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Vitamin Food Sources Supplements Functions Deficiency ToxicityCalcium Milk, cheese, yogurt, turnip or mustard greens, broccoli, cauliflower, legumes, tofu, salmon, sardines with bones, clams and oysters, fortified foods (OJ)**not spinach, rhubarb, or swiss chard1) Calcium citrate-malate 35%2) Calcium monophosphate 25%3) Calcium carbonate 40%Absorption: Small intestine = calbindin/paracellularLarge intestine - passive1) non-osseous (1%) -enzyme activation (free Ca induces Phosphlipase A), blood clotting, muscle contraction (req. Mg), nerve impulses, hormones. 2) osseous (99%)- bone formation1) Rickets -secondary to Vitamin D deficiency2) Tetany3) osteoporosis(Type I, Type II)Phosphorous Organic phosphorous (animal sources): meat, fish, poultry, milk, eggsInorganic (plants): legumes, cereals, whole grainsOther: coffee, tea, soft drinks1) skeletal- laid down on collagen to form bone2) energy – ATP, creatine phosphate3) phosphorylase Reactions4) structural- cell membranes, DNA/RNA, phosopholipids5) 2nd messengers: cAMP, glycogenolysis and glycogenesis1. <1.5 mg/dLsymptoms: anorexia, bone loss, muscle weakness, cardiac dysfunctionAt risk: malnourished (refeeding syndrome=hypophosphatemia )RareThose at risk: dialysisMagnesium Coffee, tea, cocoa, whole grains, legumes, nuts, green leafy vegetables (chlorophyll has Mg), hard water (Add Fluorine and Mg)1) used in over 300 enzyme rxns2) glycolysis – hexokinase, PFK3)kerbs – decarboxylation4) HMP shunt – transketolase5) Beta-Oxidaiton- macronutrient metabolism/energy production Mg2+ provides stability to ATP1) HypomagnesemiaSymptoms: anorexia, muscle weakness, spasms, hallucinations and personality change, changes in cardiovascular and neuromuscular function, usually see with hypokalemia, hypocalcemia, low Vitamin D levelsAt risk: Renal disease, uncontrolled diabetes, excessive alcohol, refeeding syndrome, parathyroid disease1) excessive intake will not cause toxicity except with case of renal failure2) high levels of Mg salts – diarrhea and dehydration3) acute toxicity (IV) – muscular paralysis, cardiac/respiratory failureVitamin D Animal: beef, eggs, milk, and dairy (most Vit D fortified), saltwater fish (salmon, tuna), fortified breads/cereals, almost none from plants,sunlight (10 min = 10 micrograms vitamin D)Vitamin Forms:1) Ergocalciferol (D2) plants2) Chlecalciferol (D3) cholestrolReactions*liver: cholecalciferol  calcidiol*kidney: calcidiol  calcitriol (via 1-hydroxylase)1) insulin secretion2) thyroid hormone synthesis3) proliferation and differentiation of immune cells4) treatmet of psoriasisQuestion: How does Vitamin D maintain Calcium? *transcaltachia (intestine, osteoblasts, skeletal muscles) *PTH (intestine, bone, kidney)Children – ricketsAdults – osteomalaciaAt Risk: 1. elderly: indoors, poor diet2. climate- north = less sun3. fat malabsorption4. renal disease5. brastfed infants (400 IU supplements)1. Overexposure to Sun will not Cause toxicitysymptoms:nausea/vomiting, diarrhea, headache, HTN, renal dysfunction, calcification of soft tissues (heart, lungs, kidney, blood vessels)Vitamin CWater citrus, broccoli, brussel sprouts, green peppers, Forms:1. resembles glucose1)antioxidants: regenerates other antiox: Vit. E,Glutathione1) scurvy- impaired hydroxyproline and hydroxylysine synthesis Not common (water soluble)Symptoms: diarrhea, abdominalsoluble cantaloupe, strawberries, papaya supplements2) we cant synthesize – lack enzyme gulonolactone oxidase3) free ascorbic acid form 4) dehydroascorbic acidDigestion/Absorption:GLUT transporter passiveHigh intake (>12 g) = lot excretedLow intake (<2o mg) – body keepsLarge amounts iron may decrease absorption2) preoxidant – reduces transition metals3) carnitine synthesis – B – oxidation4) microsomal metabolism- endogenous: syn. Of bile acids, aldosteroneXenobiotics: drugs, carcinogens, food additives,pollutants5) colds- controversial6) cancer- controversial7) CVD- low vit C correlated with Increased blood cholesterol8) cataracts- oxidative eye damageinteractions with other nutrients: IRON-ascrobate enhances absorption of non-heme ironCOPPER: vit C intakes of 1.5 g daily for 2 months = decreased ceruloplasminsymptoms: 4HS1. hemorhhagic signs2. hyperkeratosis3. hydrochondriasis4. hematologic abnormalitiesAt Risk: elderly (dentures), poor diets (alc/drug abuse), some cancersAssessment: serum levels, leukocyte levels,urinary excretionpain (MEGA DOSES), kidney stones, rebound scurvyVitamin EFat solublePlants: oils (canola, olive, sunflower, safflower, cottonseed), mayonnaise, margarine, peanut butter, whole grain cereals, legumes, animals (fatty tissues)Forms: 1. tocopherol-saturated side chain (most bioavailable)2. tocotrienols- unsaturated side chainDigestion:Bile salts = emulsifyMicelle formation = passiveIn enteroctye- chylomicron, Transport:Chylomicron remnants to LiverLipoproteinsVLDL – uses alpha-tocopherol transfer proteinTissues Delivery  LDL = RME(receptor mediated endocytosis)VLDL – LPLStorage adipose (main), small amoutns in liver,heart, lung, muscle1. membrane integrity2. antioxidant3. decrease activity of HMG CoA reducatse4. decrease cell proliferation5. heart disease6. cataracts?7. Diabetes mellitus (Type 2)Interactions:Selenium :necessary for glutathione peroxidaseCysteine/methionine – synthesis of glutathioneVitamin C- can regenerate Vitamin EBetacarotene- Vit. E can inhibit absorptionVitamin K- Vit E can impair absorptionExcreted as BileRARE:Genetic mutation of Alpha-pi-P causes vitamin deficiencyAt risk: fat malabsorption, cystic fibrosis in children, genetic defectsSymptoms: hemolytic anemiaA ssessment : serum, erythrocyte hemolysisRare = one of least toxic vitaminsSymptoms: increased bleedingVitamin KHas AIFat solubleLeafy greens: kale, swiss chard, turnip, watercress, collards, spinach, mustard greens, broccoli, cabbage, oils (soybean, rapeseed, olive oil)Forms:1. phylloquinone = green plants2. menaquinones = bacteria in gut3. menadione – syn. Form, converted to menaquinone in liver1. post translational carboxylation of glutamyl residues2. blood clotting3. inhibitors of blood coagulation1. Rare in healthy adultssymptoms: (severe) hemorrhagi episodes due to increase prothrombin timeNone from foods.Supplements (Menadione) = liver damage Infants=hemolytic anemia, jaundice, hyperbilirubinemiaLower GI- we can make this- not enough to meet needs thought.Digestion/AbsorptionJejunum – bile saltsColon –

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