NMDF121 SN13 Lecture WSV3 · PDF file• Niacin flush can occur with relatively low doses, as little as 50mg depending upon chemical form and individual factors ... (Guyton 2007) •

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NMDF121

Session 13

WATER SOLUBLE

VITAMINS PART 3

Naturopathic Medicine

Department


Topic Summary

o B Vitamins

• Vitamin B3

• Vitamin B5

• Biotin


Activity

o View the following video on B complex

vitamins (2 mins)

http://www.youtube.com/watch?v=72Obfr0tT6k

http://www.youtube.com/watch?v=72Obfr0tT6k


Niacin - Vitamin B3

http://upload.wikimedia.org/wikipedia

/commons/f/f8/Niacin.png


Vitamin B3

Food Amount Niacin (mg)

Tuna, canned 100g 11.7

Lamb liver 100g 12.2

Peanuts, salted ½ cup 8.8

Chicken, roast 100g 7.9

Lamb, cooked 100g 6.6

Wheatgerm ½ cup 3.9

Kidney beans 1 cup 3.0

Corn 1 cup 2.6


Vitamin B3

• Niacin is generic term for nicotinic acid and

nicotinamide

• Both forms can be absorbed in the stomach, but are

more readily absorbed in the small intestine.

• In some foods, such as corn, niacin may be tightly bound

to small peptides, decreasing bioavailability.

(Groff, Smith & Gropper, 2004)

• Although resistant to heat, may be leeched out

of food in water


Vitamin B3

• Synthesised in liver from tryptophan ~3%

• 1mg of niacin is produced from ingestion of 60mg of

dietary tryptophan

• Vitamins B2, B6 and Fe required for conversion of

tryptophan NAD.

• Deficiency of any of these factors can impair NAD

synthesis.


Functions

• NAD and NADP enzyme cofactor (~200 enzymes)

• ATP production

• Insulin receptor function

• Alcohol dehydrogenase

• Synthesis of fatty acids, cholesterol

and steroid hormones

• Calcium signaling

• DNA synthesis and repair


Factors Increasing Demand

• Dietary deficiency of niacin or protein

• Vitamin B6 deficiency impairs conversion from tryptophan

• Inflammatory bowel disease

• Alcohol consumption

• Medications

• Antituberculosis

• Sedative/anticonvulsant - Phenobarbitol

• Hartnup syndrome

• Reduced conversion from tryptophan

(Shils et al, 2006)


Deficiency Symptoms

o Pellagra

• Characterised by the 4

D’s

–Dermatitis

–Dementia

–Diarrhoea

–Death


Deficiency Symptomso Photophobia

o Abdominal pain, diarrhoea; Digestive disturbances,

indigestion

o Glossitis; Bright red painful ‘raw beef’ tongue with

fissures

o Fatigue and weakness; Depression

o Symmetrical dermatitis on dorsal surface of hands with

erythema, slight oedema, pruritus and burning (Ryan 1999)

o Cheilosis/ chelitis (Pencharz 1982)

o Anxiety (Gibson 2005)


Toxicity

• Niacin flush can occur with relatively low doses, as little

as 50mg depending upon chemical form and individual

factors (MacKay et al 2010).

• Flushing does occur at therapeutic dosages of 1500-

2000 per/day used for CVD risk reduction

• Consuming with meals and aspirin can reduce(Reavley 1998, Papaliodis 2008)

• Liver toxicity reports with use of slow-release

unregulated supplements (Guyton 2007)

• Other symptoms:

• Impaired glucose tolerance

• Nausea and vomiting (Whitney 2011)


RDI

• Therapeutic

Range 100-

3000mg

NHMRC, 2009


Therapeutic Uses• CVD

• Reverse thickening of lining of carotid artery, increase HDL, reduce

triglycerides, improve endothelial function and decrease vascular

inflammation (Thoenes, 2007)

• Gastric acid secretion

• Promotes histamine release (Prousky and Kerwin, 2002)

• Post-ischemic injury

• Reduces size of infarction and improves recovery (Hoane et al, 2003)

• Peripheral vascular disease

• Lowers fibrinogen levels (Phillip et al, 1998)

• Skin cancer

• Prevents photoimmunosuppression (Gensler et al, 1999)


Review Questions

1. List the foods highest in niacin

2. What are the main functions of niacin?

3. Which factors may increase the demand for niacin

intake?

4. How might we recognise a niacin deficiency?

5. From which substance can niacin be synthesised

endogenously?

6. How has B3 been utilised therapeutically in the

research?


