Vitamin B Complex

Vitamin B6  Pyridoxine / Pyridoxal / Pyridoxamine

Vit B 6 is referred as pyridoxine which is available from plant sources and Pyridoxal phosphate which is available from animal sources.

The vitamin is found in legumes, wheat grain covering(bran), meat, nuts etc.

Deficiency states are due to poor intake of the vitamin. It can also occur if the bran is removed from wheat and starvation states. Deficiency may occur if less than .2 mg is taken daily. If a person is put on antituberculosis drug Isoniazid, deficiency symptoms can occur. This drug interacts with pyridoxal phosphate and hence vitamin B 6 is given together with Isoniazid to TB patients.

Symptoms of deficiency are burning and strange sensations in hands and feet (neuropathy), confusion, madness (psychosis), anemia, fits, depression, red tongue and seborrhea.

Deficiency is treated by giving Vit B6 in a dose of 50 mg/day. Intake of > 100 mg/day may cause toxic side effects which can be severe.

Vitamin B12  Cyanocobalmin

Vitamin B12  is otherwise also known as cyanocobalamin. It is required daily in minuscule quantities (1 microgram /day).

This vitamin is not available in plant-based food and requires acid in the stomach and a binding factor for its absorption. It is absorbed in the last part of intestines.

Deficiency is seen in strict vegetarians (Vegans), alcoholics, after prolonged acid-blocking drugs, diseases of terminal ileum etc.

Diagnosis is made easily by checking blood levels once the diagnosis is suspected.

Deficiency manifests in the form of anemia with large RBCs (megaloblasts), unsteadiness of gait, loss of position and vibration sense in feet, bladder and bowel incontinence, impotence and decrease cognitive abilities (dementia). The changes may become permanent if not treated early and may even result in death. Deficiency can also cause an increase in homocysteine levels and increased likelihood of heart attacks and strokes.

In overt deficiency, it is given by injections to ensure rapid action. Oral preparations are also available for regular use.

Riboflavin B2 Niacin B3

Riboflavin (Vitamin B 2)

This is another Vitamin of the B group. It is water soluble. The rich sources of this vitamin are, eggs, meat, milk and other dairy products, fish, green vegetables, yeast etc.

This vitamin works in the cells mainly in energy transport, dehydrogenation, oxidation and electron transport mechanisms.

Deficiency of this vitamin is common in cases  where food intake is less

  • starvation,
  • after natural and man-made calamities,
  • in anorexia nervosa
  • and diseases of intestines where absorption is limited,

Deficiency suggests relatively recent problem as the vitamin is not stored for long in the body.

The daily requirement is about 1.3 mg in men and 1.1 mg in women.

Deficiency causes non-specific signs and symptoms. The common manifestations are

  • Redness of throat, 
  • Sores at angles of the mouth, 
  • Redness of inner lining of cheeks, 
  • Dermatitis with excess sebum production, 
  • Anemia etc.

Treatment consists of replacement of the hormone.

Niacin (Vitamin B 3)

The symptoms of Niacin deficiency were first described in 18th century. This disease was common in people partaking a diet of corn. This vitamin is found in meats, eggs, legumes, yeast etc. It can also be made from the amino acid tryptophan.

This vitamin is also a cofactor in enzyme activities in cells and is required for oxidation and reduction processes.

About 18 mg of niacin is required daily by man and 16 mg by woman.

Deficiency is seen in starvation states as in Vit B2 def, in diseases of the intestines.

It is also caused by anti TB drug Isoniazid. In some cases of cancers, the requirement is high as nutrition is consumed by cancer cells.

The symptoms of deficiency are 3 D’s i.e.

  • Dermatitis, it is typically photosensitive and looks like crazy pavement
  • Diarrhoea
  • Dementia ( or loss of various cognitive functions of the brain)

Very high doses of this vitamin (in gms/day) decrease cholesterol levels and slow atherosclerosis.

