(Courtesy of Parkview Pharmacy) Vitamins/supplements do not need FDA approval before marketing nor do they need to be registered with the FDA before being produced or sold.

A physical exam is rarely helpful in early diagnosis of vitamin deficiency. Most characteristic physical findings are seen late in the course of the syndrome, such as glossitis and cheilosis (Inflammation and small cracks in one or both corners of the mouth), which are examples of deficiencies in B vitamins.

At Risk Populations for vitamin deficiency:

• Pregnant women
• Infants
• The elderly
• Patients with chronic disease
• Alcoholics
• Strict vegetarians
• Drugs causing vitamin depletion
• Undernourished populations
• Hemodialysis patients
• Total parenteral nutrition patients
• Inborn errors of metabolism
• Anorexic/bulimic patients

Vitamin B-1: Thiamine

Most B1 deficiencies in the US are due to alcoholism.

Health benefits: relief of anxiety and depression.

Adverse reaction: feeling of warmth or pruritus.

Vitamin B-2: Riboflavin

Health benefits: prevention of stress, depression and cataracts; possibly also migraine prevention.

Drug interactions/Adverse effects: minimal. Not toxic due to limited GI absorption.

Vitamin B-3: Niacin

Deficiency states: dermatitis, diarrhea, dementia

Health benefits: decreases cholesterol, may decrease risk of heart disease and decrease triglycerides.

Adverse effects: flushing, GI upset, may increase blood sugar levels

Vitamin B-5: Pantothenic Acid

It helps with breakdown of fats and carbohydrates for energy; critical to the manufacture of red blood cells, as well as sex and stress-related hormones; helps with maintaining a healthy digestive tract.

Vitamin B-6: Pyridoxine

Deficiency states: anemia and neuropathy.

Health benefits: may alleviate PMS symptoms, improves mood, decreases risk of heart disease, stimulates immune system. Possibly decreases the nausea from pregnancy.

Biotin

(Vitamin B-7 or Vitamin-H)

Deficiency states: hair loss, dry scaly skin, glossitis, dry eyes, loss of appetite, fatigue, insomnia, and depression.

• Deficiency in developed countries is rare.
• High levels found in liver, cauliflower, salmon, carrots, bananas, cereals, nuts, chocolate and yeast; also synthesized by the body.
• Excess: slower release of insulin, skin rashes.

Vitamin B-9: Folic acid

Who needs it?

• Pregnant women: decreased incidence of spina bifida and anencephaly. Supplement 400-800 mcg before pregnancy occurs.
• Users of drugs that lower folic acid.
• Users of seizure medication, oral contraceptives, antacids, methotrexate (for RA).

Vitamin B-12: Cobalamin

Source: muscle meats, liver and dairy products. Not found in vegetables.

Vegetarians are at risk of B-12 deficiency

Causes: Dietary deficiency (rare)

(Vegans need to supplement B-12)

• Decreased production of intrinsic factor: due to pernicious anemia, gastrectomy or bariatric surgery.
• Helicobacter pylori infection
• Metformin therapy
• Decreased ileal absorption of B-12: surgical resection and Crohn’s disease.

Vitamin C: Ascorbic Acid

Source: citrus fruits, tomatoes, potatoes, cabbage, green peppers.

Deficiency States:

• Will see capillary fragility (especially in gingival cases), loose teeth and hemorrhages. In children abnormal bone and tooth development. May see swollen joints.

Adverse effects: renal calculi, GI irritation and diarrhea at high doses

Drug interaction: increases iron absorption.

Vitamin A

Source: fish liver oils, egg yolks, green leafy and yellow vegetables. Toxic doses if polar bear liver is consumed.

Deficiency states:

• Night blindness

Adverse effects: skin and mucous membranes: dry mucous membranes, cheilitis, yellowing of skin, fatigue, nausea, hair loss, headache, vertigo, blurred vision.

Vitamin D

Source: fish liver oils, egg yolk, fortified milk; synthesized in skin exposed to UV light.

• Vitamin-D3 comes from animal sources. Vitamin-D2 comes from

plant sources.

• Function: acts as a hormone, and plays a role in calcium absorption.

Dose: recommend 800-2000 iu per day for adults.

Vitamin E

• An antioxidant, protecting cells from the damage caused by free radicals.(Free radicals are produced from the conversion of food to energy)
• People are also exposed to free radicals in the environment from cigarette smoke, and ultraviolet light from the sun or from air pollution,
• Source: Vegetable oils, wheat germ, leafy vegetables, egg yolk, margarine, legumes.

Vitamin K: Phylloquinone

Source: leafy vegetables, vegetable oils, liver and synthesis by intestinal flora.

Function: essential for formation of clotting factors.

Deficiency states:

Possibly due to excessive antibiotic use. Newborns and preemies are at increased risk.

Coenzyme Q-10

Source: aka ubiquinone and ubidecarenone

• Levels decline with age.
• Converts food to energy.
• Most people get enough CoQ10 eating a balanced diet.
• Dose: range 30—200 mg/day. Best absorbed with a fatty meal.

Statins may lower the levels of CoQ10 in the blood. Net effect is unclear.

During pregnancy

• Iron – 27 mg
• Calcium – at least 250 mg (elemental calcium 1000 mg per day).
• Folate – at least 0.4 mg (0.6 mg in the second and third trimesters).
• Iodine – 150 mcg
• Vitamin D – 200 to 600 international units (exact amount is controversial).
• In addition to these key ingredients, pregnant women need to get adequate amounts of vitamins A, E, C, B vitamins and zinc

Oral Contraceptive Users

• These patients make up our younger population, but still need vitamin supplementation.
• Oral contraceptives do deplete B-vitamins, especially folic acid.

Natural vs Artificial Vitamins

• Rose hips: (Vitamin-C) 541 mg/cup
• Liver = (Pantothenic Acid) 4.8mg /5oz
• Sweet potato (Vitamin A) 18,869 iu / cup
• Wheat germ (Vitamin-E) 30 iu / tablespoon
• Cod Liver oil (Vitamin-D) 1360 iu / tablespoonful

Which Vitamins Should be Avoided by Particular Populations?

Vitamin A:

• Pregnancy: Too much vitamin A during pregnancy can increase the risk of birth defects in babies.(Doesn’t apply to beta-kerotene)
• Smokers: (perhaps former smokers) should avoid MVMs with large amounts of beta-carotene and vitamin A because these ingredients might increase the risk of lung cancer.

Please stop by at Parkview Pharmacy for any questions about vitamins or supplements..