Chapter 7

Vitamins
CARAH FE R. BACUS, RN, MANc
Objectives
• State one or more functions of each of the 13
vitamins discussed.
• Identify at least two food sources of each of the
vitamins discussed.
• Identify some symptoms of, or diseases caused by,
deficiencies of the vitamins discussed.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Facts
• Organic (carbon-containing) compounds
that are essential in small amounts for
body processes
• Do not provide energy
• Enable the body to use the energy
provided by fats, carbohydrates, and
proteins
• Megadoses can be toxic.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin Types (13):
• Fat-soluble (4): A, D, E, K
• Water-soluble (9):
• Vitamin C
• Vitamin B complex which includes: thiamin (B1),
riboflavin (B2), niacin, vitamin B6, folate, vitamin
B12 (cobalamin), pantothenic acid, biotin

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Requirements
• Vitamin allowances given by weight in milligrams
(mg) or micrograms (mcg or g).
• Dietary reference intakes (DRIs) have replaced the
recommended dietary allowances (RDAs).
• Tolerable upper limits (UL): maximum level of daily
intake unlikely to cause adverse effects

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin Deficiency
• People prone to vitamin deficiency:
✓ Alcoholics
✓ Poor and incapacitated elderly
✓ Clients with serious diseases that affect
appetite
✓ Mentally retarded
✓ Children receiving inadequate care

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Deficiency of Fat-Soluble
Vitamins
• Chronic malabsorption diseases
• Cystic fibrosis
• Celiac disease
• Crohn’s disease

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Avoiding Vitamin Loss
• Buy fresh, unbruised vegetables and fruits and use them raw when
possible.
• Prepare fresh vegetables and fruits just before serving.
• Heat canned vegetables quickly and in their own liquid.
• Follow package directions when cooking frozen vegetables or fruit.
• Steam, or use as little water as possible.
• Cover pan and cook for a short period of time.
• Save cooking liquid for soups, stews, and gravy.
• Store fruits and vegetables in a cool, dark place.
NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN
 A. FAT-SOLUBLE VITAMINS
• Vitamins A, D, E, K
• Not lost easily in cooking
• Lost when mineral oil is ingested
• Excess amounts are stored in the
liver.
• Deficiencies are slow to appear.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

1) Vitamin A
• Preformed
✓ Retinol: the active form of vitamin A
• Provitamin A carotenoids
✓ Beta carotene, lutein, lycopene, and
zeaxanthin
✓ Inactive form of vitamin A found in
plants; converted to retinol

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Functions of Vitamin A
• Maintains healthy eyes and skin
• Normal bone growth and
reproduction
• Healthy immune system
• Antioxidants that protect cells from
free radicals

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Sources of Vitamin A
• Preformed vitamin A (retinol)
✓ Fat-containing animal foods: liver,
butter, cream, whole milk, cheese,
egg yolk
• Beta carotene
✓ Carrots, sweet potatoes, spinach,
broccoli, pumpkin, squash, mango,
and cantaloupe

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin A Requirements
• Commonly listed as retinol equivalents
(RE)
• A retinol equivalent is 1 g retinol or 6
g beta carotene

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

• Excess
▪ Birth defects, hair loss, dry skin,
headaches, nausea, dry mucous mem-
branes, liver damage, and bone and
joint pain
• Deficit
▪ Night blindness, dry, rough skin,
increased susceptibility to infections, and
blindness or xerophthalmia

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

2) Vitamin D
• Prohormone: it is converted to a
hormone in the body
• D2 (ergocalciferol) is formed in plants.
• D3 (cholecalciferol) is formed in humans
from cholesterol in the skin.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Functions of Vitamin D
•Promotes calcium and
phosphorus absorption in the
body
•Values are given in micrograms
or in international units.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Sources of Vitamin D
• Sunlight: changes provitamin to
vitamin D3
• Food sources: milk, fish liver oils, egg
yolk, butter, and fortified margarine
• Most milk in the U.S. has 10 g of
vitamin D concentrate added per
quart.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

• Excess
▪ Deposits of calcium and phosphorus in
soft tissues, kidney, and heart damage,
and bone fragility

• Deficit
▪ Poor bone and tooth formation, rickets
which causes malformed bones and pain
in infants
▪ Osteomalacia (softening of bones)
▪ Osteoporosis (brittle, porous bones)

