{"id":178,"date":"2019-03-11T17:45:36","date_gmt":"2019-03-11T17:45:36","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/sunyltnutrition\/?post_type=chapter&#038;p=178"},"modified":"2019-04-12T18:17:10","modified_gmt":"2019-04-12T18:17:10","slug":"7-3-water-soluble-vitamins","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/sunyltnutrition\/chapter\/7-3-water-soluble-vitamins\/","title":{"raw":"7.3: Water Soluble Vitamins","rendered":"7.3: Water Soluble Vitamins"},"content":{"raw":"<p class=\"mt-align-justify\">Nine vitamins are considered water soluble, including: vitamin C and all of the B vitamins (Riboflavin, Niacin, Thiamin, B<sub>6<\/sub>, Folate, B<sub>12<\/sub>, Pantothenic\u00a0Acid and Biotin). In contrast to the four\u00a0<a href=\"https:\/\/courses.lumenlearning.com\/sunyltnutrition\/chapter\/7-2-fat-soluble-vitamins\/\">Fat-Soluble Vitamins<\/a>, Water-soluble vitamins dissolve easily in water and, in general, are readily excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption.\u00a0Because they are not as readily stored, more consistent intake is important.<span class=\"mt-font-size-12\">\u00a0<\/span>Many types of water-soluble vitamins are synthesized by bacteria.<\/p>\r\n\r\n<header>\r\n<h2 id=\"title\">7.3A: Vitamin B\u2081 (Thiamine)<\/h2>\r\n<\/header><section class=\"mt-content-container\">Thiamine, also known as\u00a0thiamin\u00a0or\u00a0vitamin B1, is a\u00a0vitamin\u00a0found in food and used as a\u00a0dietary supplement.\u00a0As a supplement it is used to treat and prevent\u00a0thiamine deficiency\u00a0and disorders that result from it, including\u00a0beriberi,\u00a0Korsakoff's syndrome, and\u00a0Korsakoff's psychosis. Other uses include\u00a0maple syrup urine disease\u00a0and\u00a0Leigh's disease. It is taken\u00a0by mouth\u00a0or by\u00a0injection. Side effects are generally few.\u00a0Allergic reactions\u00a0including\u00a0anaphylaxis\u00a0may occur. Thiamine is in the\u00a0B complex\u00a0family. It is needed for the\u00a0metabolism\u00a0of\u00a0carbohydrates.[1]\u00a0As people are unable to make it, thiamine is an\u00a0essential nutrient. Food sources include\u00a0whole grains, meat, and fish.Thiamine was discovered in 1897 and is\u00a0on the\u00a0World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a\u00a0health system.\u00a0Thiamine is available as a\u00a0generic medication\u00a0and\u00a0over the counter.\u00a0The wholesale cost in the\u00a0developing world\u00a0is about 2.17 USD per one gm vial.\u00a0In the United States a month of replacement is less than 25 USD.\u00a0Some countries require its addition to certain foods such as\u00a0grains. Thiamine is used to treat\u00a0thiamine deficiency\u00a0which can prove fatal.\u00a0In less-severe cases, nonspecific signs include\u00a0malaise, weight loss, irritability and confusion.Thiamine is a colorless\u00a0organosulfur compound\u00a0with a\u00a0chemical formula\u00a0<span id=\"MathJax-Element-1-Frame\" class=\"MathJax\" style=\"font-style: normal;font-weight: normal;line-height: normal;font-size: 14.4px;text-indent: 0px;text-align: left;letter-spacing: normal;float: none;direction: ltr;max-width: none;max-height: none;min-width: 0px;min-height: 0px;border: 0px;padding: 0px;margin: 0px\" role=\"presentation\"><span id=\"MathJax-Span-1\" class=\"math\"><span id=\"MathJax-Span-2\" class=\"mrow\"><span id=\"MathJax-Span-3\" class=\"msubsup\"><span id=\"MathJax-Span-4\" class=\"mtext\">C<\/span><span id=\"MathJax-Span-5\" class=\"texatom\"><span id=\"MathJax-Span-6\" class=\"mrow\"><span id=\"MathJax-Span-7\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-8\" class=\"texatom\"><span id=\"MathJax-Span-9\" class=\"mrow\"><span id=\"MathJax-Span-10\" class=\"mn\">12<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-11\" class=\"msubsup\"><span id=\"MathJax-Span-12\" class=\"mtext\">H<\/span><span id=\"MathJax-Span-13\" class=\"texatom\"><span id=\"MathJax-Span-14\" class=\"mrow\"><span id=\"MathJax-Span-15\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-16\" class=\"texatom\"><span id=\"MathJax-Span-17\" class=\"mrow\"><span id=\"MathJax-Span-18\" class=\"mn\">17<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-19\" class=\"msubsup\"><span id=\"MathJax-Span-20\" class=\"mtext\">N<\/span><span id=\"MathJax-Span-21\" class=\"texatom\"><span id=\"MathJax-Span-22\" class=\"mrow\"><span id=\"MathJax-Span-23\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-24\" class=\"texatom\"><span id=\"MathJax-Span-25\" class=\"mrow\"><span id=\"MathJax-Span-26\" class=\"mn\">4<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-27\" class=\"mtext\">OS<\/span><\/span><\/span><span class=\"MJX_Assistive_MathML\" role=\"presentation\">C12H17N4OS<\/span><\/span>\u00a0(Figure\u00a0<span id=\"MathJax-Element-2-Frame\" class=\"MathJax\" style=\"font-style: normal;font-weight: normal;line-height: normal;font-size: 14.4px;text-indent: 0px;text-align: left;letter-spacing: normal;float: none;direction: ltr;max-width: none;max-height: none;min-width: 0px;min-height: 0px;border: 0px;padding: 0px;margin: 0px\" role=\"presentation\"><span id=\"MathJax-Span-28\" class=\"math\"><span id=\"MathJax-Span-29\" class=\"mrow\"><span id=\"MathJax-Span-30\" class=\"texatom\"><span id=\"MathJax-Span-31\" class=\"mrow\"><span id=\"MathJax-Span-32\" class=\"mn\">7.3<\/span><span id=\"MathJax-Span-33\" class=\"mi\">A<\/span><span id=\"MathJax-Span-34\" class=\"mo\">.<\/span><span id=\"MathJax-Span-35\" class=\"mn\">1<\/span><\/span><\/span><\/span><\/span><span class=\"MJX_Assistive_MathML\" role=\"presentation\">7.3A.1<\/span><\/span>). Its structure consists of an\u00a0aminopyrimidine\u00a0and a\u00a0thiazole\u00a0ring linked by a\u00a0methylene bridge. The thiazole is substituted with methyl and hydroxyethyl side chains. Thiamine is\u00a0soluble\u00a0in\u00a0water,\u00a0methanol, and\u00a0glycerol\u00a0and practically insoluble in less polar\u00a0organic solvents. It is stable at acidic pH, but is unstable in alkaline solutions. Thiamine, which is a\u00a0N-heterocyclic carbene, can be used in place of\u00a0cyanide\u00a0as a catalyst for\u00a0benzoin condensation.\u00a0Thiamine is unstable to heat, but stable during frozen storage.[citation needed]\u00a0It is unstable when exposed to ultraviolet light[9]\u00a0and gamma irradiation.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"346\"]<img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4097\/346px-Thiamin.svg.png?revision=1\" alt=\"346px-Thiamin.svg.png\" width=\"346\" height=\"201\" \/> <em>Figure\u00a0<\/em><strong>7.3A.1<\/strong><em>: Structure of thiamine<\/em>[\/caption]\r\n\r\nThiamin is found in a wide variety of processed and whole foods, with edible seeds,\u00a0legumes,\u00a0rice\u00a0and\u00a0processed foods, such as\u00a0breakfast cereals, having among the highest contents.\u00a0Some other foods naturally rich in thiamin are\u00a0corn flour, pork,\u00a0pecans\u00a0and\u00a0spinach.\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intakes<\/h3>\r\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for thiamine in 1998. The current EARs for thiamine for women and men ages 14 and up are 0.9\u00a0mg\/day and 1.0\u00a0mg\/day, respectively; the RDAs are 1.1 and 1.2\u00a0mg\/day. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 1.4\u00a0mg\/day. RDA for lactation equals 1.4\u00a0mg\/day. For infants up to 12 months the Adequate Intake (AI) is 0.2-0.3\u00a0mg\/day. and for children ages 1\u201313 years the RDA increases with age from 0.5 to 0.9\u00a0mg\/day.<\/p>\r\n<p class=\"mt-align-justify\">As for safety, the Food and Nutrition Board of the U.S. Institute of Medicine sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of thiamine there is no UL, as there is no human data for adverse effects from high doses. The European Food Safety Authority reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for thiamine. Collectively the EARs, RDAs and ULs are referred to as\u00a0Dietary Reference Intakes.<\/p>\r\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For thiamine labeling purposes 100% of the Daily Value was 1.5\u00a0mg, but as of May 2016 it has been revised to 1.2\u00a0mg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until July 28, 2018 to comply with the change.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Antagonists<\/h3>\r\nThiamine in foods can be degraded in a variety of ways.\u00a0Sulfites, which are added to foods usually as a preservative,\u00a0will attack thiamine at the methylene bridge in the structure, cleaving the pyrimidine ring from the thiazole ring.\u00a0The rate of this reaction is increased under acidic conditions. Thiamine is degraded by thermolabile\u00a0thiaminases\u00a0(present in raw fish and shellfish). Some thiaminases are produced by bacteria. Bacterial thiaminases are cell surface enzymes that must dissociate from the membrane before being activated; the dissociation can occur in ruminants under acidotic conditions. Rumen bacteria also reduce sulfate to sulfite, therefore high dietary intakes of sulfate can have thiamine-antagonistic activities.\r\n\r\nPlant thiamine antagonists are heat-stable and occur as both the ortho- and para-hydroxyphenols. Some examples of these antagonists are\u00a0caffeic acid,\u00a0chlorogenic acid, and\u00a0tannic acid. These compounds interact with the thiamine to oxidize the thiazole ring, thus rendering it unable to be absorbed. Two flavonoids,\u00a0quercetin\u00a0and\u00a0rutin, have also been implicated as thiamine antagonists.\r\n\r\n<\/div>\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Absorption<\/h3>\r\n<p class=\"mt-align-justify\">Thiamine is released by the action of phosphatase and pyrophosphatase in the upper small intestine. At low concentrations, the process is carrier-mediated, and, at higher concentrations, absorption occurs via passive diffusion. Active transport is greatest in the jejunum and ileum; but, active transport can be inhibited by alcohol consumption and by folic deficiency.\u00a0Decline in thiamine absorption occurs at intakes above 5\u00a0mg\/day.\u00a0The cells of the intestinal mucosa have thiamine pyrophosphokinase activity, but it is unclear as to whether the enzyme is linked to active absorption. The majority of thiamine present in the intestine is in the pyrophosphorylated form ThDP, but when thiamine arrives on the serosal side of the intestine it is often in the free form. The uptake of thiamine by the mucosal cell is likely coupled in some way to its phosphorylation\/dephosphorylation. On the serosal side of the intestine, evidence has shown that discharge of the vitamin by those cells is dependent on Na<sup>+<\/sup>-dependent ATPase.<\/p>\r\n<p class=\"mt-align-justify\">Uptake of thiamine by cells of the blood and other tissues occurs via active transport and passive diffusion.\u00a0The brain requires much more thiamine than other tissues of the body. Much of ingested thiamine never reaches the brain because of passive diffusion and the\u00a0blood\u2013brain barrier. About 80% of intracellular thiamine is phosphorylated and most is bound to proteins. In some tissues, thiamine uptake and secretion appears to be mediated by a soluble thiamine transporter that is dependent on Na<sup>+<\/sup>\u00a0and a transcellular proton gradient.<\/p>\r\n<p class=\"mt-align-justify\">Human storage of thiamine is about 25 to 30\u00a0mg, with the greatest concentrations in skeletal muscle, heart, brain, liver, and kidneys. ThMP and free (unphosphorylated) thiamine is present in plasma, milk, cerebrospinal fluid, and, it is presumed, all extracellular fluids. Unlike the highly phosphorylated forms of thiamine, ThMP and free thiamine are capable of crossing cell membranes. Thiamine contents in human tissues are less than those of other species.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\">\r\n<h3 class=\"editable\">Contributors<\/h3>\r\n<ul>\r\n \t<li class=\"mt-align-justify\">Wikipedia. Content is copyrighted under a CC-BY-SA 4.0 license.<\/li>\r\n<\/ul>\r\n<h2>7.3B: Vitamin B\u2082 (Riboflavin)<\/h2>\r\n<header><\/header><section class=\"mt-content-container\">\r\n<p class=\"mt-align-justify\">Riboflavin, also known as\u00a0vitamin B<sub>2<\/sub>, is a\u00a0vitamin\u00a0found in food and used as a\u00a0dietary supplement. As a supplement it is used to prevent and treat\u00a0riboflavin deficiency\u00a0and prevent\u00a0migraines. It may be given by mouth or injection. It is nearly always well tolerated. Normal doses are safe during\u00a0pregnancy. Riboflavin is in the\u00a0vitamin B\u00a0group. It is required by the body for\u00a0cellular respiration. Food sources include\u00a0eggs,\u00a0green vegetables, milk, and meat. Riboflavin was discovered in 1920, isolated in 1933, and first made in 1935. It is on the\u00a0World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a\u00a0health system. Riboflavin is available as a\u00a0generic medication\u00a0and\u00a0over the counter. In the United States a month of supplements costs less than 25 USD.\u00a0Some countries require its addition to\u00a0grains.<\/p>\r\n\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"200\"]<img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4100\/502px-Riboflavin_solution.jpg?revision=1\" alt=\"502px-Riboflavin_solution.jpg\" width=\"200\" height=\"238\" \/> <em>A solution of riboflavin. Image used with permission (CC BY-SA 4.0;\u00a0Patr\u00edciaR)<\/em>[\/caption]\r\n<p class=\"mt-align-justify\">Riboflavin has been used in several clinical and therapeutic situations. For over 30 years, riboflavin supplements have been used as part of the\u00a0phototherapy\u00a0treatment of\u00a0neonatal jaundice. The light used to irradiate the infants breaks down not only\u00a0bilirubin, the toxin causing the jaundice, but also the naturally occurring riboflavin within the infant's blood, so extra supplementation is necessary.<\/p>\r\n<p class=\"mt-align-justify\">Riboflavin functions as a coenzyme, meaning that it is required for enzymes (proteins) to perform normal physiological actions. Specifically, the active forms of riboflavin\u00a0flavin mononucleotide\u00a0(FMN) and\u00a0flavin adenine dinucleotide\u00a0(FAD) function as cofactors for a variety of flavoproteine enzyme reactions:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"mt-align-justify\">Flavoproteins\u00a0of\u00a0electron transport chain, including FMN in\u00a0Complex I\u00a0and FAD in\u00a0Complex II<\/li>\r\n \t<li class=\"mt-align-justify\">FAD is required for the production of pyridoxic acid from pyridoxal (vitamin B<sub>6<\/sub>) by\u00a0pyridoxine 5'-phosphate oxidase<\/li>\r\n \t<li class=\"mt-align-justify\">The primary coenzyme form of vitamin B<sub>6<\/sub>\u00a0(pyridoxal phosphate) is FMN dependent<\/li>\r\n \t<li class=\"mt-align-justify\">Oxidation\u00a0of pyruvate, \u03b1-ketoglutarate, and branched-chain amino acids requires FAD in the shared\u00a0E3\u00a0portion of their respective dehydrogenase complexes<\/li>\r\n \t<li class=\"mt-align-justify\">Fatty\u00a0acyl CoA dehydrogenase\u00a0requires FAD in fatty acid oxidation<\/li>\r\n \t<li class=\"mt-align-justify\">FAD is required to convert\u00a0retinol\u00a0(vitamin A) to retinoic acid via cytosolic\u00a0retinal dehydrogenase<\/li>\r\n \t<li class=\"mt-align-justify\">Synthesis of an active form of folate (5-methyltetrahydrofolate) from\u00a05,10-methylenetetrahydrofolate\u00a0by\u00a0Methylenetetrahydrofolate reductase\u00a0is FADH<sub>2<\/sub>\u00a0dependent<\/li>\r\n \t<li class=\"mt-align-justify\">FAD is required to convert\u00a0tryptophan\u00a0to\u00a0niacin\u00a0(vitamin B<sub>3<\/sub>)<\/li>\r\n \t<li class=\"mt-align-justify\">Reduction of the oxidized form of\u00a0glutathione\u00a0(GSSG) to its reduced form (GSH) by\u00a0Glutathione reductase\u00a0is FAD dependent<\/li>\r\n<\/ul>\r\n<p class=\"mt-align-justify\">For the molecular mechanism of action see main articles\u00a0Flavin mononucleotide\u00a0(FMN) and\u00a0flavin adenine dinucleotide\u00a0(FAD)<\/p>\r\n\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Sources<\/h3>\r\n<p class=\"mt-align-justify\">Food and beverages that provide riboflavin without fortification are\u00a0milk,\u00a0cheese,\u00a0eggs,\u00a0leaf vegetables,\u00a0liver,\u00a0kidneys,\u00a0legumes,\u00a0mushrooms, and\u00a0almonds. The milling of cereals results in considerable loss (up to 60%) of vitamin B<sub>2<\/sub>, so white\u00a0flour\u00a0is enriched in some countries such as US by addition of the vitamin. The enrichment of bread and ready-to-eat breakfast cereals contributes significantly to the dietary supply of vitamin B<sub>2<\/sub>. Polished\u00a0rice\u00a0is not usually enriched, because the vitamin\u2019s yellow color would make the rice visually unacceptable to the major rice-consumption populations. However, most of the flavin content of whole brown rice is retained if the rice is steamed (parboiled) prior to milling. This process drives the flavins in the germ and aleurone layers into the endosperm. Free riboflavin is naturally present in foods along with protein-bound FMN and FAD. Bovine milk contains mainly free riboflavin, with a minor contribution from FMN and FAD. In whole milk, 14% of the flavins are bound noncovalently to specific proteins.\u00a0Egg white and egg yolk contain specialized riboflavin-binding proteins, which are required for storage of free riboflavin in the egg for use by the developing embryo.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intake<\/h3>\r\n<p class=\"mt-align-justify\">In humans, there is no evidence for riboflavin toxicity produced by excessive intakes, in part because it has lower water solubility than other B vitamins, because absorption becomes less efficient as doses increase, and because what excess is absorbed is excreted via the kidneys into urine. Even when 400\u00a0mg of riboflavin per day was given orally to subjects in one study for three months to investigate the efficacy of riboflavin in the prevention of migraine headache, no short-term side effects were reported.\u00a0Although toxic doses can be administered by injection,\u00a0any excess at nutritionally relevant doses is excreted in the urine,<span class=\"mt-font-size-12\">\u00a0<\/span>imparting a bright yellow color when in large quantities.<\/p>\r\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of riboflavin there is no UL, as there is no human data for adverse effects from high doses. The European Food Safety Authority reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for riboflavin.<\/p>\r\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) in 1998. The current EARs for riboflavin for women and men ages 14 and up are 0.9\u00a0mg\/day and 1.1\u00a0mg\/day, respectively; the RDAs are 1.1 and 1.3\u00a0mg\/day. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 1.4\u00a0mg\/day. RDA for lactation equals 1.6\u00a0mg\/day. For infants up to 12 months the Adequate Intake (AI) is 0.3-0.4\u00a0mg\/day and for children ages 1\u201313 years the RDA increases with age from 0.5 to 0.9\u00a0mg\/day. Collectively the EARs, RDAs and ULs (see Toxicity) are referred to as\u00a0Dietary Reference Intakes.<sup id=\"cite_ref-Gropper_S.S._2009.2C_P329-333_18-1\">[18]<\/sup><sup id=\"cite_ref-26\">[26]<\/sup><\/p>\r\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For riboflavin labeling purposes 100% of the Daily Value was 1.7\u00a0mg, but as of May 2016 it has been revised to 1.3\u00a0mg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until July 2018 to comply with the change.<\/p>\r\n\r\n<div class=\"note1\">\r\n<div class=\"textbox shaded\">\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<div class=\"note1\">\r\n<h3 class=\"boxtitle\">RIBOFLAVIN DEFICIENCY<\/h3>\r\n<p class=\"mt-align-justify\">Mild deficiencies can exceed 50% of the population in third world countries and in refugee situations. Deficiency is uncommon in the United States and in other countries that have wheat flour, bread, pasta, corn meal or rice enrichment regulations. In the U.S., starting in the 1940s, flour, corn meal and rice have been fortified with B vitamins as a means of restoring some of what is lost in milling, bleaching and other processing. For adults 20 and older, average intake from food and beverages is 1.8\u00a0mg\/day for women and 2.5\u00a0mg\/day for men. An estimated 23% consume a riboflavin-containing dietary supplement that provides on average 10\u00a0mg. The U.S. Department of Health and Human Services conducts National Health and Nutrition Examination Survey every two years and reports food results in a series of reports referred to as \"What We Eat In America.\" From NHANES 2011\u20132012, the latest for which data has been reported, estimates are that 8% of women and 3% of men consume less than the RDA. When compared to the lower Estimated Average Requirements, fewer than 3% do not achieve the EAR level. However, anyone choosing a gluten-free or low gluten diet should as a precaution take a multi-vitamin\/mineral dietary supplement which provides 100% DV for riboflavin and other B vitamins.<\/p>\r\n<p class=\"mt-align-justify\">Riboflavin deficiency (also called ariboflavinosis) results in\u00a0stomatitis\u00a0including painful red tongue with sore throat, chapped and fissured lips (cheilosis), and inflammation of the corners of the mouth (angular stomatitis). There can be oily scaly skin rashes on the\u00a0scrotum,\u00a0vulva,\u00a0philtrum\u00a0of the lip, or the\u00a0nasolabial folds. The eyes can become itchy, watery, bloodshot and sensitive to light.\u00a0Due to interference with iron absorption, even mild to moderate riboflavin deficiency results in an\u00a0anemia\u00a0with normal cell size and normal\u00a0hemoglobin\u00a0content (i.e. normochromic normocytic\u00a0anemia). This is distinct from anemia caused by deficiency of\u00a0folic acid\u00a0(B<sub>9<\/sub>) or\u00a0cyanocobalamin\u00a0(B<sub>12<\/sub>), which causes anemia with large blood cells (megaloblastic anemia).\u00a0Deficiency of riboflavin during pregnancy can result in birth defects including congenital heart defects\u00a0and limb deformities.<\/p>\r\n<p class=\"mt-align-justify\">The stomatitis symptoms are similar to those seen in\u00a0pellagra, which is caused by\u00a0niacin\u00a0(B<sub>3<\/sub>) deficiency. Therefore, riboflavin deficiency is sometimes called \"pellagra sine pellagra\" (pellagra without pellagra), because it causes stomatitis but not widespread peripheral skin lesions characteristic of niacin deficiency.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/section><\/div>\r\n<\/section><header>\r\n<h2 id=\"title\">7.3C: Vitamin B\u2083 (Niacin)<\/h2>\r\n<\/header><section class=\"mt-content-container\">\r\n<p class=\"mt-align-justify\">Niacin, also known as\u00a0vitamin B<sub>3<\/sub>\u00a0or nicotinic acid, is an\u00a0organic compound\u00a0with the\u00a0formula\u00a0<span id=\"MathJax-Element-1-Frame\" class=\"MathJax\" style=\"font-style: normal;font-weight: normal;line-height: normal;font-size: 14.4px;text-indent: 0px;text-align: left;letter-spacing: normal;float: none;direction: ltr;max-width: none;max-height: none;min-width: 0px;min-height: 0px;border: 0px;padding: 0px;margin: 0px\" role=\"presentation\"><span id=\"MathJax-Span-1\" class=\"math\"><span id=\"MathJax-Span-2\" class=\"mrow\"><span id=\"MathJax-Span-3\" class=\"msubsup\"><span id=\"MathJax-Span-4\" class=\"mtext\">C<\/span><span id=\"MathJax-Span-5\" class=\"texatom\"><span id=\"MathJax-Span-6\" class=\"mrow\"><span id=\"MathJax-Span-7\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-8\" class=\"texatom\"><span id=\"MathJax-Span-9\" class=\"mrow\"><span id=\"MathJax-Span-10\" class=\"mn\">6<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-11\" class=\"msubsup\"><span id=\"MathJax-Span-12\" class=\"mtext\">H<\/span><span id=\"MathJax-Span-13\" class=\"texatom\"><span id=\"MathJax-Span-14\" class=\"mrow\"><span id=\"MathJax-Span-15\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-16\" class=\"texatom\"><span id=\"MathJax-Span-17\" class=\"mrow\"><span id=\"MathJax-Span-18\" class=\"mn\">5<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-19\" class=\"msubsup\"><span id=\"MathJax-Span-20\" class=\"mtext\">NO<\/span><span id=\"MathJax-Span-21\" class=\"texatom\"><span id=\"MathJax-Span-22\" class=\"mrow\"><span id=\"MathJax-Span-23\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-24\" class=\"texatom\"><span id=\"MathJax-Span-25\" class=\"mrow\"><span id=\"MathJax-Span-26\" class=\"mn\">2<\/span><\/span><\/span><\/span><\/span><\/span><span class=\"MJX_Assistive_MathML\" role=\"presentation\">C6H5NO2<\/span><\/span>\u00a0and, depending on the definition used, one of the 20 to 80\u00a0essential human nutrients.\u00a0Pharmaceutical\u00a0and\u00a0supplemental\u00a0niacin are primarily used to treat\u00a0hypercholesterolemia\u00a0(high cholesterol) and\u00a0pellagra\u00a0(niacin deficiency). Insufficient niacin in the diet can cause nausea, skin and mouth lesions, anemia, headaches, and tiredness. The lack of niacin may also be observed in\u00a0pandemic\u00a0deficiency disease, which is caused by a lack of five crucial vitamins (niacin,\u00a0vitamin C,\u00a0thiamin,\u00a0vitamin D, and\u00a0vitamin A) and is usually found in areas of widespread poverty and malnutrition. Niacin is provided in the diet from a variety of\u00a0whole\u00a0and\u00a0processed foods, with highest contents in\u00a0fortified\u00a0packaged foods\u00a0and\u00a0meat\u00a0from various animal sources.<\/p>\r\n\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"180\"]<img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4101\/Nicotinamid.svg.png?revision=2\" alt=\"Nicotinamid.svg.png\" width=\"180\" height=\"140\" \/> <em>Structure of nicotinamide (niacinamide).<\/em>[\/caption]\r\n<p class=\"mt-align-justify\">Niacin supplementation has not been found useful for decreasing the risk of\u00a0cardiovascular disease\u00a0in those already on a\u00a0statin,\u00a0but appears to be effective in those not taking a statin.<sup id=\"cite_ref-7\">[<\/sup>Although niacin and nicotinamide are identical in their vitamin activity, nicotinamide does not have the same pharmacological effects (lipid modifying effects) as niacin. Nicotinamide does not reduce cholesterol or cause\u00a0flushing.\u00a0As the precursor for NAD and NADP, niacin is also involved in DNA repair.<\/p>\r\n\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"editable\">Dietary\u00a0Reference Intake<\/h3>\r\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for niacin in 1998. The current EARs for niacin for women and men ages 14 and up are 11\u00a0mg\/day and 12\u00a0mg\/day, respectively; the RDAs are 14 and 16\u00a0mg\/day, respectively. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 18\u00a0mg\/day. RDA for lactation equals 17\u00a0mg\/day. For infants up to 12 months the Adequate Intake (AI) is 2\u20134\u00a0mg\/day. and for children ages 1\u201313 years the RDA increases with age from 6 to 12\u00a0mg\/day. As for safety, the Food and Nutrition Board also sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of niacin the UL is set at 35\u00a0mg\/day.