Vitamins are organic substances that are essential in tiny amounts for growth and

activity of the
body. They are obtained naturally from plant and animal foods.

The word organic means that the molecules of the substance contain the element
carbon

Vitamins work with other substances in the body like enzymes and minerals.
Together they perform such functions as strengthening bones, healing
wounds, keeping the skin healthy, building cells, and helping to resist infections.
Vitamins are separated into two groups, fat soluble and water soluble.

The fat soluble vitamins are A, D, E, and K, and can dissolve in dietary fats and
are stored in the liver and body fat.
The body stores them for a longer amount of time, so they are not needed every
day.
Too much of these vitamins can become toxic and cause health problems.

The water soluble vitamins are made up of 8 B vitamins and vitamin C.

Water soluble vitamins dissolve in water, and are not stored in the body. Rather
they travel through the bloodstream and need to be replenished every day.
These vitamins are easily destroyed during food preparation and storage.

Vitamin A, also known as retinol, is needed for skin and body tissue repairs.
Children need vitamin A to build bones and teeth. Vitamin A is part of the body’s
defense system against infections.
One of the first signs of a vitamin A deficiency is difficulty seeing at night
because the
retina of the eye needs the vitamin to function well.
However, taking in extra vitamin A will not help healthy people see better. Skin
creams and
moisturizers with vitamin A might smooth skin, but it does not rewind the clock.

Vitamin A is in fish, meat,and dairy foods, especially concentrated in the liver of

fish and animals. Many vegetables also supply vitaminA, such as carrots, pumpkins

Most of these fruits and vegetables do not actually

contain vitamin A, but rather contain beta carotene which the body converts to
vitamin A.
Carotene is the pigment that makes egg yolks yellow and carrots bright orange. Most
adults carry
enough vitamin A in their livers to supply them for months. Large doses of vitamin
A can cause
liver damage, and this is why most multi-vitamin supplements have some of the
vitamin A come
from beta carotene rather than retinol.

Many studies have made claims that beta carotene in fruits and
vegetables helps reduce the risk of some cancers.
Cancer is a major public health concern in China. According to the NaDonal Central
Cancer Registry of China, there were around 4.3 million new cancer cases and 2.8
million cancer deaths in China in 2015. Improving the accessibility and
availability of
effecDve treatments is key to resolve the huge problem of cancer in China, however
China has the less affordable prices of cancer drugs in the world.
To reduce the financial struggles of paDents with cancer and reduce the price of
costly cancer drugs, the Chinese government has voted to exempt tariffs on cancer
drugs, to procure them and to incorporate them into the catalogue of medical
insurance reimbursement. The vice director of the NaDonal Health Commission Zeng
Yixin pointed out that a stategy of controlling the prices will be built up by
encouraging new cancer drug discovery and development, acceleraDng the review
and approval procedures for new medicines, reducing circulaDon costs and
improving cancer diagnosis and raDonal drug use in China. There's concern that the
tariff cut could put some pressure on domesDc pharmaceuDcal companies due to
more tense compeDDon. However this is important also to strenghten China's own
pharmaceuDcal industry and to develop affordable medicines for paDents.
Vitamin A deciciency affects almost half of children under 5 years in south Asia
and
sub-Saharan Africa. A UNICEF report highlights the current problems facing vitamin
A supplementaDon programmes around the world. Vitamin A distribuDon has
reached a 6-year low, with 62 million children in high-mortality countries not
receiving the supplement. This supplemenDon is a cost-effecDve public health
intervenDon. These supplements do a vital work in countries with the lowest levels
of nutriDon. In these sesngs, the delivery of vitamin A is of extreme importance.
Unfortunately, the process made over the past 2 decades is stalling and receding.
As
the world moves towards the eradicaDon of polio, countries are stopping their polio

immunezaDon programmes which, in low-income countries, were typically the

vehicle for delivery of vitamin A supplements.
It's important to keep in mind that medical infrastructure created is not
necessarily
infrastructure that should be removed, even if the original goals have been
fulfilled,
because it can be vital to public health especially in those countries

VITAMIN D
Vitamin D is an important sterol hormone. Vitamin D receptors have a regulatory
role for the immune system, pancreas, brain and cardiovascular system.
As a consequence, it is implicated in diseases such as diabetes, mulDple
sclerosis,
cardiovascular disease and increased mortality. Research interest in vitamin D has
grown by more than 250% in a decade. Vitamin D deficiency is prevalent among the
UK populaDon because of poor summers, reduced sun exposure. The benefits of
treaDng deficiency showed reduced risk of fractures, reduced cardiovascular and
mortality also.
There are some controversies surrounding the vitamin D prescripDon. Some argue
that there's no evidence to support treatment of vitamin D deficiency because of
its
subtle symptoms. However, subtle symptoms are typical of many hormonal
disorders, so here the importance of vitamin D is unquesDonable.
The effects that vitamin d deficiency has (bone mineralisaDon, fragility and
fractures)
are parDcularly problemaDc in childhood, pregnancy and in older people. There are
some meta-analyses of trials of vitamin D that show that the use of it for fracture

prevenDon in adults without specific factors for deficiency is inappropriate

Whenever we invesDgate whether paDent characterisDcs are related to treatment
effect, IPD meta-analysis will be necessary. In their IPD meta-analysis Bischoff-
Ferrari
demonstrated that high use of vitamin D supplementaDon reduced both the risk of
hip fracture by 30% and the risk of non-vertebral fracture by 14% in adults.
Analyses
that include younger subjects are unlikely to demonstrate a posiDve effect. Data on