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

3) Vitamin E
• Tocopherols
• Alpha (most biologically active)
• Beta, delta, and gamma
• Tocotrienols
• Given as -TE (alpha-tocopherol
equivalents)
• 1 mg of -TE = 1 international unit

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Functions of Vitamin E
• Antioxidant
• Prevention of hemolytic anemia
among premature infants
• Enhances immune system
• Retards spoilage of commercial
foods

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Sources of Vitamin E
• Vegetable oils: corn, soybean, safflower,
and cottonseed, and products made
from them, such as margarine
• Wheat germ, nuts, and green leafy
vegetables
• The U.S. diet is thought to contain
sufficient vitamin E.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

• Excess
➢ Relatively nontoxic, fat-soluble
vitamin
➢ Excess stored in adipose tissue
➢ Avoid long-term megadoses.
• Deficit
➢ Serious neurological defects can
occur from malabsorption.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

4) Vitamin K
• Made up of several compounds
essential to blood clotting
• Vitamin K1 (phylloquinone)
• Vitamin K2 (menaquinone)
• Synthetic vitamin K (menadione)
• Vitamin K is destroyed by light and
alkalis.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Functions of Vitamin K
• Formation of prothrombin for clotting of
blood
• Candidates likely to receive vitamin K
✓ Newborns immediately after birth
✓ Clients who suffer from faulty fat absorption
✓ After extensive antibiotic therapy
✓ Antidote for an overdose of anticoagulant or
treatment of hemorrhage

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Sources of Vitamin K
• Green leafy vegetables such as broccoli,
cabbage, spinach, and kale
• Dairy products, cow’s milk, eggs, meats, fruits,
and cereals
• Bacteria in small intestine synthesizes some
vitamin K, but must be supplemented by
dietary sources.
• Measured in micrograms

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

• Excess
➢ Anemia can result from excessive
amounts of synthetic vitamin K.
• Deficit
➢ Defective blood coagulation, which
increases clotting time and makes client
prone to hemorrhage.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

 B. WATER-SOLUBLE VITAMINS
•Vitamin B complex and C
•Dissolve in water
•Easily destroyed by air, light,
and cooking

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin B Complex:
1) Thiamin/B1
• Essential for nerve and muscle action, and
metabolism of carbohydrates and some amino acids
• Sources include unrefined and enriched cereals,
yeast, wheat germ, lean pork, organ meats, and
legumes
• Deficiency symptoms include loss of appetite, fatigue,
nervous irritability, and constipation
• Beriberi is a disease caused by extreme deficiency of
vitamin B1
NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN
Vitamin B Complex:
2) Riboflavin/B2
• Necessary for the metabolism of carbohydrates,
protein, and fats; tissue maintenance (especially the
skin around the mouth); and healthy eyes
• Sources: milk, meats, poultry, fish, enriched breads,
cereals, broccoli, spinach, and asparagus
• Deficiency can cause cheilosis (sores on the lips and
cracks at the corners of the mouth); glossitis
(inflammation of the tongue); dermatitis; and eye
strain in the form of itching, burning, and eye fatigue

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin B Complex:
3) Niacin
• Generic name for nicotinic acid and nicotinamide
• A coenzyme in energy metabolism
• Sources include meats, poultry, fish, peanuts, and
legumes
• Milk and eggs are sources of tryptophan (precursor of
niacin)
• Measured in niacin equivalents (NE)

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

• Excessive amounts of niacin can cause flushing due to
vascular dilation, gastrointestinal problems, itching, and liver
damage.
• May be used as a cholesterol-lowering agent under close
supervision of a physician because of adverse side effects,
which include liver damage and peptic ulcers
• Deficiency symptoms include weakness, anorexia,
indigestion, anxiety, and irritability.
• Pellagra is an extreme deficiency causing sores on the skin,
diarrhea, anxiety, confusion, irritability, poor memory,
dizziness, and untimely death.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin B Complex:
4) B6 (Pyridoxine, pyridoxal, and
pyridoxamine)
• Essential for protein metabolism and absorption, and aids
in the release of glucose from glycogen
• Serves as a catalyst in conversion of tryptophan to niacin;
helps synthesize neurotransmitters such as serotonin and
dopamine

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

• Measured in milligrams
• Sources include poultry, fish, liver, kidney,
potatoes, bananas, spinach, and unrefined
whole grains (oats and wheat)
• Deficiency symptoms include irritability,
depression, and dermatitis
• Deficiency in infants can cause various
neurological symptoms and abdominal
problems
• Toxicity is rare; may cause temporary
neurological problems