<sup id=\"cite_ref-11\">[11]<\/sup>\u00a0The European Food Safety Authority reviewed the same safety question and set its UL at 10\u00a0mg\/day.<sup id=\"cite_ref-12\">[12]<\/sup>\u00a0Safety issues are presented at length in the Side Effects section. Collectively the EARs, RDAs, AIs and ULs are referred to as\u00a0Dietary Reference Intakes.<\/p>\r\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes, the amount in a serving is expressed as a percent of Daily Value (%DV). For niacin labeling purposes, 100% of the Daily Value was 20\u00a0mg, but as of May 2016 it has been revised to 16\u00a0mg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until July 28, 2018, to comply with the change.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Sources<\/h3>\r\n<p class=\"mt-align-justify\">Niacin is found in a variety of\u00a0whole\u00a0and\u00a0processed foods, including\u00a0fortified\u00a0packaged foods,\u00a0meat\u00a0from various animal sources,\u00a0seafoods, and\u00a0spices. Among whole food sources with the highest niacin content per 100 grams:<\/p>\r\n<p class=\"mt-align-justify\">Meats<\/p>\r\n\r\n<ul>\r\n \t<li class=\"mt-align-justify\">cooked\u00a0skipjack tuna, 18.8\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">cooked light meat\u00a0turkey, 11.8\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">cooked, lean\u00a0ground pork, 11.1\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">cooked\u00a0venison, 10.8\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">cooked, lean\u00a0veal, 8.0\u00a0mg<\/li>\r\n<\/ul>\r\n<p class=\"mt-align-justify\">Plant foods\u00a0and\u00a0spices<\/p>\r\n\r\n<ul>\r\n \t<li class=\"mt-align-justify\">sesame seed\u00a0flour, 12.5\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">ground\u00a0ginger, 9.6\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">dried\u00a0tarragon, 9.0\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">dried, green\u00a0sweet peppers, 7.4\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">grilled\u00a0portabella mushrooms, 6.2\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">roasted\u00a0sunflower seeds, 4.1\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">dehydrated\u00a0apricots, 3.6\u00a0mg<\/li>\r\n \t<li class=\"mt-align-justify\">baked\u00a0potato, 3.1\u00a0mg<\/li>\r\n<\/ul>\r\n<p class=\"mt-align-justify\">Fortified\u00a0breakfast cereals\u00a0have among the highest niacin contents (more than 20\u00a0mg per 100 grams).<sup id=\"cite_ref-usda_13-1\">[13]<\/sup>\u00a0Whole grain\u00a0flours, such as from wheat, rice, barley or corn, and\u00a0pasta\u00a0have niacin contents in a range of 3\u201310\u00a0mg per 100 grams.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 class=\"editable\">Deficiencies<\/h3>\r\n<p class=\"mt-align-justify\">Between 1906 and 1940 more than 3 million Americans were affected by pellagra with more than 100,000 deaths. Dr.\u00a0Joseph Goldberger\u00a0was assigned to study pellagra by the Surgeon General of the United States and produced good results. In the late 1930s, studies by Dr.\u00a0Tom Spies, Marion Blankenhorn, and Clark Cooper established that niacin cured pellagra in humans. The disease was greatly reduced as a result.<\/p>\r\n<p class=\"mt-align-justify\">At present, niacin deficiency is sometimes seen in developed countries, and it is usually apparent in conditions of poverty, malnutrition, and chronic alcoholism.\u00a0It also tends to occur in areas where people eat\u00a0maize\u00a0(corn) as a staple food, since it is the only grain low in digestible niacin. A cooking technique called\u00a0nixtamalization\u00a0increases the bioavailability of niacin during maize meal\/flour production.<\/p>\r\n\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"220\"]<img src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Pellagra_NIH.jpg\/220px-Pellagra_NIH.jpg\" alt=\"\" width=\"220\" height=\"282\" \/> <em>A man with scurvy, which is caused by a chronic lack of vitamin B3\u00a0in the diet<\/em>[\/caption]\r\n<p class=\"mt-align-justify\">Mild niacin deficiency has been shown to slow metabolism, causing decreased tolerance to cold. Severe deficiency of niacin in the diet causes the disease\u00a0pellagra, which is characterized by diarrhea, dermatitis, and dementia, as well as\u00a0Casal's necklace\u00a0lesions on the lower neck, hyperpigmentation, thickening of the skin, inflammation of the mouth and tongue, digestive disturbances, amnesia, delirium, and eventually death, if left untreated. Common psychiatric symptoms of niacin deficiency include irritability, poor concentration, anxiety, fatigue, restlessness, apathy, and depression.\u00a0Studies have indicated that, in patients with alcoholic pellagra, niacin deficiency may be an important factor influencing both the onset and severity of this condition. Patients with alcoholism typically experience increased\u00a0intestinal permeability, leading to negative health outcomes.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\"><header>\r\n<h2 id=\"title\">7.3D: Vitamin B\u2085 (Pantothenic acid)<\/h2>\r\n<\/header><section class=\"mt-content-container\">\r\n<p class=\"mt-align-justify\">Pantothenic acid, also called\u00a0vitamin B<sub>5<\/sub>, is a\u00a0water-soluble\u00a0vitamin. Pantothenic acid is an\u00a0essential nutrient. Animals require pantothenic acid to synthesize\u00a0coenzyme-A\u00a0(CoA), as well as to synthesize and metabolize\u00a0proteins,\u00a0carbohydrates, and\u00a0fats.\u00a0Pantothenic acid is the\u00a0amide\u00a0between\u00a0pantoic acid\u00a0and\u00a0\u03b2-alanine. Its name derives from the\u00a0Greek\u00a0<i>pantothen<\/i>, meaning \"from everywhere\", and small quantities of pantothenic acid are found in nearly every food, with high amounts in\u00a0fortified\u00a0whole-grain\u00a0cereals, egg\u00a0yolks,\u00a0liver\u00a0and dried\u00a0mushrooms.\u00a0It is commonly found as its alcohol analog, the\u00a0provitamin\u00a0panthenol\u00a0(pantothenol), and as calcium pantothenate.<\/p>\r\n\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"405\"]<img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4102\/405px-(R)-Pantothenic_acid_Formula_V.1.svg.png?revision=1\" alt=\"405px-(R)-Pantothenic_acid_Formula_V.1.svg.png\" width=\"405\" height=\"136\" \/> <em>Skeletal formula of (R)-pantothenic acid<\/em>[\/caption]\r\n\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Sources<\/h3>\r\n<p class=\"mt-align-justify\">Content of pantothenic acid varies among manufactured and natural foods, especially fortified ready-to-eat cereals,\u00a0infant formulas,\u00a0energy bars\u00a0and dried foods.\u00a0Major food sources of pantothenic acid are dried mushrooms, liver, dried egg yolks and sunflower seeds.\u00a0Whole grains are another good source of the vitamin, but milling removes much of the pantothenic acid, as it is found in the outer layers of whole grains.\u00a0In animal feeds, the most important sources are alfalfa, cereal, fish meal, peanut meal, molasses, mushrooms, rice, wheat bran, and yeasts.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intake<\/h3>\r\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for B vitamins in 1998. At that time there was not sufficient information to establish EARs and RDAs for pantothenic acid. In instances such as this, the Board sets Adequate Intakes (AIs), with the understanding that at some later date, AIs will be replaced by more exact information. As for safety, the FNB sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of pantothenic acid there is no UL, as there is insufficient human data to identify adverse effects from high doses.<span class=\"mt-font-size-12\">\u00a0<\/span>The European Food Safety Authority reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for pantothenic acid.\u00a0Collectively the EARs, RDAs and ULs are referred to as\u00a0Dietary Reference Intakes.<\/p>\r\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For pantothenic acid labeling purposes 100% of the Daily Value was 10\u00a0mg, but as of May 2016 it has been revised to 5\u00a0mg. Food and supplement companies have until July 2018 to comply with the change.<\/p>\r\n\r\n<table class=\"mt-responsive-table\">\r\n<thead>\r\n<tr>\r\n<th class=\"mt-align-center\" scope=\"col\"><strong>Age group<\/strong><\/th>\r\n<th class=\"mt-align-center\" scope=\"col\"><strong>Age<\/strong><\/th>\r\n<th class=\"mt-align-center\" scope=\"col\"><strong>Adequate intake<\/strong><\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr>\r\n<td class=\"mt-align-center\">Infants<\/td>\r\n<td class=\"mt-align-center\">0\u20136 months<\/td>\r\n<td class=\"mt-align-center\">1.7\u00a0mg<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Infants<\/td>\r\n<td class=\"mt-align-center\">7\u201312 months<\/td>\r\n<td class=\"mt-align-center\">1.8\u00a0mg<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Children<\/td>\r\n<td class=\"mt-align-center\">1\u20133 years<\/td>\r\n<td class=\"mt-align-center\">2\u00a0mg<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Children<\/td>\r\n<td class=\"mt-align-center\">4\u20138 years<\/td>\r\n<td class=\"mt-align-center\">3\u00a0mg<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Children<\/td>\r\n<td class=\"mt-align-center\">9\u201313 years<\/td>\r\n<td class=\"mt-align-center\">4\u00a0mg<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Adult men and women<\/td>\r\n<td class=\"mt-align-center\">14+ years<\/td>\r\n<td class=\"mt-align-center\">5\u00a0mg<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Pregnant women<\/td>\r\n<td class=\"mt-align-center\">(vs. 5)<\/td>\r\n<td class=\"mt-align-center\">6\u00a0mg<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Breastfeeding women<\/td>\r\n<td class=\"mt-align-center\">(vs. 5)<\/td>\r\n<td class=\"mt-align-center\">7\u00a0mg<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p class=\"mt-align-justify\">Toxicity of pantothenic acid is unlikely. In fact, no Tolerable Upper Level Intake (UL) has been established for the vitamin.\u00a0Large doses of the vitamin, when ingested, have no reported side effects and massive doses (e.g., 10\u00a0g\/day) may only yield mild intestinal distress, and diarrhea at worst.\u00a0It has been suggested, however, that high doses of pantothenic acid might worsen panic attacks in those with panic disorder by prolonging the duration until adrenal exhaustion. Pantothenic acid, at a human equivalent dose within the range of common supplementation, was shown to induce adrenal hyper-responsiveness to stress stimulation.\u00a0There are also no adverse reactions known following parenteral (injected) or topical (skin) applications of the vitamin.<\/p>\r\n\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 class=\"editable\">Absorption<\/h3>\r\n<p class=\"mt-align-justify\">When found in foods, most pantothenic acid is in the form of CoA or\u00a0acyl carrier protein\u00a0(ACP). For the intestinal cells to absorb this vitamin, it must be converted into free pantothenic acid.<span class=\"mt-font-size-12\">\u00a0<\/span>Within the lumen of the intestine, CoA and ACP are hydrolyzed into 4'-phosphopantetheine.\u00a0The 4'-phosphopantetheine is then dephosphorylated into pantetheine.\u00a0Pantetheinase, an intestinal enzyme, then hydrolyzes pantetheine into free pantothenic acid. Free pantothenic acid is absorbed into intestinal cells via a saturable, sodium-dependent active transport system.\u00a0At high levels of intake, when this mechanism is saturated, some pantothenic acid may also be absorbed via passive diffusion.<span class=\"mt-font-size-12\">\u00a0<\/span>As intake increases 10-fold, however, absorption rate decreases to 10%.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\">\r\n<h3 class=\"editable\">Deficiency<\/h3>\r\n<p class=\"mt-align-justify\">Pantothenic acid deficiency is exceptionally rare and has not been thoroughly studied. In the few cases where deficiency has been seen (victims of starvation and limited volunteer trials), nearly all symptoms can be reversed with the return of pantothenic acid. Symptoms of deficiency are similar to other\u00a0vitamin B\u00a0deficiencies. There is impaired energy production, due to low CoA levels, which could cause symptoms of irritability,\u00a0fatigue, and\u00a0apathy.Acetylcholine synthesis is also impaired; therefore, neurological symptoms can also appear in deficiency;\u00a0they include numbness,\u00a0paresthesia, and muscle cramps.<span class=\"mt-font-size-12\">\u00a0<\/span>Deficiency in pantothenic acid can also cause\u00a0hypoglycemia, or an increased sensitivity to\u00a0insulin.\u00a0Insulin receptors are acylated with palmitic acid when they do not want to bind with insulin.\u00a0Therefore, more insulin will bind to receptors when acylation decreases, causing hypoglycemia.\u00a0Additional symptoms could include restlessness, malaise, sleep disturbances, nausea, vomiting, and abdominal cramps.\u00a0In a few rare circumstances, more serious (but reversible) conditions have been seen, such as\u00a0adrenal\u00a0insufficiency and\u00a0hepatic encephalopathy.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_5\" class=\"mt-section\"><header>\r\n<h2 id=\"title\">7.3E: Vitamin B\u2086 (Pyridoxine)<\/h2>\r\n<\/header><section class=\"mt-content-container\">\r\n<p class=\"mt-align-justify\">Vitamin B<sub>6<\/sub>\u00a0refers to a group of chemically similar compounds which can be interconverted in biological systems. Vitamin B<sub>6\u00a0<\/sub>is part of the\u00a0vitamin B\u00a0group of\u00a0essential nutrients. Its active form,\u00a0pyridoxal 5\u2032-phosphate, serves as a\u00a0coenzyme\u00a0in some 100\u00a0enzyme\u00a0reactions in\u00a0amino acid,\u00a0glucose, and\u00a0lipid\u00a0metabolism. Several forms<\/p>\r\n\r\n<ul>\r\n \t<li class=\"mt-align-justify\">Pyridoxine 5\u2032-phosphate (P5P)<\/li>\r\n \t<li class=\"mt-align-justify\">Pyridoxal\u00a0(PL)<\/li>\r\n \t<li class=\"mt-align-justify\">Pyridoxal 5\u2032-phosphate\u00a0(PLP), the metabolically active form (sold as P-5-P vitamin supplement)<\/li>\r\n \t<li class=\"mt-align-justify\">Pyridoxamine\u00a0(PM)<\/li>\r\n \t<li class=\"mt-align-justify\">Pyridoxamine 5\u2032-phosphate (PMP)<\/li>\r\n \t<li class=\"mt-align-justify\">4-Pyridoxic acid (PA), the\u00a0catabolite\u00a0which is excreted in urine<\/li>\r\n \t<li class=\"mt-align-justify\">Pyritinol, a semi-synthetic derivative of\u00a0pyridoxine, where two pyridoxine moieties are bound by a\u00a0disulfide\u00a0bridge.<\/li>\r\n<\/ul>\r\nAll forms except pyridoxic acid\u00a0and pyritinol can be interconverted. Absorbed pyridoxamine is converted to PMP by\u00a0pyridoxal kinase, which is further converted to PLP by\u00a0pyridoxamine-phosphate transaminase\u00a0or\u00a0pyridoxine 5\u2032-phosphate oxidase\u00a0which also catalyzes the conversion of PNP to PLP. Pyridoxine 5\u2032-phosphate oxidase is dependent on\u00a0flavin mononucleotide\u00a0(FMN) as a cofactor which is produced from\u00a0<a title=\"Vitamin B2 (Riboflavin)\" href=\"https:\/\/med.libretexts.org\/Courses\/Sacramento_City_College\/SCC%3A_Nutri_300_(Coppola)\/Chapters\/07%3A_Vitamins\/7.3%3A_Water_Soluble_Vitamins\/7.3B%3A_Vitamin_B%E2%82%82_(Riboflavin)\" rel=\"internal\">riboflavin\u00a0<\/a>(vitamin B<sub>2<\/sub>) i.e. in this biochemical pathway, dietary vitamin B<sub>6<\/sub>\u00a0cannot be used without vitamin B<sub>2<\/sub>.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"200\"]<img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4103\/1224px-Pyridoxal-phosphate.svg.png?revision=1\" alt=\"1224px-Pyridoxal-phosphate.svg.png\" width=\"200\" height=\"118\" \/> <em>Pyridoxine\u00a0and\u00a0Pyridoxamine<\/em>[\/caption]\r\n\r\nPLP, the metabolically active form of vitamin B6, is involved in many aspects of\u00a0mcronutrient\u00a0metabolism,\u00a0neurotransmitter\u00a0synthesis,\u00a0histamine\u00a0synthesis,\u00a0hemoglobin\u00a0synthesis and function, and\u00a0gene expression. PLP generally serves as a\u00a0coenzyme\u00a0(cofactor) for many reactions including\u00a0decarboxylation,\u00a0transamination,\u00a0racemization, elimination, replacement, and beta-group interconversion. The liver is the site for vitamin B6\u00a0metabolism.Amino acid metabolism PLP is a cofactor in the biosynthesis of five important\u00a0neurotransmitters:\u00a0serotonin,\u00a0dopamine,\u00a0epinephrine,\u00a0norepinephrine, and\u00a0gamma-aminobutyric acid\u00a0(GABA). PLP is also involved in the synthesis of\u00a0histamine.\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"editable\">Dietary Sources<\/h3>\r\n<p class=\"mt-align-justify\">Vitamin B<sub>6<\/sub>\u00a0is widely distributed in foods in both its free and bound forms. Cooking, storage, and processing losses of vitamin B<sub>6<\/sub>\u00a0vary and in some foods may be more than 50%,\u00a0depending on the form of vitamin present in the food. Plant foods lose the least during processing, as they contain mostly pyridoxine, which is far more stable than the pyridoxal or pyridoxamine found in animal foods. For example, milk can lose 30\u201370% of its vitamin B<sub>6<\/sub>\u00a0content when\u00a0dried.\u00a0Vitamin B<sub>6<\/sub>\u00a0is found in the\u00a0germ\u00a0and\u00a0aleurone\u00a0layer of grains, and milling results in the reduction of this vitamin in white flour. The heating that occurs before most freezing and canning processes are other methods that may result in the loss of vitamin B<sub>6<\/sub>\u00a0in foods.<\/p>\r\nFoods that contain large amounts of vitamin B6\u00a0include:\r\n<ul>\r\n \t<li>fortified\u00a0breakfast cereals<\/li>\r\n \t<li>pork<\/li>\r\n \t<li>turkey<\/li>\r\n \t<li>beef<\/li>\r\n \t<li>bananas<\/li>\r\n \t<li>chickpeas<\/li>\r\n \t<li>potatoes<\/li>\r\n \t<li>pistachios<\/li>\r\n<\/ul>\r\n<\/div>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intake<\/h3>\r\n<p class=\"mt-align-justify\">The Food and Nutrition Board (FNB) of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for vitamin B<sub>6<\/sub>\u00a0in 1998. The current EARs for vitamin B<sub>6<\/sub>\u00a0for women and men ages 14 and up increase with age from 1.0 to 1.3\u00a0mg\/day and from 1.1 to 1.4\u00a0mg\/day, respectively; the RDAs increase with age from 1.2 to 1.5 and from 1.3 to 1.7\u00a0mg\/day, respectively. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 1.9\u00a0mg\/day. RDA for lactation equals 2.0\u00a0mg\/day. For infants up to 12 months the Adequate Intake (AI) is 0.1\u20130.3\u00a0mg\/day. and for children ages 1\u201313 years the RDA increases with age from 0.5 to 1.0\u00a0mg\/day. As for safety, the FNB sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of vitamin B<sub>6<\/sub>\u00a0the UL is set at 100\u00a0mg\/day.\u00a0The European Food Safety Authority reviewed the same safety question and set its UL at 25\u00a0mg\/day. Safety issues are presented at length in the Toxicity section.<\/p>\r\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of daily value (%DV). For vitamin B<sub>6<\/sub>\u00a0labeling purposes 100% of the Daily Value was 2.0\u00a0mg, but as of May 2016 it has been revised to 1.7\u00a0mg. Food and supplement companies have until July 28, 2018 to comply with the change.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Absorption and excretion<\/h3>\r\n<p class=\"mt-align-justify\">Vitamin B<sub>6<\/sub>\u00a0is absorbed in the\u00a0jejunum\u00a0and\u00a0ileum\u00a0by passive diffusion. With the capacity for absorption being so great, animals are able to absorb quantities much greater than necessary for physiological demands. The absorption of pyridoxal phosphate and pyridoxamine phosphate involves their dephosphorylation catalyzed by a membrane-bound\u00a0alkaline phosphatase. Those products and nonphosphorylated forms in the digestive tract are absorbed by diffusion, which is driven by trapping of the vitamin as 5\u2032-phosphates through the action of phosphorylation (by a pyridoxal kinase) in the jejunal mucosa. The trapped pyridoxine and pyridoxamine are oxidized to pyridoxal phosphate in the tissue.<\/p>\r\n<p class=\"mt-align-justify\">The products of vitamin B<sub>6<\/sub>\u00a0metabolism are excreted in the urine, the major product of which is 4-pyridoxic acid. An estimated 40\u201360% of ingested vitamin B<sub>6<\/sub>\u00a0is oxidized to 4-pyridoxic acid. Several studies have shown that 4-pyridoxic acid is undetectable in the urine of vitamin B<sub>6<\/sub>-deficient subjects, making it a useful clinical marker to assess the vitamin B<sub>6<\/sub>\u00a0status of an individual.\u00a0Other products of vitamin B<sub>6<\/sub>metabolism excreted in the urine when high doses of the vitamin have been given include pyridoxal, pyridoxamine, and pyridoxine and their phosphates. A small amount of vitamin B<sub>6<\/sub>\u00a0is also excreted in the feces.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\">\r\n<h3 class=\"editable\">Deficiencies<\/h3>\r\nThe classic clinical syndrome for vitamin B6\u00a0deficiency is a\u00a0seborrhoeic dermatitis-like eruption,\u00a0atrophic glossitis\u00a0with\u00a0ulceration,\u00a0angular cheilitis,\u00a0conjunctivitis,\u00a0intertrigo, and neurologic symptoms of\u00a0somnolence, confusion, and\u00a0neuropathy\u00a0(due to impaired\u00a0sphingosine\u00a0synthesis) and\u00a0sideroblastic anemia\u00a0(due to impaired\u00a0heme\u00a0synthesis).\r\n\r\nLess severe cases present with\u00a0metabolic disease\u00a0associated with insufficient activities of the\u00a0coenzyme\u00a0PLP. The most prominent of the lesions is due to impaired\u00a0tryptophan\u2013niacin\u00a0conversion. This can be detected based on urinary excretion of\u00a0xanthurenic acid\u00a0after an oral tryptophan load. Vitamin B6\u00a0deficiency can also result in impaired\u00a0transsulfuration\u00a0of\u00a0methionine\u00a0to\u00a0cysteine. The PLP-dependent transaminases and glycogen phosphorylase provide the vitamin with its role in gluconeogenesis, so deprivation of vitamin B6\u00a0results in impaired glucose tolerance.\r\n\r\nA deficiency of vitamin B6\u00a0alone is relatively uncommon and often occurs in association with other vitamins of the B complex. The elderly and\u00a0alcoholics\u00a0have an increased risk of vitamin B6\u00a0deficiency, as well as other micronutrient deficiencies. Evidence exists for decreased levels of vitamin B6\u00a0in women with\u00a0type 1 diabetes\u00a0and in patients with systemic inflammation, liver disease, rheumatoid arthritis, and those infected with HIV.\r\n\r\n<\/div>\r\n<div id=\"section_5\" class=\"mt-section\"><header>\r\n<h2 id=\"title\">7.3F: Vitamin B\u2087 (Biotin)<\/h2>\r\n<\/header><section class=\"mt-content-container\">\r\n<p class=\"mt-align-justify\">Biotin\u00a0is a water-soluble\u00a0B-vitamin, also called\u00a0vitamin B7\u00a0and formerly known as\u00a0vitamin H\u00a0or\u00a0coenzyme R.[2]\u00a0It is composed of a ureido ring fused with a\u00a0tetrahydrothiophene\u00a0ring. A\u00a0valeric acid\u00a0substituent is attached to one of the carbon atoms of the tetrahydrothiophene ring. Biotin is a\u00a0coenzyme\u00a0for\u00a0carboxylase\u00a0enzymes, involved in the synthesis of\u00a0fatty acids,\u00a0isoleucine, and\u00a0valine, and in\u00a0gluconeogenesis.\u00a0Biotin deficiency\u00a0can be caused by inadequate dietary intake or inheritance of one or more inborn genetic disorders that affect biotin metabolism. Subclinical deficiency can cause mild symptoms, such as hair thinning or skin rash typically on the face. Neonatal screening for biotinidase deficiency began in the United States in 1984 and today many countries test for this disorder at birth. Individuals born prior to 1984 are unlikely to have been screened, thus the true prevalence of the disorder is unknown.<\/p>\r\n\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"300\"]<img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4104\/Biotin_structure.svg.png?revision=1\" alt=\"Biotin_structure.svg.png\" width=\"300\" height=\"167\" \/> <em>Skeletal formula of biotin<\/em>[\/caption]\r\n<p class=\"mt-align-justify\">Biotin is necessary for cell growth, the production of fatty acids, and the metabolism of fats and\u00a0amino acids.\u00a0Biotin assists in various metabolic reactions involving the transfer of\u00a0carbon dioxide. It may also be helpful in maintaining a steady\u00a0blood sugar\u00a0level. Biotin is often recommended as a\u00a0dietary supplement\u00a0for strengthening hair and nails, though scientific data supporting this outcome are weak.\u00a0Nevertheless, biotin is found in many cosmetics and health products for the hair and skin.<\/p>\r\n\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"editable\">Dietary Reference Intake<\/h3>\r\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for B vitamins in 1998. At that time there was not sufficient information to establish EARs and RDAs for biotin. In instances such as this, the Board sets Adequate Intakes (AIs), with the understanding that at some later date, AIs will be replaced by more exact information. The current AI for adults ages 19 and up is 30 \u03bcg\/day. AI for pregnancy is 30 \u03bcg\/day. AI for lactation is 35 \u03bcg\/day. For infants up to 12 months the AI is 5-6 \u03bcg\/day For children ages 1\u201318 years the AI increases with age from 8 to 25 \u03bcg\/day.<\/p>\r\n<p class=\"mt-align-justify\">As for safety, the FNB sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of biotin there is no UL, as there is insufficient human data to identify adverse effects from high doses. The European Food Safety Authority reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for biotin.<\/p>\r\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For biotin labeling purposes 100% of the Daily Value was 300 \u03bcg, but as of May 2016 it has been revised to 30 \u03bcg to bring it into agreement with the AI. Food and supplement companies have until July 2018 to comply with the change.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"editable\">Dietary Sources<\/h3>\r\n<p class=\"mt-align-justify\">Biotin is synthesized by\u00a0intestinal\u00a0bacteria, but there is a lack of good quality studies about how much biotin they provide.<sup id=\"cite_ref-lpi_16-0\">\u00a0<\/sup>Biotin is stable at room temperature and isn\u2019t destroyed by cooking. Some of the best sources are (content per 100 grams):<\/p>\r\n\r\n<ul>\r\n \t<li class=\"mt-align-justify\">Brewer's yeast: 188.8 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Soybeans: 179.4 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Beef liver: 113.3 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Butter: 94.3 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Split peas: 77.7 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Sunflower seeds: 66 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Green peas\/lentils: 40 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Peanuts\/walnuts: 37.5 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Pecans: 27.75 mcg<\/li>\r\n \t<li class=\"mt-align-justify\">Eggs: 18.9 mcg<\/li>\r\n<\/ul>\r\n<p class=\"mt-align-justify\">Egg whites contain a protein (avidin) that blocks the absorption of biotin, so people who regularly consume a large number of eggs may become biotin-deficient.