Dietary sources and requirements

Fat-Soluble Vitamins - ADEK's Rich Pantry

• Vitamin A (Retinoids): Found in liver, fish oil, eggs, and dairy. Provitamin A (carotenoids) from yellow/orange/green leafy vegetables (carrots, spinach, sweet potatoes).
• Vitamin D (Calciferol): Synthesized via sun exposure. Dietary sources include fatty fish (salmon, mackerel), fortified milk, and cereals.
• Vitamin E (Tocopherol): Abundant in nuts, seeds, vegetable oils, and green leafy vegetables.
• Vitamin K (Phylloquinone/Menaquinone): Sourced from green leafy vegetables (spinach, kale, broccoli) and synthesized by gut bacteria.

⭐ Patients with malabsorption syndromes (e.g., cystic fibrosis, celiac disease, Crohn's disease) or on bile acid sequestrants are at high risk for deficiencies.

Water-Soluble Vitamins - B & C's Daily Dose

• General: Absorbed in the small intestine; excess is excreted in urine (except B12, B9 stored in liver). Toxicity is rare.
• 📌 Mnemonic: "The Romans Never Painted Pyramids Before College" for B1, B2, B3, B5, B6, B7, B9, B12.

• B1 (Thiamine): Coenzyme for dehydrogenase reactions (e.g., PDH, α-KGDH). Deficiency leads to Beriberi (wet/dry), Wernicke-Korsakoff syndrome. Found in grains, pork.
• B2 (Riboflavin): Component of FAD/FMN. Deficiency causes cheilosis, corneal vascularization (2 C's).
• B3 (Niacin): Component of NAD+/NADP+. Deficiency leads to Pellagra (Diarrhea, Dementia, Dermatitis). Found in grains, milk, meat. Can be synthesized from tryptophan.
• B9 (Folate): DNA/RNA synthesis. Deficiency causes megaloblastic anemia, neural tube defects. Found in leafy greens.
• B12 (Cobalamin): Coenzyme for homocysteine methyltransferase. Deficiency leads to megaloblastic anemia and irreversible nerve damage.
• Vitamin C (Ascorbic Acid): Antioxidant, collagen synthesis. Deficiency causes Scurvy (bleeding gums, poor wound healing). Found in fruits, vegetables.

⭐ High-Yield: Vitamin B12 deficiency causes subacute combined degeneration of the spinal cord (dorsal columns, lateral corticospinal tracts), leading to symmetric paresthesias, ataxia, and weakness.

Essential Minerals - The Body's Builders

• Iron (Fe): Essential for hemoglobin & myoglobin.

  • Deficiency: Microcytic anemia, fatigue, pallor, koilonychia (spoon nails).
  • Sources: Red meat, spinach, lentils.

• Iodine (I): Component of thyroid hormones (T3, T4).

  • Deficiency: Goiter, hypothyroidism, cretinism (congenital).
  • Sources: Iodized salt, seafood.

• Zinc (Zn): Cofactor for >100 enzymes (e.g., carbonic anhydrase).

  • Deficiency: Delayed wound healing, hypogonadism, anosmia, dysgeusia.
  • Sources: Meat, shellfish, seeds.

• Copper (Cu): Component of cytochrome c oxidase, dopamine β-hydroxylase.

  • Deficiency: Anemia, bone abnormalities. See Wilson's & Menkes disease.
  • Sources: Organ meats, shellfish, nuts.

⭐ Wilson's Disease: Autosomal recessive mutation in ATP7B gene leads to copper accumulation. Look for Kayser-Fleischer rings in the cornea.

High‑Yield Points - ⚡ Biggest Takeaways

• Fat-soluble vitamins (A, D, E, K) are stored in the body, posing a risk of toxicity.
• B-complex vitamins act as coenzymes in metabolism; deficiencies often cause dermatitis, glossitis, and cheilosis.
• Vitamin C is vital for collagen synthesis; deficiency results in scurvy.
• B12 and Folate deficiencies lead to megaloblastic anemia; only B12 deficiency causes neurological symptoms.
• Iron deficiency is the leading cause of microcytic anemia.
• Thiamine (B1) deficiency in alcoholism can cause Wernicke-Korsakoff syndrome.