Pantothenic Acid - Vitamin B5

http://commons.wikimedia.org/wiki/Fil

e:Pantothenic_acid_structure.svg

http://upload.wikimedia.org/wikipedia/commons/6/69/Pantothenic_acid_structure.svg

http://upload.wikimedia.org/wikipedia/commons/6/69/Pantothenic_acid_structure.svg


Vitamin B5 – Pantothenic Acid

Food Amount Pantothenic Acid

(mg)

Beef liver, cooked 85g 5.03

Avocado 1 avocado 1.95

Mushrooms 1 cup 1.46

Trout, cooked 1 fillet 1.39

Wheatgerm ½ cup 1.24

Peanuts ½ cup 1.23

Lentils, cooked 1 cup 1.20

Whole milk 1 cup 0.73

Eggs, hard boiled 1 large 0.70

Cottage cheese 1 cup 0.47

Almonds ½ cup 0.33


Vitamin B5 – Pantothenic Acid

• Distributed widely in nature, therefore because it

is present in virtually all plants and animal foods,

a deficiency is quite unlikely.• Easily damaged with freezing and canning

• Processing and refining grains decreases by 75%


Functions

• Coenzyme A production• Energy production from CHO, fats and protein

o Acetyl CoA production• Starts citric acid cycle

• First step in fatty acid synthesis

• Accelerate healing process• Fibroblast multiplication


Functions

• Production of:

• Acetylcholine

• Antibodies

• Cholesterol

• Bile salts

• Haeme in haemoglobin

• Steroid hormones

• Ketones

• Cell membranes

(McGuire, 2011)


Deficiency

• Deficiency is rare, however symptoms include:

• Burning feet syndrome –

– Tingling in feet and legs with fatigue, weakness and nausea

(McGuire, 2011)

• Vomiting, nausea, and stomach cramps

• Insomnia and fatigue

• Irritability, restlessness, and apathy

• Numbness, tingling

• Muscle cramps, staggering gait

• Hypoglycemia (Insel, 2011)


Toxicity

• No reported toxicities

• >10g may cause diarrhoea and increase in histamine

• doses up to 10g have been taken for several months

without toxicity

• 100mg may cause increased niacin excretion

(Zimmerman, 2001)


RDI

• Therapeutic range is 20-200 mg

(NHMRC, 2009)


Activity

o Conduct a brief literature search in

relation to the therapeutic use of

pantothenic acid in the treatment of

health conditions?

• Discuss your findings and where you

searched, initially in small groups then

share these with the class group.

• Online students should discuss their

findings in the relevant discussion forum.


Review Questions

1. List the foods highest in pantothenic acid

2. What are the substrates produced from

pantothenate used in energy production?

3. B5 also acts as a cofactor in the production of

many substances throughout the body. List some

of these.

4. How might we recognise a B5 deficiency?


Biotin

http://commons.wikimedia.

org/wiki/File:Biotin.png

http://upload.wikimedia.org/wikipedia/commons/a/af/Biotin.png

http://upload.wikimedia.org/wikipedia/commons/a/af/Biotin.png


Biotin

Food Amount Biotin (mcg)

Bakers yeast 7g 14

Wheat bran 1 oz 14

Wholemeal bread 1 slice 6

Cheese, camembert 1 oz 6

Liver 3 oz 27

Chicken 3 oz 3

Avocado 100g 10

Salmon 3 oz 4

Raspberries 1 cup 2

Soybeans 100g 60

Mushrooms 100g 16

Egg 1, average size 12

Milk 1 large glass 3.5

Adapted from Zimmerman, 2001


Biotin

• Body stores of biotin are small, thus diets lacking in biotin will produce signs of deficiency within 3-4 weeks.

• Sources of biotin not only include those through dietary foods, it also includes biotin manufactured by intestinal bacteria within the large intestine.

• Within many foods biotin is found either bound to protein or as biocytin.

(Zimmerman, 2001; Groff, Smith & Gropper, 2004)


Biotin

• The glycoprotein avidin, has been found to bind biotin and prevent its absorption and utilisation by the body. • Avidin is heat labile

(unstable to heat) thus ingestion of cooked egg whites does not compromise biotin absorption


Functions

• Carboxylation reactions

• Transfer CO2 groups between molecules in the

metabolism of carbohydrates, lipids and amino acids.

• Assists in glycogen and fat synthesis and amino acid

metabolism

• DNA and gene expression

• Required for transcription of

some genes


Factors Increasing Demand

• Drugs

• Anticonvulsants, antibiotics, alcohol

• Pregnancy and lactation

• Achlorhydria

• Hypocaloric dieting for weight loss can produce biotin

deficiency.