\u00a0The dietary biotin intake in Western populations has been estimated to be 35 to 70\u00a0micrograms per day (143\u2013287\u00a0nmol per day).<sup id=\"cite_ref-jnb_19-0\">\u00a0<\/sup>Biotin is also available in\u00a0dietary supplements\u00a0in which a dose of 30 micrograms meets 100% of the\u00a0Daily Value\u00a0for adults.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 class=\"editable\">Deficiency<\/h3>\r\n<p class=\"mt-align-justify\">Biotin deficiency is rare. The amounts needed are small, a wide range of foods contain biotin, and intestinal bacteria synthesize biotin, which is then absorbed by the host animal. For that reason, statutory agencies in many countries, for example the USA\u00a0and Australia,<span class=\"mt-font-size-12\">\u00a0<\/span>have not formally established a recommended daily intake of biotin. Instead, an Adequate Intake (AI) is identified based on the theory that average intake meets needs.\u00a0A number of rare\u00a0metabolic disorders\u00a0exist in which an individual's metabolism of biotin is abnormal.<\/p>\r\n<p class=\"mt-align-justify\">Biotin deficiency\u00a0typically occurs from dietary absence of the vitamin. Consuming raw egg whites over months may result in biotin deficiency.<sup id=\"cite_ref-mlp_2-4\">\u00a0<\/sup>Deficiency can be addressed with nutritional supplementation.<sup id=\"cite_ref-mlp_2-5\">\u00a0<\/sup>Deficiency symptoms include:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"mt-align-justify\">Brittle and thin fingernails<\/li>\r\n \t<li class=\"mt-align-justify\">Hair loss (alopecia)<\/li>\r\n \t<li class=\"mt-align-justify\">Conjunctivitis<\/li>\r\n \t<li class=\"mt-align-justify\">Dermatitis\u00a0in the form of a scaly, red rash around the eyes, nose, mouth, and genital area.<\/li>\r\n \t<li class=\"mt-align-justify\">Neurological symptoms in adults, such as depression, lethargy, hallucination, and numbness and tingling of the extremities<\/li>\r\n<\/ul>\r\n<p class=\"mt-align-justify\">The neurological and psychological symptoms can occur with only mild deficiencies. Dermatitis, conjunctivitis, and hair loss will generally occur only when deficiency becomes more severe. Individuals with hereditary disorders of biotin deficiency have evidence of impaired immune system function, including increased susceptibility to bacterial and fungal infections.<\/p>\r\n<p class=\"mt-align-justify\">Pregnant women tend to have a high risk of biotin deficiency. Nearly half of pregnant women have abnormal increases of 3-hydroxyisovaleric acid, which reflects reduced status of biotin. Several studies have reported this possible biotin deficiency during the pregnancy may cause infants' congenital malformations, such as cleft palate. Mice fed with dried raw egg to induce biotin deficiency during the gestation resulted in up to 100% incidence of the infants' malnourishment. Infants and embryos are more sensitive to the biotin deficiency. Therefore, even a mild level of the mother's biotin deficiency that does not reach the appearance of physiological deficiency signs may cause a serious consequence in the infants.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\"><header>\r\n<h2 id=\"title\">7.3G: Vitamin B\u2089 (Folic acid)<\/h2>\r\n<\/header><section class=\"mt-content-container\">Folic acid, another form of which is known as\u00a0folate, is one of the\u00a0B vitamins.\u00a0The recommended daily intake level of folate is 400\u00a0micrograms\u00a0from foods or\u00a0dietary supplements.\u00a0Folic acid is used to treat\u00a0anemia\u00a0caused by\u00a0folic acid deficiency.\u00a0It is also used as a\u00a0supplement\u00a0by women during\u00a0pregnancy\u00a0to prevent\u00a0neural tube defects\u00a0(NTDs) in the baby.\u00a0Low levels in early\u00a0pregnancy\u00a0are believed to be the cause of more than half of babies born with\u00a0neural tube defects.\u00a0More than 50 countries use\u00a0fortification of certain foods\u00a0with folic acid as a measure to decrease the rate of NTDs in the population.\u00a0Long term supplementation is also associated with small reductions in the risk of\u00a0stroke\u00a0and\u00a0cardiovascular disease.\u00a0It may be taken by mouth or by injection.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"420\"]<img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4105\/420px-Folic_acid.svg.png?revision=1\" alt=\"420px-Folic_acid.svg.png\" width=\"420\" height=\"153\" \/> <em>Skeletal formula<\/em>[\/caption]\r\n\r\nThere are no common side effects. It is not known whether high doses over a long period of time are of concern. There are concerns that large amounts of folic acid might hide\u00a0vitamin B12 deficiency. It is\u00a0essential\u00a0for the body to make\u00a0DNA,\u00a0RNA, and metabolise\u00a0amino acids\u00a0which are required for\u00a0cell division.[8]\u00a0As humans cannot make folic acid, it is required from the diet, making it an\u00a0essential vitamin.\r\n\r\nNot consuming enough folate can lead to\u00a0folate deficiency. This may result in a type of anemia in which\u00a0low numbers of large red blood cells\u00a0occur. Symptoms may include\u00a0feeling tired,\u00a0heart palpitations,\u00a0shortness of breath, open sores on the tongue, and changes in the color of the skin or hair. Deficiency in children may develop within a month of poor dietary intake.[13]\u00a0In adults normal total body folate is between 10,000\u201330,000\u00a0micrograms (\u00b5g) with blood levels of greater than 7 nmol\/L (3\u00a0ng\/mL).[8]\r\n\r\nFolic acid was discovered between 1931 and 1943.[14]\u00a0It is on the\u00a0World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a\u00a0health system.[15]\u00a0The wholesale cost of supplements in the\u00a0developing world\u00a0is between 0.001 and 0.005 USD per dose as of 2014.[16]The term \"folic\" is from the Latin word\u00a0folium, which means leaf. Folates occur naturally in many foods especially dark green leafy\u00a0vegetables\u00a0and\u00a0liver.[8]\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Pregnancy and Fertility<\/h3>\r\nFolic acid intake during pregnancy has been linked to a lessened risk of\u00a0neural tube defects.\u00a0Likewise, a meta-analysis of folic acid supplementation during pregnancy reported a 28% lower risk of newborn\u00a0congenital heart defects. The\u00a0United States Preventive Services Task Force\u00a0recommends folic acid supplementation for all women able to become pregnant.\r\n\r\nDevakamar reviewed long-term outcomes for live births that did not involve neural tube defects and fortification with folic acid did not have an impact on childhood survival, growth, body composition, or cognitive outcomes. Prenatal supplementation did not appear to reduce the risk of pre-term births.\u00a0And there does not appear to be a correlation between maternal folic acid supplementation and an increased risk for asthma in the child.\r\n<p class=\"mt-align-justify\">Folate is necessary for\u00a0fertility\u00a0in both men and women. It contributes to\u00a0spermatogenesis. Therefore, it is necessary to receive sufficient amounts through the diet to avoid\u00a0subfertility.\u00a0Also, polymorphisms in genes of enzymes involved in folate metabolism could be one reason for fertility complications in some women with\u00a0unexplained infertility.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Heart Disease, Stroke and Cancer<\/h3>\r\n<p class=\"mt-align-justify\">Taking folic acid over years reduced the risk of cardiovascular disease by 4%,\u00a0where another study found it did not affect cardiovascular disease, even while reducing\u00a0homocysteine\u00a0levels.<\/p>\r\n<p class=\"mt-align-justify\">Long-term supplementation with folic acid reduced the risk of stroke by 10%, which may be due to the role folate plays in regulating homocysteine concentration.The reviews indicate the risk of stroke appears to be reduced only in some individuals, but a definite recommendation regarding supplementation beyond the current RDA has not been established for stroke prevention.\u00a0Asian populations had greater protection against stroke with folate supplementation than did European or North American subjects.<\/p>\r\n<p class=\"mt-align-justify\">Observed stroke reduction is consistent with the reduction in\u00a0pulse pressure\u00a0produced by folate supplementation of 5\u00a0mg per day, since hypertension is a key risk factor for stroke. Folic supplements are inexpensive and relatively safe to use, which is why stroke or\u00a0hyperhomocysteinemia\u00a0patients are encouraged to consume daily B vitamins including folic acid.<\/p>\r\n<p class=\"mt-align-justify\">Studies on folic acid intake from food and folate supplementation with regards to cancer risk are based on the adequacy of chronic intake. Chronically insufficient intake of folic acid (below the recommended level of 400 micrograms per day<span class=\"mt-font-size-12\">)<\/span>\u00a0may increase the risk of\u00a0colorectal, breast, ovarian, pancreas, brain, lung,\u00a0cervical, and\u00a0prostate\u00a0cancers.\u00a0Other studies showed that excessive dietary supplementation with synthetic folate may increase the risk of certain cancers, in particular\u00a0prostate.<span class=\"mt-font-size-12\">\u00a0<\/span>A 2017 review found no relationship between taking folate supplements and cancer risk.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 class=\"editable\">Dietary Reference Intake<\/h3>\r\n<p class=\"mt-align-justify\">Because of the difference in bioavailability between supplemented folic acid and the different forms of folate found in food, the dietary folate equivalent (DFE) system was established. One DFE is defined as 1\u00a0\u03bcg of dietary folate, or 0.6\u00a0\u03bcg of folic acid supplement.<\/p>\r\n\r\n<table class=\"mt-responsive-table mt-table-big\" summary=\" National Institutes of Health\u00a0(US) nutritional requirements[65]\u00a0(\u00b5g DFE per day)\"><caption><em>National Institutes of Health\u00a0(US) nutritional requirements[65]\u00a0(\u00b5g DFE per day)<\/em><\/caption>\r\n<thead>\r\n<tr>\r\n<th class=\"mt-align-center\" scope=\"col\">Age<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Infants (AI)<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Infants (UL)<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Adults (RDA)<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Adults (UL)<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Pregnant women (RDA)<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Pregnant women (UL)<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Lactating women (RDA)<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Lactating women (UL)<\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr>\r\n<td class=\"mt-align-center\">0\u20136 months<\/td>\r\n<td class=\"mt-align-center\">65<\/td>\r\n<td class=\"mt-align-center\">None set<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">7\u201312 months<\/td>\r\n<td class=\"mt-align-center\">80<\/td>\r\n<td class=\"mt-align-center\">None set<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">1\u20133 years<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">150<\/td>\r\n<td class=\"mt-align-center\">300<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">4\u20138 years<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">200<\/td>\r\n<td class=\"mt-align-center\">400<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u00a0\u2013<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">9\u201313 years<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">300<\/td>\r\n<td class=\"mt-align-center\">600<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">14\u201318<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">400<\/td>\r\n<td class=\"mt-align-center\">800<\/td>\r\n<td class=\"mt-align-center\">600<\/td>\r\n<td class=\"mt-align-center\">800<\/td>\r\n<td class=\"mt-align-center\">500<\/td>\r\n<td class=\"mt-align-center\">800<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">19+<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">\u2013<\/td>\r\n<td class=\"mt-align-center\">400<\/td>\r\n<td class=\"mt-align-center\">1000<\/td>\r\n<td class=\"mt-align-center\">600<\/td>\r\n<td class=\"mt-align-center\">1000<\/td>\r\n<td class=\"mt-align-center\">500<\/td>\r\n<td class=\"mt-align-center\">1000<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For folic acid labeling purposes 100% of the Daily Value was 400 \u03bcg. As of the May 2016 update it was kept unchanged at 400 \u03bcg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until 28 July 2018 to comply with the change.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Sources<\/h3>\r\nFolate naturally occurs in a wide variety of foods, including vegetables (particularly dark green\u00a0leafy vegetables), fruits and fruit juices, nuts, beans, peas, dairy products, poultry and meat, eggs, seafood, grains, and some beers.\u00a0Avocado,\u00a0beetroot,\u00a0spinach,\u00a0liver,\u00a0yeast,\u00a0asparagus, and\u00a0Brussels sprouts\u00a0are among the foods with the highest levels of folate. Folic acid is added to grain products in many countries, and in these countries, fortified products make up a significant source of the population's folic acid intake. Because of the difference in bioavailability between supplemented folic acid and the different forms of folate found in food, the dietary folate equivalent (DFE) system was established. 1 DFE is defined as 1 \u03bcg of dietary folate, or 0.6 \u03bcg of folic acid supplement. This is reduced to 0.5 \u03bcg of folic acid if the supplement is taken on an empty stomach. bFolate naturally found in food is susceptible to high heat and ultraviolet light, and is soluble in water.\u00a0It is heat-labile in acidic environments and may also be subject to oxidation. Some meal replacement products do not meet the folate requirements as specified by the\u00a0RDAs.\r\n<div class=\"note1\">\r\n<div class=\"textbox shaded\">\r\n<h3 class=\"boxtitle\">FOOD FORTIFICATION<\/h3>\r\n\r\n<hr \/>\r\n<p class=\"mt-align-justify\"><i>Folic acid fortification<\/i>\u00a0is a process where folic acid is added to flour with the intention of promoting public health through increasing blood folate levels in the populace. In the USA, food is fortified with folic acid, only one of the many naturally occurring forms of folate, and a substance contributing only a minor amount to the folates in natural foods. Since the discovery of the link between insufficient folic acid and\u00a0neural tube defects, governments and health organizations worldwide have made recommendations concerning folic acid\u00a0<i>supplementation<\/i>\u00a0for women intending to become\u00a0pregnant.<\/p>\r\n<p class=\"mt-align-justify\">Fortification is controversial, with issues having been raised concerning individual liberty, as well as the health concerns described in the\u00a0Toxicity\u00a0section above. In the USA, there is concern that the federal government mandates fortification, but does not provide monitoring of potential undesirable effects of fortification. 76 countries worldwide (inclduing the USA) require mandatory folic acid fortification of at least one major cereal grain, with nearly all fortifying at least wheat flour, according to November 2013 data from the Flour Fortification Initiative.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div id=\"section_5\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Folate Deficiency<\/h3>\r\n<p class=\"mt-align-justify\">Folate deficiency can be caused by unhealthy diets that do not include enough fruits and vegetables, diseases in which folic acid is not well absorbed in the digestive system (such as\u00a0Crohn's disease\u00a0or\u00a0celiac disease), some genetic disorders that affect levels of folate, and certain medicines (such as phenytoin, sulfasalazine, or trimethoprim-sulfamethoxazole).\u00a0Folate deficiency is accelerated by alcohol consumption.<\/p>\r\n<p class=\"mt-align-justify\">Folate deficiency may lead to\u00a0glossitis, diarrhea, depression, confusion, anemia, and fetal\u00a0neural tube defects\u00a0and brain defects (during pregnancy).\u00a0Other symptoms include fatigue, gray hair, mouth sores, poor growth, and swollen tongue. Folate deficiency is diagnosed by analyzing\u00a0CBC\u00a0and plasma vitamin B<sub>12<\/sub>\u00a0and folate levels.<span class=\"mt-font-size-12\">\u00a0<\/span>CBC may indicate megaloblastic anemia but this could also be a sign of vitamin B<sub>12<\/sub>\u00a0deficiency.\u00a0A serum folate of 3 \u03bcg\/L or lower indicates deficiency.\u00a0Serum folate level reflects folate status but erythrocyte folate level better reflects tissue stores after intake. Serum folate reacts more rapidly to folate intake than erythrocyte folate.\u00a0An erythrocyte folate level of 140 \u03bcg\/L or lower indicates inadequate folate status.\u00a0Increased homocysteine level suggests tissue folate deficiency but homocysteine is also affected by vitamin B<sub>12<\/sub>\u00a0and vitamin B<sub>6<\/sub>, renal function, and genetics.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_6\" class=\"mt-section\"><header>\r\n<h2 id=\"title\">7.3H: Vitamin B\u2081\u2082 (Cobalamin)<\/h2>\r\n<\/header><section class=\"mt-content-container\">Vitamin B<sub>12<\/sub>, also called\u00a0cobalamin, is a water-soluble\u00a0vitamin\u00a0that has a key role in the normal functioning of the\u00a0brain\u00a0and\u00a0nervous system, and the formation of red blood cells. It is one of eight\u00a0B vitamins. It is involved in the\u00a0metabolism\u00a0of every\u00a0cell\u00a0of the human body, especially affecting\u00a0DNA\u00a0synthesis,\u00a0fatty acid\u00a0and\u00a0amino acid\u00a0metabolism.[1]\u00a0No fungi, plants, nor animals (including humans) are capable of producing vitamin B<sub>12<\/sub>. Only\u00a0bacteria\u00a0and\u00a0archaea\u00a0have the enzymes needed for its synthesis. Proven sources of B<sub>12<\/sub>\u00a0are animal products (meat, fish, dairy products) and supplements. Some research states that certain non-animal products possibly can be a natural source of B<sub>12<\/sub>\u00a0because of\u00a0bacterial symbiosis. B<sub>12<\/sub>\u00a0is the largest and most structurally complicated vitamin and can be produced industrially only through a bacterial fermentation-synthesis. This synthetic B<sub>12<\/sub>\u00a0is used to\u00a0fortify foods\u00a0and sold as a dietary supplement.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"350\"]<img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4106\/800px-Cyanocobalamin-b12.png?revision=1\" alt=\"800px-Cyanocobalamin-b12.png\" width=\"350\" height=\"404\" \/> <em>Chemical structure of cyanocobalamin. Image used with permission (CC BY-SA 4.0;\u00a0Alsosaid1987).<\/em>[\/caption]\r\n\r\nVitamin B<sub>12\u00a0<\/sub>consists of a class of chemically related compounds (vitamers), all of which show\u00a0pharmacological activity. It contains the biochemically rare element\u00a0cobalt\u00a0(chemical symbol\u00a0Co) positioned in the center of a planar tetra-pyrrole\u00a0ring called a\u00a0corrin\u00a0ring. The vitamer is produced by bacteria as\u00a0hydroxocobalamin, but conversion between different forms of the vitamin occurs in the body after consumption.\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intake<\/h3>\r\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine (IOM) updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for vitamin B<sub>12<\/sub>\u00a0in 1998. The current EAR for vitamin B<sub>12<\/sub>\u00a0for women and men ages 14 and up is 2.0 \u03bcg\/day; the RDA is 2.4 \u03bcg\/day. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 2.6 \u03bcg\/day. RDA for lactation equals 2.8 \u03bcg\/day. For infants up to 12 months the Adequate Intake (AI) is 0.4-0.5 \u03bcg\/day. and for children ages 1\u201313 years the RDA increases with age from 0.9 to 1.8 \u03bcg\/day. Because 10 to 30 percent of older people may be unable to effectively absorb vitamin B<sub>12<\/sub>\u00a0naturally occurring in foods, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B<sub>12<\/sub>\u00a0or a supplement containing vitamin B<sub>12<\/sub>.<\/p>\r\nFor U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For vitamin B<sub>12<\/sub>\u00a0labeling purposes 100% of the Daily Value was 6.0 \u03bcg, but as of May 2016 has been revised downward to 2.4 \u03bcg.\r\n\r\n<\/div>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"editable\">Deficiency<\/h3>\r\n<p class=\"mt-align-justify\">Vitamin B<sub>12<\/sub>\u00a0deficiency can potentially cause severe and irreversible damage, especially to the brain and nervous system. At levels only slightly lower than normal, a range of symptoms such as\u00a0fatigue,\u00a0lethargy,\u00a0depression, poor\u00a0memory, breathlessness, headaches, and pale skin, among others, may be experienced, especially in elderly people (over age 60)\u00a0who produce less stomach acid as they age, thereby increasing their probability of B<sub>12<\/sub>deficiencies.<\/p>\r\n<p class=\"mt-align-justify\">Vitamin B<sub>12<\/sub>\u00a0deficiency is most commonly caused by low intakes, but can also result from malabsorption, certain intestinal disorders, low presence of binding proteins, and use of certain medications. Vitamin B<sub>12<\/sub>\u00a0is rare from plant sources, so vegetarians are most likely to suffer from vitamin B<sub>12<\/sub>\u00a0deficiency. Infants are at a higher risk of vitamin B<sub>12<\/sub>\u00a0deficiency if they were born to vegetarian mothers. The elderly who have diets with limited meat or animal products are vulnerable populations as well. Vitamin B<sub>12<\/sub>\u00a0deficiency may occur in between 40% to 80% of the vegetarian population.<\/p>\r\n<p class=\"mt-align-justify\">Vitamin B<sub>12<\/sub>\u00a0is a co-substrate of various cell reactions involved in methylation synthesis of nucleic acid and neurotransmitters. Synthesis of the trimonoamine neurotransmitters can enhance the effects of a traditional antidepressant.\u00a0The intracellular concentrations of vitamin B<sub>12<\/sub>\u00a0can be inferred through the total plasma concentration of homocysteine, which can be converted to methionine through an enzymatic reaction that uses 5-methyltetrahydrofolate as the methyl donor group. Consequently, the plasma concentration of homocysteine falls as the intracellular concentration of vitamin B<sub>12<\/sub>\u00a0rises. The active metabolite of vitamin B<sub>12<\/sub>\u00a0is required for the methylation of homocysteine in the production of methionine, which is involved in a number of biochemical processes including the monoamine neurotransmitters metabolism. Thus, a deficiency in vitamin B<sub>12<\/sub>\u00a0may impact the production and function of those neurotransmitters.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 class=\"editable\">Dietary Sources<\/h3>\r\n<p class=\"mt-align-justify\">Foods having rich content of vitamin B<sub>12<\/sub>\u00a0include\u00a0clams,\u00a0organ meats\u00a0(especially\u00a0liver) from\u00a0lamb,\u00a0veal, beef, and\u00a0turkey,\u00a0fish eggs,\u00a0mackerel, and\u00a0crab meat.<span class=\"mt-font-size-12\">\u00a0<\/span>B<sub>12<\/sub>\u00a0is synthesized by some\u00a0gut bacteria\u00a0in humans and other animals, but humans cannot absorb the B<sub>12<\/sub>\u00a0made in their guts, as it is made in the\u00a0colon\u00a0which is too far from the\u00a0small intestine, where absorption of B<sub>12<\/sub>\u00a0occurs.<\/p>\r\n<p class=\"mt-align-justify\">Animals store vitamin B<sub>12<\/sub>\u00a0in liver and muscle and some pass the vitamin into their eggs and milk; meat, liver, eggs and milk are therefore sources of the vitamin for other animals, including people.<span class=\"mt-font-size-12\">\u00a0<\/span>For humans, the bioavailability from eggs is less than 9%, compared to 40% to 60% from fish, fowl and meat.\u00a0Insects are also a source of B<sub>12<\/sub>.\u00a0Foods\u00a0fortified\u00a0with B<sub>12<\/sub>\u00a0are also dietary sources of the vitamin. Foods for which B<sub>12<\/sub>-fortified versions are widely available include\u00a0breakfast cereals,\u00a0soy\u00a0products,\u00a0energy bars, and\u00a0nutritional yeast.<\/p>\r\n<p class=\"mt-align-justify\">Vitamin B<sub>12<\/sub>\u00a0is an ingredient in multi-vitamin pills and in some countries used to enrich grain-based foods such as bread and pasta. In the U.S. non-prescription products can be purchased providing up to 5000\u00a0\u00b5g\/serving, and it is a common ingredient in\u00a0energy drinks\u00a0and\u00a0energy shots, usually at many times the recommended dietary allowance of B<sub>12<\/sub>. The vitamin can also be a prescription product via injection or other means.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Absorption and Distribution<\/h3>\r\n<p class=\"mt-align-justify\">Methyl-B<sub>12<\/sub>\u00a0is absorbed by two processes. The first is an intestinal mechanism using\u00a0intrinsic factor\u00a0through which 1-2 micrograms can be absorbed every few hours. The second is a diffusion process by which approximately 1% of the remainder is absorbed.\u00a0The human physiology of vitamin B<sub>12<\/sub>\u00a0is complex, and therefore is prone to mishaps leading to\u00a0vitamin B<sub>12<\/sub>\u00a0deficiency. Protein-bound vitamin B<sub>12<\/sub>must be released from the proteins by the action of digestive proteases in both the stomach and small intestine.<\/p>\r\n<p class=\"mt-align-justify\">Absorption of food vitamin B<sub>12<\/sub>\u00a0thus requires an intact and functioning\u00a0stomach,\u00a0exocrine pancreas, intrinsic factor, and small bowel. Problems with any one of these organs makes a\u00a0vitamin B<sub>12<\/sub>\u00a0deficiency\u00a0possible. Individuals who lack intrinsic factor have a decreased ability to absorb B<sub>12<\/sub>. The total amount of vitamin B<sub>12<\/sub>\u00a0stored in body is about 2\u20135\u00a0mg in adults. Around 50% of this is stored in the liver. Approximately 0.1% of this is lost per day by secretions into the gut, as not all these secretions are reabsorbed. Bile is the main form of B<sub>12<\/sub>\u00a0excretion; most of the B<sub>12<\/sub>\u00a0secreted in the bile is recycled via enterohepatic circulation. Excess B<sub>12<\/sub>\u00a0beyond the blood's binding capacity is typically excreted in urine. Owing to the extremely efficient enterohepatic circulation of B<sub>12<\/sub>, the liver can store 3 to 5 years\u2019 worth of vitamin B<sub>12<\/sub>;<span class=\"mt-font-size-12\">\u00a0<\/span>therefore, nutritional deficiency of this vitamin is rare. How fast B<sub>12<\/sub>levels change depends on the balance between how much B<sub>12<\/sub>\u00a0is obtained from the diet, how much is secreted and how much is absorbed. B<sub>12<\/sub>\u00a0deficiency may arise in a year if initial stores are low and genetic factors unfavorable, or may not appear for decades. In infants, B<sub>12<\/sub>\u00a0deficiency can appear much more quickly.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_5\" class=\"mt-section\"><header>\r\n<h2 id=\"title\">7.3I: Vitamin C (Ascorbic acid)<\/h2>\r\n<\/header><section class=\"mt-content-container\">\r\n<p class=\"mt-align-justify\">Vitamin C (ascorbic acid\u00a0and\u00a0L-ascorbic acid)\u00a0is a\u00a0vitamin\u00a0found in food and used as a\u00a0dietary supplement. As a supplement it is used to treat and prevent\u00a0scurvy.