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin B Complex:
5) Folate
• Folate, folacin, and folic acid are chemically
similar compounds, and names are used
interchangeably.
• Needed for DNA synthesis, protein metabolism,
and formation of hemoglobin
• Sources include cereals fortified with folate,
green leafy vegetables, legumes, sunflower seeds,
fruits such as oranges and strawberries

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

• Measured in micrograms
• Average adult requires 400 g/day
• 600 g/day required 1 month before conception through first 6
weeks of pregnancy
• Excess can mask vitamin B12 deficiency and inactivates phenytoin,
an anticonvulsant drug used by epileptics
• Deficiency linked to neural tube defects in fetus, such as spina bifida
(spinal cord or spinal fluid bulge through the back) and anencephaly
(absence of the brain).
• Other signs include inflammation of mouth and tongue, poor
growth, depression and mental confusion, problems with nerve
functions, and megaloblastic anemia.

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin B Complex:
6) B12
• Cobalamin: contains mineral cobalt
• Involved in folate metabolism, maintenance of the
myelin sheath, and healthy red blood cells
• To be absorbed, must bind with intrinsic factor in
stomach.
• Sources include animal foods, especially organ meats,
lean meat, seafood, eggs, and dairy products

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

• Increased need during pregnancy and lactation
• Deficiency is rare and may be due to congenital
problems of absorption or years of a vegetarian
diet with no animal foods.
• Symptoms include megaloblastic anemia,
pernicious anemia (if intrinsic factor absent),
anorexia, glossitis, sore mouth, tongue, pallor,
depression, dizziness, weight loss, neurological
system damage

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin B Complex:
7) Pantothenic Acid
• Involved in metabolism of carbohydrates, fats, and proteins
• Essential for synthesis of neurotransmitter acetylcholine, and steroid
hormones
• Sources include meats, poultry, fish, eggs, whole-grain cereals, and
legumes
• Thought to be synthesized by the body
• Toxicity from excess not confirmed
• Natural deficiencies unknown
• Signs include weakness, fatigue, burning sensation in feet (deficiencies
produced experimentally)
NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN
Vitamin B Complex:
8) Biotin
• Coenzyme in synthesis of fatty acids and amino acids
• Sources include liver, egg yolk, soy flour, cereals, and yeast
• Synthesized in intestine by micro-organisms
• Toxicity from excess unknown
• Deficiency symptoms include nausea, anorexia,
depression, pallor, dermatitis, and increase in serum
cholesterol

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Vitamin C: Ascorbic Acid
• Has antioxidant properties and protects food from oxidation
• Role in formation of collagen and absorption of nonheme iron
• Prevents scurvy
• May be involved with formation or functioning of norepinephrine,
some amino acids, folate, leukocytes, the immune system, and
allergic reactions
• Sources include citrus fruits, melon, strawberries, tomatoes,
potatoes, red and green peppers, cabbage, and broccoli
• Stress and cigarette smoking increase need
NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN
• Scurvy: disease characterized by gingivitis, easy bruising, pinpoint
hemorrhages of the skin, poor wound healing, sore joints and muscles, and
weight loss. Extreme cases result in death.
• Found in sailors who lived without fresh fruits and vegetables

• Deficiency of vitamin C: bleeding gums, loose teeth, tendency to bruise easily,

poor wound healing, scurvy
• Excess: diarrhea, nausea, cramps, excessive absorption of food iron, rebound
scurvy (when megadoses are stopped abruptly) and possibly oxalate kidney
stones; generally considered nontoxic

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

 VITAMIN SUPPLEMENTATION
• Balanced diet provides nutritional needs of healthy
people.
• No amount of vitamins will build muscles.
• Vitamins do not provide energy; they help to release
the energy provided by nutrients.
• Heart disease, cancer, and the common cold cannot be
cured by vitamin supplements

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN

Conclusion
• Organic compounds that regulate body functions
and promote growth
• Each vitamin has a specific function.
• Well-balanced diet provides sufficient vitamins to
fulfill body requirements.
• Fat-soluble vitamins: A, D, E, K
• Water-soluble vitamins: B complex, C

NUTRITION AND DIET THERAPY BY: CARAH FE BACUS, RN