bone mineral density are difficult to interpret because changes in bone

mineralisaDon take years to develop.
Other data suggest that vitamin D posiDvely impacts on aeDologies contributory to
fracture risk such as falling. The American and BriDsh Geriatrics SocieDes now
recommend vitamin D therapy at doses of at least 800 IU daily in those who risk
deficiency, for the prevenDon of falls. The US PreventaDve Task Force concluded
that
the number needed to treat NNT to prevent one fall is 10, in comparison with a NNT
of 16 for physical therapy.
Another problem is the issue of quality of available vitamin D preparaDons. There
are serious inaccuracies in stated dosing among over-the-counter (OTC)
supplements, not only between batches but also between pills from the same pack.
The Medicines and Healthcare Products Regulatory Agency sDpulates that
unlicensed products shouldn't be used in the presence of equivalence licensed
preparaDons. PrescripDon cost analysis shows that colecalciferol products in the UK
account for
only one-quarter of all prescripDons dispensed in primary care. The average
prescripDon cost of unlicensed preparaDons is more than 3 Dmes greater than for
licensed products.
If the NHS purchased all low-dose preparaDons at a uniform cost per IU, it would
have saved lots of money per month at current prescribing levels, because there's
variaDon in the cost of dosage forms.
When appropriate, prescribed therapy should be favoured over OTC preparaDons in
order to improve quality and paDent compliance with treatment.
Licensed preparaDons should be the first choice for the treatment of vitamin D
deficiency. FINE
In the issue of The Archives of Endocrinology and Metabolism 2 papers invesDgated
the impact of vitamin D in two different health condiDons: one showed a negaDve
result invesDgaDng the associaDon of vitamin D levels with inferDlity and the other

one the posiDve effect of vitamin D supplementaDon in the physiological lung

funcDon. Vitamin D is a pre-hormone produced in the skin under sunlight exposure
which undergoes various metabolic steps unDl its acDve form, 1,25-dihydroxyvitamin
D3, is formed.
The intermediary form, 25-hydroxyvitamin D, is the recommended form for
monitoring vitamin D status. The presence of 1a-hydroxylase and the vitamin D
receptor in many cells indicates a possible ability to synthesize 1,25-
dihydroxyvitamin D3, the acDve metabolite of vitamin D
In recent decades, several studies have demonstrated the associaDon of circulaDng
25OHD levels with different diseases, their acDvity and health condiDons. A posiDve

associaDon was found in several disorders such as systemic lupus erythematosus and
its acDvity, chronic obstrucDve pulmonary disease, inflammatory bowel disease,
systemic sclerosis, endocrine disorders, cancer ecc
Other studies show a modest effects on blood pressure, glysemic control, cancer and

immune response. Hypovitaminosis D is highly frequent worldwide and especially in

Brazil. There's an interesDng presence of Hypovitaminosis D in a young
premenopausal populaDon, which is an agreement with the low vitamin D levels
described for postmenopausal and older women in Brazil. Vitamin D and its level of
impact on ferDlity is a ma[er to be defined. Nolasco and cols. showed a posiDve
effect of vitamin D on pulmonary funcDon in healthy postmenopausal women
parDcipaDng in an aquaDc exercise program.
Studies examining the effect of vitamin supplementaDon on pulmonary diseases have
shown diverse results. The response
to tubercolosis treatment with and without vitamin D was no different. Other
studies have shown improvement in pulmonary funcDon with vitamin D, so this
proves the controversy around vitamin D.
Considering all these aspects, we can give Vitamin D the Dtle "The Tricky Hormone",

as the medical community is challenged to clarify the real impact of this complex
hormone.

EXACTA
More than three millennia before the concept of vitamins became common
knowledge, ancient EgypDan and Babylonian text described a diet of liver to cure
night blindness. The transoceanic voyages of the Renaissance led to long periods
without fruit or vegetables and explorers like Vasco da Gama witnessed the curaDve
effects of lemons and oranges on scurvy vicDms. It took 250 years unDl the Scossh
physician James Lind described the prevenDve effects of citrus fruit on scurvy.
Casimir Funk discovered in 1911 what he called "vitamins": Dny amounts contained
in food could cure deadly diseases. Albert Szent-Gyorgyi von Nagyrapolt won the
Nobel Prize for discovering vitamin C and the flavonoids. Vitamic C has had an
incredible career since then.
While randomized clinical trials with supplements of beta-carotene, vitamin A and
vitamin E singly or in different combinaDons found no effect on mortality rate and
cancer risk or may even increase cancer risk, vitamin C may marginally shorten the
duraDon of the common cold. Vitamin E has shown some prevenDve effects
regarding atheroscleroDc events in hypercholesterolaemic animal models by
modulaDng VEGF/VEGF-R2 expression. Healthy oxidaDve states in different systems
within the human body are crucial and are being studied as hopes for a beneficial
therapeuDc intervenDon other than mere dietary supplementaDon remain high.
Markers of oxidaDve state may be used in the diagnosis of acute mountain sickness.
AnDoxidants systems play a crucial role in the physiological funcDon og the
respiratory and cardiovascular systems and provide potenDal therapeuDc targets.
Flavonoids have recently been idenDfied as non-compeDDve P2Y2 antagonists, while
vitamin D3 exerts an immunomodulatory funcDon by the inducDon of tolerogenic
cells. Another important research focus is on the interacDon of vitamins and their
receptors, either with carrier proteins or in receptor heterodimer formaDon,
modifying their effects. In a society characterized by nutriDonal abundance, not
eaDng certain things makes
one stand out from the crowd, while some industries create demands for
supplements by communicaDng to potenDal customers that, if a deficiency causes a
symptom, prevenDve supplementaDon must produce the opposite effects.