\u00a0Evidence does not support use in the general population for the prevention of the\u00a0common cold.\u00a0It may be taken by mouth or by injection. It is generally well tolerated.\u00a0Large doses may cause gastrointestinal upset, headache, trouble sleeping, and flushing of the skin.<span class=\"mt-font-size-12\">\u00a0<\/span>Normal doses are safe during\u00a0pregnancy.\u00a0Vitamin C is an\u00a0essential nutrient\u00a0involved in the repair of\u00a0tissue. Foods that contain vitamin C include\u00a0citrus fruit,\u00a0tomatoes, and\u00a0potatoes.<\/p>\r\n\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"220\"]<a class=\"link-https\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ascorbic-acid-3D-vdW.png\" target=\"_blank\" rel=\"external nofollow noopener\"><img src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1b\/Ascorbic-acid-3D-vdW.png\/220px-Ascorbic-acid-3D-vdW.png\" alt=\"\" width=\"220\" height=\"230\" \/><\/a> <em>Model of a vitamin C\u00a0molecule. Black is\u00a0carbon, red is\u00a0oxygen, and white is\u00a0hydrogen<\/em>[\/caption]\r\n<p class=\"mt-align-justify\">Vitamin C was discovered in 1912, isolated in 1928, and first made in 1933.\u00a0It is on the\u00a0World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a\u00a0health system.<span class=\"mt-font-size-12\">\u00a0<\/span>Vitamin C is available as a\u00a0generic medication\u00a0and\u00a0over the counter.\u00a0In 2015, the wholesale cost in the\u00a0developing world\u00a0was about 0.003 to 0.007 USD per tablet. In some countries, ascorbic acid may be added to foods such as\u00a0breakfast cereal.<\/p>\r\n\r\n<div id=\"section_1\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Medical uses<\/h3>\r\n<p class=\"mt-align-justify\">A 2012 Cochrane review found no effect of vitamin C supplementation on overall mortality.<\/p>\r\n\r\n<ul>\r\n \t<li><strong>Scurvy<\/strong>: Although rare in modern times,\u00a0scurvy\u00a0and its associated destabilization of\u00a0collagen,\u00a0connective tissue, and bone can be prevented by adequate vitamin C intake.<\/li>\r\n \t<li class=\"mt-align-justify\"><strong>Cancer prevention:<\/strong>\u00a0A 2014 review found that, \"Currently, the use of high-dose IV vitamin C [as an anticancer agent] cannot be recommended outside of a clinical trial.\" A 2013 Cochrane review found no evidence that vitamin C supplementation reduces the risk of lung cancer in healthy or high risk (smokers and asbestos-exposed) people.\u00a0A 2014 meta-analysis found that vitamin C intake might protect against lung cancer risk.\u00a0A second meta-analysis found no effect on the risk of prostate cancer. Two meta-analyses evaluated the effect of vitamin C supplementation on the risk of colorectal cancer. One found a weak association between vitamin C consumption and reduced risk, and the other found no effect of supplementation.\u00a0A 2011 meta-analysis failed to find support for the prevention of breast cancer with vitamin C supplementation,but a second study concluded that vitamin C may be associated with increased survival in those already diagnosed.<\/li>\r\n \t<li class=\"mt-align-justify\"><strong>Cardiovascular disease:\u00a0<\/strong>A 2013 meta-analysis found no evidence that vitamin C supplementation reduces the risk of myocardial infarction, stroke, cardiovascular mortality, or all-cause mortality. However, a second analysis found an inverse relationship between circulating vitamin C levels or dietary vitamin C and the risk of stroke.<sup id=\"cite_ref-18\">\u00a0<\/sup>A meta-analysis of 44 clinical trials has shown a significant positive effect of vitamin C on\u00a0endothelial\u00a0function when taken at doses greater than 500\u00a0mg per day. The researchers noted that the effect of vitamin C supplementation appeared to be dependent on health status, with stronger effects in those at higher cardiovascular disease risk.<\/li>\r\n \t<li class=\"mt-align-justify\"><strong>Chronic diseases<\/strong>: A 2010 review found no role for vitamin C supplementation in the treatment of rheumatoid arthritis.<span class=\"mt-font-size-12\">\u00a0<\/span>Studies examining the effects of vitamin C intake on the risk of Alzheimer's disease have reached conflicting conclusions.\u00a0Maintaining a healthy dietary intake is probably more important than supplementation for achieving any potential benefit. Vitamin C supplementation above the RDA has been used in trials to study a potential effect on preventing and slowing the progression of age-related\u00a0cataract. However, no significant effects were found from the research.<\/li>\r\n \t<li class=\"mt-align-justify\"><strong>Common cold<\/strong>: Vitamin C's effect on the\u00a0common cold\u00a0has been extensively researched. It has not been shown effective in prevention or treatment of the common cold, except in limited circumstances (specifically, individuals exercising vigorously in cold environments).\u00a0Routine vitamin C supplementation does not reduce the incidence or severity of the\u00a0common cold\u00a0in the general population, though it may reduce the duration of illness.<\/li>\r\n<\/ul>\r\n<div id=\"section_2\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Possible<\/h3>\r\n<p class=\"mt-align-justify\">As vitamin C enhances iron absorption,\u00a0iron poisoning\u00a0can become an issue to people with rare\u00a0iron overload disorders, such as\u00a0haemochromatosis. A genetic condition that results in inadequate levels of the enzyme\u00a0glucose-6-phosphate dehydrogenase\u00a0(G6PD) can cause sufferers to develop\u00a0hemolytic anemia\u00a0after ingesting specific oxidizing substances, such as very large dosages of vitamin C.<\/p>\r\n<p class=\"mt-align-justify\">There is a longstanding belief among the mainstream medical community that vitamin C causes kidney stones, which is based on little science.\u00a0Although recent studies have found a relationship,<span class=\"mt-font-size-12\">\u00a0<\/span>a clear link between excess\u00a0ascorbic acid\u00a0intake and\u00a0kidney stone\u00a0formation has not been generally established. Some case reports exist for a link between patients with oxalate deposits and a history of high-dose vitamin C usage.<\/p>\r\n<p class=\"mt-align-justify\">In a study conducted on rats, during the first month of pregnancy, high doses of vitamin C may suppress the production of\u00a0progesterone\u00a0from the\u00a0corpus luteum.\u00a0Progesterone, necessary for the maintenance of a pregnancy, is produced by the corpus luteum for the first few weeks, until the placenta is developed enough to produce its own source. By blocking this function of the corpus luteum, high doses of vitamin C (1000+ mg) are theorized to induce an early miscarriage. In a group of spontaneously aborting women at the end of the first trimester, the mean values of vitamin C were significantly higher in the aborting group. However, the authors do state: 'This could not be interpreted as an evidence of causal association.' However, in a previous study of 79 women with threatened, previous spontaneous, or habitual abortion, Javert and Stander (1943) had 91% success with 33 patients who received vitamin C together with bioflavonoids and\u00a0<a title=\"Vitamin K\" href=\"https:\/\/med.libretexts.org\/Courses\/Sacramento_City_College\/SCC%3A_Nutri_300_(Coppola)\/Chapters\/07%3A_Vitamins\/7.2%3A_Fat_Soluble_Vitamins\/7.2D%3A_Vitamin_K\" rel=\"internal\">Vitamin K<\/a>\u00a0(only three abortions), whereas all of the 46 patients who did not receive the vitamins aborted.<\/p>\r\n<p class=\"mt-align-justify\">A study in rats and humans suggested that adding Vitamin C supplements to an exercise training program lowered the expected effect of training on\u00a0VO2 Max. Although the results in humans were not statistically significant, this study is often cited as evidence that high doses of Vitamin C have an adverse effect on exercise performance. In rats, it was shown that the additional Vitamin C resulted in lowered mitochondria production.\u00a0Since rats are able to produce all of their needed Vitamin C, however, it is questionable whether they offer a relevant model of human physiological processes in this regard.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<h3 class=\"editable\">Biological Significance<\/h3>\r\n<p class=\"mt-align-justify\">Vitamin C is an\u00a0essential nutrient\u00a0for certain animals including humans. Vitamin C describes several\u00a0vitamers\u00a0that have vitamin C activity in animals, including ascorbic acid and its salts, and some oxidized forms of the molecule like\u00a0dehydroascorbic acid. Ascorbate and ascorbic acid are both naturally present in the body when either of these is introduced into cells, since the forms interconvert according to\u00a0pH. Vitamin C is a\u00a0cofactor\u00a0in at least eight\u00a0enzymatic\u00a0reactions, including several\u00a0collagen\u00a0synthesis reactions that, when dysfunctional, cause the most severe symptoms of\u00a0scurvy.\u00a0In animals, these reactions are especially important in wound-healing and in preventing bleeding from capillaries. Ascorbate also acts as an\u00a0antioxidant, protecting against\u00a0oxidative stress.<\/p>\r\n<p class=\"mt-align-justify\">The biological role of ascorbate is to act as a\u00a0reducing agent, donating electrons to various enzymatic and a few non-enzymatic reactions. The one- and two-electron oxidized forms of vitamin C, semidehydroascorbic acid and\u00a0dehydroascorbic acid, respectively, can be reduced in the body by\u00a0glutathione\u00a0and\u00a0NADPH-dependent\u00a0enzymatic\u00a0mechanisms.\u00a0The presence of glutathione in cells and extracellular fluids helps maintain ascorbate in a reduced state.<\/p>\r\n<p class=\"mt-align-justify\">In humans, vitamin C is essential to a healthy diet as well as being a highly effective\u00a0antioxidant, acting to lessen\u00a0oxidative stress; a substrate for\u00a0ascorbate peroxidase\u00a0in plants (APX is plant specific enzyme);<span class=\"mt-font-size-12\">\u00a0<\/span>and an enzyme\u00a0cofactor\u00a0for the\u00a0biosynthesis\u00a0of many important biochemicals. Vitamin C acts as an\u00a0electron donor\u00a0for important\u00a0enzymes.<\/p>\r\n<p class=\"mt-align-justify\">Ascorbate is required for a range of essential\u00a0metabolic reactions\u00a0in all animals and plants. It is\u00a0made internally\u00a0by almost all organisms; the main exceptions are most\u00a0bats, all\u00a0guinea pigs,\u00a0capybaras, and the\u00a0Haplorrhini\u00a0(one of the two major\u00a0primate\u00a0suborders, consisting of\u00a0tarsiers,\u00a0monkeys, and\u00a0humans\u00a0and other\u00a0ape<a class=\"link-https\" title=\"Ape\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ape\" target=\"_blank\" rel=\"external nofollow noopener\">s<\/a>). Ascorbate is also not synthesized by many species of birds and fish. All species that do not synthesize ascorbate require it in the diet.<\/p>\r\n\r\n<div class=\"note1\">\r\n<div class=\"textbox shaded\">\r\n<div id=\"section_3\" class=\"mt-section\">\r\n<div class=\"note1\">\r\n<h3 class=\"boxtitle\">DEFICIENCY<\/h3>\r\n<p class=\"mt-align-justify\">Scurvy\u00a0is an\u00a0avitaminosis\u00a0resulting from lack of vitamin C, since without this vitamin, the synthesized\u00a0collagen\u00a0is too unstable to perform its function.\u00a0Scurvy leads to the formation of\u00a0brown spots\u00a0on the skin, spongy gums, and bleeding from all\u00a0mucous membranes. The spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. In advanced scurvy there are open,\u00a0suppurating wounds\u00a0and loss of\u00a0teeth\u00a0and, eventually, death. The human body can store only a certain amount of vitamin C,\u00a0and so the body stores are depleted if fresh supplies are not consumed. The time frame for onset of symptoms of scurvy in unstressed adults on a completely vitamin C free diet, however, may range from one month to more than six months, depending on previous loading of vitamin C.<\/p>\r\n<p class=\"mt-align-justify\">Western societies generally consume far more than sufficient vitamin C to prevent scurvy. In 2004, a Canadian Community health survey reported that Canadians of 19 years and above have intakes of vitamin C from food of 133\u00a0mg\/d for males and 120\u00a0mg\/d for females;\u00a0these are higher than the RDA recommendations.<\/p>\r\n<p class=\"mt-align-justify\">Notable human dietary studies of experimentally induced scurvy have been conducted on conscientious objectors during WWII in Britain and on Iowa state prisoners in the late 1960s to the 1980s. These studies both found that all obvious symptoms of scurvy previously induced by an experimental\u00a0scorbutic\u00a0diet with extremely low vitamin C content could be completely reversed by additional vitamin C supplementation of only 10\u00a0mg a day. In these experiments, there was no clinical difference noted between men given 70\u00a0mg vitamin C per day (which produced blood level of vitamin C of about 0.55\u00a0mg\/dl, about 1\/3 of tissue saturation levels) and those given 10\u00a0mg per day. Men in the prison study developed the first signs of scurvy about 4 weeks after starting the vitamin C-free diet, whereas in the British study, six to eight months were required, possibly due to the pre-loading of this group with a 70\u00a0mg\/day supplement for six weeks before the scorbutic diet was fed.<\/p>\r\n<p class=\"mt-align-justify\">Men in both studies on a diet devoid, or nearly devoid, of vitamin C had blood levels of vitamin C too low to be accurately measured when they developed signs of scurvy, and in the Iowa study, at this time were estimated (by labeled vitamin C dilution) to have a body pool of less than 300\u00a0mg, with daily turnover of only 2.5\u00a0mg\/day, implying an instantaneous half-life of 83 days by this time (elimination constant of 4 months).<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\">\r\n\r\n&nbsp;\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div id=\"section_4\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Absorption, transport, and excretion<\/h3>\r\n<p class=\"mt-align-justify\">Ascorbic acid is absorbed in the body by both active transport and simple diffusion. Sodium-Dependent Active Transport\u2014Sodium-Ascorbate Co-Transporters (SVCTs) and Hexose transporters (GLUTs)\u2014are the two transporters required for absorption.\u00a0SVCT1\u00a0and\u00a0SVCT2\u00a0import the reduced form of ascorbate across plasma membrane.GLUT1\u00a0and\u00a0GLUT3\u00a0are the two glucose transporters, and transfer only the dehydroascorbic acid form of Vitamin C.<sup id=\"cite_ref-pmid9228080_82-0\">[82]<\/sup>\u00a0Although dehydroascorbic acid is absorbed in higher rate than ascorbate, the amount of dehydroascorbic acid found in plasma and tissues under normal conditions is low, as cells rapidly reduce dehydroascorbic acid to ascorbate.\u00a0Thus, SVCTs appear to be the predominant system for vitamin C transport in the body.<\/p>\r\n<p class=\"mt-align-justify\">SVCT2 is involved in vitamin C transport in almost every tissue,<sup id=\"cite_ref-Savini_2008_81-1\">[81]<\/sup>\u00a0the notable exception being red blood cells, which lose SVCT proteins during maturation.<sup id=\"cite_ref-pmid17586466_85-0\">[85]<\/sup>\u00a0\"SVCT2 knockout\" animals genetically engineered to lack this functional gene, die shortly after birth,<sup id=\"cite_ref-pmid11984597_86-0\">[86]<\/sup>\u00a0suggesting that SVCT2-mediated vitamin C transport is necessary for life.<\/p>\r\n<p class=\"mt-align-justify\">With regular intake the absorption rate varies between 70 and 95%. However, the degree of absorption decreases as intake increases. At high intake (1.25 g), fractional human absorption of ascorbic acid may be as low as 33%; at low intake (&lt;200\u00a0mg) the absorption rate can reach up to 98%.<\/p>\r\n<p class=\"mt-align-justify\">Ascorbate concentrations over the renal re-absorption threshold pass freely into the urine and are excreted. At high dietary doses (corresponding to several hundred mg\/day in humans) ascorbate is accumulated in the body until the plasma levels reach the renal resorption threshold, which is about 1.5\u00a0mg\/dL in men and 1.3\u00a0mg\/dL in women. Concentrations in the plasma larger than this value (thought to represent body saturation) are rapidly excreted in the urine with a half-life of about 30 minutes. Concentrations less than this threshold amount are actively retained by the kidneys, and the excretion half-life for the remainder of the vitamin C store in the body thus increases greatly, with the half-life lengthening as the body stores are depleted. This half-life rises until it is as long as 83 days by the onset of the first symptoms of scurvy.<sup id=\"cite_ref-pmid8263270_88-0\">[88]<\/sup><\/p>\r\n<p class=\"mt-align-justify\">Although the body's maximal store of vitamin C is largely determined by the renal threshold for blood, there are many tissues that maintain vitamin C concentrations far higher than in blood. Biological\u00a0tissues\u00a0that accumulate over 100 times the level in blood plasma of vitamin C are the\u00a0adrenal glands,\u00a0pituitary,\u00a0thymus,\u00a0corpus luteum, and\u00a0retina.<sup id=\"cite_ref-pmid11984580_89-0\">[89]<\/sup>\u00a0Those with 10 to 50 times the concentration present in blood plasma include the\u00a0brain,\u00a0spleen,\u00a0lung,\u00a0testicle,\u00a0lymph nodes,\u00a0liver,\u00a0thyroid,\u00a0small intestinal\u00a0mucosa,\u00a0leukocytes,\u00a0pancreas,\u00a0kidney, and\u00a0salivary glands.<\/p>\r\n<p class=\"mt-align-justify\">Ascorbic acid can be\u00a0oxidized\u00a0(broken down) in the human body by the enzyme\u00a0L-ascorbate oxidase. Ascorbate that is not directly excreted in the urine as a result of body saturation or destroyed in other body metabolism is oxidized by this enzyme and removed.<\/p>\r\n\r\n<div id=\"section_6\" class=\"mt-section\">\r\n<h3 class=\"editable\">Immune system<\/h3>\r\n<p class=\"mt-align-justify\">Vitamin C is found in high concentrations in\u00a0immune cells, and is consumed quickly during infections. It is not certain how vitamin C interacts with the immune system; it has been hypothesized to modulate the activities of\u00a0phagocytes, the production of\u00a0cytokines\u00a0and\u00a0lymphocytes, and the number of\u00a0cell adhesion molecules\u00a0in\u00a0monocytes.<sup id=\"cite_ref-Preedy_101-0\">[101]<\/sup><\/p>\r\n\r\n<\/div>\r\n<div id=\"section_7\" class=\"mt-section\">\r\n<h3 class=\"editable\">Daily Requirements<\/h3>\r\n<p class=\"mt-align-justify\">The\u00a0North American\u00a0Dietary Reference Intake\u00a0recommends 90 milligrams per day for adult men, 75\u00a0mg\/day for adult women, and no more than 2\u00a0grams (2,000 milligrams) per day.\u00a0A balanced diet without supplementation usually contains enough vitamin C to prevent scurvy in an average healthy adult, while those who smoke tobacco or are under stress require slightly more.<\/p>\r\n\r\n<table class=\"mt-responsive-table\"><caption><em>United States vitamin C recommendations<\/em><\/caption>\r\n<tbody>\r\n<tr>\r\n<td class=\"mt-align-center mt-noheading\">Recommended Dietary Allowance\u00a0(adult male)<\/td>\r\n<td class=\"mt-align-center mt-colspan mt-noheading\">90\u00a0mg\u00a0per day<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center mt-noheading\">Recommended Dietary Allowance (adult female)<\/td>\r\n<td class=\"mt-align-center mt-colspan mt-noheading\">75\u00a0mg\u00a0per day<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center mt-noheading\">Recommended Dietary Allowance (pregnancy)<\/td>\r\n<td class=\"mt-align-center mt-colspan mt-noheading\">85\u00a0mg\u00a0per day<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center mt-noheading\">Recommended Dietary Allowance (lactation)<\/td>\r\n<td class=\"mt-align-center mt-colspan mt-noheading\">120\u00a0mg\u00a0per day<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center mt-noheading\">Tolerable Upper Intake Level (adult male)<\/td>\r\n<td class=\"mt-align-center mt-colspan mt-noheading\">2,000\u00a0mg\u00a0per day<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center mt-noheading\">Tolerable Upper Intake Level (adult female)<\/td>\r\n<td class=\"mt-align-center mt-colspan mt-noheading\">2,000\u00a0mg\u00a0per day<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<div id=\"section_8\" class=\"mt-section\">\r\n<h3 class=\"mt-align-justify editable\">Recommended intake<\/h3>\r\n<p class=\"mt-align-justify\">Recommendations for vitamin C intake have been set by various national agencies:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"mt-align-justify\">40 milligrams per day or 280 milligrams per week taken all at once: the United Kingdom's\u00a0Food Standards Agency<\/li>\r\n \t<li class=\"mt-align-justify\">40 milligrams per day as per the recommendations of India's\u00a0National Institute of Nutrition, Hyderabad<\/li>\r\n \t<li class=\"mt-align-justify\">45 milligrams per day 300 milligrams per week: the\u00a0World Health Organization<\/li>\r\n \t<li class=\"mt-align-justify\">80 milligrams per day: the\u00a0European Commission's Council on nutrition labeling<\/li>\r\n \t<li class=\"mt-align-justify\">90\u00a0mg\/day (males) and 75\u00a0mg\/day (females): Health Canada 2007<\/li>\r\n \t<li class=\"mt-align-justify\">90\u00a0mg\/day (males) and 75\u00a0mg\/day (females): United States'\u00a0National Academy of Sciences.<\/li>\r\n \t<li class=\"mt-align-justify\">100 milligrams per day: Japan's National Institute of Health and Nutrition.<\/li>\r\n<\/ul>\r\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For vitamin C labeling purposes 100% of the Daily Value was 60\u00a0mg, but as of May 2016 it has been revised to 90\u00a0mg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until July 28, 2018 to comply with the change.<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_9\" class=\"mt-section\">\r\n<h3 class=\"editable\">Dietary Sources<\/h3>\r\n[caption id=\"\" align=\"aligncenter\" width=\"448\"]<a class=\"link-https\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:Rosa_rubiginosa_hips.jpg\" target=\"_blank\" rel=\"external nofollow noopener\"><img class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4098\/Rosa_rubiginosa_hips.jpg?revision=1&amp;size=bestfit&amp;width=224&amp;height=267\" alt=\"Rosa_rubiginosa_hips.jpg\" width=\"448\" height=\"533\" \/><\/a> <em>Rose hips\u00a0are a particularly rich source of vitamin C. Image used with permission (CC BY-SA 3.0;\u00a0en:User:MPF) <\/em>[\/caption]\r\n<p class=\"mt-align-justify\">The richest natural sources are fruits and vegetables.\u00a0Vitamin C is the most widely taken\u00a0nutritional supplement\u00a0and is available in a variety of forms, including tablets,\u00a0drink mixes, and in capsules. Vitamin C is absorbed by the intestines using a sodium-ion dependent channel. It is transported through the intestine via both glucose-sensitive and glucose-insensitive mechanisms. The presence of large quantities of sugar either in the intestines or in the blood can slow absorption.<\/p>\r\n<p class=\"mt-align-justify\">While plants are generally a good source of vitamin C, the amount in foods of plant origin depends on the precise variety of the plant, soil condition, climate where it grew, length of time since it was picked, storage conditions, and method of preparation. The following table is approximate and shows the relative abundance in different raw plant sources.\u00a0As some plants were analyzed fresh while others were dried (thus, artifactually increasing concentration of individual constituents like vitamin C), the data are subject to potential variation and difficulties for comparison. The amount is given in milligrams per 100\u00a0grams of fruit or vegetable and is a rounded average from multiple authoritative sources:<\/p>\r\n\r\n<table class=\"mt-responsive-table\">\r\n<thead>\r\n<tr>\r\n<th class=\"mt-align-center\" scope=\"col\">Plant source<\/th>\r\n<th class=\"mt-align-center\" scope=\"col\">Amount (mg \/ 100g)<\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr>\r\n<td class=\"mt-align-center\">Kakadu plum<\/td>\r\n<td class=\"mt-align-center\">1000\u20135300<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Camu Camu<\/td>\r\n<td class=\"mt-align-center\">2800<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Acerola<\/td>\r\n<td class=\"mt-align-center\">1677<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Seabuckthorn<\/td>\r\n<td class=\"mt-align-center\">695<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Indian gooseberry<\/td>\r\n<td class=\"mt-align-center\">445<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Rose hip<\/td>\r\n<td class=\"mt-align-center\">426<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Baobab<\/td>\r\n<td class=\"mt-align-center\">400<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Chili pepper\u00a0(green)<\/td>\r\n<td class=\"mt-align-center\">244<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Guava\u00a0(common, raw)<\/td>\r\n<td class=\"mt-align-center\">228.3<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Blackcurrant<\/td>\r\n<td class=\"mt-align-center\">200<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Red pepper<\/td>\r\n<td class=\"mt-align-center\">190<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Chili pepper\u00a0(red)<\/td>\r\n<td class=\"mt-align-center\">144<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Parsley<\/td>\r\n<td class=\"mt-align-center\">130<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Kiwifruit<\/td>\r\n<td class=\"mt-align-center\">90<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Broccoli<\/td>\r\n<td class=\"mt-align-center\">90<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Loganberry<\/td>\r\n<td class=\"mt-align-center\">80<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Redcurrant<\/td>\r\n<td class=\"mt-align-center\">80<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Brussels sprouts<\/td>\r\n<td class=\"mt-align-center\">80<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Wolfberry\u00a0(Goji)<\/td>\r\n<td class=\"mt-align-center\">73 \u2020<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Lychee<\/td>\r\n<td class=\"mt-align-center\">70<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Persimmon\u00a0(native, raw)<\/td>\r\n<td class=\"mt-align-center\">66.0<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Cloudberry<\/td>\r\n<td class=\"mt-align-center\">60<\/td>\r\n<\/tr>\r\n<tr>\r\n<td class=\"mt-align-center\">Elderberry<\/td>\r\n<td class=\"mt-align-center\">60<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p class=\"mt-align-justify\">\u2020 average of 3 sources; dried<\/p>\r\n\r\n<\/div>\r\n<div id=\"section_10\" class=\"mt-section\">\r\n<h3 class=\"editable\">Contributors<\/h3>\r\n<ul>\r\n \t<li class=\"mt-align-justify\">Wikipedia. Content is copyrighted under a CC-BY-SA 4.0 license.