Deficiency states are treated by replacement of the vitamin by tablets.

Water Soluble Vitamins

Water Soluble Vitamins

Thiamine

BeriBeri was known to the Chinese 5000 years back. However the fact that it was due to Vitamin Bdeficiency was only known in 1926. This vitamin is found in nuts, legumes, yeast and rice (unpolished). It is not found in fruits, milk or vegetables. The meagre quantities found in these can be destroyed by cooking as well.

This vitamin is required for the metabolism of carbohydrates and proteins in the body. It forms part of a chemical required for enzymatic activity.

The requirement for man and woman is slightly more than 1 mg /day. A pregnant woman may require about one and half times of this.

Severe deficiency of this vitamin can cause the following diseases:

Infantile beriberi

Adult beriberi

Wernicke-Korsakoff syndrome

Leigh disease

Infantile beriberi occurs in infants less than 6 months fed exclusively on formula feeds not having thiamine. It is now rare.

Adult Beriberi:

Dry beriberi usually causes nervous system disorder. Wet beriberi causes swelling of feet, breathlessness, enlargement of the heart and high output heart failure.

Wernicke’s disease causes unsteady walk, nystagmus ( rhythmic involuntary eye oscillations), paralysis of eye muscles etc. Korsakoff’s on the other hand results in short-term memory loss. Confabulations (making up stories) often occurs when facts are not remembered and this may be perceived as madness.

Leigh’s disease means a type of chronic nervous system disorder due to thiamine deficiency.

Deficiency can occur in hospitalised patients in ICUs and wards if vitamins are not supplemented, patients on intravenous feeds, after surgery for obesity and most often in alcoholics or situation of famine, starvation etc. Diagnosis is made by blood tests and the vitamin can be replaced easily.

Folic acid

It is required in small quantities. It has a role in the formation of nucleic acids. Deficiency can lead to a type of anemia called megaloblastic anemia due to the large size of RBC precursors in bone marrow and larger size of RBCs.

This vitamin is present in green and leafy vegetable, a variety of fruits, grains, cereals, nonvegetarian foods like meat etc. In nature, this vitamin is present as folate. The synthetic form provided in tablets or syrup consists of folic acid.

Deficiency can be seen where cell division is increased as in pregnancy.

Benefits of supplementing folic acid in the diet.

In a pregnant woman, supplementing folic acid by 150 to 250 micrograms daily results in lower incidence of neural tube defects. This is important since neural tube defects in children can cause a life of paralysis.

Supplementation can also reduce the risk of certain type of cancers, age-related deafness and high blood pressure.

If a person has high levels of homocysteine in the blood, he or she is more prone to heart attacks and strokes. Folic acid and cobalamins may reduce homocysteine levels.

Higher doses in a non-deficient population may not be altogether safe. Western countries fortify grains with folic acid to reduce the incidence of deficiency. Deficiency can be prevented by taking a large variety of foods, fruits etc.

Vitamin D

Vitamin D

Vitamins are essential parts of nutrition, required in small quantities for normal metabolism. These are not produced in human bodies and their deficiency can cause diseases. Vitamin D however, is an exception as it can be produced in the human skin.

Vitamin D :

Rickets in children and osteomalacia in adults are bone diseases due to deficiency of Vitamin D. Rickets was 1st described in 1600 but the cause of the disease discovered later.

Vit D is also called Calciferol. Vitamin D2 from plants is called ergosterol while the vitamin found in animal sources is Vitamin D3.

Sources:

Vitamin D is found in fatty fish, cod liver, eggs etc. Milk is, however, a poor source. Milk and vegetable oils in some countries may be fortified with Vitamin D. In human beings, Provitamin D in the skin is converted to Cholecalciferol. This then is converted 1st in the liver and then in the kidneys to its active form (1,25 OHD).