• Excess raw egg white consumption


Deficiency Symptoms

• Deficiency symptoms include:

• Nausea, vomiting

• Weight loss, anorexia

• Smooth shiny tongue

(Carlson, 1995)

• Premature hair graying

• Pallor (Rushton, 2002)

• Hair thinning with loss of colour

• Grayish mucous membranes

(Ryan, 1996)

http://upload.wikimedia.org/wikipedia/commons/3/38/Allopecia_areata.JPG

http://upload.wikimedia.org/wikipedia/commons/3/38/Allopecia_areata.JPG


Toxicity & RDI

• No reported toxicities

• Therapeutic Range

500 - 5000mcg


Therapeutic Uses

• Impaired biotin metabolism

• Anticonvulsant therapy (Mock

1997)

• Diabetes (Hemmati 2013)

• Nail disorders (Scheinfeld 2007)

• Uncombable hair syndrome (Boccaletti 2007)


Review Questions

1. List the foods highest in biotin

2. How is biotin manufactured endogenously?

3. Which factors might increase demand for biotin?

4. How might we recognise a biotin deficiency?


References

Boccaletti et al. (2007). Familial uncombable hair syndrome: ultrastructural hair study and response to

biotin. Pediatr Dermatol. 24:3; E14-16

Bolkent, S., Yanardag, R., Bolkent, S. & Doger, M. M. (2004). Beneficial effects of combined

treatment with niacin and chromium on the liver of hyperlipemic rats, Biological Trace

Element Research, 101, 219-229.

Carlson GL, Williams N, Barber D, Shaffer JL, Wales S. (1995). Biotin deficiency complicating

long-term total parenteral nutrition in an adult patient. Clinical Nutrition 14: 186-190.

Garg, R., Malinow, M., Pettinger, M., Upson, B. & Hunninghake, D. (1999). Niacin treatment increases

plasma homocyst(e)ine levels, American Heart Journal, 138, 1082-1087.

Garrow J.S., James W.P.T. (1998). Human Nutrition and Dietetics 9th Ed. Churchill Livingstone:

Edinburgh UK

Gensler, H. L., Williams, T., Huang, A. C. & Jacobson, E. L. (1999). Oral niacin prevents

photocarcinogenesis and photoimmunosuppression in mice, Nutrition and Cancer, 34, 36-

41.

Guyton et al. (2007). Safety considerations with niacin therapy. Am J Cardiol. 99; 6A; 22C-31C

Gibson R (2005). Principles of Nutritional Assessment. USA: Oxford University Press.

Hemmati et al. (2013). Survey of the effect of biotin on glycemic control and plasma lipid

concentrations in type 1 diabetic patients in Kermanshah in Iran . Oman Med J. 28:3 195-8


References

Hoane, M. R., Akstulewicz, S. L. & Toppen, J. (2003). Treatment with Vitamin B3 Improves Functional

Recovery and Reduces GFAP Expression following Traumatic Brain Injury in Rats, Journal

of Neurotrauma, 20, 1189-1199.

Insel et al. (2011). Nutrition 4th Ed. Jones and Bartlett Publishers. Canada

McGuire et al. (2011). Nutritional Sciences from fundamentals to food. Cengage Learning USA

Mock DM, Dyken ME. (1997). Biotin catabolism is accelerated in adults receiving long-term therapy

with anticonvulsants. Neurology;49:1444-7

Pencharz, P. B. (1982). Making a nutritional assessment. Canadian Medical Association Journal 127:

823-835.

Philipp, C. S., Cisar, L. A., Saidi, P. & Kostis, J. B. (1998). Effect of niacin supplementation on

fibrinogen levels in patients with peripheral vascular disease, The American Journal of

Cardiology, 82, 697-699.

Prousky, J. E. and Kerwin, C. (2002). Niacin (Nicotinic Acid) a Putative Treatment for Hypochlorhydria

Re-Analysis of Two Case Reports, Journal of Orthomolecular Medicine, 17, 163-169.

Reavley, N. (1997) The Vitamin Guide. Melbourne: Bookman Press


References

Rushton, D. H. (2002). Nutritional factors and hair loss. Clinical & Experimental Dermatology 27: 400-

408.

Ryan, A. S. & Goldsmith, L. A. (1996). Nutrition and the skin. Clinics in Dermatology 14: 389-406.

Scheinfeld et al. (2007). Vitamins and minerals: their role in nail health and disease. J Drugs Dermatol.

6:8; 782-787

Thoenes et al. (2007). The effects of extended release niacin on carotid intimal media thickness,

endothelial function and inflammatory markers in patients with the metabolic syndrome. Int

J Clin Pract 61:11, 1942-48

Webster, R. P., Gawde, M. D. & Bhattacharya, R. K. (1996). Protective effect of rutin, a flavonol

glycoside, on the carcinogen-induced DNA damage and repair enzymes in rats, Cancer

Letters, 98, 129-135.

Whitney, E., Rolfes, S., Crowe, T., Cameron-Smith, D. & Walsh, A. (2017). Understanding Nutrition:

Australian & New Zealand edition. (3rd Ed.). Melbourne: Cengage Learning


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Documents

NMDF121 SN13 Lecture WSV3 · PDF file• Niacin flush can occur with relatively low doses, as little as 50mg depending upon chemical form and individual factors ... (Guyton 2007) •