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/section><\/div>\r\n<footer class=\"mt-content-footer\"><\/footer><\/section><footer class=\"elm-content-footer\"><\/footer><\/div>\r\n<footer class=\"mt-content-footer\"><\/footer><\/section><footer class=\"elm-content-footer\"><\/footer><\/div>\r\n<\/section><\/div>\r\n<\/section><\/div>\r\n<\/div>\r\n<footer class=\"mt-content-footer\"><\/footer><\/section><footer class=\"elm-content-footer\"><\/footer><\/div>\r\n<footer class=\"mt-content-footer\"><\/footer><\/section><footer class=\"elm-content-footer\"><\/footer>","rendered":"<p class=\"mt-align-justify\">Nine vitamins are considered water soluble, including: vitamin C and all of the B vitamins (Riboflavin, Niacin, Thiamin, B<sub>6<\/sub>, Folate, B<sub>12<\/sub>, Pantothenic\u00a0Acid and Biotin). In contrast to the four\u00a0<a href=\"https:\/\/courses.lumenlearning.com\/sunyltnutrition\/chapter\/7-2-fat-soluble-vitamins\/\">Fat-Soluble Vitamins<\/a>, Water-soluble vitamins dissolve easily in water and, in general, are readily excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption.\u00a0Because they are not as readily stored, more consistent intake is important.<span class=\"mt-font-size-12\">\u00a0<\/span>Many types of water-soluble vitamins are synthesized by bacteria.<\/p>\n<header>\n<h2 id=\"title\">7.3A: Vitamin B\u2081 (Thiamine)<\/h2>\n<\/header>\n<section class=\"mt-content-container\">Thiamine, also known as\u00a0thiamin\u00a0or\u00a0vitamin B1, is a\u00a0vitamin\u00a0found in food and used as a\u00a0dietary supplement.\u00a0As a supplement it is used to treat and prevent\u00a0thiamine deficiency\u00a0and disorders that result from it, including\u00a0beriberi,\u00a0Korsakoff&#8217;s syndrome, and\u00a0Korsakoff&#8217;s psychosis. Other uses include\u00a0maple syrup urine disease\u00a0and\u00a0Leigh&#8217;s disease. It is taken\u00a0by mouth\u00a0or by\u00a0injection. Side effects are generally few.\u00a0Allergic reactions\u00a0including\u00a0anaphylaxis\u00a0may occur. Thiamine is in the\u00a0B complex\u00a0family. It is needed for the\u00a0metabolism\u00a0of\u00a0carbohydrates.[1]\u00a0As people are unable to make it, thiamine is an\u00a0essential nutrient. Food sources include\u00a0whole grains, meat, and fish.Thiamine was discovered in 1897 and is\u00a0on the\u00a0World Health Organization&#8217;s List of Essential Medicines, the most effective and safe medicines needed in a\u00a0health system.\u00a0Thiamine is available as a\u00a0generic medication\u00a0and\u00a0over the counter.\u00a0The wholesale cost in the\u00a0developing world\u00a0is about 2.17 USD per one gm vial.\u00a0In the United States a month of replacement is less than 25 USD.\u00a0Some countries require its addition to certain foods such as\u00a0grains. Thiamine is used to treat\u00a0thiamine deficiency\u00a0which can prove fatal.\u00a0In less-severe cases, nonspecific signs include\u00a0malaise, weight loss, irritability and confusion.Thiamine is a colorless\u00a0organosulfur compound\u00a0with a\u00a0chemical formula\u00a0<span id=\"MathJax-Element-1-Frame\" class=\"MathJax\" style=\"font-style: normal;font-weight: normal;line-height: normal;font-size: 14.4px;text-indent: 0px;text-align: left;letter-spacing: normal;float: none;direction: ltr;max-width: none;max-height: none;min-width: 0px;min-height: 0px;border: 0px;padding: 0px;margin: 0px\" role=\"presentation\"><span id=\"MathJax-Span-1\" class=\"math\"><span id=\"MathJax-Span-2\" class=\"mrow\"><span id=\"MathJax-Span-3\" class=\"msubsup\"><span id=\"MathJax-Span-4\" class=\"mtext\">C<\/span><span id=\"MathJax-Span-5\" class=\"texatom\"><span id=\"MathJax-Span-6\" class=\"mrow\"><span id=\"MathJax-Span-7\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-8\" class=\"texatom\"><span id=\"MathJax-Span-9\" class=\"mrow\"><span id=\"MathJax-Span-10\" class=\"mn\">12<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-11\" class=\"msubsup\"><span id=\"MathJax-Span-12\" class=\"mtext\">H<\/span><span id=\"MathJax-Span-13\" class=\"texatom\"><span id=\"MathJax-Span-14\" class=\"mrow\"><span id=\"MathJax-Span-15\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-16\" class=\"texatom\"><span id=\"MathJax-Span-17\" class=\"mrow\"><span id=\"MathJax-Span-18\" class=\"mn\">17<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-19\" class=\"msubsup\"><span id=\"MathJax-Span-20\" class=\"mtext\">N<\/span><span id=\"MathJax-Span-21\" class=\"texatom\"><span id=\"MathJax-Span-22\" class=\"mrow\"><span id=\"MathJax-Span-23\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-24\" class=\"texatom\"><span id=\"MathJax-Span-25\" class=\"mrow\"><span id=\"MathJax-Span-26\" class=\"mn\">4<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-27\" class=\"mtext\">OS<\/span><\/span><\/span><span class=\"MJX_Assistive_MathML\" role=\"presentation\">C12H17N4OS<\/span><\/span>\u00a0(Figure\u00a0<span id=\"MathJax-Element-2-Frame\" class=\"MathJax\" style=\"font-style: normal;font-weight: normal;line-height: normal;font-size: 14.4px;text-indent: 0px;text-align: left;letter-spacing: normal;float: none;direction: ltr;max-width: none;max-height: none;min-width: 0px;min-height: 0px;border: 0px;padding: 0px;margin: 0px\" role=\"presentation\"><span id=\"MathJax-Span-28\" class=\"math\"><span id=\"MathJax-Span-29\" class=\"mrow\"><span id=\"MathJax-Span-30\" class=\"texatom\"><span id=\"MathJax-Span-31\" class=\"mrow\"><span id=\"MathJax-Span-32\" class=\"mn\">7.3<\/span><span id=\"MathJax-Span-33\" class=\"mi\">A<\/span><span id=\"MathJax-Span-34\" class=\"mo\">.<\/span><span id=\"MathJax-Span-35\" class=\"mn\">1<\/span><\/span><\/span><\/span><\/span><span class=\"MJX_Assistive_MathML\" role=\"presentation\">7.3A.1<\/span><\/span>). Its structure consists of an\u00a0aminopyrimidine\u00a0and a\u00a0thiazole\u00a0ring linked by a\u00a0methylene bridge. The thiazole is substituted with methyl and hydroxyethyl side chains. Thiamine is\u00a0soluble\u00a0in\u00a0water,\u00a0methanol, and\u00a0glycerol\u00a0and practically insoluble in less polar\u00a0organic solvents. It is stable at acidic pH, but is unstable in alkaline solutions. Thiamine, which is a\u00a0N-heterocyclic carbene, can be used in place of\u00a0cyanide\u00a0as a catalyst for\u00a0benzoin condensation.\u00a0Thiamine is unstable to heat, but stable during frozen storage.[citation needed]\u00a0It is unstable when exposed to ultraviolet light[9]\u00a0and gamma irradiation.<\/p>\n<div style=\"width: 356px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4097\/346px-Thiamin.svg.png?revision=1\" alt=\"346px-Thiamin.svg.png\" width=\"346\" height=\"201\" \/><\/p>\n<p class=\"wp-caption-text\"><em>Figure\u00a0<\/em><strong>7.3A.1<\/strong><em>: Structure of thiamine<\/em><\/p>\n<\/div>\n<p>Thiamin is found in a wide variety of processed and whole foods, with edible seeds,\u00a0legumes,\u00a0rice\u00a0and\u00a0processed foods, such as\u00a0breakfast cereals, having among the highest contents.\u00a0Some other foods naturally rich in thiamin are\u00a0corn flour, pork,\u00a0pecans\u00a0and\u00a0spinach.<\/p>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intakes<\/h3>\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for thiamine in 1998. The current EARs for thiamine for women and men ages 14 and up are 0.9\u00a0mg\/day and 1.0\u00a0mg\/day, respectively; the RDAs are 1.1 and 1.2\u00a0mg\/day. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 1.4\u00a0mg\/day. RDA for lactation equals 1.4\u00a0mg\/day. For infants up to 12 months the Adequate Intake (AI) is 0.2-0.3\u00a0mg\/day. and for children ages 1\u201313 years the RDA increases with age from 0.5 to 0.9\u00a0mg\/day.<\/p>\n<p class=\"mt-align-justify\">As for safety, the Food and Nutrition Board of the U.S. Institute of Medicine sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of thiamine there is no UL, as there is no human data for adverse effects from high doses. The European Food Safety Authority reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for thiamine. Collectively the EARs, RDAs and ULs are referred to as\u00a0Dietary Reference Intakes.<\/p>\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For thiamine labeling purposes 100% of the Daily Value was 1.5\u00a0mg, but as of May 2016 it has been revised to 1.2\u00a0mg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until July 28, 2018 to comply with the change.<\/p>\n<\/div>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Antagonists<\/h3>\n<p>Thiamine in foods can be degraded in a variety of ways.\u00a0Sulfites, which are added to foods usually as a preservative,\u00a0will attack thiamine at the methylene bridge in the structure, cleaving the pyrimidine ring from the thiazole ring.\u00a0The rate of this reaction is increased under acidic conditions. Thiamine is degraded by thermolabile\u00a0thiaminases\u00a0(present in raw fish and shellfish). Some thiaminases are produced by bacteria. Bacterial thiaminases are cell surface enzymes that must dissociate from the membrane before being activated; the dissociation can occur in ruminants under acidotic conditions. Rumen bacteria also reduce sulfate to sulfite, therefore high dietary intakes of sulfate can have thiamine-antagonistic activities.<\/p>\n<p>Plant thiamine antagonists are heat-stable and occur as both the ortho- and para-hydroxyphenols. Some examples of these antagonists are\u00a0caffeic acid,\u00a0chlorogenic acid, and\u00a0tannic acid. These compounds interact with the thiamine to oxidize the thiazole ring, thus rendering it unable to be absorbed. Two flavonoids,\u00a0quercetin\u00a0and\u00a0rutin, have also been implicated as thiamine antagonists.<\/p>\n<\/div>\n<div id=\"section_3\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Absorption<\/h3>\n<p class=\"mt-align-justify\">Thiamine is released by the action of phosphatase and pyrophosphatase in the upper small intestine. At low concentrations, the process is carrier-mediated, and, at higher concentrations, absorption occurs via passive diffusion. Active transport is greatest in the jejunum and ileum; but, active transport can be inhibited by alcohol consumption and by folic deficiency.\u00a0Decline in thiamine absorption occurs at intakes above 5\u00a0mg\/day.\u00a0The cells of the intestinal mucosa have thiamine pyrophosphokinase activity, but it is unclear as to whether the enzyme is linked to active absorption. The majority of thiamine present in the intestine is in the pyrophosphorylated form ThDP, but when thiamine arrives on the serosal side of the intestine it is often in the free form. The uptake of thiamine by the mucosal cell is likely coupled in some way to its phosphorylation\/dephosphorylation. On the serosal side of the intestine, evidence has shown that discharge of the vitamin by those cells is dependent on Na<sup>+<\/sup>-dependent ATPase.<\/p>\n<p class=\"mt-align-justify\">Uptake of thiamine by cells of the blood and other tissues occurs via active transport and passive diffusion.\u00a0The brain requires much more thiamine than other tissues of the body. Much of ingested thiamine never reaches the brain because of passive diffusion and the\u00a0blood\u2013brain barrier. About 80% of intracellular thiamine is phosphorylated and most is bound to proteins. In some tissues, thiamine uptake and secretion appears to be mediated by a soluble thiamine transporter that is dependent on Na<sup>+<\/sup>\u00a0and a transcellular proton gradient.<\/p>\n<p class=\"mt-align-justify\">Human storage of thiamine is about 25 to 30\u00a0mg, with the greatest concentrations in skeletal muscle, heart, brain, liver, and kidneys. ThMP and free (unphosphorylated) thiamine is present in plasma, milk, cerebrospinal fluid, and, it is presumed, all extracellular fluids. Unlike the highly phosphorylated forms of thiamine, ThMP and free thiamine are capable of crossing cell membranes. Thiamine contents in human tissues are less than those of other species.<\/p>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<h3 class=\"editable\">Contributors<\/h3>\n<ul>\n<li class=\"mt-align-justify\">Wikipedia. Content is copyrighted under a CC-BY-SA 4.0 license.<\/li>\n<\/ul>\n<h2>7.3B: Vitamin B\u2082 (Riboflavin)<\/h2>\n<header><\/header>\n<section class=\"mt-content-container\">\n<p class=\"mt-align-justify\">Riboflavin, also known as\u00a0vitamin B<sub>2<\/sub>, is a\u00a0vitamin\u00a0found in food and used as a\u00a0dietary supplement. As a supplement it is used to prevent and treat\u00a0riboflavin deficiency\u00a0and prevent\u00a0migraines. It may be given by mouth or injection. It is nearly always well tolerated. Normal doses are safe during\u00a0pregnancy. Riboflavin is in the\u00a0vitamin B\u00a0group. It is required by the body for\u00a0cellular respiration. Food sources include\u00a0eggs,\u00a0green vegetables, milk, and meat. Riboflavin was discovered in 1920, isolated in 1933, and first made in 1935. It is on the\u00a0World Health Organization&#8217;s List of Essential Medicines, the most effective and safe medicines needed in a\u00a0health system. Riboflavin is available as a\u00a0generic medication\u00a0and\u00a0over the counter. In the United States a month of supplements costs less than 25 USD.\u00a0Some countries require its addition to\u00a0grains.<\/p>\n<div style=\"width: 210px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4100\/502px-Riboflavin_solution.jpg?revision=1\" alt=\"502px-Riboflavin_solution.jpg\" width=\"200\" height=\"238\" \/><\/p>\n<p class=\"wp-caption-text\"><em>A solution of riboflavin. Image used with permission (CC BY-SA 4.0;\u00a0Patr\u00edciaR)<\/em><\/p>\n<\/div>\n<p class=\"mt-align-justify\">Riboflavin has been used in several clinical and therapeutic situations. For over 30 years, riboflavin supplements have been used as part of the\u00a0phototherapy\u00a0treatment of\u00a0neonatal jaundice. The light used to irradiate the infants breaks down not only\u00a0bilirubin, the toxin causing the jaundice, but also the naturally occurring riboflavin within the infant&#8217;s blood, so extra supplementation is necessary.<\/p>\n<p class=\"mt-align-justify\">Riboflavin functions as a coenzyme, meaning that it is required for enzymes (proteins) to perform normal physiological actions. Specifically, the active forms of riboflavin\u00a0flavin mononucleotide\u00a0(FMN) and\u00a0flavin adenine dinucleotide\u00a0(FAD) function as cofactors for a variety of flavoproteine enzyme reactions:<\/p>\n<ul>\n<li class=\"mt-align-justify\">Flavoproteins\u00a0of\u00a0electron transport chain, including FMN in\u00a0Complex I\u00a0and FAD in\u00a0Complex II<\/li>\n<li class=\"mt-align-justify\">FAD is required for the production of pyridoxic acid from pyridoxal (vitamin B<sub>6<\/sub>) by\u00a0pyridoxine 5&#8242;-phosphate oxidase<\/li>\n<li class=\"mt-align-justify\">The primary coenzyme form of vitamin B<sub>6<\/sub>\u00a0(pyridoxal phosphate) is FMN dependent<\/li>\n<li class=\"mt-align-justify\">Oxidation\u00a0of pyruvate, \u03b1-ketoglutarate, and branched-chain amino acids requires FAD in the shared\u00a0E3\u00a0portion of their respective dehydrogenase complexes<\/li>\n<li class=\"mt-align-justify\">Fatty\u00a0acyl CoA dehydrogenase\u00a0requires FAD in fatty acid oxidation<\/li>\n<li class=\"mt-align-justify\">FAD is required to convert\u00a0retinol\u00a0(vitamin A) to retinoic acid via cytosolic\u00a0retinal dehydrogenase<\/li>\n<li class=\"mt-align-justify\">Synthesis of an active form of folate (5-methyltetrahydrofolate) from\u00a05,10-methylenetetrahydrofolate\u00a0by\u00a0Methylenetetrahydrofolate reductase\u00a0is FADH<sub>2<\/sub>\u00a0dependent<\/li>\n<li class=\"mt-align-justify\">FAD is required to convert\u00a0tryptophan\u00a0to\u00a0niacin\u00a0(vitamin B<sub>3<\/sub>)<\/li>\n<li class=\"mt-align-justify\">Reduction of the oxidized form of\u00a0glutathione\u00a0(GSSG) to its reduced form (GSH) by\u00a0Glutathione reductase\u00a0is FAD dependent<\/li>\n<\/ul>\n<p class=\"mt-align-justify\">For the molecular mechanism of action see main articles\u00a0Flavin mononucleotide\u00a0(FMN) and\u00a0flavin adenine dinucleotide\u00a0(FAD)<\/p>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Sources<\/h3>\n<p class=\"mt-align-justify\">Food and beverages that provide riboflavin without fortification are\u00a0milk,\u00a0cheese,\u00a0eggs,\u00a0leaf vegetables,\u00a0liver,\u00a0kidneys,\u00a0legumes,\u00a0mushrooms, and\u00a0almonds. The milling of cereals results in considerable loss (up to 60%) of vitamin B<sub>2<\/sub>, so white\u00a0flour\u00a0is enriched in some countries such as US by addition of the vitamin. The enrichment of bread and ready-to-eat breakfast cereals contributes significantly to the dietary supply of vitamin B<sub>2<\/sub>. Polished\u00a0rice\u00a0is not usually enriched, because the vitamin\u2019s yellow color would make the rice visually unacceptable to the major rice-consumption populations. However, most of the flavin content of whole brown rice is retained if the rice is steamed (parboiled) prior to milling. This process drives the flavins in the germ and aleurone layers into the endosperm. Free riboflavin is naturally present in foods along with protein-bound FMN and FAD. Bovine milk contains mainly free riboflavin, with a minor contribution from FMN and FAD. In whole milk, 14% of the flavins are bound noncovalently to specific proteins.\u00a0Egg white and egg yolk contain specialized riboflavin-binding proteins, which are required for storage of free riboflavin in the egg for use by the developing embryo.<\/p>\n<\/div>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intake<\/h3>\n<p class=\"mt-align-justify\">In humans, there is no evidence for riboflavin toxicity produced by excessive intakes, in part because it has lower water solubility than other B vitamins, because absorption becomes less efficient as doses increase, and because what excess is absorbed is excreted via the kidneys into urine. Even when 400\u00a0mg of riboflavin per day was given orally to subjects in one study for three months to investigate the efficacy of riboflavin in the prevention of migraine headache, no short-term side effects were reported.\u00a0Although toxic doses can be administered by injection,\u00a0any excess at nutritionally relevant doses is excreted in the urine,<span class=\"mt-font-size-12\">\u00a0<\/span>imparting a bright yellow color when in large quantities.<\/p>\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of riboflavin there is no UL, as there is no human data for adverse effects from high doses. The European Food Safety Authority reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for riboflavin.<\/p>\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) in 1998. The current EARs for riboflavin for women and men ages 14 and up are 0.9\u00a0mg\/day and 1.1\u00a0mg\/day, respectively; the RDAs are 1.1 and 1.3\u00a0mg\/day. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 1.4\u00a0mg\/day. RDA for lactation equals 1.6\u00a0mg\/day. For infants up to 12 months the Adequate Intake (AI) is 0.3-0.4\u00a0mg\/day and for children ages 1\u201313 years the RDA increases with age from 0.5 to 0.9\u00a0mg\/day. Collectively the EARs, RDAs and ULs (see Toxicity) are referred to as\u00a0Dietary Reference Intakes.<sup id=\"cite_ref-Gropper_S.S._2009.2C_P329-333_18-1\">[18]<\/sup><sup id=\"cite_ref-26\">[26]<\/sup><\/p>\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For riboflavin labeling purposes 100% of the Daily Value was 1.7\u00a0mg, but as of May 2016 it has been revised to 1.3\u00a0mg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until July 2018 to comply with the change.<\/p>\n<div class=\"note1\">\n<div class=\"textbox shaded\">\n<div id=\"section_2\" class=\"mt-section\">\n<div class=\"note1\">\n<h3 class=\"boxtitle\">RIBOFLAVIN DEFICIENCY<\/h3>\n<p class=\"mt-align-justify\">Mild deficiencies can exceed 50% of the population in third world countries and in refugee situations. Deficiency is uncommon in the United States and in other countries that have wheat flour, bread, pasta, corn meal or rice enrichment regulations. In the U.S., starting in the 1940s, flour, corn meal and rice have been fortified with B vitamins as a means of restoring some of what is lost in milling, bleaching and other processing. For adults 20 and older, average intake from food and beverages is 1.8\u00a0mg\/day for women and 2.5\u00a0mg\/day for men. An estimated 23% consume a riboflavin-containing dietary supplement that provides on average 10\u00a0mg. The U.S. Department of Health and Human Services conducts National Health and Nutrition Examination Survey every two years and reports food results in a series of reports referred to as &#8220;What We Eat In America.&#8221; From NHANES 2011\u20132012, the latest for which data has been reported, estimates are that 8% of women and 3% of men consume less than the RDA. When compared to the lower Estimated Average Requirements, fewer than 3% do not achieve the EAR level. However, anyone choosing a gluten-free or low gluten diet should as a precaution take a multi-vitamin\/mineral dietary supplement which provides 100% DV for riboflavin and other B vitamins.<\/p>\n<p class=\"mt-align-justify\">Riboflavin deficiency (also called ariboflavinosis) results in\u00a0stomatitis\u00a0including painful red tongue with sore throat, chapped and fissured lips (cheilosis), and inflammation of the corners of the mouth (angular stomatitis). There can be oily scaly skin rashes on the\u00a0scrotum,\u00a0vulva,\u00a0philtrum\u00a0of the lip, or the\u00a0nasolabial folds. The eyes can become itchy, watery, bloodshot and sensitive to light.\u00a0Due to interference with iron absorption, even mild to moderate riboflavin deficiency results in an\u00a0anemia\u00a0with normal cell size and normal\u00a0hemoglobin\u00a0content (i.e. normochromic normocytic\u00a0anemia). This is distinct from anemia caused by deficiency of\u00a0folic acid\u00a0(B<sub>9<\/sub>) or\u00a0cyanocobalamin\u00a0(B<sub>12<\/sub>), which causes anemia with large blood cells (megaloblastic anemia).\u00a0Deficiency of riboflavin during pregnancy can result in birth defects including congenital heart defects\u00a0and limb deformities.<\/p>\n<p class=\"mt-align-justify\">The stomatitis symptoms are similar to those seen in\u00a0pellagra, which is caused by\u00a0niacin\u00a0(B<sub>3<\/sub>) deficiency. Therefore, riboflavin deficiency is sometimes called &#8220;pellagra sine pellagra&#8221; (pellagra without pellagra), because it causes stomatitis but not widespread peripheral skin lesions characteristic of niacin deficiency.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/section>\n<header>\n<h2 id=\"title\">7.3C: Vitamin B\u2083 (Niacin)<\/h2>\n<\/header>\n<section class=\"mt-content-container\">\n<p class=\"mt-align-justify\">Niacin, also known as\u00a0vitamin B<sub>3<\/sub>\u00a0or nicotinic acid, is an\u00a0organic compound\u00a0with the\u00a0formula\u00a0<span id=\"MathJax-Element-1-Frame\" class=\"MathJax\" style=\"font-style: normal;font-weight: normal;line-height: normal;font-size: 14.4px;text-indent: 0px;text-align: left;letter-spacing: normal;float: none;direction: ltr;max-width: none;max-height: none;min-width: 0px;min-height: 0px;border: 0px;padding: 0px;margin: 0px\" role=\"presentation\"><span id=\"MathJax-Span-1\" class=\"math\"><span id=\"MathJax-Span-2\" class=\"mrow\"><span id=\"MathJax-Span-3\" class=\"msubsup\"><span id=\"MathJax-Span-4\" class=\"mtext\">C<\/span><span id=\"MathJax-Span-5\" class=\"texatom\"><span id=\"MathJax-Span-6\" class=\"mrow\"><span id=\"MathJax-Span-7\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-8\" class=\"texatom\"><span id=\"MathJax-Span-9\" class=\"mrow\"><span id=\"MathJax-Span-10\" class=\"mn\">6<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-11\" class=\"msubsup\"><span id=\"MathJax-Span-12\" class=\"mtext\">H<\/span><span id=\"MathJax-Span-13\" class=\"texatom\"><span id=\"MathJax-Span-14\" class=\"mrow\"><span id=\"MathJax-Span-15\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-16\" class=\"texatom\"><span id=\"MathJax-Span-17\" class=\"mrow\"><span id=\"MathJax-Span-18\" class=\"mn\">5<\/span><\/span><\/span><\/span><span id=\"MathJax-Span-19\" class=\"msubsup\"><span id=\"MathJax-Span-20\" class=\"mtext\">NO<\/span><span id=\"MathJax-Span-21\" class=\"texatom\"><span id=\"MathJax-Span-22\" class=\"mrow\"><span id=\"MathJax-Span-23\" class=\"mspace\"><\/span><\/span><\/span><span id=\"MathJax-Span-24\" class=\"texatom\"><span id=\"MathJax-Span-25\" class=\"mrow\"><span id=\"MathJax-Span-26\" class=\"mn\">2<\/span><\/span><\/span><\/span><\/span><\/span><span class=\"MJX_Assistive_MathML\" role=\"presentation\">C6H5NO2<\/span><\/span>\u00a0and, depending on the definition used, one of the 20 to 80\u00a0essential human nutrients.\u00a0Pharmaceutical\u00a0and\u00a0supplemental\u00a0niacin are primarily used to treat\u00a0hypercholesterolemia\u00a0(high cholesterol) and\u00a0pellagra\u00a0(niacin deficiency). Insufficient niacin in the diet can cause nausea, skin and mouth lesions, anemia, headaches, and tiredness. The lack of niacin may also be observed in\u00a0pandemic\u00a0deficiency disease, which is caused by a lack of five crucial vitamins (niacin,\u00a0vitamin C,\u00a0thiamin,\u00a0vitamin D, and\u00a0vitamin A) and is usually found in areas of widespread poverty and malnutrition. Niacin is provided in the diet from a variety of\u00a0whole\u00a0and\u00a0processed foods, with highest contents in\u00a0fortified\u00a0packaged foods\u00a0and\u00a0meat\u00a0from various animal sources.<\/p>\n<div style=\"width: 190px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4101\/Nicotinamid.svg.png?revision=2\" alt=\"Nicotinamid.svg.png\" width=\"180\" height=\"140\" \/><\/p>\n<p class=\"wp-caption-text\"><em>Structure of nicotinamide (niacinamide).<\/em><\/p>\n<\/div>\n<p class=\"mt-align-justify\">Niacin supplementation has not been found useful for decreasing the risk of\u00a0cardiovascular disease\u00a0in those already on a\u00a0statin,\u00a0but appears to be effective in those not taking a statin.<sup id=\"cite_ref-7\">[<\/sup>Although niacin and nicotinamide are identical in their vitamin activity, nicotinamide does not have the same pharmacological effects (lipid modifying effects) as niacin. Nicotinamide does not reduce cholesterol or cause\u00a0flushing.\u00a0As the precursor for NAD and NADP, niacin is also involved in DNA repair.<\/p>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"editable\">Dietary\u00a0Reference Intake<\/h3>\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for niacin in 1998. The current EARs for niacin for women and men ages 14 and up are 11\u00a0mg\/day and 12\u00a0mg\/day, respectively; the RDAs are 14 and 16\u00a0mg\/day, respectively. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 18\u00a0mg\/day. RDA for lactation equals 17\u00a0mg\/day. For infants up to 12 months the Adequate Intake (AI) is 2\u20134\u00a0mg\/day. and for children ages 1\u201313 years the RDA increases with age from 6 to 12\u00a0mg\/day. As for safety, the Food and Nutrition Board also sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of niacin the UL is set at 35\u00a0mg\/day.