasma levels This is lowered by smoking contraceptives fever stress and infection though so it s not that great The other is the biochemical markers harder to assess but it shows long term This is looking at the leukocyte number and the urine metabolites Vitamin E What are the sources Best source is plant based because it is synthesized there Oils are another great source In animals it is only present in the fatty tissue What are the functions and mechanism of action Antioxidant just like vitamin C Also works inside the cells organelles mitochondria Nuclues etc It is oxidized when it reduces lipid radicals so it must be regenerated This regeneration requires vitamin C glutathione and NADP Look on the slides to learn all the reactions Other functions are maintains a normal reproductive system and it may be anti carcinogenic What is the DRI It is 15mg daily for all adults It may increase if you have a greater PUFU intake and vitamin C and selenium may spare some vitamin E How do you assess it Look at the serum levels of tocopherol the active form this is equal the Vitamin Ethe total lipid amount So if you have more lipid this can distort the test Another is Erythrocyte hemolysis which is a functional test The best test is the breath pentane measurement Pentane is a product of the omega fatty acids peroxidation and is exhaled Basically the if Vitamin E is low you can smell the pentane Vitamin A Explain the retinoids and cartoenoids You have wo main types of Vitamin A the retinoids and the carotenoinds The retinoids are the active form these are the retinal retinol ect And the cartoenoids are the provitamins These get cleaved in the body to retinal which is later reduced to retinol What are the sources for both types S P Equot 9 N The carotenoids are the form that is in the veggies like carrots The retinoids are in animal products And the form in supplements is Retinyl palmitate or some have carotene Supplements contain 3000 25000 IU Some low fat dairy is supplemented with 500 IU since the vitamin is found in fat How is it digested absorbed and transported First HCL or pepsin cleaves out the free retinols or carotenoids and these then form micelles just like lipids do when they get absorbed Retinol is 7090 absorbed and carotenoids are 2050 They then go to their target so either the retina bone kidney intestine or gonad Needs Retinol Binding Protein or RBP Binds and forms holoRBP then binds with another molecule called transthyretin or TI39R The complex is what is found in the plasma Once it is delivered to the tissue the REF and TTR are released What is the DRI This is tricky The RDA is 900 RE and 700 RE for men and women Or 5000 IU Now 1 RE is considered either lug retinol 6ug beta carotene or 12 ug of some other carotenoids The new guidelines also call them RAE sometimes and this is either lug retinol 12 ug beta carotene or 24 ug of some other carotenoids And if you want to convert between an RE and RAE 1 RAE1 RE if its retinol but lRAE2xRE if it s a carotenoid Now for the IU unit Depending on the food it will be different Animal products give 33 cheese gives 35 yogurt gives 41 and plants give 10 IU What are the functions It is essential in vision because it is a component of the pigments Specifically in rods it makes rhodopsin Look at the mechanism for this Other functions are in cell differentiation growth fertility immunity skin integrity and it s an antioxidant How do you assess There are many tests One is the serum retinol test but this is nonspecific The serum carotenoid test but this is reflective of what you just consumed The best in the relative dose response or RDR This test measures the storage amount in the liver First you measure their plasma retinol then you give them an oral dose Measure 5 hrs later and plug the values into this formula 5hr amountinitialShr multiplied answer by 100 What is the defiency and toxicity The risk groups are the malabsorptive diseases such as steatorrhea excess fat in yo poop pancreatic problems liver problems and parasites Alcoholics celiac disease can t digest gluten and premature babies because they have low liver storage capabilities Defiency is rare in the US but is common the other countries Most common symptom is nyctalopia night blindness retarded growth anorexia lower immune response and keratinzation Toxicity can happen with 10x the RDA and it cause anorexia itchy skin alopecia loss of hair ataxia loss of balance With a carotene overdoes you ll just have yellow skin which is weird


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