Requirements of Vitamin D:

About 600 units of Vit D are required from age 1 yr to 70 yrs. From 71st year 800 units may be required.

Though it can be produced in the skin from sunlight, various factors influence its production. These are

Slants of sunrays, (winter or summer)

Clothing, use of sun lotions

Pigmentation in the skin (Africans produce less vitamin D then Indians which produce less than white children. In terms of time a white child without clothes, ½ hr of sunlight in a week may be enough. In Africa, three times this exposure may be required.

Vitamin D Deficiency:

Levels of Vitamin D of about 20 are usually sufficient. Adolescents with high growth needs may be more prone to deficiency.

Causes of Vitamin D deficiency:

Commonest is lack of exposure to sunlight. Other causes may be intestinal diseases which prevent fat absorption as this vitamin is fat soluble. The lack of activation can occur in liver and kidney diseases.

Actions of Vitamin D

It takes an important part in the regulation of calcium and phosphorus metabolism. Lack of Vitamin D causes low calcium level, parathormone increases and phosphorus is excreted by kidneys. This results in changes in growing bone in children (Rickets) and in already formed bones in adults( Osteomalacia).

The bones have less calcium, are weaker, more prone to fractures and in childhood, deformed bones are common. Rickets can lead to stunted growth, height remains less, bones may be bent or broken etc. These changes can be found by clinical examination, X Rays, and bone density. The diagnosis can be made by Vitamin D levels of total Vitamin D or its activated metabolites.

Treatment is done by providing Vitamin D supplementation. In rare varieties of Rickets due to genetic causes, expert help is needed for diagnosis and therapy.

Benign Prostatic Hypertrophy

The prostate gland is located in the midline at the junction of the urinary bladder and urinary passage in the penis. It is present only in men and is about 20 gms in weight at 20 yrs of age, but increases in size to about 50 gms by the age of 80 yrs.

It surrounds the urinary passage on all sides just below the bladder and this part of the urinary passage is called prostatic urethra. The prostate gland is a chemical factory. It produces secretions which act as lubricants, produces chemicals which can increase or decrease blood pressure. It also produces a substance called prostacyclin which reduces blood clotting by stopping platelets from adhering to each other.

As the prostate enlarges over the age, in about 20% of men, it can produce symptoms or obstruction. The incidence of obstruction rises with advancing age. The symptoms of prostatic enlargement are often referred as LUTS (men) or lower urinary tract symptoms.

Symptoms

  • Urgency or inability to hold urine for adequately long time
  • Precipitancy or voiding rapidly at times soiling undergarments
  • Frequency or repeatedly passing urine more often
  • Hesitancy or difficulty in starting urination
  • Feeling of incomplete evacuation of urine
  • Incontinence or passing urine at times in clothes
  • Nocturia frequent getting up at night to pass urine

Later on a person may develop retention or a full bladder, urge to pass urine but the inability to do so.

The symptoms do not always progress and may even improve spontaneously in many. In some cases, if the passage of urine is obstructed, the bladder wall becomes thick and pressure generated for passing urine may damage the kidneys leading to renal failure.

Investigations for prostate disease.

The symptoms are investigated by

Rectal examination to look for prostate cancer.

Ultrasound examination of bladder, prostate, amount of retained urine after voiding, nodules in the prostate etc

Uroflowmetry or the time and volume study as urine is passed. Normally a person should pass urine at a rate of > 20 ml/sec.

Urine routine examination.

Prostate surface antigen Or PSA which increases with kidney size but is an important marker of cancer of the prostate.

Treatment

Treatment is both by drugs (in early cases) and by surgery in advanced cases. The drugs used are Alfa blockers which decrease the resistance to urine flow in prostate and finasteride (inhibits enzyme converting testosterone to DHT a more active form). Finasteride, dutasteride and similar drugs reduce prostate size over months.

Surgical treatment consists of the removal of partial or total of the prostate gland. It can also be done via laser (TURP) and more refined means.