<sup id=\"cite_ref-11\">[11]<\/sup>\u00a0The European Food Safety Authority reviewed the same safety question and set its UL at 10\u00a0mg\/day.<sup id=\"cite_ref-12\">[12]<\/sup>\u00a0Safety issues are presented at length in the Side Effects section. Collectively the EARs, RDAs, AIs and ULs are referred to as\u00a0Dietary Reference Intakes.<\/p>\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes, the amount in a serving is expressed as a percent of Daily Value (%DV). For niacin labeling purposes, 100% of the Daily Value was 20\u00a0mg, but as of May 2016 it has been revised to 16\u00a0mg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until July 28, 2018, to comply with the change.<\/p>\n<\/div>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Sources<\/h3>\n<p class=\"mt-align-justify\">Niacin is found in a variety of\u00a0whole\u00a0and\u00a0processed foods, including\u00a0fortified\u00a0packaged foods,\u00a0meat\u00a0from various animal sources,\u00a0seafoods, and\u00a0spices. Among whole food sources with the highest niacin content per 100 grams:<\/p>\n<p class=\"mt-align-justify\">Meats<\/p>\n<ul>\n<li class=\"mt-align-justify\">cooked\u00a0skipjack tuna, 18.8\u00a0mg<\/li>\n<li class=\"mt-align-justify\">cooked light meat\u00a0turkey, 11.8\u00a0mg<\/li>\n<li class=\"mt-align-justify\">cooked, lean\u00a0ground pork, 11.1\u00a0mg<\/li>\n<li class=\"mt-align-justify\">cooked\u00a0venison, 10.8\u00a0mg<\/li>\n<li class=\"mt-align-justify\">cooked, lean\u00a0veal, 8.0\u00a0mg<\/li>\n<\/ul>\n<p class=\"mt-align-justify\">Plant foods\u00a0and\u00a0spices<\/p>\n<ul>\n<li class=\"mt-align-justify\">sesame seed\u00a0flour, 12.5\u00a0mg<\/li>\n<li class=\"mt-align-justify\">ground\u00a0ginger, 9.6\u00a0mg<\/li>\n<li class=\"mt-align-justify\">dried\u00a0tarragon, 9.0\u00a0mg<\/li>\n<li class=\"mt-align-justify\">dried, green\u00a0sweet peppers, 7.4\u00a0mg<\/li>\n<li class=\"mt-align-justify\">grilled\u00a0portabella mushrooms, 6.2\u00a0mg<\/li>\n<li class=\"mt-align-justify\">roasted\u00a0sunflower seeds, 4.1\u00a0mg<\/li>\n<li class=\"mt-align-justify\">dehydrated\u00a0apricots, 3.6\u00a0mg<\/li>\n<li class=\"mt-align-justify\">baked\u00a0potato, 3.1\u00a0mg<\/li>\n<\/ul>\n<p class=\"mt-align-justify\">Fortified\u00a0breakfast cereals\u00a0have among the highest niacin contents (more than 20\u00a0mg per 100 grams).<sup id=\"cite_ref-usda_13-1\">[13]<\/sup>\u00a0Whole grain\u00a0flours, such as from wheat, rice, barley or corn, and\u00a0pasta\u00a0have niacin contents in a range of 3\u201310\u00a0mg per 100 grams.<\/p>\n<\/div>\n<div id=\"section_3\" class=\"mt-section\">\n<h3 class=\"editable\">Deficiencies<\/h3>\n<p class=\"mt-align-justify\">Between 1906 and 1940 more than 3 million Americans were affected by pellagra with more than 100,000 deaths. Dr.\u00a0Joseph Goldberger\u00a0was assigned to study pellagra by the Surgeon General of the United States and produced good results. In the late 1930s, studies by Dr.\u00a0Tom Spies, Marion Blankenhorn, and Clark Cooper established that niacin cured pellagra in humans. The disease was greatly reduced as a result.<\/p>\n<p class=\"mt-align-justify\">At present, niacin deficiency is sometimes seen in developed countries, and it is usually apparent in conditions of poverty, malnutrition, and chronic alcoholism.\u00a0It also tends to occur in areas where people eat\u00a0maize\u00a0(corn) as a staple food, since it is the only grain low in digestible niacin. A cooking technique called\u00a0nixtamalization\u00a0increases the bioavailability of niacin during maize meal\/flour production.<\/p>\n<div style=\"width: 230px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Pellagra_NIH.jpg\/220px-Pellagra_NIH.jpg\" alt=\"\" width=\"220\" height=\"282\" \/><\/p>\n<p class=\"wp-caption-text\"><em>A man with scurvy, which is caused by a chronic lack of vitamin B3\u00a0in the diet<\/em><\/p>\n<\/div>\n<p class=\"mt-align-justify\">Mild niacin deficiency has been shown to slow metabolism, causing decreased tolerance to cold. Severe deficiency of niacin in the diet causes the disease\u00a0pellagra, which is characterized by diarrhea, dermatitis, and dementia, as well as\u00a0Casal&#8217;s necklace\u00a0lesions on the lower neck, hyperpigmentation, thickening of the skin, inflammation of the mouth and tongue, digestive disturbances, amnesia, delirium, and eventually death, if left untreated. Common psychiatric symptoms of niacin deficiency include irritability, poor concentration, anxiety, fatigue, restlessness, apathy, and depression.\u00a0Studies have indicated that, in patients with alcoholic pellagra, niacin deficiency may be an important factor influencing both the onset and severity of this condition. Patients with alcoholism typically experience increased\u00a0intestinal permeability, leading to negative health outcomes.<\/p>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<header>\n<h2 id=\"title\">7.3D: Vitamin B\u2085 (Pantothenic acid)<\/h2>\n<\/header>\n<section class=\"mt-content-container\">\n<p class=\"mt-align-justify\">Pantothenic acid, also called\u00a0vitamin B<sub>5<\/sub>, is a\u00a0water-soluble\u00a0vitamin. Pantothenic acid is an\u00a0essential nutrient. Animals require pantothenic acid to synthesize\u00a0coenzyme-A\u00a0(CoA), as well as to synthesize and metabolize\u00a0proteins,\u00a0carbohydrates, and\u00a0fats.\u00a0Pantothenic acid is the\u00a0amide\u00a0between\u00a0pantoic acid\u00a0and\u00a0\u03b2-alanine. Its name derives from the\u00a0Greek\u00a0<i>pantothen<\/i>, meaning &#8220;from everywhere&#8221;, and small quantities of pantothenic acid are found in nearly every food, with high amounts in\u00a0fortified\u00a0whole-grain\u00a0cereals, egg\u00a0yolks,\u00a0liver\u00a0and dried\u00a0mushrooms.\u00a0It is commonly found as its alcohol analog, the\u00a0provitamin\u00a0panthenol\u00a0(pantothenol), and as calcium pantothenate.<\/p>\n<div style=\"width: 415px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4102\/405px-(R)-Pantothenic_acid_Formula_V.1.svg.png?revision=1\" alt=\"405px-(R)-Pantothenic_acid_Formula_V.1.svg.png\" width=\"405\" height=\"136\" \/><\/p>\n<p class=\"wp-caption-text\"><em>Skeletal formula of (R)-pantothenic acid<\/em><\/p>\n<\/div>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Sources<\/h3>\n<p class=\"mt-align-justify\">Content of pantothenic acid varies among manufactured and natural foods, especially fortified ready-to-eat cereals,\u00a0infant formulas,\u00a0energy bars\u00a0and dried foods.\u00a0Major food sources of pantothenic acid are dried mushrooms, liver, dried egg yolks and sunflower seeds.\u00a0Whole grains are another good source of the vitamin, but milling removes much of the pantothenic acid, as it is found in the outer layers of whole grains.\u00a0In animal feeds, the most important sources are alfalfa, cereal, fish meal, peanut meal, molasses, mushrooms, rice, wheat bran, and yeasts.<\/p>\n<\/div>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intake<\/h3>\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for B vitamins in 1998. At that time there was not sufficient information to establish EARs and RDAs for pantothenic acid. In instances such as this, the Board sets Adequate Intakes (AIs), with the understanding that at some later date, AIs will be replaced by more exact information. As for safety, the FNB sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of pantothenic acid there is no UL, as there is insufficient human data to identify adverse effects from high doses.<span class=\"mt-font-size-12\">\u00a0<\/span>The European Food Safety Authority reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for pantothenic acid.\u00a0Collectively the EARs, RDAs and ULs are referred to as\u00a0Dietary Reference Intakes.<\/p>\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For pantothenic acid labeling purposes 100% of the Daily Value was 10\u00a0mg, but as of May 2016 it has been revised to 5\u00a0mg. Food and supplement companies have until July 2018 to comply with the change.<\/p>\n<table class=\"mt-responsive-table\">\n<thead>\n<tr>\n<th class=\"mt-align-center\" scope=\"col\"><strong>Age group<\/strong><\/th>\n<th class=\"mt-align-center\" scope=\"col\"><strong>Age<\/strong><\/th>\n<th class=\"mt-align-center\" scope=\"col\"><strong>Adequate intake<\/strong><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"mt-align-center\">Infants<\/td>\n<td class=\"mt-align-center\">0\u20136 months<\/td>\n<td class=\"mt-align-center\">1.7\u00a0mg<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Infants<\/td>\n<td class=\"mt-align-center\">7\u201312 months<\/td>\n<td class=\"mt-align-center\">1.8\u00a0mg<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Children<\/td>\n<td class=\"mt-align-center\">1\u20133 years<\/td>\n<td class=\"mt-align-center\">2\u00a0mg<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Children<\/td>\n<td class=\"mt-align-center\">4\u20138 years<\/td>\n<td class=\"mt-align-center\">3\u00a0mg<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Children<\/td>\n<td class=\"mt-align-center\">9\u201313 years<\/td>\n<td class=\"mt-align-center\">4\u00a0mg<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Adult men and women<\/td>\n<td class=\"mt-align-center\">14+ years<\/td>\n<td class=\"mt-align-center\">5\u00a0mg<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Pregnant women<\/td>\n<td class=\"mt-align-center\">(vs. 5)<\/td>\n<td class=\"mt-align-center\">6\u00a0mg<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Breastfeeding women<\/td>\n<td class=\"mt-align-center\">(vs. 5)<\/td>\n<td class=\"mt-align-center\">7\u00a0mg<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mt-align-justify\">Toxicity of pantothenic acid is unlikely. In fact, no Tolerable Upper Level Intake (UL) has been established for the vitamin.\u00a0Large doses of the vitamin, when ingested, have no reported side effects and massive doses (e.g., 10\u00a0g\/day) may only yield mild intestinal distress, and diarrhea at worst.\u00a0It has been suggested, however, that high doses of pantothenic acid might worsen panic attacks in those with panic disorder by prolonging the duration until adrenal exhaustion. Pantothenic acid, at a human equivalent dose within the range of common supplementation, was shown to induce adrenal hyper-responsiveness to stress stimulation.\u00a0There are also no adverse reactions known following parenteral (injected) or topical (skin) applications of the vitamin.<\/p>\n<div id=\"section_3\" class=\"mt-section\">\n<h3 class=\"editable\">Absorption<\/h3>\n<p class=\"mt-align-justify\">When found in foods, most pantothenic acid is in the form of CoA or\u00a0acyl carrier protein\u00a0(ACP). For the intestinal cells to absorb this vitamin, it must be converted into free pantothenic acid.<span class=\"mt-font-size-12\">\u00a0<\/span>Within the lumen of the intestine, CoA and ACP are hydrolyzed into 4&#8242;-phosphopantetheine.\u00a0The 4&#8242;-phosphopantetheine is then dephosphorylated into pantetheine.\u00a0Pantetheinase, an intestinal enzyme, then hydrolyzes pantetheine into free pantothenic acid. Free pantothenic acid is absorbed into intestinal cells via a saturable, sodium-dependent active transport system.\u00a0At high levels of intake, when this mechanism is saturated, some pantothenic acid may also be absorbed via passive diffusion.<span class=\"mt-font-size-12\">\u00a0<\/span>As intake increases 10-fold, however, absorption rate decreases to 10%.<\/p>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<h3 class=\"editable\">Deficiency<\/h3>\n<p class=\"mt-align-justify\">Pantothenic acid deficiency is exceptionally rare and has not been thoroughly studied. In the few cases where deficiency has been seen (victims of starvation and limited volunteer trials), nearly all symptoms can be reversed with the return of pantothenic acid. Symptoms of deficiency are similar to other\u00a0vitamin B\u00a0deficiencies. There is impaired energy production, due to low CoA levels, which could cause symptoms of irritability,\u00a0fatigue, and\u00a0apathy.Acetylcholine synthesis is also impaired; therefore, neurological symptoms can also appear in deficiency;\u00a0they include numbness,\u00a0paresthesia, and muscle cramps.<span class=\"mt-font-size-12\">\u00a0<\/span>Deficiency in pantothenic acid can also cause\u00a0hypoglycemia, or an increased sensitivity to\u00a0insulin.\u00a0Insulin receptors are acylated with palmitic acid when they do not want to bind with insulin.\u00a0Therefore, more insulin will bind to receptors when acylation decreases, causing hypoglycemia.\u00a0Additional symptoms could include restlessness, malaise, sleep disturbances, nausea, vomiting, and abdominal cramps.\u00a0In a few rare circumstances, more serious (but reversible) conditions have been seen, such as\u00a0adrenal\u00a0insufficiency and\u00a0hepatic encephalopathy.<\/p>\n<\/div>\n<div id=\"section_5\" class=\"mt-section\">\n<header>\n<h2 id=\"title\">7.3E: Vitamin B\u2086 (Pyridoxine)<\/h2>\n<\/header>\n<section class=\"mt-content-container\">\n<p class=\"mt-align-justify\">Vitamin B<sub>6<\/sub>\u00a0refers to a group of chemically similar compounds which can be interconverted in biological systems. Vitamin B<sub>6\u00a0<\/sub>is part of the\u00a0vitamin B\u00a0group of\u00a0essential nutrients. Its active form,\u00a0pyridoxal 5\u2032-phosphate, serves as a\u00a0coenzyme\u00a0in some 100\u00a0enzyme\u00a0reactions in\u00a0amino acid,\u00a0glucose, and\u00a0lipid\u00a0metabolism. Several forms<\/p>\n<ul>\n<li class=\"mt-align-justify\">Pyridoxine 5\u2032-phosphate (P5P)<\/li>\n<li class=\"mt-align-justify\">Pyridoxal\u00a0(PL)<\/li>\n<li class=\"mt-align-justify\">Pyridoxal 5\u2032-phosphate\u00a0(PLP), the metabolically active form (sold as P-5-P vitamin supplement)<\/li>\n<li class=\"mt-align-justify\">Pyridoxamine\u00a0(PM)<\/li>\n<li class=\"mt-align-justify\">Pyridoxamine 5\u2032-phosphate (PMP)<\/li>\n<li class=\"mt-align-justify\">4-Pyridoxic acid (PA), the\u00a0catabolite\u00a0which is excreted in urine<\/li>\n<li class=\"mt-align-justify\">Pyritinol, a semi-synthetic derivative of\u00a0pyridoxine, where two pyridoxine moieties are bound by a\u00a0disulfide\u00a0bridge.<\/li>\n<\/ul>\n<p>All forms except pyridoxic acid\u00a0and pyritinol can be interconverted. Absorbed pyridoxamine is converted to PMP by\u00a0pyridoxal kinase, which is further converted to PLP by\u00a0pyridoxamine-phosphate transaminase\u00a0or\u00a0pyridoxine 5\u2032-phosphate oxidase\u00a0which also catalyzes the conversion of PNP to PLP. Pyridoxine 5\u2032-phosphate oxidase is dependent on\u00a0flavin mononucleotide\u00a0(FMN) as a cofactor which is produced from\u00a0<a title=\"Vitamin B2 (Riboflavin)\" href=\"https:\/\/med.libretexts.org\/Courses\/Sacramento_City_College\/SCC%3A_Nutri_300_(Coppola)\/Chapters\/07%3A_Vitamins\/7.3%3A_Water_Soluble_Vitamins\/7.3B%3A_Vitamin_B%E2%82%82_(Riboflavin)\" rel=\"internal\">riboflavin\u00a0<\/a>(vitamin B<sub>2<\/sub>) i.e. in this biochemical pathway, dietary vitamin B<sub>6<\/sub>\u00a0cannot be used without vitamin B<sub>2<\/sub>.<\/p>\n<div style=\"width: 210px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4103\/1224px-Pyridoxal-phosphate.svg.png?revision=1\" alt=\"1224px-Pyridoxal-phosphate.svg.png\" width=\"200\" height=\"118\" \/><\/p>\n<p class=\"wp-caption-text\"><em>Pyridoxine\u00a0and\u00a0Pyridoxamine<\/em><\/p>\n<\/div>\n<p>PLP, the metabolically active form of vitamin B6, is involved in many aspects of\u00a0mcronutrient\u00a0metabolism,\u00a0neurotransmitter\u00a0synthesis,\u00a0histamine\u00a0synthesis,\u00a0hemoglobin\u00a0synthesis and function, and\u00a0gene expression. PLP generally serves as a\u00a0coenzyme\u00a0(cofactor) for many reactions including\u00a0decarboxylation,\u00a0transamination,\u00a0racemization, elimination, replacement, and beta-group interconversion. The liver is the site for vitamin B6\u00a0metabolism.Amino acid metabolism PLP is a cofactor in the biosynthesis of five important\u00a0neurotransmitters:\u00a0serotonin,\u00a0dopamine,\u00a0epinephrine,\u00a0norepinephrine, and\u00a0gamma-aminobutyric acid\u00a0(GABA). PLP is also involved in the synthesis of\u00a0histamine.<\/p>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"editable\">Dietary Sources<\/h3>\n<p class=\"mt-align-justify\">Vitamin B<sub>6<\/sub>\u00a0is widely distributed in foods in both its free and bound forms. Cooking, storage, and processing losses of vitamin B<sub>6<\/sub>\u00a0vary and in some foods may be more than 50%,\u00a0depending on the form of vitamin present in the food. Plant foods lose the least during processing, as they contain mostly pyridoxine, which is far more stable than the pyridoxal or pyridoxamine found in animal foods. For example, milk can lose 30\u201370% of its vitamin B<sub>6<\/sub>\u00a0content when\u00a0dried.\u00a0Vitamin B<sub>6<\/sub>\u00a0is found in the\u00a0germ\u00a0and\u00a0aleurone\u00a0layer of grains, and milling results in the reduction of this vitamin in white flour. The heating that occurs before most freezing and canning processes are other methods that may result in the loss of vitamin B<sub>6<\/sub>\u00a0in foods.<\/p>\n<p>Foods that contain large amounts of vitamin B6\u00a0include:<\/p>\n<ul>\n<li>fortified\u00a0breakfast cereals<\/li>\n<li>pork<\/li>\n<li>turkey<\/li>\n<li>beef<\/li>\n<li>bananas<\/li>\n<li>chickpeas<\/li>\n<li>potatoes<\/li>\n<li>pistachios<\/li>\n<\/ul>\n<\/div>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intake<\/h3>\n<p class=\"mt-align-justify\">The Food and Nutrition Board (FNB) of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for vitamin B<sub>6<\/sub>\u00a0in 1998. The current EARs for vitamin B<sub>6<\/sub>\u00a0for women and men ages 14 and up increase with age from 1.0 to 1.3\u00a0mg\/day and from 1.1 to 1.4\u00a0mg\/day, respectively; the RDAs increase with age from 1.2 to 1.5 and from 1.3 to 1.7\u00a0mg\/day, respectively. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 1.9\u00a0mg\/day. RDA for lactation equals 2.0\u00a0mg\/day. For infants up to 12 months the Adequate Intake (AI) is 0.1\u20130.3\u00a0mg\/day. and for children ages 1\u201313 years the RDA increases with age from 0.5 to 1.0\u00a0mg\/day. As for safety, the FNB sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of vitamin B<sub>6<\/sub>\u00a0the UL is set at 100\u00a0mg\/day.\u00a0The European Food Safety Authority reviewed the same safety question and set its UL at 25\u00a0mg\/day. Safety issues are presented at length in the Toxicity section.<\/p>\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of daily value (%DV). For vitamin B<sub>6<\/sub>\u00a0labeling purposes 100% of the Daily Value was 2.0\u00a0mg, but as of May 2016 it has been revised to 1.7\u00a0mg. Food and supplement companies have until July 28, 2018 to comply with the change.<\/p>\n<\/div>\n<div id=\"section_3\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Absorption and excretion<\/h3>\n<p class=\"mt-align-justify\">Vitamin B<sub>6<\/sub>\u00a0is absorbed in the\u00a0jejunum\u00a0and\u00a0ileum\u00a0by passive diffusion. With the capacity for absorption being so great, animals are able to absorb quantities much greater than necessary for physiological demands. The absorption of pyridoxal phosphate and pyridoxamine phosphate involves their dephosphorylation catalyzed by a membrane-bound\u00a0alkaline phosphatase. Those products and nonphosphorylated forms in the digestive tract are absorbed by diffusion, which is driven by trapping of the vitamin as 5\u2032-phosphates through the action of phosphorylation (by a pyridoxal kinase) in the jejunal mucosa. The trapped pyridoxine and pyridoxamine are oxidized to pyridoxal phosphate in the tissue.<\/p>\n<p class=\"mt-align-justify\">The products of vitamin B<sub>6<\/sub>\u00a0metabolism are excreted in the urine, the major product of which is 4-pyridoxic acid. An estimated 40\u201360% of ingested vitamin B<sub>6<\/sub>\u00a0is oxidized to 4-pyridoxic acid. Several studies have shown that 4-pyridoxic acid is undetectable in the urine of vitamin B<sub>6<\/sub>-deficient subjects, making it a useful clinical marker to assess the vitamin B<sub>6<\/sub>\u00a0status of an individual.\u00a0Other products of vitamin B<sub>6<\/sub>metabolism excreted in the urine when high doses of the vitamin have been given include pyridoxal, pyridoxamine, and pyridoxine and their phosphates. A small amount of vitamin B<sub>6<\/sub>\u00a0is also excreted in the feces.<\/p>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<h3 class=\"editable\">Deficiencies<\/h3>\n<p>The classic clinical syndrome for vitamin B6\u00a0deficiency is a\u00a0seborrhoeic dermatitis-like eruption,\u00a0atrophic glossitis\u00a0with\u00a0ulceration,\u00a0angular cheilitis,\u00a0conjunctivitis,\u00a0intertrigo, and neurologic symptoms of\u00a0somnolence, confusion, and\u00a0neuropathy\u00a0(due to impaired\u00a0sphingosine\u00a0synthesis) and\u00a0sideroblastic anemia\u00a0(due to impaired\u00a0heme\u00a0synthesis).<\/p>\n<p>Less severe cases present with\u00a0metabolic disease\u00a0associated with insufficient activities of the\u00a0coenzyme\u00a0PLP. The most prominent of the lesions is due to impaired\u00a0tryptophan\u2013niacin\u00a0conversion. This can be detected based on urinary excretion of\u00a0xanthurenic acid\u00a0after an oral tryptophan load. Vitamin B6\u00a0deficiency can also result in impaired\u00a0transsulfuration\u00a0of\u00a0methionine\u00a0to\u00a0cysteine. The PLP-dependent transaminases and glycogen phosphorylase provide the vitamin with its role in gluconeogenesis, so deprivation of vitamin B6\u00a0results in impaired glucose tolerance.<\/p>\n<p>A deficiency of vitamin B6\u00a0alone is relatively uncommon and often occurs in association with other vitamins of the B complex. The elderly and\u00a0alcoholics\u00a0have an increased risk of vitamin B6\u00a0deficiency, as well as other micronutrient deficiencies. Evidence exists for decreased levels of vitamin B6\u00a0in women with\u00a0type 1 diabetes\u00a0and in patients with systemic inflammation, liver disease, rheumatoid arthritis, and those infected with HIV.<\/p>\n<\/div>\n<div id=\"section_5\" class=\"mt-section\">\n<header>\n<h2 id=\"title\">7.3F: Vitamin B\u2087 (Biotin)<\/h2>\n<\/header>\n<section class=\"mt-content-container\">\n<p class=\"mt-align-justify\">Biotin\u00a0is a water-soluble\u00a0B-vitamin, also called\u00a0vitamin B7\u00a0and formerly known as\u00a0vitamin H\u00a0or\u00a0coenzyme R.[2]\u00a0It is composed of a ureido ring fused with a\u00a0tetrahydrothiophene\u00a0ring. A\u00a0valeric acid\u00a0substituent is attached to one of the carbon atoms of the tetrahydrothiophene ring. Biotin is a\u00a0coenzyme\u00a0for\u00a0carboxylase\u00a0enzymes, involved in the synthesis of\u00a0fatty acids,\u00a0isoleucine, and\u00a0valine, and in\u00a0gluconeogenesis.\u00a0Biotin deficiency\u00a0can be caused by inadequate dietary intake or inheritance of one or more inborn genetic disorders that affect biotin metabolism. Subclinical deficiency can cause mild symptoms, such as hair thinning or skin rash typically on the face. Neonatal screening for biotinidase deficiency began in the United States in 1984 and today many countries test for this disorder at birth. Individuals born prior to 1984 are unlikely to have been screened, thus the true prevalence of the disorder is unknown.<\/p>\n<div style=\"width: 310px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4104\/Biotin_structure.svg.png?revision=1\" alt=\"Biotin_structure.svg.png\" width=\"300\" height=\"167\" \/><\/p>\n<p class=\"wp-caption-text\"><em>Skeletal formula of biotin<\/em><\/p>\n<\/div>\n<p class=\"mt-align-justify\">Biotin is necessary for cell growth, the production of fatty acids, and the metabolism of fats and\u00a0amino acids.\u00a0Biotin assists in various metabolic reactions involving the transfer of\u00a0carbon dioxide. It may also be helpful in maintaining a steady\u00a0blood sugar\u00a0level. Biotin is often recommended as a\u00a0dietary supplement\u00a0for strengthening hair and nails, though scientific data supporting this outcome are weak.\u00a0Nevertheless, biotin is found in many cosmetics and health products for the hair and skin.<\/p>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"editable\">Dietary Reference Intake<\/h3>\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for B vitamins in 1998. At that time there was not sufficient information to establish EARs and RDAs for biotin. In instances such as this, the Board sets Adequate Intakes (AIs), with the understanding that at some later date, AIs will be replaced by more exact information. The current AI for adults ages 19 and up is 30 \u03bcg\/day. AI for pregnancy is 30 \u03bcg\/day. AI for lactation is 35 \u03bcg\/day. For infants up to 12 months the AI is 5-6 \u03bcg\/day For children ages 1\u201318 years the AI increases with age from 8 to 25 \u03bcg\/day.<\/p>\n<p class=\"mt-align-justify\">As for safety, the FNB sets Tolerable Upper Intake Levels (known as ULs) for vitamins and minerals when evidence is sufficient. In the case of biotin there is no UL, as there is insufficient human data to identify adverse effects from high doses. The European Food Safety Authority reviewed the same safety question and also reached the conclusion that there was not sufficient evidence to set a UL for biotin.<\/p>\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For biotin labeling purposes 100% of the Daily Value was 300 \u03bcg, but as of May 2016 it has been revised to 30 \u03bcg to bring it into agreement with the AI. Food and supplement companies have until July 2018 to comply with the change.<\/p>\n<\/div>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"editable\">Dietary Sources<\/h3>\n<p class=\"mt-align-justify\">Biotin is synthesized by\u00a0intestinal\u00a0bacteria, but there is a lack of good quality studies about how much biotin they provide.<sup id=\"cite_ref-lpi_16-0\">\u00a0<\/sup>Biotin is stable at room temperature and isn\u2019t destroyed by cooking. Some of the best sources are (content per 100 grams):<\/p>\n<ul>\n<li class=\"mt-align-justify\">Brewer&#8217;s yeast: 188.8 mcg<\/li>\n<li class=\"mt-align-justify\">Soybeans: 179.4 mcg<\/li>\n<li class=\"mt-align-justify\">Beef liver: 113.3 mcg<\/li>\n<li class=\"mt-align-justify\">Butter: 94.3 mcg<\/li>\n<li class=\"mt-align-justify\">Split peas: 77.7 mcg<\/li>\n<li class=\"mt-align-justify\">Sunflower seeds: 66 mcg<\/li>\n<li class=\"mt-align-justify\">Green peas\/lentils: 40 mcg<\/li>\n<li class=\"mt-align-justify\">Peanuts\/walnuts: 37.5 mcg<\/li>\n<li class=\"mt-align-justify\">Pecans: 27.75 mcg<\/li>\n<li class=\"mt-align-justify\">Eggs: 18.9 mcg<\/li>\n<\/ul>\n<p class=\"mt-align-justify\">Egg whites contain a protein (avidin) that blocks the absorption of biotin, so people who regularly consume a large number of eggs may become biotin-deficient.\u00a0The dietary biotin intake in Western populations has been estimated to be 35 to 70\u00a0micrograms per day (143\u2013287\u00a0nmol per day).