JOSE MARIA COLLEGECOLLEGE OF MEDICINE

Section of Biochemistry

Clinically-Oriented Session

Aubrey Unique Evangelista

JMCM 1ST YEAR

CASE VIGNETTE 1:

Sharon, a 38-year-old female presents to your clinic to discuss her plans for a new vegetarian
diet. The patient heard from a friend about a new vegetarian diet that promised rapid weight
loss. The diet consists of many leafy vegetables with no pork, chicken, beef, eggs, or milk. She is
also planning on working out regularly with the goal of running a marathon within the year.

GUIDE QUESTIONS:

1. Are there any health considerations of a complete vegan diet? If yes, explain and propose
measures of prevention.

Vegetarians consume fewer carbohydrates, protein with no pork, chicken, beef, eggs, or
dairy products included in their diet. They consume more magnesium, vitamins, folic acid, iron,
and phytochemical. Overall, vegetarians typically relish a lower risk of diabetes, cardiac disease,
and some kind of cancers. A vegan diet appears to be beneficial for increasing the absorption of
protective phytochemicals and nutrients and for reducing the intake of dietary factors
associated with several chronic illnesses. Though vegan diets serve to be loaded in many
nutrients, low in cholesterol levels and higher in dietary fiber, there are several nutrients that
those following a vegan regime oftentimes do not consume enough of. One well-known
concern is whether a vegan diet gives a sufficient amount of vitamin B12. This vitamin B12 aids
in the prevention of nerve damage, and is profoundly found in fish, eggs, meat, and dairy
products, but not in vegetables. It's advised that adults should have an intake of 1.5 micrograms
of vitamin B12 per day. A deficit of vitamin B12 in the body can lead to neurological
manifestations such as numbness, tremors, and it is irreversible if the deficiency is not
addressed for too long. Another neurological problem would be the choline crisis. Choline is a
nutrient that is mostly found in meat and poultry. Choline is substantial for a better brain
functioning and cognition. A choline deficiency can lead to damage to the liver, muscle cramps,
and nonalcoholic fatty liver disease.

Dietary recommendations for optimal vegan diets:

 To avoid B-12 deficiency, vegans must daily consume vitamin B-12–foods, such as
fortified soy and rice, cereals and meat analogs, and or take daily vitamin B-12 vitamins

 To ensure adequate calcium in the diet, calcium-fortified plant foods should be regularly
consumed in addition to consuming the traditional calcium sources for a vegan like
green tofu. The calcium-fortified foods include cereals, soy and rice, orange and apple
juices, and other beverages

 To ensure an adequate vitamin D status, vegans must regularly consume vitamin D–

foods such as soy milk, rice, orange juice, cereals, and margarines that are fortified with
vitamin D

 A vegan should regularly consume plant foods naturally rich in the n-3 fatty acid ALA,
such as ground flaxseed, walnuts, canola oil, and soy products

 Because of the high phytate content of a typical vegan diet, it is important that a vegan
consume foods that are rich in zinc, such as whole grains, legumes, and soy products, to
provide a sufficient zinc intake

2. Create a table listing essential and non-essential amino acids.

ESSENTIAL AMINO ACIDS NON-ESSENTIAL AMINO ACIDS

HISTIDINE ARGININE
ISOLEUCINE GLUTAMINE
LEUCINE TYROSINE
LYSINE CYSTEINE
METHIONINE GLYCINE
PHENYLALANINE PROLINE
THREONINE SERINE
TRYPTOPHAN ORNITHINE
VALINE ALANINE
ASPARAGINE
ASPARTATE
CASE VIGNETTE 2:

Jen, a 1-year-old girl is brought to your clinic by her mother due to concerns about her
development. History revealed that child was delivered via NSD at home by a “hilot.” The
mother reports that the baby is not achieving the normal milestones for a baby of her age. She
also reports an unusual odor to her urine and some areas of hypopigmentation on her skin and
hair. On exam, the girl is noted to have some muscle hypotonia and microcephaly. The urine
collected is found to have a “mousy” odor.

GUIDE QUESTIONS:

1. What is the most likely diagnosis?

2. Describe the pathophysiology of the disease.

3. What is the biochemical basis of the hypopigmented skin and hair?

Sources:
1. https://academic.oup.com/ajcn/article/89/5/1627S/4596952
2. https://www.bbc.com/future/article/20200122-are-there-health-benefits-to-
going-vegan
3. https://en.wikipedia.org/wiki/Essential_amino_acid