<sup id=\"cite_ref-jnb_19-0\">\u00a0<\/sup>Biotin is also available in\u00a0dietary supplements\u00a0in which a dose of 30 micrograms meets 100% of the\u00a0Daily Value\u00a0for adults.<\/p>\n<\/div>\n<div id=\"section_3\" class=\"mt-section\">\n<h3 class=\"editable\">Deficiency<\/h3>\n<p class=\"mt-align-justify\">Biotin deficiency is rare. The amounts needed are small, a wide range of foods contain biotin, and intestinal bacteria synthesize biotin, which is then absorbed by the host animal. For that reason, statutory agencies in many countries, for example the USA\u00a0and Australia,<span class=\"mt-font-size-12\">\u00a0<\/span>have not formally established a recommended daily intake of biotin. Instead, an Adequate Intake (AI) is identified based on the theory that average intake meets needs.\u00a0A number of rare\u00a0metabolic disorders\u00a0exist in which an individual&#8217;s metabolism of biotin is abnormal.<\/p>\n<p class=\"mt-align-justify\">Biotin deficiency\u00a0typically occurs from dietary absence of the vitamin. Consuming raw egg whites over months may result in biotin deficiency.<sup id=\"cite_ref-mlp_2-4\">\u00a0<\/sup>Deficiency can be addressed with nutritional supplementation.<sup id=\"cite_ref-mlp_2-5\">\u00a0<\/sup>Deficiency symptoms include:<\/p>\n<ul>\n<li class=\"mt-align-justify\">Brittle and thin fingernails<\/li>\n<li class=\"mt-align-justify\">Hair loss (alopecia)<\/li>\n<li class=\"mt-align-justify\">Conjunctivitis<\/li>\n<li class=\"mt-align-justify\">Dermatitis\u00a0in the form of a scaly, red rash around the eyes, nose, mouth, and genital area.<\/li>\n<li class=\"mt-align-justify\">Neurological symptoms in adults, such as depression, lethargy, hallucination, and numbness and tingling of the extremities<\/li>\n<\/ul>\n<p class=\"mt-align-justify\">The neurological and psychological symptoms can occur with only mild deficiencies. Dermatitis, conjunctivitis, and hair loss will generally occur only when deficiency becomes more severe. Individuals with hereditary disorders of biotin deficiency have evidence of impaired immune system function, including increased susceptibility to bacterial and fungal infections.<\/p>\n<p class=\"mt-align-justify\">Pregnant women tend to have a high risk of biotin deficiency. Nearly half of pregnant women have abnormal increases of 3-hydroxyisovaleric acid, which reflects reduced status of biotin. Several studies have reported this possible biotin deficiency during the pregnancy may cause infants&#8217; congenital malformations, such as cleft palate. Mice fed with dried raw egg to induce biotin deficiency during the gestation resulted in up to 100% incidence of the infants&#8217; malnourishment. Infants and embryos are more sensitive to the biotin deficiency. Therefore, even a mild level of the mother&#8217;s biotin deficiency that does not reach the appearance of physiological deficiency signs may cause a serious consequence in the infants.<\/p>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<header>\n<h2 id=\"title\">7.3G: Vitamin B\u2089 (Folic acid)<\/h2>\n<\/header>\n<section class=\"mt-content-container\">Folic acid, another form of which is known as\u00a0folate, is one of the\u00a0B vitamins.\u00a0The recommended daily intake level of folate is 400\u00a0micrograms\u00a0from foods or\u00a0dietary supplements.\u00a0Folic acid is used to treat\u00a0anemia\u00a0caused by\u00a0folic acid deficiency.\u00a0It is also used as a\u00a0supplement\u00a0by women during\u00a0pregnancy\u00a0to prevent\u00a0neural tube defects\u00a0(NTDs) in the baby.\u00a0Low levels in early\u00a0pregnancy\u00a0are believed to be the cause of more than half of babies born with\u00a0neural tube defects.\u00a0More than 50 countries use\u00a0fortification of certain foods\u00a0with folic acid as a measure to decrease the rate of NTDs in the population.\u00a0Long term supplementation is also associated with small reductions in the risk of\u00a0stroke\u00a0and\u00a0cardiovascular disease.\u00a0It may be taken by mouth or by injection.<\/p>\n<div style=\"width: 430px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4105\/420px-Folic_acid.svg.png?revision=1\" alt=\"420px-Folic_acid.svg.png\" width=\"420\" height=\"153\" \/><\/p>\n<p class=\"wp-caption-text\"><em>Skeletal formula<\/em><\/p>\n<\/div>\n<p>There are no common side effects. It is not known whether high doses over a long period of time are of concern. There are concerns that large amounts of folic acid might hide\u00a0vitamin B12 deficiency. It is\u00a0essential\u00a0for the body to make\u00a0DNA,\u00a0RNA, and metabolise\u00a0amino acids\u00a0which are required for\u00a0cell division.[8]\u00a0As humans cannot make folic acid, it is required from the diet, making it an\u00a0essential vitamin.<\/p>\n<p>Not consuming enough folate can lead to\u00a0folate deficiency. This may result in a type of anemia in which\u00a0low numbers of large red blood cells\u00a0occur. Symptoms may include\u00a0feeling tired,\u00a0heart palpitations,\u00a0shortness of breath, open sores on the tongue, and changes in the color of the skin or hair. Deficiency in children may develop within a month of poor dietary intake.[13]\u00a0In adults normal total body folate is between 10,000\u201330,000\u00a0micrograms (\u00b5g) with blood levels of greater than 7 nmol\/L (3\u00a0ng\/mL).[8]<\/p>\n<p>Folic acid was discovered between 1931 and 1943.[14]\u00a0It is on the\u00a0World Health Organization&#8217;s List of Essential Medicines, the most effective and safe medicines needed in a\u00a0health system.[15]\u00a0The wholesale cost of supplements in the\u00a0developing world\u00a0is between 0.001 and 0.005 USD per dose as of 2014.[16]The term &#8220;folic&#8221; is from the Latin word\u00a0folium, which means leaf. Folates occur naturally in many foods especially dark green leafy\u00a0vegetables\u00a0and\u00a0liver.[8]<\/p>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Pregnancy and Fertility<\/h3>\n<p>Folic acid intake during pregnancy has been linked to a lessened risk of\u00a0neural tube defects.\u00a0Likewise, a meta-analysis of folic acid supplementation during pregnancy reported a 28% lower risk of newborn\u00a0congenital heart defects. The\u00a0United States Preventive Services Task Force\u00a0recommends folic acid supplementation for all women able to become pregnant.<\/p>\n<p>Devakamar reviewed long-term outcomes for live births that did not involve neural tube defects and fortification with folic acid did not have an impact on childhood survival, growth, body composition, or cognitive outcomes. Prenatal supplementation did not appear to reduce the risk of pre-term births.\u00a0And there does not appear to be a correlation between maternal folic acid supplementation and an increased risk for asthma in the child.<\/p>\n<p class=\"mt-align-justify\">Folate is necessary for\u00a0fertility\u00a0in both men and women. It contributes to\u00a0spermatogenesis. Therefore, it is necessary to receive sufficient amounts through the diet to avoid\u00a0subfertility.\u00a0Also, polymorphisms in genes of enzymes involved in folate metabolism could be one reason for fertility complications in some women with\u00a0unexplained infertility.<\/p>\n<\/div>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Heart Disease, Stroke and Cancer<\/h3>\n<p class=\"mt-align-justify\">Taking folic acid over years reduced the risk of cardiovascular disease by 4%,\u00a0where another study found it did not affect cardiovascular disease, even while reducing\u00a0homocysteine\u00a0levels.<\/p>\n<p class=\"mt-align-justify\">Long-term supplementation with folic acid reduced the risk of stroke by 10%, which may be due to the role folate plays in regulating homocysteine concentration.The reviews indicate the risk of stroke appears to be reduced only in some individuals, but a definite recommendation regarding supplementation beyond the current RDA has not been established for stroke prevention.\u00a0Asian populations had greater protection against stroke with folate supplementation than did European or North American subjects.<\/p>\n<p class=\"mt-align-justify\">Observed stroke reduction is consistent with the reduction in\u00a0pulse pressure\u00a0produced by folate supplementation of 5\u00a0mg per day, since hypertension is a key risk factor for stroke. Folic supplements are inexpensive and relatively safe to use, which is why stroke or\u00a0hyperhomocysteinemia\u00a0patients are encouraged to consume daily B vitamins including folic acid.<\/p>\n<p class=\"mt-align-justify\">Studies on folic acid intake from food and folate supplementation with regards to cancer risk are based on the adequacy of chronic intake. Chronically insufficient intake of folic acid (below the recommended level of 400 micrograms per day<span class=\"mt-font-size-12\">)<\/span>\u00a0may increase the risk of\u00a0colorectal, breast, ovarian, pancreas, brain, lung,\u00a0cervical, and\u00a0prostate\u00a0cancers.\u00a0Other studies showed that excessive dietary supplementation with synthetic folate may increase the risk of certain cancers, in particular\u00a0prostate.<span class=\"mt-font-size-12\">\u00a0<\/span>A 2017 review found no relationship between taking folate supplements and cancer risk.<\/p>\n<\/div>\n<div id=\"section_3\" class=\"mt-section\">\n<h3 class=\"editable\">Dietary Reference Intake<\/h3>\n<p class=\"mt-align-justify\">Because of the difference in bioavailability between supplemented folic acid and the different forms of folate found in food, the dietary folate equivalent (DFE) system was established. One DFE is defined as 1\u00a0\u03bcg of dietary folate, or 0.6\u00a0\u03bcg of folic acid supplement.<\/p>\n<table class=\"mt-responsive-table mt-table-big\" summary=\"National Institutes of Health\u00a0(US) nutritional requirements[65]\u00a0(\u00b5g DFE per day)\">\n<caption><em>National Institutes of Health\u00a0(US) nutritional requirements[65]\u00a0(\u00b5g DFE per day)<\/em><\/caption>\n<thead>\n<tr>\n<th class=\"mt-align-center\" scope=\"col\">Age<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Infants (AI)<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Infants (UL)<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Adults (RDA)<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Adults (UL)<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Pregnant women (RDA)<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Pregnant women (UL)<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Lactating women (RDA)<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Lactating women (UL)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"mt-align-center\">0\u20136 months<\/td>\n<td class=\"mt-align-center\">65<\/td>\n<td class=\"mt-align-center\">None set<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">7\u201312 months<\/td>\n<td class=\"mt-align-center\">80<\/td>\n<td class=\"mt-align-center\">None set<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">1\u20133 years<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">150<\/td>\n<td class=\"mt-align-center\">300<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">4\u20138 years<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">200<\/td>\n<td class=\"mt-align-center\">400<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u00a0\u2013<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">9\u201313 years<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">300<\/td>\n<td class=\"mt-align-center\">600<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">14\u201318<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">400<\/td>\n<td class=\"mt-align-center\">800<\/td>\n<td class=\"mt-align-center\">600<\/td>\n<td class=\"mt-align-center\">800<\/td>\n<td class=\"mt-align-center\">500<\/td>\n<td class=\"mt-align-center\">800<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">19+<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">\u2013<\/td>\n<td class=\"mt-align-center\">400<\/td>\n<td class=\"mt-align-center\">1000<\/td>\n<td class=\"mt-align-center\">600<\/td>\n<td class=\"mt-align-center\">1000<\/td>\n<td class=\"mt-align-center\">500<\/td>\n<td class=\"mt-align-center\">1000<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For folic acid labeling purposes 100% of the Daily Value was 400 \u03bcg. As of the May 2016 update it was kept unchanged at 400 \u03bcg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until 28 July 2018 to comply with the change.<\/p>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Sources<\/h3>\n<p>Folate naturally occurs in a wide variety of foods, including vegetables (particularly dark green\u00a0leafy vegetables), fruits and fruit juices, nuts, beans, peas, dairy products, poultry and meat, eggs, seafood, grains, and some beers.\u00a0Avocado,\u00a0beetroot,\u00a0spinach,\u00a0liver,\u00a0yeast,\u00a0asparagus, and\u00a0Brussels sprouts\u00a0are among the foods with the highest levels of folate. Folic acid is added to grain products in many countries, and in these countries, fortified products make up a significant source of the population&#8217;s folic acid intake. Because of the difference in bioavailability between supplemented folic acid and the different forms of folate found in food, the dietary folate equivalent (DFE) system was established. 1 DFE is defined as 1 \u03bcg of dietary folate, or 0.6 \u03bcg of folic acid supplement. This is reduced to 0.5 \u03bcg of folic acid if the supplement is taken on an empty stomach. bFolate naturally found in food is susceptible to high heat and ultraviolet light, and is soluble in water.\u00a0It is heat-labile in acidic environments and may also be subject to oxidation. Some meal replacement products do not meet the folate requirements as specified by the\u00a0RDAs.<\/p>\n<div class=\"note1\">\n<div class=\"textbox shaded\">\n<h3 class=\"boxtitle\">FOOD FORTIFICATION<\/h3>\n<hr \/>\n<p class=\"mt-align-justify\"><i>Folic acid fortification<\/i>\u00a0is a process where folic acid is added to flour with the intention of promoting public health through increasing blood folate levels in the populace. In the USA, food is fortified with folic acid, only one of the many naturally occurring forms of folate, and a substance contributing only a minor amount to the folates in natural foods. Since the discovery of the link between insufficient folic acid and\u00a0neural tube defects, governments and health organizations worldwide have made recommendations concerning folic acid\u00a0<i>supplementation<\/i>\u00a0for women intending to become\u00a0pregnant.<\/p>\n<p class=\"mt-align-justify\">Fortification is controversial, with issues having been raised concerning individual liberty, as well as the health concerns described in the\u00a0Toxicity\u00a0section above. In the USA, there is concern that the federal government mandates fortification, but does not provide monitoring of potential undesirable effects of fortification. 76 countries worldwide (inclduing the USA) require mandatory folic acid fortification of at least one major cereal grain, with nearly all fortifying at least wheat flour, according to November 2013 data from the Flour Fortification Initiative.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"section_5\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Folate Deficiency<\/h3>\n<p class=\"mt-align-justify\">Folate deficiency can be caused by unhealthy diets that do not include enough fruits and vegetables, diseases in which folic acid is not well absorbed in the digestive system (such as\u00a0Crohn&#8217;s disease\u00a0or\u00a0celiac disease), some genetic disorders that affect levels of folate, and certain medicines (such as phenytoin, sulfasalazine, or trimethoprim-sulfamethoxazole).\u00a0Folate deficiency is accelerated by alcohol consumption.<\/p>\n<p class=\"mt-align-justify\">Folate deficiency may lead to\u00a0glossitis, diarrhea, depression, confusion, anemia, and fetal\u00a0neural tube defects\u00a0and brain defects (during pregnancy).\u00a0Other symptoms include fatigue, gray hair, mouth sores, poor growth, and swollen tongue. Folate deficiency is diagnosed by analyzing\u00a0CBC\u00a0and plasma vitamin B<sub>12<\/sub>\u00a0and folate levels.<span class=\"mt-font-size-12\">\u00a0<\/span>CBC may indicate megaloblastic anemia but this could also be a sign of vitamin B<sub>12<\/sub>\u00a0deficiency.\u00a0A serum folate of 3 \u03bcg\/L or lower indicates deficiency.\u00a0Serum folate level reflects folate status but erythrocyte folate level better reflects tissue stores after intake. Serum folate reacts more rapidly to folate intake than erythrocyte folate.\u00a0An erythrocyte folate level of 140 \u03bcg\/L or lower indicates inadequate folate status.\u00a0Increased homocysteine level suggests tissue folate deficiency but homocysteine is also affected by vitamin B<sub>12<\/sub>\u00a0and vitamin B<sub>6<\/sub>, renal function, and genetics.<\/p>\n<\/div>\n<div id=\"section_6\" class=\"mt-section\">\n<header>\n<h2 id=\"title\">7.3H: Vitamin B\u2081\u2082 (Cobalamin)<\/h2>\n<\/header>\n<section class=\"mt-content-container\">Vitamin B<sub>12<\/sub>, also called\u00a0cobalamin, is a water-soluble\u00a0vitamin\u00a0that has a key role in the normal functioning of the\u00a0brain\u00a0and\u00a0nervous system, and the formation of red blood cells. It is one of eight\u00a0B vitamins. It is involved in the\u00a0metabolism\u00a0of every\u00a0cell\u00a0of the human body, especially affecting\u00a0DNA\u00a0synthesis,\u00a0fatty acid\u00a0and\u00a0amino acid\u00a0metabolism.[1]\u00a0No fungi, plants, nor animals (including humans) are capable of producing vitamin B<sub>12<\/sub>. Only\u00a0bacteria\u00a0and\u00a0archaea\u00a0have the enzymes needed for its synthesis. Proven sources of B<sub>12<\/sub>\u00a0are animal products (meat, fish, dairy products) and supplements. Some research states that certain non-animal products possibly can be a natural source of B<sub>12<\/sub>\u00a0because of\u00a0bacterial symbiosis. B<sub>12<\/sub>\u00a0is the largest and most structurally complicated vitamin and can be produced industrially only through a bacterial fermentation-synthesis. This synthetic B<sub>12<\/sub>\u00a0is used to\u00a0fortify foods\u00a0and sold as a dietary supplement.<\/p>\n<div style=\"width: 360px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4106\/800px-Cyanocobalamin-b12.png?revision=1\" alt=\"800px-Cyanocobalamin-b12.png\" width=\"350\" height=\"404\" \/><\/p>\n<p class=\"wp-caption-text\"><em>Chemical structure of cyanocobalamin. Image used with permission (CC BY-SA 4.0;\u00a0Alsosaid1987).<\/em><\/p>\n<\/div>\n<p>Vitamin B<sub>12\u00a0<\/sub>consists of a class of chemically related compounds (vitamers), all of which show\u00a0pharmacological activity. It contains the biochemically rare element\u00a0cobalt\u00a0(chemical symbol\u00a0Co) positioned in the center of a planar tetra-pyrrole\u00a0ring called a\u00a0corrin\u00a0ring. The vitamer is produced by bacteria as\u00a0hydroxocobalamin, but conversion between different forms of the vitamin occurs in the body after consumption.<\/p>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Dietary Reference Intake<\/h3>\n<p class=\"mt-align-justify\">The Food and Nutrition Board of the U.S. Institute of Medicine (IOM) updated Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for vitamin B<sub>12<\/sub>\u00a0in 1998. The current EAR for vitamin B<sub>12<\/sub>\u00a0for women and men ages 14 and up is 2.0 \u03bcg\/day; the RDA is 2.4 \u03bcg\/day. RDAs are higher than EARs so as to identify amounts that will cover people with higher than average requirements. RDA for pregnancy equals 2.6 \u03bcg\/day. RDA for lactation equals 2.8 \u03bcg\/day. For infants up to 12 months the Adequate Intake (AI) is 0.4-0.5 \u03bcg\/day. and for children ages 1\u201313 years the RDA increases with age from 0.9 to 1.8 \u03bcg\/day. Because 10 to 30 percent of older people may be unable to effectively absorb vitamin B<sub>12<\/sub>\u00a0naturally occurring in foods, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B<sub>12<\/sub>\u00a0or a supplement containing vitamin B<sub>12<\/sub>.<\/p>\n<p>For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For vitamin B<sub>12<\/sub>\u00a0labeling purposes 100% of the Daily Value was 6.0 \u03bcg, but as of May 2016 has been revised downward to 2.4 \u03bcg.<\/p>\n<\/div>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"editable\">Deficiency<\/h3>\n<p class=\"mt-align-justify\">Vitamin B<sub>12<\/sub>\u00a0deficiency can potentially cause severe and irreversible damage, especially to the brain and nervous system. At levels only slightly lower than normal, a range of symptoms such as\u00a0fatigue,\u00a0lethargy,\u00a0depression, poor\u00a0memory, breathlessness, headaches, and pale skin, among others, may be experienced, especially in elderly people (over age 60)\u00a0who produce less stomach acid as they age, thereby increasing their probability of B<sub>12<\/sub>deficiencies.<\/p>\n<p class=\"mt-align-justify\">Vitamin B<sub>12<\/sub>\u00a0deficiency is most commonly caused by low intakes, but can also result from malabsorption, certain intestinal disorders, low presence of binding proteins, and use of certain medications. Vitamin B<sub>12<\/sub>\u00a0is rare from plant sources, so vegetarians are most likely to suffer from vitamin B<sub>12<\/sub>\u00a0deficiency. Infants are at a higher risk of vitamin B<sub>12<\/sub>\u00a0deficiency if they were born to vegetarian mothers. The elderly who have diets with limited meat or animal products are vulnerable populations as well. Vitamin B<sub>12<\/sub>\u00a0deficiency may occur in between 40% to 80% of the vegetarian population.<\/p>\n<p class=\"mt-align-justify\">Vitamin B<sub>12<\/sub>\u00a0is a co-substrate of various cell reactions involved in methylation synthesis of nucleic acid and neurotransmitters. Synthesis of the trimonoamine neurotransmitters can enhance the effects of a traditional antidepressant.\u00a0The intracellular concentrations of vitamin B<sub>12<\/sub>\u00a0can be inferred through the total plasma concentration of homocysteine, which can be converted to methionine through an enzymatic reaction that uses 5-methyltetrahydrofolate as the methyl donor group. Consequently, the plasma concentration of homocysteine falls as the intracellular concentration of vitamin B<sub>12<\/sub>\u00a0rises. The active metabolite of vitamin B<sub>12<\/sub>\u00a0is required for the methylation of homocysteine in the production of methionine, which is involved in a number of biochemical processes including the monoamine neurotransmitters metabolism. Thus, a deficiency in vitamin B<sub>12<\/sub>\u00a0may impact the production and function of those neurotransmitters.<\/p>\n<\/div>\n<div id=\"section_3\" class=\"mt-section\">\n<h3 class=\"editable\">Dietary Sources<\/h3>\n<p class=\"mt-align-justify\">Foods having rich content of vitamin B<sub>12<\/sub>\u00a0include\u00a0clams,\u00a0organ meats\u00a0(especially\u00a0liver) from\u00a0lamb,\u00a0veal, beef, and\u00a0turkey,\u00a0fish eggs,\u00a0mackerel, and\u00a0crab meat.<span class=\"mt-font-size-12\">\u00a0<\/span>B<sub>12<\/sub>\u00a0is synthesized by some\u00a0gut bacteria\u00a0in humans and other animals, but humans cannot absorb the B<sub>12<\/sub>\u00a0made in their guts, as it is made in the\u00a0colon\u00a0which is too far from the\u00a0small intestine, where absorption of B<sub>12<\/sub>\u00a0occurs.<\/p>\n<p class=\"mt-align-justify\">Animals store vitamin B<sub>12<\/sub>\u00a0in liver and muscle and some pass the vitamin into their eggs and milk; meat, liver, eggs and milk are therefore sources of the vitamin for other animals, including people.<span class=\"mt-font-size-12\">\u00a0<\/span>For humans, the bioavailability from eggs is less than 9%, compared to 40% to 60% from fish, fowl and meat.\u00a0Insects are also a source of B<sub>12<\/sub>.\u00a0Foods\u00a0fortified\u00a0with B<sub>12<\/sub>\u00a0are also dietary sources of the vitamin. Foods for which B<sub>12<\/sub>-fortified versions are widely available include\u00a0breakfast cereals,\u00a0soy\u00a0products,\u00a0energy bars, and\u00a0nutritional yeast.<\/p>\n<p class=\"mt-align-justify\">Vitamin B<sub>12<\/sub>\u00a0is an ingredient in multi-vitamin pills and in some countries used to enrich grain-based foods such as bread and pasta. In the U.S. non-prescription products can be purchased providing up to 5000\u00a0\u00b5g\/serving, and it is a common ingredient in\u00a0energy drinks\u00a0and\u00a0energy shots, usually at many times the recommended dietary allowance of B<sub>12<\/sub>. The vitamin can also be a prescription product via injection or other means.<\/p>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Absorption and Distribution<\/h3>\n<p class=\"mt-align-justify\">Methyl-B<sub>12<\/sub>\u00a0is absorbed by two processes. The first is an intestinal mechanism using\u00a0intrinsic factor\u00a0through which 1-2 micrograms can be absorbed every few hours. The second is a diffusion process by which approximately 1% of the remainder is absorbed.\u00a0The human physiology of vitamin B<sub>12<\/sub>\u00a0is complex, and therefore is prone to mishaps leading to\u00a0vitamin B<sub>12<\/sub>\u00a0deficiency. Protein-bound vitamin B<sub>12<\/sub>must be released from the proteins by the action of digestive proteases in both the stomach and small intestine.<\/p>\n<p class=\"mt-align-justify\">Absorption of food vitamin B<sub>12<\/sub>\u00a0thus requires an intact and functioning\u00a0stomach,\u00a0exocrine pancreas, intrinsic factor, and small bowel. Problems with any one of these organs makes a\u00a0vitamin B<sub>12<\/sub>\u00a0deficiency\u00a0possible. Individuals who lack intrinsic factor have a decreased ability to absorb B<sub>12<\/sub>. The total amount of vitamin B<sub>12<\/sub>\u00a0stored in body is about 2\u20135\u00a0mg in adults. Around 50% of this is stored in the liver. Approximately 0.1% of this is lost per day by secretions into the gut, as not all these secretions are reabsorbed. Bile is the main form of B<sub>12<\/sub>\u00a0excretion; most of the B<sub>12<\/sub>\u00a0secreted in the bile is recycled via enterohepatic circulation. Excess B<sub>12<\/sub>\u00a0beyond the blood&#8217;s binding capacity is typically excreted in urine. Owing to the extremely efficient enterohepatic circulation of B<sub>12<\/sub>, the liver can store 3 to 5 years\u2019 worth of vitamin B<sub>12<\/sub>;<span class=\"mt-font-size-12\">\u00a0<\/span>therefore, nutritional deficiency of this vitamin is rare. How fast B<sub>12<\/sub>levels change depends on the balance between how much B<sub>12<\/sub>\u00a0is obtained from the diet, how much is secreted and how much is absorbed. B<sub>12<\/sub>\u00a0deficiency may arise in a year if initial stores are low and genetic factors unfavorable, or may not appear for decades. In infants, B<sub>12<\/sub>\u00a0deficiency can appear much more quickly.<\/p>\n<\/div>\n<div id=\"section_5\" class=\"mt-section\">\n<header>\n<h2 id=\"title\">7.3I: Vitamin C (Ascorbic acid)<\/h2>\n<\/header>\n<section class=\"mt-content-container\">\n<p class=\"mt-align-justify\">Vitamin C (ascorbic acid\u00a0and\u00a0L-ascorbic acid)\u00a0is a\u00a0vitamin\u00a0found in food and used as a\u00a0dietary supplement. As a supplement it is used to treat and prevent\u00a0scurvy.\u00a0Evidence does not support use in the general population for the prevention of the\u00a0common cold.\u00a0It may be taken by mouth or by injection. It is generally well tolerated.\u00a0Large doses may cause gastrointestinal upset, headache, trouble sleeping, and flushing of the skin.<span class=\"mt-font-size-12\">\u00a0<\/span>Normal doses are safe during\u00a0pregnancy.\u00a0Vitamin C is an\u00a0essential nutrient\u00a0involved in the repair of\u00a0tissue. Foods that contain vitamin C include\u00a0citrus fruit,\u00a0tomatoes, and\u00a0potatoes.<\/p>\n<div style=\"width: 230px\" class=\"wp-caption aligncenter\"><a class=\"link-https\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ascorbic-acid-3D-vdW.png\" target=\"_blank\" rel=\"external nofollow noopener\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1b\/Ascorbic-acid-3D-vdW.png\/220px-Ascorbic-acid-3D-vdW.png\" alt=\"\" width=\"220\" height=\"230\" \/><\/a><\/p>\n<p class=\"wp-caption-text\"><em>Model of a vitamin C\u00a0molecule. Black is\u00a0carbon, red is\u00a0oxygen, and white is\u00a0hydrogen<\/em><\/p>\n<\/div>\n<p class=\"mt-align-justify\">Vitamin C was discovered in 1912, isolated in 1928, and first made in 1933.\u00a0It is on the\u00a0World Health Organization&#8217;s List of Essential Medicines, the most effective and safe medicines needed in a\u00a0health system.<span class=\"mt-font-size-12\">\u00a0<\/span>Vitamin C is available as a\u00a0generic medication\u00a0and\u00a0over the counter.\u00a0In 2015, the wholesale cost in the\u00a0developing world\u00a0was about 0.003 to 0.007 USD per tablet. In some countries, ascorbic acid may be added to foods such as\u00a0breakfast cereal.<\/p>\n<div id=\"section_1\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Medical uses<\/h3>\n<p class=\"mt-align-justify\">A 2012 Cochrane review found no effect of vitamin C supplementation on overall mortality.<\/p>\n<ul>\n<li><strong>Scurvy<\/strong>: Although rare in modern times,\u00a0scurvy\u00a0and its associated destabilization of\u00a0collagen,\u00a0connective tissue, and bone can be prevented by adequate vitamin C intake.<\/li>\n<li class=\"mt-align-justify\"><strong>Cancer prevention:<\/strong>\u00a0A 2014 review found that, &#8220;Currently, the use of high-dose IV vitamin C [as an anticancer agent] cannot be recommended outside of a clinical trial.&#8221; A 2013 Cochrane review found no evidence that vitamin C supplementation reduces the risk of lung cancer in healthy or high risk (smokers and asbestos-exposed) people.\u00a0A 2014 meta-analysis found that vitamin C intake might protect against lung cancer risk.\u00a0A second meta-analysis found no effect on the risk of prostate cancer. Two meta-analyses evaluated the effect of vitamin C supplementation on the risk of colorectal cancer. One found a weak association between vitamin C consumption and reduced risk, and the other found no effect of supplementation.\u00a0A 2011 meta-analysis failed to find support for the prevention of breast cancer with vitamin C supplementation,but a second study concluded that vitamin C may be associated with increased survival in those already diagnosed.<\/li>\n<li class=\"mt-align-justify\"><strong>Cardiovascular disease:\u00a0<\/strong>A 2013 meta-analysis found no evidence that vitamin C supplementation reduces the risk of myocardial infarction, stroke, cardiovascular mortality, or all-cause mortality. However, a second analysis found an inverse relationship between circulating vitamin C levels or dietary vitamin C and the risk of stroke.<sup id=\"cite_ref-18\">\u00a0<\/sup>A meta-analysis of 44 clinical trials has shown a significant positive effect of vitamin C on\u00a0endothelial\u00a0function when taken at doses greater than 500\u00a0mg per day. The researchers noted that the effect of vitamin C supplementation appeared to be dependent on health status, with stronger effects in those at higher cardiovascular disease risk.<\/li>\n<li class=\"mt-align-justify\"><strong>Chronic diseases<\/strong>: A 2010 review found no role for vitamin C supplementation in the treatment of rheumatoid arthritis.<span class=\"mt-font-size-12\">\u00a0<\/span>Studies examining the effects of vitamin C intake on the risk of Alzheimer&#8217;s disease have reached conflicting conclusions.\u00a0Maintaining a healthy dietary intake is probably more important than supplementation for achieving any potential benefit. Vitamin C supplementation above the RDA has been used in trials to study a potential effect on preventing and slowing the progression of age-related\u00a0cataract. However, no significant effects were found from the research.<\/li>\n<li class=\"mt-align-justify\"><strong>Common cold<\/strong>: Vitamin C&#8217;s effect on the\u00a0common cold\u00a0has been extensively researched. It has not been shown effective in prevention or treatment of the common cold, except in limited circumstances (specifically, individuals exercising vigorously in cold environments).\u00a0Routine vitamin C supplementation does not reduce the incidence or severity of the\u00a0common cold\u00a0in the general population, though it may reduce the duration of illness.<\/li>\n<\/ul>\n<div id=\"section_2\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Possible<\/h3>\n<p class=\"mt-align-justify\">As vitamin C enhances iron absorption,\u00a0iron poisoning\u00a0can become an issue to people with rare\u00a0iron overload disorders, such as\u00a0haemochromatosis. A genetic condition that results in inadequate levels of the enzyme\u00a0glucose-6-phosphate dehydrogenase\u00a0(G6PD) can cause sufferers to develop\u00a0hemolytic anemia\u00a0after ingesting specific oxidizing substances, such as very large dosages of vitamin C.<\/p>\n<p class=\"mt-align-justify\">There is a longstanding belief among the mainstream medical community that vitamin C causes kidney stones, which is based on little science.\u00a0Although recent studies have found a relationship,<span class=\"mt-font-size-12\">\u00a0<\/span>a clear link between excess\u00a0ascorbic acid\u00a0intake and\u00a0kidney stone\u00a0formation has not been generally established. Some case reports exist for a link between patients with oxalate deposits and a history of high-dose vitamin C usage.<\/p>\n<p class=\"mt-align-justify\">In a study conducted on rats, during the first month of pregnancy, high doses of vitamin C may suppress the production of\u00a0progesterone\u00a0from the\u00a0corpus luteum.\u00a0Progesterone, necessary for the maintenance of a pregnancy, is produced by the corpus luteum for the first few weeks, until the placenta is developed enough to produce its own source. By blocking this function of the corpus luteum, high doses of vitamin C (1000+ mg) are theorized to induce an early miscarriage. In a group of spontaneously aborting women at the end of the first trimester, the mean values of vitamin C were significantly higher in the aborting group. However, the authors do state: &#8216;This could not be interpreted as an evidence of causal association.&#8217; However, in a previous study of 79 women with threatened, previous spontaneous, or habitual abortion, Javert and Stander (1943) had 91% success with 33 patients who received vitamin C together with bioflavonoids and\u00a0<a title=\"Vitamin K\" href=\"https:\/\/med.libretexts.org\/Courses\/Sacramento_City_College\/SCC%3A_Nutri_300_(Coppola)\/Chapters\/07%3A_Vitamins\/7.2%3A_Fat_Soluble_Vitamins\/7.2D%3A_Vitamin_K\" rel=\"internal\">Vitamin K<\/a>\u00a0(only three abortions), whereas all of the 46 patients who did not receive the vitamins aborted.<\/p>\n<p class=\"mt-align-justify\">A study in rats and humans suggested that adding Vitamin C supplements to an exercise training program lowered the expected effect of training on\u00a0VO2 Max. Although the results in humans were not statistically significant, this study is often cited as evidence that high doses of Vitamin C have an adverse effect on exercise performance. In rats, it was shown that the additional Vitamin C resulted in lowered mitochondria production.\u00a0Since rats are able to produce all of their needed Vitamin C, however, it is questionable whether they offer a relevant model of human physiological processes in this regard.<\/p>\n<\/div>\n<div id=\"section_3\" class=\"mt-section\">\n<h3 class=\"editable\">Biological Significance<\/h3>\n<p class=\"mt-align-justify\">Vitamin C is an\u00a0essential nutrient\u00a0for certain animals including humans. Vitamin C describes several\u00a0vitamers\u00a0that have vitamin C activity in animals, including ascorbic acid and its salts, and some oxidized forms of the molecule like\u00a0dehydroascorbic acid. Ascorbate and ascorbic acid are both naturally present in the body when either of these is introduced into cells, since the forms interconvert according to\u00a0pH. Vitamin C is a\u00a0cofactor\u00a0in at least eight\u00a0enzymatic\u00a0reactions, including several\u00a0collagen\u00a0synthesis reactions that, when dysfunctional, cause the most severe symptoms of\u00a0scurvy.\u00a0In animals, these reactions are especially important in wound-healing and in preventing bleeding from capillaries. Ascorbate also acts as an\u00a0antioxidant, protecting against\u00a0oxidative stress.<\/p>\n<p class=\"mt-align-justify\">The biological role of ascorbate is to act as a\u00a0reducing agent, donating electrons to various enzymatic and a few non-enzymatic reactions. The one- and two-electron oxidized forms of vitamin C, semidehydroascorbic acid and\u00a0dehydroascorbic acid, respectively, can be reduced in the body by\u00a0glutathione\u00a0and\u00a0NADPH-dependent\u00a0enzymatic\u00a0mechanisms.\u00a0The presence of glutathione in cells and extracellular fluids helps maintain ascorbate in a reduced state.<\/p>\n<p class=\"mt-align-justify\">In humans, vitamin C is essential to a healthy diet as well as being a highly effective\u00a0antioxidant, acting to lessen\u00a0oxidative stress; a substrate for\u00a0ascorbate peroxidase\u00a0in plants (APX is plant specific enzyme);<span class=\"mt-font-size-12\">\u00a0<\/span>and an enzyme\u00a0cofactor\u00a0for the\u00a0biosynthesis\u00a0of many important biochemicals. Vitamin C acts as an\u00a0electron donor\u00a0for important\u00a0enzymes.<\/p>\n<p class=\"mt-align-justify\">Ascorbate is required for a range of essential\u00a0metabolic reactions\u00a0in all animals and plants. It is\u00a0made internally\u00a0by almost all organisms; the main exceptions are most\u00a0bats, all\u00a0guinea pigs,\u00a0capybaras, and the\u00a0Haplorrhini\u00a0(one of the two major\u00a0primate\u00a0suborders, consisting of\u00a0tarsiers,\u00a0monkeys, and\u00a0humans\u00a0and other\u00a0ape<a class=\"link-https\" title=\"Ape\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ape\" target=\"_blank\" rel=\"external nofollow noopener\">s<\/a>). Ascorbate is also not synthesized by many species of birds and fish. All species that do not synthesize ascorbate require it in the diet.<\/p>\n<div class=\"note1\">\n<div class=\"textbox shaded\">\n<div id=\"section_3\" class=\"mt-section\">\n<div class=\"note1\">\n<h3 class=\"boxtitle\">DEFICIENCY<\/h3>\n<p class=\"mt-align-justify\">Scurvy\u00a0is an\u00a0avitaminosis\u00a0resulting from lack of vitamin C, since without this vitamin, the synthesized\u00a0collagen\u00a0is too unstable to perform its function.\u00a0Scurvy leads to the formation of\u00a0brown spots\u00a0on the skin, spongy gums, and bleeding from all\u00a0mucous membranes. The spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. In advanced scurvy there are open,\u00a0suppurating wounds\u00a0and loss of\u00a0teeth\u00a0and, eventually, death. The human body can store only a certain amount of vitamin C,\u00a0and so the body stores are depleted if fresh supplies are not consumed. The time frame for onset of symptoms of scurvy in unstressed adults on a completely vitamin C free diet, however, may range from one month to more than six months, depending on previous loading of vitamin C.<\/p>\n<p class=\"mt-align-justify\">Western societies generally consume far more than sufficient vitamin C to prevent scurvy. In 2004, a Canadian Community health survey reported that Canadians of 19 years and above have intakes of vitamin C from food of 133\u00a0mg\/d for males and 120\u00a0mg\/d for females;\u00a0these are higher than the RDA recommendations.<\/p>\n<p class=\"mt-align-justify\">Notable human dietary studies of experimentally induced scurvy have been conducted on conscientious objectors during WWII in Britain and on Iowa state prisoners in the late 1960s to the 1980s. These studies both found that all obvious symptoms of scurvy previously induced by an experimental\u00a0scorbutic\u00a0diet with extremely low vitamin C content could be completely reversed by additional vitamin C supplementation of only 10\u00a0mg a day. In these experiments, there was no clinical difference noted between men given 70\u00a0mg vitamin C per day (which produced blood level of vitamin C of about 0.55\u00a0mg\/dl, about 1\/3 of tissue saturation levels) and those given 10\u00a0mg per day. Men in the prison study developed the first signs of scurvy about 4 weeks after starting the vitamin C-free diet, whereas in the British study, six to eight months were required, possibly due to the pre-loading of this group with a 70\u00a0mg\/day supplement for six weeks before the scorbutic diet was fed.<\/p>\n<p class=\"mt-align-justify\">Men in both studies on a diet devoid, or nearly devoid, of vitamin C had blood levels of vitamin C too low to be accurately measured when they developed signs of scurvy, and in the Iowa study, at this time were estimated (by labeled vitamin C dilution) to have a body pool of less than 300\u00a0mg, with daily turnover of only 2.5\u00a0mg\/day, implying an instantaneous half-life of 83 days by this time (elimination constant of 4 months).<\/p>\n<\/div>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"section_4\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Absorption, transport, and excretion<\/h3>\n<p class=\"mt-align-justify\">Ascorbic acid is absorbed in the body by both active transport and simple diffusion. Sodium-Dependent Active Transport\u2014Sodium-Ascorbate Co-Transporters (SVCTs) and Hexose transporters (GLUTs)\u2014are the two transporters required for absorption.\u00a0SVCT1\u00a0and\u00a0SVCT2\u00a0import the reduced form of ascorbate across plasma membrane.GLUT1\u00a0and\u00a0GLUT3\u00a0are the two glucose transporters, and transfer only the dehydroascorbic acid form of Vitamin C.<sup id=\"cite_ref-pmid9228080_82-0\">[82]<\/sup>\u00a0Although dehydroascorbic acid is absorbed in higher rate than ascorbate, the amount of dehydroascorbic acid found in plasma and tissues under normal conditions is low, as cells rapidly reduce dehydroascorbic acid to ascorbate.\u00a0Thus, SVCTs appear to be the predominant system for vitamin C transport in the body.<\/p>\n<p class=\"mt-align-justify\">SVCT2 is involved in vitamin C transport in almost every tissue,<sup id=\"cite_ref-Savini_2008_81-1\">[81]<\/sup>\u00a0the notable exception being red blood cells, which lose SVCT proteins during maturation.<sup id=\"cite_ref-pmid17586466_85-0\">[85]<\/sup>\u00a0&#8220;SVCT2 knockout&#8221; animals genetically engineered to lack this functional gene, die shortly after birth,<sup id=\"cite_ref-pmid11984597_86-0\">[86]<\/sup>\u00a0suggesting that SVCT2-mediated vitamin C transport is necessary for life.<\/p>\n<p class=\"mt-align-justify\">With regular intake the absorption rate varies between 70 and 95%. However, the degree of absorption decreases as intake increases. At high intake (1.25 g), fractional human absorption of ascorbic acid may be as low as 33%; at low intake (&lt;200\u00a0mg) the absorption rate can reach up to 98%.<\/p>\n<p class=\"mt-align-justify\">Ascorbate concentrations over the renal re-absorption threshold pass freely into the urine and are excreted. At high dietary doses (corresponding to several hundred mg\/day in humans) ascorbate is accumulated in the body until the plasma levels reach the renal resorption threshold, which is about 1.5\u00a0mg\/dL in men and 1.3\u00a0mg\/dL in women. Concentrations in the plasma larger than this value (thought to represent body saturation) are rapidly excreted in the urine with a half-life of about 30 minutes. Concentrations less than this threshold amount are actively retained by the kidneys, and the excretion half-life for the remainder of the vitamin C store in the body thus increases greatly, with the half-life lengthening as the body stores are depleted. This half-life rises until it is as long as 83 days by the onset of the first symptoms of scurvy.<sup id=\"cite_ref-pmid8263270_88-0\">[88]<\/sup><\/p>\n<p class=\"mt-align-justify\">Although the body&#8217;s maximal store of vitamin C is largely determined by the renal threshold for blood, there are many tissues that maintain vitamin C concentrations far higher than in blood. Biological\u00a0tissues\u00a0that accumulate over 100 times the level in blood plasma of vitamin C are the\u00a0adrenal glands,\u00a0pituitary,\u00a0thymus,\u00a0corpus luteum, and\u00a0retina.<sup id=\"cite_ref-pmid11984580_89-0\">[89]<\/sup>\u00a0Those with 10 to 50 times the concentration present in blood plasma include the\u00a0brain,\u00a0spleen,\u00a0lung,\u00a0testicle,\u00a0lymph nodes,\u00a0liver,\u00a0thyroid,\u00a0small intestinal\u00a0mucosa,\u00a0leukocytes,\u00a0pancreas,\u00a0kidney, and\u00a0salivary glands.<\/p>\n<p class=\"mt-align-justify\">Ascorbic acid can be\u00a0oxidized\u00a0(broken down) in the human body by the enzyme\u00a0L-ascorbate oxidase. Ascorbate that is not directly excreted in the urine as a result of body saturation or destroyed in other body metabolism is oxidized by this enzyme and removed.<\/p>\n<div id=\"section_6\" class=\"mt-section\">\n<h3 class=\"editable\">Immune system<\/h3>\n<p class=\"mt-align-justify\">Vitamin C is found in high concentrations in\u00a0immune cells, and is consumed quickly during infections. It is not certain how vitamin C interacts with the immune system; it has been hypothesized to modulate the activities of\u00a0phagocytes, the production of\u00a0cytokines\u00a0and\u00a0lymphocytes, and the number of\u00a0cell adhesion molecules\u00a0in\u00a0monocytes.<sup id=\"cite_ref-Preedy_101-0\">[101]<\/sup><\/p>\n<\/div>\n<div id=\"section_7\" class=\"mt-section\">\n<h3 class=\"editable\">Daily Requirements<\/h3>\n<p class=\"mt-align-justify\">The\u00a0North American\u00a0Dietary Reference Intake\u00a0recommends 90 milligrams per day for adult men, 75\u00a0mg\/day for adult women, and no more than 2\u00a0grams (2,000 milligrams) per day.\u00a0A balanced diet without supplementation usually contains enough vitamin C to prevent scurvy in an average healthy adult, while those who smoke tobacco or are under stress require slightly more.<\/p>\n<table class=\"mt-responsive-table\">\n<caption><em>United States vitamin C recommendations<\/em><\/caption>\n<tbody>\n<tr>\n<td class=\"mt-align-center mt-noheading\">Recommended Dietary Allowance\u00a0(adult male)<\/td>\n<td class=\"mt-align-center mt-colspan mt-noheading\">90\u00a0mg\u00a0per day<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center mt-noheading\">Recommended Dietary Allowance (adult female)<\/td>\n<td class=\"mt-align-center mt-colspan mt-noheading\">75\u00a0mg\u00a0per day<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center mt-noheading\">Recommended Dietary Allowance (pregnancy)<\/td>\n<td class=\"mt-align-center mt-colspan mt-noheading\">85\u00a0mg\u00a0per day<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center mt-noheading\">Recommended Dietary Allowance (lactation)<\/td>\n<td class=\"mt-align-center mt-colspan mt-noheading\">120\u00a0mg\u00a0per day<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center mt-noheading\">Tolerable Upper Intake Level (adult male)<\/td>\n<td class=\"mt-align-center mt-colspan mt-noheading\">2,000\u00a0mg\u00a0per day<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center mt-noheading\">Tolerable Upper Intake Level (adult female)<\/td>\n<td class=\"mt-align-center mt-colspan mt-noheading\">2,000\u00a0mg\u00a0per day<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div id=\"section_8\" class=\"mt-section\">\n<h3 class=\"mt-align-justify editable\">Recommended intake<\/h3>\n<p class=\"mt-align-justify\">Recommendations for vitamin C intake have been set by various national agencies:<\/p>\n<ul>\n<li class=\"mt-align-justify\">40 milligrams per day or 280 milligrams per week taken all at once: the United Kingdom&#8217;s\u00a0Food Standards Agency<\/li>\n<li class=\"mt-align-justify\">40 milligrams per day as per the recommendations of India&#8217;s\u00a0National Institute of Nutrition, Hyderabad<\/li>\n<li class=\"mt-align-justify\">45 milligrams per day 300 milligrams per week: the\u00a0World Health Organization<\/li>\n<li class=\"mt-align-justify\">80 milligrams per day: the\u00a0European Commission&#8217;s Council on nutrition labeling<\/li>\n<li class=\"mt-align-justify\">90\u00a0mg\/day (males) and 75\u00a0mg\/day (females): Health Canada 2007<\/li>\n<li class=\"mt-align-justify\">90\u00a0mg\/day (males) and 75\u00a0mg\/day (females): United States&#8217;\u00a0National Academy of Sciences.<\/li>\n<li class=\"mt-align-justify\">100 milligrams per day: Japan&#8217;s National Institute of Health and Nutrition.<\/li>\n<\/ul>\n<p class=\"mt-align-justify\">For U.S. food and dietary supplement labeling purposes the amount in a serving is expressed as a percent of Daily Value (%DV). For vitamin C labeling purposes 100% of the Daily Value was 60\u00a0mg, but as of May 2016 it has been revised to 90\u00a0mg. A table of the pre-change adult Daily Values is provided at\u00a0Reference Daily Intake. Food and supplement companies have until July 28, 2018 to comply with the change.<\/p>\n<\/div>\n<div id=\"section_9\" class=\"mt-section\">\n<h3 class=\"editable\">Dietary Sources<\/h3>\n<div style=\"width: 458px\" class=\"wp-caption aligncenter\"><a class=\"link-https\" href=\"https:\/\/en.wikipedia.org\/wiki\/File:Rosa_rubiginosa_hips.jpg\" target=\"_blank\" rel=\"external nofollow noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"internal\" src=\"https:\/\/med.libretexts.org\/@api\/deki\/files\/4098\/Rosa_rubiginosa_hips.jpg?revision=1&amp;size=bestfit&amp;width=224&amp;height=267\" alt=\"Rosa_rubiginosa_hips.jpg\" width=\"448\" height=\"533\" \/><\/a><\/p>\n<p class=\"wp-caption-text\"><em>Rose hips\u00a0are a particularly rich source of vitamin C. Image used with permission (CC BY-SA 3.0;\u00a0en:User:MPF) <\/em><\/p>\n<\/div>\n<p class=\"mt-align-justify\">The richest natural sources are fruits and vegetables.\u00a0Vitamin C is the most widely taken\u00a0nutritional supplement\u00a0and is available in a variety of forms, including tablets,\u00a0drink mixes, and in capsules. Vitamin C is absorbed by the intestines using a sodium-ion dependent channel. It is transported through the intestine via both glucose-sensitive and glucose-insensitive mechanisms. The presence of large quantities of sugar either in the intestines or in the blood can slow absorption.<\/p>\n<p class=\"mt-align-justify\">While plants are generally a good source of vitamin C, the amount in foods of plant origin depends on the precise variety of the plant, soil condition, climate where it grew, length of time since it was picked, storage conditions, and method of preparation. The following table is approximate and shows the relative abundance in different raw plant sources.\u00a0As some plants were analyzed fresh while others were dried (thus, artifactually increasing concentration of individual constituents like vitamin C), the data are subject to potential variation and difficulties for comparison. The amount is given in milligrams per 100\u00a0grams of fruit or vegetable and is a rounded average from multiple authoritative sources:<\/p>\n<table class=\"mt-responsive-table\">\n<thead>\n<tr>\n<th class=\"mt-align-center\" scope=\"col\">Plant source<\/th>\n<th class=\"mt-align-center\" scope=\"col\">Amount (mg \/ 100g)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"mt-align-center\">Kakadu plum<\/td>\n<td class=\"mt-align-center\">1000\u20135300<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Camu Camu<\/td>\n<td class=\"mt-align-center\">2800<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Acerola<\/td>\n<td class=\"mt-align-center\">1677<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Seabuckthorn<\/td>\n<td class=\"mt-align-center\">695<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Indian gooseberry<\/td>\n<td class=\"mt-align-center\">445<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Rose hip<\/td>\n<td class=\"mt-align-center\">426<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Baobab<\/td>\n<td class=\"mt-align-center\">400<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Chili pepper\u00a0(green)<\/td>\n<td class=\"mt-align-center\">244<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Guava\u00a0(common, raw)<\/td>\n<td class=\"mt-align-center\">228.3<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Blackcurrant<\/td>\n<td class=\"mt-align-center\">200<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Red pepper<\/td>\n<td class=\"mt-align-center\">190<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Chili pepper\u00a0(red)<\/td>\n<td class=\"mt-align-center\">144<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Parsley<\/td>\n<td class=\"mt-align-center\">130<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Kiwifruit<\/td>\n<td class=\"mt-align-center\">90<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Broccoli<\/td>\n<td class=\"mt-align-center\">90<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Loganberry<\/td>\n<td class=\"mt-align-center\">80<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Redcurrant<\/td>\n<td class=\"mt-align-center\">80<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Brussels sprouts<\/td>\n<td class=\"mt-align-center\">80<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Wolfberry\u00a0(Goji)<\/td>\n<td class=\"mt-align-center\">73 \u2020<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Lychee<\/td>\n<td class=\"mt-align-center\">70<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Persimmon\u00a0(native, raw)<\/td>\n<td class=\"mt-align-center\">66.0<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Cloudberry<\/td>\n<td class=\"mt-align-center\">60<\/td>\n<\/tr>\n<tr>\n<td class=\"mt-align-center\">Elderberry<\/td>\n<td class=\"mt-align-center\">60<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"mt-align-justify\">\u2020 average of 3 sources; dried<\/p>\n<\/div>\n<div id=\"section_10\" class=\"mt-section\">\n<h3 class=\"editable\">Contributors<\/h3>\n<ul>\n<li class=\"mt-align-justify\">Wikipedia. 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